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UNIVERSITY HOSPITALS HEALTH SYSTEM INC: Form 990, tax year 2018

View the entire original 990 at ProPublica ↗

Organization
UNIVERSITY HOSPITALS HEALTH SYSTEM INC (EIN 34-1425870)
Tax period
2018-01-01 to 2018-12-31
Filed
2019-11-14
IRS object ID
201923189349301352
Schema version
2018v3.1
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Return2019-11-14T07:02:20-06:00ReturnTs
Tax Period End2018-12-31TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

FieldValueIRS element (for citing)
Preparer Firm EIN381357951PreparerFirmEIN

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1PLANTE & MORAN PLLCBusinessNameLine1Txt

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line1250 S HIGH ST SUITE 100AddressLine1Txt
CityCOLUMBUSCityNm
State AbbreviationOHStateAbbreviationCd
ZIP43215ZIPCd
FieldValueIRS element (for citing)
Return Type990ReturnTypeCd
Tax Period Begin2018-01-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN341425870EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1LAKE HOSPITAL SYSTEM INCBusinessNameLine1Txt
FieldValueIRS element (for citing)
Business Name ControlLAKEBusinessNameControlTxt
Phone4403541991PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line17590 AUBURN ROADAddressLine1Txt
CityCONCORDCityNm
State AbbreviationOHStateAbbreviationCd
ZIP44077ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonROBERT TRACZPersonNm
Person TitleSENIOR VP & CFOPersonTitleTxt
Phone4403541991PhoneNum
Signature2019-11-05SignatureDt
Discuss With Paid PreparerYes (1)DiscussWithPaidPreparerInd

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonBERNIE OSTROWSKIPreparerPersonNm
PTINP00366367PTIN
Phone6148493000PhoneNum
Preparation2019-11-05PreparationDt

Filing Security Information FilingSecurityInformation

IP Address IPAddress

FieldValueIRS element (for citing)
I Pv4 Address67.59.56.33IPv4AddressTxt
FieldValueIRS element (for citing)
IP2019-11-05IPDt
IP Tm09:22:30IPTm
IP TimezoneESIPTimezoneCd
Filing License TypePFilingLicenseTypeCd
At Submission Creation Device IdDA39A3EE5E6B4B0D3255BFEF95601890AFD80709AtSubmissionCreationDeviceId
At Submission Filing Device Id6C9B1A35775087DBDB8A6D25ECA509C7F6C27838AtSubmissionFilingDeviceId
FieldValueIRS element (for citing)
Tax2018TaxYr
Build TS2020-04-17 16:48:07ZBuildTS

Form 990 IRS990

Doing Business As Name DoingBusinessAsName

FieldValueIRS element (for citing)
Business Name Line1LAKE HEALTHBusinessNameLine1Txt
FieldValueIRS element (for citing)
Principal OfficerCYNTHIA MOORE-HARDYPrincipalOfficerNm

US Address USAddress

FieldValueIRS element (for citing)
Address Line17590 AUBURN ROADAddressLine1Txt
CityCONCORDCityNm
State AbbreviationOHStateAbbreviationCd
ZIP44077ZIPCd
FieldValueIRS element (for citing)
Gross Receipts$484,404,109GrossReceiptsAmt
Group Return For Affiliates0GroupReturnForAffiliatesInd
Organization501c3Yes (X)Organization501c3Ind
Website AddressWWW.LAKEHEALTH.ORGWebsiteAddressTxt
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Formation1983FormationYr
Legal Domicile StateOHLegalDomicileStateCd
Activity Or MissionTO 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.ActivityOrMissionDesc
Voting Members Governing Body11VotingMembersGoverningBodyCnt
Voting Members Independent11VotingMembersIndependentCnt
Total Employee3330TotalEmployeeCnt
Total Volunteers871TotalVolunteersCnt
Total Gross UBI$2,551,934TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm$0NetUnrelatedBusTxblIncmAmt
PY Contributions Grants$2,246,424PYContributionsGrantsAmt
CY Contributions Grants$1,903,511CYContributionsGrantsAmt
PY Program Service Revenue$367,307,188PYProgramServiceRevenueAmt
CY Program Service Revenue$380,077,771CYProgramServiceRevenueAmt
PY Investment Income$5,721,441PYInvestmentIncomeAmt
CY Investment Income$9,039,337CYInvestmentIncomeAmt
PY Other Revenue$17,646,600PYOtherRevenueAmt
CY Other Revenue$23,495,360CYOtherRevenueAmt
PY Total Revenue$392,921,653PYTotalRevenueAmt
CY Total Revenue$414,515,979CYTotalRevenueAmt
PY Grants And Similar Paid$0PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid$10,000CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members$0PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members$0CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$180,076,116PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$189,506,079CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns$0PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$0CYTotalFundraisingExpenseAmt
PY Other Expenses$211,660,742PYOtherExpensesAmt
CY Other Expenses$215,546,363CYOtherExpensesAmt
PY Total Expenses$391,736,858PYTotalExpensesAmt
CY Total Expenses$405,062,442CYTotalExpensesAmt
PY Revenues Less Expenses$1,184,795PYRevenuesLessExpensesAmt
CY Revenues Less Expenses$9,453,537CYRevenuesLessExpensesAmt
Total Assets BOY$549,215,936TotalAssetsBOYAmt
Total Assets EOY$532,511,689TotalAssetsEOYAmt
Total Liabilities BOY$311,984,993TotalLiabilitiesBOYAmt
Total Liabilities EOY$301,182,681TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$237,230,943NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$231,329,008NetAssetsOrFundBalancesEOYAmt
Info In Schedule O Part IIIYes (X)InfoInScheduleOPartIIIInd
MissionIT IS LAKE HOSPITAL SYSTEM'S MISSION 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.MissionDesc
Significant New Program Srvc0SignificantNewProgramSrvcInd
Significant Change0SignificantChangeInd
Expense$356,255,897ExpenseAmt
Grant$10,000GrantAmt
Revenue$398,785,079RevenueAmt
DescAS AN INDEPENDENT, COMMUNITY-BASED HOSPITAL SYSTEM, LAKE HOSPITAL SYSTEM, INC., DBA 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 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. LAKE HEALTH'S GROWTH AS A COMMUNITY-BASED HEALTH CARE SYSTEM CONTINUES TO BUILD ON ITS LONG HISTORY OF PROVIDING PROGRESSIVE, PERSONALIZED CARE THAT YOU NORMALLY WOULDN'T EXPECT TO FIND AT A COMMUNITY HOSPITAL. 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 DIABETES, CONGESTIVE HEART FAILURE, HEART DISEASE, ACCESS TO PREVENTIVE SCREENINGS, AND HIGH BLOOD PRESSURE. LAKE HEALTH IS COMPRISED OF 12 FACILITIES IN LAKE AND GEAUGA COUNTIES, WHICH INCLUDE THE FOLLOWING:1. TRIPOINT MEDICAL CENTER (FULL-SERVICE, ACUTE CARE HOSPITAL)2. WEST MEDICAL CENTER (FULL-SERVICE, ACUTE CARE HOSPITAL)3. MENTOR CAMPUS (OUTPATIENT LAB AND DIAGNOSTICS, PHYSICIAN OFFICES, CANCER SERVICES)4. MENTOR WELLNESS CAMPUS (URGENT CARE, OUTPATIENT LAB AND DIAGNOSTICS, PHYSICIAN OFFICES, PHYSICAL THERAPY, OCCUPATIONAL HEALTH SERVICES AND A MEDICALLY BASED FITNESS CENTER)5. MADISON CAMPUS (FREE-STANDING ER, OUTPATIENT LAB AND DIAGNOSTICS, PHYSICIAN OFFICES, PHYSICAL THERAPY)6. WILLOWICK CAMPUS (URGENT CARE, OUTPATIENT LAB AND DIAGNOSTICS, PHYSICIAN OFFICES)7. CHARDON CAMPUS (URGENT CARE, OUTPATIENT LAB AND DIAGNOSTICS, PHYSICIAN OFFICES)8. PAINESVILLE QUICK CARE CENTER (WALK-IN CARE)9. PERRICO HEALTH CAMPUS (PHYSICIAN OFFICES, PHYSICAL THERAPY, LAB)10. SOM CENTER CAMPUS (PHYSICIAN OFFICES, LAB AND DIAGNOSTICS)11. CONTINUING CARE CAMPUS (COMPREHENSIVE, INPATIENT REHABILITATION; GERIATRIC PSYCHIATRY)12. WILLOUGHBY HILLS DIAGNOSTICS (OUTPATIENT IMAGING)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 WITHIN LAKE COUNTY AT TRIPOINT MEDICAL CENTER IN CONCORD TOWNSHIP, WEST MEDICAL CENTER IN WILLOUGHBY, AND THE FREE-STANDING MADISON EMERGENCY DEPARTMENT WITHIN THE MADISON CAMPUS. THESE EMERGENCY DEPARTMENTS ARE OPEN TO ALL PERSONS, REGARDLESS OF ABILITY TO PAY.FOR THE 18TH YEAR IN A ROW, LAKE HEALTH WAS HONORED AS ONE OF NORTHCOAST 99'S "BEST PLACES TO WORK IN NORTHEAST OHIO." 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 2018, WE PROVIDED OVER $380,000 IN COMMUNITY BENEFIT THROUGH HEALTH EDUCATION PROGRAMS, EXCLUDING BLOOD DRIVES. THIS INCLUDES PHYSICIAN LECTURES, FREE OR LOW-COST SCREENINGS, PRINTED MATERIALS, AMENITIES, ETC. LAKE HEALTH CONTRIBUTED APPROXIMATELY $1,649,000 IN 2018 IN CASH AND IN-KIND DONATIONS TO CIVIC AND COMMUNITY EVENTS, PROGRAMS AND PARTNERSHIPS WITH A HEALTH AND WELLNESS FOCUS. SOME OF THE PROGRAMS AND EVENTS ARE HIGHLIGHTED BELOW. MANY OF THEM ARE FACILITATED THROUGH OUR HEALTH PROMOTION DEPARTMENT AND/OR OUR COMMUNITY OUTREACH COORDINATOR.COMMUNITY PROGRAMS AND EVENTS: AMERICAN HEART WALK INFANT AND CHILDBIRTH PROGRAMS INCLUDING CHILDBIRTH PREPARATION, INFANT CARE, BREASTFEEDING PROGRAM, SIBLING PROGRAM, INFANT AND CHILD CPR, AND CAR SEAT CHECKS. BE FIT FOR LIFE HEART SMART KIDS ASSEMBLY (FORMERLY HEALTHY HEART PROGRAM) LIFECYCLES FOR WOMEN EVENT SENIOR CONNECTION LUNCH & LEARN PROGRAMS COMMUNITY HEALTH LECTURES SUPPORT GROUPS, INCLUDING BREAST CANCER, DIABETES, STROKE, AMPUTEE AND PULMONARY PARTICIPATION IN THE UNITED WAY DAY OF CARING AND HARVEST FOR HUNGER SCHOOL PARTNERSHIPS MALL WALKING PROGRAM IN PARTNERSHIP WITH GREAT LAKES MALL, WHICH INCLUDES BI-MONTHLY LECTURES/ACTIVITIES AND MONTHLY BLOOD PRESSURE SCREENINGS.LAKE HEALTH JOINED FORCES WITH LAKE METROPARKS, LAKE COUNTY YMCA AND THE LAKE COUNTY GENERAL HEALTH DISTRICT AGAIN IN 2018 TO CONTINUE BE FIT FOR LIFE, A COUNTYWIDE INITIATIVE THAT FEATURES EDUCATION, PREVENTION AND WELLNESS PROGRAMS TO ENHANCE AND IMPROVE THE QUALITY OF LIFE IN LAKE COUNTY AND NEIGHBORING COMMUNITIES. THE INITIATIVE INCLUDES THE B FIT 4 LIFE FITNESS CHALLENGE IN WHICH AREA BUSINESSES VIE FOR THE MOST POINTS AS THEIR EMPLOYEES EXERCISE THEIR WAY TO BETTER HEALTH.Desc
Total Program Service Expenses$356,255,897TotalProgramServiceExpensesAmt
Described In Section501c3Yes (1)DescribedInSection501c3Ind
Schedule B RequiredYes (1)ScheduleBRequiredInd
Political Campaign Acty0PoliticalCampaignActyInd
Lobbying ActivitiesYes (1)LobbyingActivitiesInd
Subject To Proxy Tax0SubjectToProxyTaxInd
Donor Advised Fund0DonorAdvisedFundInd
Conservation Easements0ConservationEasementsInd
Collections Of Art0CollectionsOfArtInd
Credit Counseling0CreditCounselingInd
Temp Or Permanent EndowmentsYes (1)TempOrPermanentEndowmentsInd
Report Land Building EquipmentYes (1)ReportLandBuildingEquipmentInd
Report Investments Other Sec0ReportInvestmentsOtherSecInd
Report Program Related Invst0ReportProgramRelatedInvstInd
Report Other Assets0ReportOtherAssetsInd
Report Other LiabilitiesYes (1)ReportOtherLiabilitiesInd
Include FIN48 FootnoteYes (1)IncludeFIN48FootnoteInd
Independent Audit Fincl Stmt0IndependentAuditFinclStmtInd
Consolidated Audit Fincl StmtYes (1)ConsolidatedAuditFinclStmtInd
School Operating0SchoolOperatingInd
Foreign Office0ForeignOfficeInd
Foreign ActivitiesYes (1)ForeignActivitiesInd
More Than5000 K To Org0MoreThan5000KToOrgInd
More Than5000 K To Individuals0MoreThan5000KToIndividualsInd
Professional Fundraising0ProfessionalFundraisingInd
Fundraising Activities0FundraisingActivitiesInd
Gaming Activities0GamingActivitiesInd
Operate HospitalYes (1)OperateHospitalInd
Audited Financial Stmt AttYes (1)AuditedFinancialStmtAttInd
Grants To Organizations0GrantsToOrganizationsInd
Grants To IndividualsYes (1)GrantsToIndividualsInd
Schedule J RequiredYes (1)ScheduleJRequiredInd
Tax Exempt BondsYes (1)TaxExemptBondsInd
Invest Tax Exempt Bonds0InvestTaxExemptBondsInd
Escrow Account0EscrowAccountInd
On Behalf Of Issuer0OnBehalfOfIssuerInd
Engaged In Excess Benefit Trans0EngagedInExcessBenefitTransInd
PY Excess Benefit Trans0PYExcessBenefitTransInd
Loan Outstanding0LoanOutstandingInd
Grant To Related Person0GrantToRelatedPersonInd
Business Rln With Org MemYes (1)BusinessRlnWithOrgMemInd
Business Rln With Fam Mem0BusinessRlnWithFamMemInd
Business Rln With Officer Ent0BusinessRlnWithOfficerEntInd
Deductible Non Cash ContriYes (1)DeductibleNonCashContriInd
Deductible Art Contribution0DeductibleArtContributionInd
Terminate Operations0TerminateOperationsInd
Partial Liquidation0PartialLiquidationInd
Disregarded EntityYes (1)DisregardedEntityInd
Related EntityYes (1)RelatedEntityInd
Related Organization Ctrl EntYes (1)RelatedOrganizationCtrlEntInd
Transaction With Control EntYes (1)TransactionWithControlEntInd
Trnsfr Exmpt Non Chrtbl Rltd Org0TrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted Prtshp0ActivitiesConductedPrtshpInd
Schedule O RequiredYes (1)ScheduleORequiredInd
IRP Document263IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Backup Wthld ComplianceYes (1)BackupWthldComplianceInd
Employee3330EmployeeCnt
Employment Tax Returns FiledYes (1)EmploymentTaxReturnsFiledInd
Unrelated Bus Incm Over LimitYes (1)UnrelatedBusIncmOverLimitInd
Form990 T FiledYes (1)Form990TFiledInd
Foreign Financial AccountYes (1)ForeignFinancialAccountInd
Foreign CountryCJForeignCountryCd
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTransInd
Taxable Party Notification0TaxablePartyNotificationInd
Nondeductible Contributions0NondeductibleContributionsInd
Quid Pro Quo Contributions0QuidProQuoContributionsInd
Form8282 Property Disposed Of0Form8282PropertyDisposedOfInd
Rcv Fnds To Pay Prsnl Bnft Cntrct0RcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft Cntrct0PayPremiumsPrsnlBnftCntrctInd
Indoor Tanning Services0IndoorTanningServicesInd
Subj To Tax Rmnrtn Ex Prcht Pymt0SubjToTaxRmnrtnExPrchtPymtInd
Subject To Excs Tax Net Invst Inc0SubjectToExcsTaxNetInvstIncInd
Info In Schedule O Part VIYes (X)InfoInScheduleOPartVIInd
Governing Body Voting Members11GoverningBodyVotingMembersCnt
Independent Voting Member11IndependentVotingMemberCnt
Family Or Business Rln0FamilyOrBusinessRlnInd
Delegation Of Mgmt Duties0DelegationOfMgmtDutiesInd
Change To Org Documents0ChangeToOrgDocumentsInd
Material Diversion Or Misuse0MaterialDiversionOrMisuseInd
Members Or Stockholders0MembersOrStockholdersInd
Election Of Board Members0ElectionOfBoardMembersInd
Decisions Subject To Approva0DecisionsSubjectToApprovaInd
Minutes Of Governing BodyYes (1)MinutesOfGoverningBodyInd
Minutes Of CommitteesYes (1)MinutesOfCommitteesInd
Officer Mailing Address0OfficerMailingAddressInd
Local Chapters0LocalChaptersInd
Form990 Provided To Gvrn BodyYes (1)Form990ProvidedToGvrnBodyInd
Conflict Of Interest PolicyYes (1)ConflictOfInterestPolicyInd
Annual Disclosure Covered PrsnYes (1)AnnualDisclosureCoveredPrsnInd
Regular Monitoring EnfrcYes (1)RegularMonitoringEnfrcInd
Whistleblower PolicyYes (1)WhistleblowerPolicyInd
Document Retention PolicyYes (1)DocumentRetentionPolicyInd
Compensation Process CEOYes (1)CompensationProcessCEOInd
Compensation Process OtherYes (1)CompensationProcessOtherInd
Investment In Joint VentureYes (1)InvestmentInJointVentureInd
Written Policy Or ProcedureYes (1)WrittenPolicyOrProcedureInd
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1LISA MOTHERSBAUGHBusinessNameLine1Txt
FieldValueIRS element (for citing)
Phone4403541984PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line17590 AUBURN ROADAddressLine1Txt
CityCONCORDCityNm
State AbbreviationOHStateAbbreviationCd
ZIP44077ZIPCd

Form990 Part VII Section A Form990PartVIISectionAGrp (24 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtAverage Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndOfficerOfficerIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmtKey EmployeeKeyEmployeeIndHighest Compensated EmployeeHighestCompensatedEmployeeInd
MICHAEL E MAYHER
CHAIR5.000.00Yes (X)Yes (X)$0$0$0
DAVID STEIGER MD
VICE CHAIR5.000.00Yes (X)Yes (X)$0$0$0
LISA KLAMMER ESQ
SECRETARY2.000.00Yes (X)Yes (X)$0$0$0
BRETT HIMES
TREASURER2.000.00Yes (X)Yes (X)$0$0$0
THOMAS P JUBECK
TRUSTEE2.000.00Yes (X)$0$0$0
I JAMES HACKENBERG ESQ
TRUSTEE1.000.00Yes (X)$0$0$0
FRANK JEVNIKAR MD
TRUSTEE1.000.00Yes (X)$0$0$0
JOHN F PLATZ
TRUSTEE1.000.00Yes (X)$0$0$0
ROBERT G SCHIEBLI
TRUSTEE1.000.00Yes (X)$0$0$0
STEPHEN C ELLIS
TRUSTEE1.000.00Yes (X)$0$0$0
RODNEY HOWELL
TRUSTEE1.000.00Yes (X)$0$0$0
RAYMOND SINES
TRUSTEE1.000.00Yes (X)$0$0$0
CYNTHIA MOORE-HARDY
PRESIDENT AND CEO55.0010.00Yes (X)$851,123$0$26,140
ROBERT TRACZ
SR. VP/CFO50.0010.00Yes (X)$437,206$0$24,914
JOHN BANIEWICZ MD
SR VP, MEDICAL AFFAIRS45.0010.00$461,963$0$29,282Yes (X)
STEVE R KARNS
SR VP, ADMINISTRATIVE SERV (THROUGH OCT)55.000.00$658,449$0$21,961Yes (X)
RICHARD D CICERO
SR VP, MARKETING & BUSINES45.0010.00$468,802$0$20,779Yes (X)
MARY L OGRINC
CHIEF NURSING OFFICER55.0010.00$612,631$0$19,404Yes (X)
JOYCE A TAYLOR
VP, QUALITY SERVICES, CQO40.000.00$206,712$0$9,847Yes (X)
CYNTHIA J RACER
VP, CLINICAL SERVICES40.000.00$185,508$0$14,265Yes (X)
DAVID HERMAN
VP, FINANCE40.0010.00$193,716$0$16,419Yes (X)
PHIL BROOKS
VP, REVENUE CYCLE40.005.00$213,870$0$13,093Yes (X)
CRAIG GHIDOTTI
VP, HUMAN RESOURCES40.005.00$178,829$0$11,773Yes (X)
JERROLD M PETERS
VP, INFORMATION TECH/CIO40.000.00$173,108$0$6,859Yes (X)
FieldValueIRS element (for citing)
Total Reportable Comp From Org$4,641,917TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org$0TotReportableCompRltdOrgAmt
Total Other Compensation$214,736TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K99IndivRcvdGreaterThan100KCnt
Former Ofcr Employees Listed0FormerOfcrEmployeesListedInd
Total Comp Greater Than150 KYes (1)TotalCompGreaterThan150KInd
Compensation From Other Srcs0CompensationFromOtherSrcsInd

Contractor Compensation ContractorCompensationGrp (5 entries)

Address Line1ContractorAddress/USAddress/AddressLine1TxtCityContractorAddress/USAddress/CityNmState AbbreviationContractorAddress/USAddress/StateAbbreviationCdZIPContractorAddress/USAddress/ZIPCdServicesServicesDescCompensationCompensationAmt
COMMUNITY HOSPITALISTS LLC
30680 BAINBRIDGE ROADSOLONOH44139MEDICAL PROVIDERS$5,971,286
CROTHALL HEALTHCARE INC
13028 COLLECTIONS CENTER DRCHICAGOIL60693HOUSEKEEPING$4,056,549
SODEXO INC AND AFFILIATES
PO BOX 360170PITTSBURGPA152516170NUTRITION SERVICES$3,415,174
CERNER HEALTH SERVICES INC
PO BOX 959167ST LOUISMO631959167INFO TECH CONSULTING$2,618,855
PAYMED SOLUTIONS INC
3250 W MARKET ST SUITE 304AKRONOH44333CONSULTING$1,831,405
FieldValueIRS element (for citing)
Cntrct Rcvd Greater Than100 K236CntrctRcvdGreaterThan100KCnt
Related Organizations$1,327,511RelatedOrganizationsAmt
All Other Contributions$576,000AllOtherContributionsAmt
Noncash Contributions$79,086NoncashContributionsAmt
Total Contributions$1,903,511TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp

FieldValueIRS element (for citing)
DescPATIENT CAREDesc
Business621110BusinessCd
Total Revenue Column$380,077,771TotalRevenueColumnAmt
Related Or Exempt Func Income$380,076,770RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$1,001UnrelatedBusinessRevenueAmt
FieldValueIRS element (for citing)
Total Program Service Revenue$380,077,771TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$7,191,976TotalRevenueColumnAmt
Exclusion$7,191,976ExclusionAmt

Incm From Invest Bond Proceeds IncmFromInvestBondProceedsGrp

FieldValueIRS element (for citing)
Total Revenue Column$29,728TotalRevenueColumnAmt
Exclusion$29,728ExclusionAmt

Gross Rents GrossRentsGrp

FieldValueIRS element (for citing)
Real$2,480,902RealAmt

Less Rental Expenses LessRentalExpensesGrp

FieldValueIRS element (for citing)
Real$0RealAmt

Rental Income Or Loss RentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Real$2,480,902RealAmt

Net Rental Income Or Loss NetRentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Total Revenue Column$2,480,902TotalRevenueColumnAmt
Unrelated Business Revenue$382,929UnrelatedBusinessRevenueAmt
Exclusion$2,097,973ExclusionAmt

Gross Amount Sales Assets GrossAmountSalesAssetsGrp

FieldValueIRS element (for citing)
Securities$71,512,380SecuritiesAmt
Other$193,383OtherAmt

Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp

FieldValueIRS element (for citing)
Securities$69,337,794SecuritiesAmt
Other$550,336OtherAmt

Gain Or Loss GainOrLossGrp

FieldValueIRS element (for citing)
Securities$2,174,586SecuritiesAmt
Other-$356,953OtherAmt

Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp

FieldValueIRS element (for citing)
Total Revenue Column$1,817,633TotalRevenueColumnAmt
Exclusion$1,817,633ExclusionAmt

Other Revenue Misc OtherRevenueMiscGrp (3 entries)

DescDescBusinessBusinessCdTotal Revenue ColumnTotalRevenueColumnAmtRelated Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmtUnrelated Business RevenueUnrelatedBusinessRevenueAmtExclusionExclusionAmt
RELATED SALES AND SERVICES621110$8,628,527$6,322,378$2,168,004$138,145
PURCHASE DISCOUNTS621110$5,558,140$5,558,140
MWC FITNESS CENTER713940$3,811,340$3,811,340

Miscellaneous Revenue MiscellaneousRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$3,016,451TotalRevenueColumnAmt
Related Or Exempt Func Income$3,016,451RelatedOrExemptFuncIncomeAmt
FieldValueIRS element (for citing)
Other Revenue Total$21,014,458OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$414,515,979TotalRevenueColumnAmt
Related Or Exempt Func Income$398,785,079RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$2,551,934UnrelatedBusinessRevenueAmt
Exclusion$11,275,455ExclusionAmt

Grants To Domestic Individuals GrantsToDomesticIndividualsGrp

FieldValueIRS element (for citing)
Total$10,000TotalAmt
Program Services$10,000ProgramServicesAmt

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

FieldValueIRS element (for citing)
Total$3,632,654TotalAmt
Management And General$3,632,654ManagementAndGeneralAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

FieldValueIRS element (for citing)
Total$161,858,670TotalAmt
Program Services$142,442,298ProgramServicesAmt
Management And General$19,416,372ManagementAndGeneralAmt

Pension Plan Contributions PensionPlanContributionsGrp

FieldValueIRS element (for citing)
Total$1,880,290TotalAmt
Program Services$1,635,852ProgramServicesAmt
Management And General$244,438ManagementAndGeneralAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

FieldValueIRS element (for citing)
Total$13,055,734TotalAmt
Program Services$12,515,268ProgramServicesAmt
Management And General$540,466ManagementAndGeneralAmt

Payroll Taxes PayrollTaxesGrp

FieldValueIRS element (for citing)
Total$9,078,731TotalAmt
Program Services$7,814,279ProgramServicesAmt
Management And General$1,264,452ManagementAndGeneralAmt

Fees For Services Management FeesForServicesManagementGrp

FieldValueIRS element (for citing)
Total$1,601,192TotalAmt
Program Services$1,576,342ProgramServicesAmt
Management And General$24,850ManagementAndGeneralAmt

Fees For Services Legal FeesForServicesLegalGrp

FieldValueIRS element (for citing)
Total$526,535TotalAmt
Program Services$470,364ProgramServicesAmt
Management And General$56,171ManagementAndGeneralAmt

Fees For Services Accounting FeesForServicesAccountingGrp

FieldValueIRS element (for citing)
Total$86,103TotalAmt
Management And General$86,103ManagementAndGeneralAmt

Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp

FieldValueIRS element (for citing)
Total$978,944TotalAmt
Program Services$978,944ProgramServicesAmt

Fees For Services Other FeesForServicesOtherGrp

FieldValueIRS element (for citing)
Total$39,270,576TotalAmt
Program Services$34,965,524ProgramServicesAmt
Management And General$4,305,052ManagementAndGeneralAmt

Advertising AdvertisingGrp

FieldValueIRS element (for citing)
Total$1,755,964TotalAmt
Program Services$782,035ProgramServicesAmt
Management And General$973,929ManagementAndGeneralAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$3,627,613TotalAmt
Program Services$2,510,332ProgramServicesAmt
Management And General$1,117,281ManagementAndGeneralAmt

Information Technology InformationTechnologyGrp

FieldValueIRS element (for citing)
Total$10,319,189TotalAmt
Program Services$981,889ProgramServicesAmt
Management And General$9,337,300ManagementAndGeneralAmt

Occupancy OccupancyGrp

FieldValueIRS element (for citing)
Total$13,946,577TotalAmt
Program Services$13,941,854ProgramServicesAmt
Management And General$4,723ManagementAndGeneralAmt

Travel TravelGrp

FieldValueIRS element (for citing)
Total$264,978TotalAmt
Program Services$199,184ProgramServicesAmt
Management And General$65,794ManagementAndGeneralAmt

Conferences Meetings ConferencesMeetingsGrp

FieldValueIRS element (for citing)
Total$591,982TotalAmt
Program Services$454,803ProgramServicesAmt
Management And General$137,179ManagementAndGeneralAmt

Interest InterestGrp

FieldValueIRS element (for citing)
Total$7,271,687TotalAmt
Program Services$7,258,180ProgramServicesAmt
Management And General$13,507ManagementAndGeneralAmt

Depreciation Depletion DepreciationDepletionGrp

FieldValueIRS element (for citing)
Total$23,366,185TotalAmt
Program Services$16,255,440ProgramServicesAmt
Management And General$7,110,745ManagementAndGeneralAmt

Insurance InsuranceGrp

FieldValueIRS element (for citing)
Total$4,351,506TotalAmt
Program Services$3,910,315ProgramServicesAmt
Management And General$441,191ManagementAndGeneralAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDescTotalTotalAmtProgram ServicesProgramServicesAmtManagement And GeneralManagementAndGeneralAmt
MEDICAL SUPPLIES$69,275,229$69,275,186$43
BAD DEBT$31,861,444$31,861,444
HOSPITAL FRANCHISE FEE$5,402,955$5,402,955
MEMBERSHIP DUES$1,042,304$1,008,009$34,295

All Other Expenses AllOtherExpensesGrp

FieldValueIRS element (for citing)
Total$5,400TotalAmt
Program Services$5,400ProgramServicesAmt

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$405,062,442TotalAmt
Program Services$356,255,897ProgramServicesAmt
Management And General$48,806,545ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$790,747BOYAmt
EOY$3,746,710EOYAmt

Accounts Receivable AccountsReceivableGrp

FieldValueIRS element (for citing)
BOY$41,977,123BOYAmt
EOY$42,181,954EOYAmt

Inventories For Sale Or Use InventoriesForSaleOrUseGrp

FieldValueIRS element (for citing)
BOY$4,372,097BOYAmt
EOY$4,817,443EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

FieldValueIRS element (for citing)
BOY$10,319,114BOYAmt
EOY$15,817,061EOYAmt
FieldValueIRS element (for citing)
Land Bldg Equip Cost Or Other Bss$509,861,434LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec$292,787,820LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
BOY$225,754,125BOYAmt
EOY$217,073,614EOYAmt

Investments Pub Traded Sec InvestmentsPubTradedSecGrp

FieldValueIRS element (for citing)
BOY$240,970,947BOYAmt
EOY$223,182,453EOYAmt

Other Assets Total OtherAssetsTotalGrp

FieldValueIRS element (for citing)
BOY$25,031,783BOYAmt
EOY$25,692,454EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$549,215,936BOYAmt
EOY$532,511,689EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$39,241,076BOYAmt
EOY$38,563,829EOYAmt

Deferred Revenue DeferredRevenueGrp

FieldValueIRS element (for citing)
BOY$393,298BOYAmt
EOY$601,912EOYAmt

Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$219,712,975BOYAmt
EOY$215,679,977EOYAmt

Other Liabilities OtherLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$52,637,644BOYAmt
EOY$46,336,963EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$311,984,993BOYAmt
EOY$301,182,681EOYAmt
FieldValueIRS element (for citing)
Organization Follows SFAS117Yes (X)OrganizationFollowsSFAS117Ind

Unrestricted Net Assets UnrestrictedNetAssetsGrp

FieldValueIRS element (for citing)
BOY$237,230,943BOYAmt
EOY$231,329,008EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$237,230,943BOYAmt
EOY$231,329,008EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$549,215,936BOYAmt
EOY$532,511,689EOYAmt
FieldValueIRS element (for citing)
Info In Schedule O Part XIYes (X)InfoInScheduleOPartXIInd
Reconcilation Revenue Expnss$9,453,537ReconcilationRevenueExpnssAmt
Net Unrlzd Gains Losses Invst-$17,047,705NetUnrlzdGainsLossesInvstAmt
Other Changes In Net Assets$1,692,233OtherChangesInNetAssetsAmt
Info In Schedule O Part XIIYes (X)InfoInScheduleOPartXIIInd
Method Of Accounting AccrualYes (X)MethodOfAccountingAccrualInd
Accountant Compile Or Review0AccountantCompileOrReviewInd
FS AuditedYes (1)FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

FieldValueIRS element (for citing)
Consolidated Basis Fincl StmtYes (X)ConsolidatedBasisFinclStmtInd
FieldValueIRS element (for citing)
Audit CommitteeYes (1)AuditCommitteeInd
Federal Grant Audit Required0FederalGrantAuditRequiredInd

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
HospitalYes (X)HospitalInd

Schedule B IRS990ScheduleB

Contributor Information ContributorInformationGrp

FieldValueIRS element (for citing)
ContributorRESTRICTEDContributorNum

Contributor Business Name ContributorBusinessName

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor US Address ContributorUSAddress

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Total ContributionsRESTRICTEDTotalContributionsAmt

Schedule C IRS990ScheduleC

FieldValueIRS element (for citing)
Volunteers0VolunteersInd
Paid Staff Or Management0PaidStaffOrManagementInd
Media Advertisements0MediaAdvertisementsInd
Mailings Members0MailingsMembersInd
Publications Or Broadcast0PublicationsOrBroadcastInd
Grants Other Organizations0GrantsOtherOrganizationsInd
Direct Contact Legislators0DirectContactLegislatorsInd
Rallies Demonstrations0RalliesDemonstrationsInd
Other ActivitiesYes (1)OtherActivitiesInd
Other Activities$6,940OtherActivitiesAmt
Total Lobbying Expenditures$6,940TotalLobbyingExpendituresAmt
Not Described Section501c30NotDescribedSection501c3Ind

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferencePART II-B, LINE 1:FormAndLineReferenceDesc
ExplanationLINE 1I: MEMBERSHIP DUES PAID TO HOSPITAL INDUSTRY ASSOCIATIONS AND ORGANIZATIONS, THE PERCENTAGE OF WHICH IS REPORTED UNDER IRS RULES AS LOBBYING EXPENSE.ExplanationTxt

Schedule D IRS990ScheduleD

CY Endwmt Fund CYEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$6,834,614BeginningYearBalanceAmt
Contributions$829,389ContributionsAmt
Investment Earnings Or Losses-$207,803InvestmentEarningsOrLossesAmt
Grants Or Scholarships$26,377GrantsOrScholarshipsAmt
Other Expenditures$1,157,701OtherExpendituresAmt
End Year Balance$6,272,122EndYearBalanceAmt

CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$6,265,843BeginningYearBalanceAmt
Contributions$1,432,011ContributionsAmt
Investment Earnings Or Losses$434,510InvestmentEarningsOrLossesAmt
Grants Or Scholarships$30,544GrantsOrScholarshipsAmt
Other Expenditures$1,267,206OtherExpendituresAmt
End Year Balance$6,834,614EndYearBalanceAmt

CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$4,930,675BeginningYearBalanceAmt
Contributions$1,469,849ContributionsAmt
Investment Earnings Or Losses$235,080InvestmentEarningsOrLossesAmt
Grants Or Scholarships$5,200GrantsOrScholarshipsAmt
Other Expenditures$364,561OtherExpendituresAmt
End Year Balance$6,265,843EndYearBalanceAmt

CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$4,498,522BeginningYearBalanceAmt
Contributions$848,337ContributionsAmt
Investment Earnings Or Losses$98,143InvestmentEarningsOrLossesAmt
Grants Or Scholarships$10,200GrantsOrScholarshipsAmt
Other Expenditures$504,127OtherExpendituresAmt
End Year Balance$4,930,675EndYearBalanceAmt

CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$4,690,654BeginningYearBalanceAmt
Contributions$318,956ContributionsAmt
Investment Earnings Or Losses$123,314InvestmentEarningsOrLossesAmt
Grants Or Scholarships$13,500GrantsOrScholarshipsAmt
Other Expenditures$620,902OtherExpendituresAmt
End Year Balance$4,498,522EndYearBalanceAmt
FieldValueIRS element (for citing)
Board Designated Balance EOY0.01120BoardDesignatedBalanceEOYPct
Prmnnt Endowment Balance EOY0.45510PrmnntEndowmentBalanceEOYPct
Term Endowment Balance EOY0.53370TermEndowmentBalanceEOYPct
Endowments Held Unrelated Org0EndowmentsHeldUnrelatedOrgInd
Endowments Held Related OrgYes (1)EndowmentsHeldRelatedOrgInd
Related Org List Sch RYes (1)RelatedOrgListSchRInd

Land LandGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$13,668,329OtherCostOrOtherBasisAmt
Book Value$13,668,329BookValueAmt

Buildings BuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$206,923,699OtherCostOrOtherBasisAmt
Depreciation$78,295,370DepreciationAmt
Book Value$128,628,329BookValueAmt

Leasehold Improvements LeaseholdImprovementsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$8,153,092OtherCostOrOtherBasisAmt
Depreciation$2,624,899DepreciationAmt
Book Value$5,528,193BookValueAmt

Equipment EquipmentGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$257,896,912OtherCostOrOtherBasisAmt
Depreciation$201,004,395DepreciationAmt
Book Value$56,892,517BookValueAmt

Other Land Buildings OtherLandBuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$23,219,402OtherCostOrOtherBasisAmt
Depreciation$10,863,156DepreciationAmt
Book Value$12,356,246BookValueAmt
FieldValueIRS element (for citing)
Total Book Value Land Buildings$217,073,614TotalBookValueLandBuildingsAmt

Other Liabilities Org OtherLiabilitiesOrgGrp (7 entries)

DescDescAmtAmt
THIRD PARTY SETTLEMENTS$3,962,293
WORKERS COMPENSATION LIABILITY$1,277,968
DEFERRED COMPENSATION$6,005,087
LEASE OBLIGATION$162,924
ACCRUED SELF-INSURANCE$833,789
MARKETING LIABILITY$10,000
INTEREST RATE SWAP$34,084,902
FieldValueIRS element (for citing)
Total Liability$46,336,963TotalLiabilityAmt
Footnote TextYes (X)FootnoteTextInd

Supplemental Information Detail SupplementalInformationDetail (2 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
PART V, LINE 4:LAKE HEALTH'S PERMANENT ENDOWMENT AND TEMPORARILY RESTRICTED ENDOWMENT FUNDS 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 TO USE IN REALIZING LAKE HEALTH'S VISION OF PROVIDING HEALTH CARE FOR THE COMMUNITY. THE FOUNDATION'S SOLE MEMBER IS LAKE HEALTH.
PART X, LINE 2:THE SYSTEM, THE FOUNDATION , AND LH PHYSICIAN GROUP ARE NOT-FOR-PROFIT CORPORATIONS, AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND ARE EXEMPT FROM FEDERAL INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE CODE. THE CAPTIVE IS AN EXEMPTED COMPANY UNDER THE LAWS OF THE CAYMAN ISLANDS AND OPERATES UNDER THE TERMS OF A CAYMAN ISLANDS CLASS "B(I)" INSURER'S LICENSE. ACCORDINGLY, NO PROVISION FOR INCOME TAXES HAS BEEN INCLUDED IN THE CONSOLIDATED FINANCIAL STATEMENTS FOR THESE ENTITIES. NEW MANNA IS A FOR-PROFIT LIMITED LIABILITY COMPANY. THE ENTITY IS TREATED AS A PARTNERSHIP FOR FEDERAL INCOME TAX PURPOSES. CONSEQUENTLY, FEDERAL INCOME TAXES ARE NOT PAYABLE OR PROVIDED FOR BY THE ENTITY. MEMBERS ARE TAXED INDIVIDUALLY ON THEIR PRO RATA OWNERSHIP SHARE OF THE ENTITY'S EARNINGS. THE ENTITY'S NET INCOME OR LOSS IS ALLOCATED AMONG THE MEMBERS IN ACCORDANCE WITH THE ENTITY'S OPERATING AGREEMENT. ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA REQUIRE MANAGEMENT TO EVALUATE TAX POSITIONS TAKEN BY THE SYSTEM AND RECOGNIZE A TAX LIABILITY IF THE SYSTEM HAS TAKEN AN UNCERTAIN POSITION THAT MORE LIKELY THAN NOT WOULD NOT BE SUSTAINED UPON EXAMINATION BY THE IRS OR OTHER APPLICABLE TAXING AUTHORITIES.

Schedule F IRS990ScheduleF

Account Activities Outside US AccountActivitiesOutsideUSGrp (2 entries)

RegionRegionTxtOfficesOfficesCntEmployeeEmployeeCntType Of Activities ConductedTypeOfActivitiesConductedTxtSpecific Services ProvidedSpecificServicesProvidedTxtRegion Total ExpendituresRegionTotalExpendituresAmt
CENTRAL AMERICA AND THE CARIBBEAN - ANTIGUA & BARBUDA, ARUBA, BAHAMAS,00PROGRAM SERVICESPROGRAM-RELATED INVESTMENTS$19,760,884
CENTRAL AMERICA AND THE CARIBBEAN - ANTIGUA & BARBUDA, ARUBA, BAHAMAS,00PROGRAM SERVICESMANAGEMENT FEES RELATED TO LHS ASSURANCE, LTD.$161,321
FieldValueIRS element (for citing)
Subtotal Offices0SubtotalOfficesCnt
Subtotal Employees0SubtotalEmployeesCnt
Continuation Total Office0ContinuationTotalOfficeCnt
Continuation Total Employee0ContinuationTotalEmployeeCnt
Total Office0TotalOfficeCnt
Total Employee0TotalEmployeeCnt
Subtotal Spent$19,922,205SubtotalSpentAmt
Continuation Spent$0ContinuationSpentAmt
Total Spent$19,922,205TotalSpentAmt
Transfer To Foreign Corp0TransferToForeignCorpInd
Interest In Foreign Trust0InterestInForeignTrustInd
Foreign Corp OwnershipYes (1)ForeignCorpOwnershipInd
Passive Foreign Investmest Co0PassiveForeignInvestmestCoInd
Foreign Partnership0ForeignPartnershipInd
Boycott Countries0BoycottCountriesInd

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Financial Assistance PolicyYes (1)FinancialAssistancePolicyInd
Written PolicyYes (1)WrittenPolicyInd
All Hospitals PolicyYes (X)AllHospitalsPolicyInd
FPG Reference Free CareYes (1)FPGReferenceFreeCareInd

Free Care Oth Percentage FreeCareOthPercentageGrp

FieldValueIRS element (for citing)
OtherYes (X)OtherInd
Free Care Other250.000000000000FreeCareOtherPct
FieldValueIRS element (for citing)
FPG Reference Discounted CareYes (1)FPGReferenceDiscountedCareInd
Percent400Yes (X)Percent400Ind
Free Care Medically IndigentYes (1)FreeCareMedicallyIndigentInd
Financial Assistance BudgetYes (1)FinancialAssistanceBudgetInd
Expenses Exceed Budget0ExpensesExceedBudgetInd
Annual Community Bnft ReportYes (1)AnnualCommunityBnftReportInd
Report Publically AvailableYes (1)ReportPublicallyAvailableInd

Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp

FieldValueIRS element (for citing)
Total Community Benefit Expns$2,701,047TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$2,408,690DirectOffsettingRevenueAmt
Net Community Benefit Expns$292,357NetCommunityBenefitExpnsAmt
Total Expense0.00070TotalExpensePct

Unreimbursed Medicaid UnreimbursedMedicaidGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$59,621,704TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$33,980,328DirectOffsettingRevenueAmt
Net Community Benefit Expns$25,641,376NetCommunityBenefitExpnsAmt
Total Expense0.06330TotalExpensePct

Total Financial Assistance Typ TotalFinancialAssistanceTyp

FieldValueIRS element (for citing)
Total Community Benefit Expns$62,322,751TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$36,389,018DirectOffsettingRevenueAmt
Net Community Benefit Expns$25,933,733NetCommunityBenefitExpnsAmt
Total Expense0.06400TotalExpensePct

Community Health Services CommunityHealthServicesGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$387,615TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$387,615NetCommunityBenefitExpnsAmt
Total Expense0.00100TotalExpensePct

Subsidized Health Services SubsidizedHealthServicesGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$2,378,500TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$2,378,500NetCommunityBenefitExpnsAmt
Total Expense0.00590TotalExpensePct

Cash And In Kind Contributions CashAndInKindContributionsGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$1,649,062TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$1,649,062NetCommunityBenefitExpnsAmt
Total Expense0.00410TotalExpensePct

Total Other Benefits TotalOtherBenefitsGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$4,415,177TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$4,415,177NetCommunityBenefitExpnsAmt
Total Expense0.01100TotalExpensePct

Total Community Benefits TotalCommunityBenefitsGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$66,737,928TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$36,389,018DirectOffsettingRevenueAmt
Net Community Benefit Expns$30,348,910NetCommunityBenefitExpnsAmt
Total Expense0.07500TotalExpensePct
FieldValueIRS element (for citing)
Bad Debt Expense ReportedYes (1)BadDebtExpenseReportedInd
Bad Debt Expense$31,861,444BadDebtExpenseAmt
Bad Debt Expense Attributable$0BadDebtExpenseAttributableAmt
Reimbursed By Medicare$80,699,546ReimbursedByMedicareAmt
Cost Of Care Reimbursed By Medcr$85,659,835CostOfCareReimbursedByMedcrAmt
Medicare Surplus Or Shortfall-$4,960,289MedicareSurplusOrShortfallAmt

Costing Methodology Used CostingMethodologyUsedGrp

FieldValueIRS element (for citing)
Cost To Charge RatioYes (X)CostToChargeRatioInd
FieldValueIRS element (for citing)
Written Debt Collection PolicyYes (1)WrittenDebtCollectionPolicyInd
Financial Assistance PrvsnYes (1)FinancialAssistancePrvsnInd

Management Co And Jnt Ventures ManagementCoAndJntVenturesGrp (7 entries)

Primary ActivitiesPrimaryActivitiesTxtOrg Profit Or OwnershipOrgProfitOrOwnershipPctOfcr Etc Profit Or OwnershipOfcrEtcProfitOrOwnershipPctPhysicians Profit Or OwnershipPhysiciansProfitOrOwnershipPct
1 MENTOR SURGERY CENTER LLC
OUTPATIENT SURGICAL CENTER0.420000.000000.58000
2 LAKE WEST MEDICAL SPECIALISTS
MEDICAL OFFICE BUILDING0.120000.000000.88000
3 CONCORD MEDICAL CAMPUS PHYSICIAN BUILDING LLC
MEDICAL OFFICE BUILDING0.514700.000000.48530
4 MENTOR MEDICAL CAMPUS PHYSICIAN BUILDING LLC
MEDICAL OFFICE BUILDING0.403900.000000.39610
5 LAKE PHO INC
PHYSICIAN SERVICES0.500000.000000.50000
6 LAKE WILLOUGHBY PROPERTIES LLC
MEDICAL OFFICE BUILDING0.350000.000000.65000
7 NEW MANNA CLG LLC
MEDICAL OFFICE BUILDING0.510000.000000.49000
FieldValueIRS element (for citing)
Hospital Facilities2HospitalFacilitiesCnt

Hospital Facilities HospitalFacilitiesGrp (2 entries)

FacilityFacilityNumAddress Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdWebsite AddressWebsiteAddressTxtLicensed HospitalLicensedHospitalIndGeneral Medical And SurgicalGeneralMedicalAndSurgicalIndEmergency Room24 HrsEmergencyRoom24HrsInd
WEST MEDICAL CENTER
136000 EUCLID AVENUEWILLOUGHBYOH44094WWW.LAKEHEALTH.ORGYes (X)Yes (X)Yes (X)
TRIPOINT MEDICAL CENTER
27590 AUBURN ROADCONCORDOH44077WWW.LAKEHEALTH.ORGYes (X)Yes (X)Yes (X)

Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp (2 entries)

FacilityFacilityNumFirst Licensed CY Or PYFirstLicensedCYOrPYIndTax Exempt Hospital CY Or PYTaxExemptHospitalCYOrPYIndCHNA ConductedCHNAConductedIndCommunity DefinitionCommunityDefinitionIndCommunity DemographicsCommunityDemographicsIndExisting ResourcesExistingResourcesIndHow Data ObtainedHowDataObtainedIndCommunity Health NeedsCommunityHealthNeedsIndOther Health IssuesOtherHealthIssuesIndCommunity Hlth Needs Id ProcessCommunityHlthNeedsIdProcessIndConsulting ProcessConsultingProcessIndPrior CHNA ImpactPriorCHNAImpactIndCHNA ConductedCHNAConductedYrTake Into Account Others InputTakeIntoAccountOthersInputIndCHNA Conducted With Other FcltsCHNAConductedWithOtherFcltsIndCHNA Conducted With Non FcltsCHNAConductedWithNonFcltsIndCHNA Report Widely AvailableCHNAReportWidelyAvailableIndRpt Available On Own WebsiteRptAvailableOnOwnWebsiteIndOwn Website URLOwnWebsiteURLTxtPaper Copy Public InspectionPaperCopyPublicInspectionIndImplementation Strategy AdoptImplementationStrategyAdoptIndImplementation Strategy AdptImplementationStrategyAdptYrStrategy Posted WebsiteStrategyPostedWebsiteIndStrategy Website URLStrategyWebsiteURLTxtOrganization Incur Excise TaxOrganizationIncurExciseTaxIndElig Criteria ExplainedEligCriteriaExplainedIndFPG Family Incm Lmt Free DscntFPGFamilyIncmLmtFreeDscntIndFPG Family Incm Lmt Free CareFPGFamilyIncmLmtFreeCarePctFPG Family Incm Lmt Dscnt CareFPGFamilyIncmLmtDscntCarePctIncome Level CriteriaIncomeLevelCriteriaIndAsset Level CriteriaAssetLevelCriteriaIndMedical Indigency CriteriaMedicalIndigencyCriteriaIndInsurance Status CriteriaInsuranceStatusCriteriaIndUnderinsurance Stat CriteriaUnderinsuranceStatCriteriaIndResidency CriteriaResidencyCriteriaIndExplained BasisExplainedBasisIndApp Financial Asst ExplnAppFinancialAsstExplnIndDescribed InfoDescribedInfoIndDescribed Suprt DocDescribedSuprtDocIndProvided Hospital ContactProvidedHospitalContactIndOther MethodOtherMethodIndIncludes Publicity MeasuresIncludesPublicityMeasuresIndFAP Available On WebsiteFAPAvailableOnWebsiteIndFAP Available On Website URLFAPAvailableOnWebsiteURLTxtFAP App Available On WebsiteFAPAppAvailableOnWebsiteIndFAP App Available On Website URLFAPAppAvailableOnWebsiteURLTxtFAP Summary On WebsiteFAPSummaryOnWebsiteIndFAP Summary On Website URLFAPSummaryOnWebsiteURLTxtFAP Avlbl On Request No ChargeFAPAvlblOnRequestNoChargeIndFAP App Avlbl On Request No ChrgFAPAppAvlblOnRequestNoChrgIndFAP Sum Avlbl On Request No ChrgFAPSumAvlblOnRequestNoChrgIndNotified FAP Copy Bill DisplayNotifiedFAPCopyBillDisplayIndCommuntity Notified FAPCommuntityNotifiedFAPIndFAP Actions On NonpaymentFAPActionsOnNonpaymentIndPermit No ActionsPermitNoActionsIndCollection ActivitiesCollectionActivitiesIndProvided Written NoticeProvidedWrittenNoticeIndMade Effort Orally NotifyMadeEffortOrallyNotifyIndProcessed FAP ApplicationProcessedFAPApplicationIndMade Presumptive Elig DetermMadePresumptiveEligDetermIndNondis Emergency Care PolicyNondisEmergencyCarePolicyIndProspective Medicare MedicaidProspectiveMedicareMedicaidIndAmounts Generally BilledAmountsGenerallyBilledIndGross ChargesGrossChargesInd
WEST MEDICAL CENTER
100Yes (1)Yes (X)Yes (X)Yes (X)Yes (X)Yes (X)Yes (X)Yes (X)Yes (X)Yes (X)16Yes (1)Yes (1)0Yes (1)Yes (X)HTTPS://LAKEHEALTH.ORG/ABOUT/HEALTH-NEEDS-ASSESSMENTYes (X)Yes (1)16Yes (1)HTTPS://LAKEHEALTH.ORG/ABOUT/HEALTH-NEEDS-ASSESSMENT0Yes (1)Yes (X)250.000000000000400.000000000000Yes (X)Yes (X)Yes (X)Yes (X)Yes (X)Yes (X)Yes (1)Yes (1)Yes (X)Yes (X)Yes (X)Yes (X)Yes (1)Yes (X)HTTPS://LAKEHEALTH.ORG/PATIENTS/FINANCIAL-INFORMATION/FINANCIAL-AIDYes (X)HTTPS://LAKEHEALTH.ORG/PATIENTS/FINANCIAL-INFORMATION/FINANCIAL-AIDYes (X)HTTPS://LAKEHEALTH.ORG/PATIENTS/FINANCIAL-INFORMATIONYes (X)Yes (X)Yes (X)Yes (X)Yes (X)Yes (1)Yes (X)0Yes (X)Yes (X)Yes (X)Yes (X)Yes (1)Yes (X)00
TRIPOINT MEDICAL CENTER
200Yes (1)Yes (X)Yes (X)Yes (X)Yes (X)Yes (X)Yes (X)Yes (X)Yes (X)Yes (X)16Yes (1)Yes (1)0Yes (1)Yes (X)HTTPS://LAKEHEALTH.ORG/ABOUT/HEALTH-NEEDS-ASSESSMENTYes (X)Yes (1)16Yes (1)HTTPS://LAKEHEALTH.ORG/ABOUT/HEALTH-NEEDS-ASSESSMENT0Yes (1)Yes (X)250.000000000000400.000000000000Yes (X)Yes (X)Yes (X)Yes (X)Yes (X)Yes (X)Yes (1)Yes (1)Yes (X)Yes (X)Yes (X)Yes (X)Yes (1)Yes (X)HTTPS://LAKEHEALTH.ORG/PATIENTS/FINANCIAL-INFORMATION/FINANCIAL-AIDYes (X)HTTPS://LAKEHEALTH.ORG/PATIENTS/FINANCIAL-INFORMATION/FINANCIAL-AIDYes (X)HTTPS://LAKEHEALTH.ORG/PATIENTS/FINANCIAL-INFORMATIONYes (X)Yes (X)Yes (X)Yes (X)Yes (X)Yes (1)Yes (X)0Yes (X)Yes (X)Yes (X)Yes (X)Yes (1)Yes (X)00

Supplemental Information SupplementalInformationGrp (9 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
WEST MEDICAL CENTERPART 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 CENTERPART 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 CENTERPART 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 CENTERPART 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 CENTERPART 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 CENTERPART 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 CENTERPART 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 CENTERPART 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 22DUNINSURED 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.
FieldValueIRS element (for citing)
Facility55FacilityNum

Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp

Oth Hlth Care Fclts OthHlthCareFcltsGrp (55 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdFacilityFacilityTxt
1 - MENTOR MEDICAL CAMPUS
9485 MENTOR AVENUE SUITE 101MENTOROH44060GENERAL MEDICAL & SURGICAL OUTPATIENT
2 - MADISON MEDICAL CAMPUS
6270 NORTH RIDGE RDMADISONOH44057GENERAL MEDICAL & EMERGENCY DEPARTMENT
3 - LAKE COUNTY FAMILY PRACTICE
9500 MENTOR AVENUE SUITE 100MENTOROH44060PHYSICIAN OFFICE
4 - WILLOWICK URGENT CARE
29804 LAKESHORE BLVDWILLOWICKOH44095URGENT CARE CENTER
5 - TYLER URGENT CARE
7956 TYLER BLVDMENTOROH44060URGENT CARE CENTER
6 - LHPG OBGYN WOMEN'S HEALTH SPECIALIST
35040 CHARDON RD BLDG VII SUITE 205WILLOUGHBY HILLSOH44094PHYSICIAN OFFICE
7 - WILLOUGHBY HILLS
34600 CHARDON RD UNIT HWILLOUGHBY HILLSOH44094DIAGNOSTIC CENTER
8 - LHPG MENTOR IMED
9485 MENTOR AVENUE SUITE 210MENTOROH44060PHYSICIAN OFFICE
9 - LHPG MENTOR PEDIATRICS
9485 MENTOR AVENUE SUITE 101MENTOROH44060PHYSICIAN OFFICE
10 - LHPG NORTH COAST FAMILY PRACTICE
7580 AUBURN RD SUITE 202CONCORDOH44077PHYSICIAN OFFICE
11 - CHARDON URGENT CARE
510 FIFTH AVENUECHARDONOH44024URGENT CARE CENTER
12 - LHPG MADISON FAMILY PRACTICE
6270 NORTH RIDGE RDMADISONOH44057PHYSICIAN OFFICE
13 - LHPG OBGYN - WILLOW MEDICAL
36001 EUCLID AVENUE SUITE C-10WILLOUGHBYOH44094PHYSICIAN OFFICE
14 - LHPG WILLOUGHBY IMED
36001 EUCLID AVENUE SUITE C 240 260WILLOUGHBYOH44094PHYSICIAN OFFICE
15 - LAKE WELLNESS AND REHABILITATION
9170 MENTOR AVENUEMENTOROH44060REHABILITATION CLINIC
16 - LHPG WILLOUGHBY PEDIATRICS
36100 EUCLID AVENUE SUITE 300WILLOUGHBYOH44094PHYSICIAN OFFICE
17 - LHPG MADISON PEDIATRICS
6270 NORTH RIDGE RDMADISONOH44057PHYSICIAN OFFICE
18 - LHPG WILLOUGHBY HILLS IMED
2747 SOM CENTER RD UNIT DWILLOUGHBY HILLSOH44094PHYSICIAN OFFICE
19 - LHPG CHARDON FAMILY PRACTICE
510 FIFTH AVENUE SUITE 130CHARDONOH44024PHYSICIAN OFFICE
20 - LHPG MENTOR FAMILY PRACTICE
6990 LINDSAY DRIVE 3MENTOROH44060PHYSICIAN OFFICE
21 - LHPG MENTOR GENERAL SURGERY
9500 MENTOR AVENUE SUITE 300MENTOROH44060PHYSICIAN OFFICE
22 - LHPG WILLOWICK FAMILY PRACTICE
29804 LAKESHORE BLVDWILLOWICKOH44095PHYSICIAN OFFICE
23 - LHPG PLASTIC SURGERY
9500 MENTOR AVENUE SUITE 200MENTOROH44060PHYSICIAN OFFICE
24 - LHPG GENERAL SURGERY
36060 EUCLID AVENUE SUITE 204WILLOUGHBYOH44094PHYSICIAN OFFICE
26 - LHPG CHARDON PEDIATRICS
510 FIFTH AVENUECHARDONOH44024PHYSICIAN OFFICE
27 - LAKE WELLNESS AND REHABILITATION
34881 EUCLID AVEWILLOUGHBYOH44060REHABILITATION CLINIC
28 - LHPG ORTHOPEDIC SURGERY
36060 EUCLID AVENUE SUITE 203WILLOUGHBYOH44094PHYSICIAN OFFICE
29 - PAINESVILLE QUICK CLINIC
74 S PARK PLACEPAINESVILLEOH44077QUICK CLINIC
31 - LHPG WEST CARDIO ELECTROPHYSIOLOGY
36100 EUCLID AVENUE SUITE 400WILLOUGHBYOH44094PHYSICIAN OFFICE
32 - LHPG WEST IMED
36100 EUCLID AVENUE SUITE 210WILLOUGHBYOH44094PHYSICIAN OFFICE
33 - LHPG MENTOR OBGYN
9485 MENTOR AVENUE SUITE 202MENTOROH44060PHYSICIAN OFFICE
34 - PAINESVILLE IMED
1223 MENTOR AVEPAINESVILLEOH44077PHYSICIAN OFFICE
35 - LHPG SPORTS MEDICINE & REHAB
36060 EUCLID AVENUE SUITE 105WILLOUGHBYOH44094PHYSICIAN OFFICE
36 - LHPG INTEGRATIVE MEDICINE
9500 MENTOR AVENUE SUITE 360MENTOROH44060PHYSICIAN OFFICE
37 - MENTOR MEDICAL PHYSICIAN BUILDING
9485 MENTOR AVENUE SUITES 200 203MENTOROH44060PHYSICIAN OFFICE
39 - LHPG OBGYN
36001 EUCLID SUITE C-7WILLOUGHBYOH44094PHYSICIAN OFFICE
40 - LHPG BARIATRIC SURGERY
36100 EUCLID AVENUE SUITE 170WILLOUGHBYOH44094PHYSICIAN OFFICE
42 - BARIATRIC SURGERY
34600 CHARDON RD UNIT GWILLOUGHBY HILLSOH44094PHYSICIAN OFFICE
43 - CHARDON RADIOLOGY
510 FIFTH AVE SUITE 110CHARDONOH44024PHYSICIAN OFFICE
44 - LAKE AMBULATORY BLDG REFERENCE LAB
9500 MENTOR AVE SUITE 120MENTOROH44060DIAGNOSTIC CENTER
45 - LAKE AMBULATORY BLDG PHLEBOTOMIST
9500 MENTOR AVE SUITE 220MENTOROH44060DIAGNOSTIC CENTER
46 - LHPG NEWBURY FAMILY PRACTICE
10780 KINSMAN RDNEWBURYOH44065PHYSICIAN OFFICE
48 - LAKE WEST MEDICAL CENTER REFERENCE LAB
36100 EUCLID AVE SUITE 190WILLOUGHBYOH44094DIAGNOSTIC CENTER
49 - EASTSIDE IMAGING
2785 SOM CENTER RDWILLOUGHBY HILLSOH44094DIAGNOSTIC CENTER
50 - LAKE WELLNESS & REHAB PT (WILLOUGHBY FI
37100 EUCLID AVEWILLOUGHBYOH44094REHABILITATION CLINIC
51 - LHPG NORTHEAST OHIO HEART ASSOCIATES
36100 EUCLID AVENUE SUITE 120WILLOUGHBYOH44077PHYSICIAN OFFICE
52 - LHPG NORTHEAST OHIO HEART ASSOCIATES
7580 AUBURN ROAD SUITE 106CONCORDOH44077PHYSICIAN OFFICE
53 - LHPG SPORTS MEDICINE
7580 AUBURN ROAD SUITE 214CONCORDOH44077PHYSICIAN OFFICE
54 - BEACON HEALTH
36100 EUCLID AVENUE SUITE 120WILLOUGHBYOH44094PHYSICIAN OFFICE
55 - OPHTHALMOLOGY ASSOCIATES
36100 EUCLID AVE SUITE 450WILLOUGHBYOH44094PHYSICIAN OFFICE
56 - MENTOR MEDICAL PHYSICAL FITNESS CENTER
8655 MARKET STREET MENTORMENTOROH44060MEDICAL FITNESS CENTER
57 - PERRICO HEALTH CENTER
4176 STATE ROUTE 306WILLOUGHBYOH44060PHYSICIAN OFFICE
58 - ARTHRITIS ASSOCIATES
34500 CHARDON ROAD SUITE 2WILLOUGHBY HILLSOH44094PHYSICIAN OFFICE
59 - NORTH SHORE RESPIRATORY AND SLEEP SERVIC
4212 CHILLICOTHE ROAD SUITE 110WILLOUGHBYOH44094PHYSICIAN OFFICE
60 - PULMONARY CARE
4212 CHILLICOTHE ROAD SUITE 110WILLOUGHBYOH44094PHYSICIAN OFFICE

Supplemental Information Detail SupplementalInformationDetail (15 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
PART I, LINE 3C:THE FOLLOWING STEPS WILL BE FOLLOWED TO EVALUATE PATIENT'S REQUESTS FOR CONSIDERATION UNDER THE UNINSURED/UNCOMPENSATED CARE GUIDELINES: FINANCIAL INTERVIEW: A HOSPITAL REPRESENTATIVE WILL DISCUSS WITH PATIENTS THEIR INDIVIDUAL FINANCIAL POSITION AND OBTAIN FROM THEM INFORMATION REGARDING THEIR FINANCES. THIS INFORMATION WILL BE RECORDED ON THE HCAP APPLICATION. PATIENTS WILL BE REQUESTED TO SUPPLY COPIES OF THEIR TWO MOST RECENT PAY STUBS FOR ALL FAMILY MEMBERS EMPLOYED, COPIES OF THE PREVIOUS YEAR'S TAX RETURN AND ANY OTHER PERTINENT DOCUMENTATION SUPPORTING THEIR FINANCIAL POSITION. EVALUATION PROCESS: THE HOSPITAL REPRESENTATIVE WILL COMPLETE THE FINANCIAL INTERVIEW FORM. THE HOSPITAL REPRESENTATIVE WILL EVALUATE THE APPLICATION TO DETERMINE WHETHER THE PATIENT MAY BE ELIGIBLE FOR WELFARE OR MEDICAID COVERAGE. IF THIS COVERAGE IS AVAILABLE, THE REPRESENTATIVE WILL MAKE ARRANGEMENTS WITH THE PATIENT FOR COMPLETION OF THE MEDICAID ELIGIBILITY FORMS. IF WELFARE OR MEDICAID ELIGIBILITY IS NOT AVAILABLE, THE PATIENT WILL BE SENT AN APPLICATION AND WILL BE CONSIDERED FOR UNCOMPENSATED CARE. A COPY OF THE APPLICATION WILL BE FORWARDED TO THE PATIENT ACCOUNTING DEPARTMENT. DETERMINATION OF ELIGIBILITY: THE PATIENT ACCOUNTING DEPARTMENT WILL REVIEW THE APPLICATION AND THE PATIENT'S QUALIFICATION STATUS UNDER THE UNINSURED/UNCOMPENSATED CARE GUIDELINES. IF THE PATIENT QUALIFIES FOR UNINSURED/UNCOMPENSATED CARE AND SERVICES ARE PROVIDED, THEN THE ADJUSTMENT WILL BE RECORDED AS AN ADJUSTMENT FROM CHARGES FOR LAKE HOSPITAL'S UNINSURED/UNCOMPENSATED CHARITY CARE. PATIENTS NOT ELIGIBLE: PATIENTS WHO ARE DETERMINED NOT TO BE ELIGIBLE UNDER THE GUIDELINES WILL BE REQUESTED TO PAY A DEPOSIT EQUAL TO 50% OF THE ESTIMATED PATIENT RESPONSIBILITY FOR EITHER THE ELECTIVE INPATIENT OR OUTPATIENT SERVICES, AND TO MAKE ARRANGEMENTS FOR A PAYMENT PLAN TO SATISFY THE REMAINING BALANCE AFTER SERVICES ARE PROVIDED. ELIGIBILITY: EACH ADMISSION REPRESENTS A SEPARATE FINANCIAL ENCOUNTER AND WILL BE EVALUATED WITH NEW DATA TO DETERMINE IF A CHANGE HAS TAKEN PLACE. EACH OUTPATIENT APPLICATION WILL BE REVIEWED TO DETERMINE IF THERE HAS BEEN ANY CHANGE IN FINANCIAL STATUS. A NEW APPLICATION WILL BE REQUIRED EACH MONTH.
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 $31,861,444 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 2018, LAKE HEALTH PROVIDED OVER $380,000 IN COMMUNITY BENEFIT THROUGH HEALTH EDUCATION PROGRAMS. THIS INCLUDES PHYSICIAN LECTURES, FREE OR LOW-COST SCREENINGS, PRINTED MATERIALS, AMENITIES, AND MORE. LAKE HEALTH CONTRIBUTED APPROXIMATELY $1,649,000 IN CASH AND IN-KIND DONATIONS TO CIVIC AND COMMUNITY EVENTS, PROGRAMS, AND PARTNERSHIPS WITH A HEALTH AND WELLNESS FOCUS. COALITION BUILDING LAKE HEALTH IS INVOLVED IN MANY COMMUNITY COALITIONS AND PARTNERSHIPS TO IMPROVE THE HEALTH OF INDIVIDUALS IN THE SERVICE AREA. SOME OF THESE INCLUDE PARTICIPATION IN THE LAKE COUNTY STRATEGIC PLAN, ACHIEVE (A COMMUNITY COALITION TO IMPROVE THE ENVIRONMENT IN LAKE COUNTY), AND UNITED WAY PROGRAMS DESIGNED TO IMPROVE HEALTH, PARTICULARLY IN VULNERABLE COMMUNITIES.AMONG OTHER INITIATIVES, LAKE HEALTH CONTRIBUTES TO BUILDING THE COMMUNITY 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 GENERAL HEALTH DISTRICT AGAIN IN 2018 TO CONTINUE BE FIT FOR LIFE, A COUNTYWIDE INITIATIVE THAT FEATURES EDUCATION, PREVENTION AND WELLNESS PROGRAMS TO ENHANCE AND IMPROVE THE QUALITY OF LIFE IN LAKE COUNTY AND NEIGHBORING COMMUNITIES.
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 4:PAGE 12 OF ATTACHED AUDITED FINANCIAL STATEMENTS, NOTE 2 - 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 2018 WAS $85,659,835. THE PAYMENTS RELATED TO THESE SERVICES WERE $80,699,546 LEAVING A MEDICARE SHORTFALL OF $4,960,289 FOR THE YEAR.
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:AS AN INDEPENDENT, COMMUNITY-BASED HOSPITAL SYSTEM, 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 DIABETES, CONGESTIVE HEART FAILURE, HEART DISEASE, ACCESS TO PREVENTIVE SCREENINGS, AND HIGH BLOOD PRESSURE. PROGRAMS DESIGNED TO ADDRESS WEIGHT MANAGEMENT SPAN FROM EARLY CHILDHOOD THROUGH MATURE ADULTS. BE FIT FOR LIFE IS NOW IN ITS TWELFTH YEAR OF OPERATION.OUR GROWTH AS A HEALTH 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 AND THEIR FAMILIES TO RECEIVE SUPERIOR CARE WITHOUT HAVING TO LEAVE THE COMMUNITY. THAT'S WHY WE 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 ALSO 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 230,000) AND SELECTED ZIP CODES IN ITS SECONDARY SERVICE AREAS (CUYAHOGA, ASHTABULA AND GEAUGA COUNTIES WITH A POPULATION IN THE DEFINED ZIP CODES) OF 354,000. (POPULATION FIGURES ARE AS OF 2018.)
PART VI, LINE 5:PRIOR TO 1985, 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.LAKE HEALTH HAS AN OPEN MEDICAL STAFF WITH PRIVILEGES AVAILABLE TO ALL QUALIFIED PHYSICIANS IN THE AREA. OVER 700 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 2018, WE PROVIDED OVER $380,000 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 MONTHLY E-NEWSLETTER REGARDING IMPORTANT HEALTH ISSUES AND UPCOMING HEALTH AND WELLNESS EVENTSB. EDUCATION ON SPECIFIC DISEASE CONDITIONS SENIOR CONNECTION LUNCH AND LEARNS COMMUNITY HEALTH LECTURE SERIES ARTHRITIS EXPO STRESS MANAGEMENT BREAST HEALTH FOR HISPANIC WOMEN NUTRITION AND FITNESS EDUCATION SERIES INFANT AND CHILDBIRTH PROGRAMSC. HEALTH PROMOTION AND WELLNESS PROGRAMS BE FIT FOR LIFE COOKING FOR WELLNESS SERIES CHILDREN'S WELLNESS SERIES INTEGRATIVE HEALTH & WELLNESS SERIES MALL WALKING PROGRAM LIVE HEALTHY MUSIC THERAPY LAKE HEALTH RUNNING SERIESE. 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 ASSEMBLY PROBLEM-BASED LEARNING IN ELEMENTARY SCHOOLS 48 HOURS OF HUNGER SUPPORT SPORTS MEDICINE TRAINERSG. DIGITAL CONSUMER HEALTH INFORMATION 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:LAKE HOSPITAL SYSTEM, INC. DBA LAKE HEALTH IS THE PRIMARY HEALTHCARE-PROVIDING ENTITY WHICH OPERATES TWO HOSPITAL FACILITIES AND SEVERAL OTHER OUTPATIENT, URGENT CARE AND PHYSICIAN CLINICS THROUGHOUT LAKE COUNTY AND THE SURROUNDING COMMUNITY. LAKE HEALTH IS THE SOLE MEMBER OF LAKE HEALTH FOUNDATION, INC. DBA LAKE HEALTH FOUNDATION, A NOT-FOR-PROFIT ORGANIZATION WHICH IS THE FUNDRAISING ARM OF LAKE HEALTH. LAKE HEALTH IS ALSO THE SOLE MEMBER OF PRIMEHEALTH, INC. DBA LAKE HEALTH PHYSICIAN GROUP ("LHPG") WHICH EMPLOYS LAKE HEALTH'S NETWORK OF PHYSICIANS. LAKE HEALTH IS A 50% SHAREHOLDER IN LAKE PHO, INC. DBA LAKE HEALTH PHO ("THE PHO") WHICH IS A PHYSICIAN CREDENTIALING AND MEMBERSHIP ORGANIZATION. PHYSICIANS MUST BE A MEMBER OF THE PHO IN ORDER TO PRACTICE MEDICINE AT A LAKE HEALTH HOSPITAL OR PHYSICIAN CLINIC. THE LAKE HEALTH / UNIVERSITY HOSPITALS SEIDMAN CANCER CENTER IS A JOINT VENTURE BETWEEN LAKE HEALTH AND UNIVERSITY HOSPITALS HEALTH SYSTEM OF CLEVELAND THAT PROVIDES CANCER TREATMENT IN MENTOR, OHIO.MENTOR SURGERY CENTER, LLC, MENTOR MEDICAL CAMPUS PHYSICIAN BUILDING, LLC, LAKE WEST MEDICAL SPECIALISTS, INC., AND CONCORD MEDICAL CAMPUS PHYSICIANS BUILDING, INC. ARE ENTITIES IN WHICH LAKE HEALTH OWNS A MINORITY STAKE. THESE ENTITIES LEASE MEDICAL OFFICE SPACE AT WHICH BOTH LAKE HEALTH AND NON-AFFILIATED PRACTITIONERS PRACTICE.
PART VI, LINE 7, REPORTS FILED WITH STATESOH

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Grant Records MaintainedYes (1)GrantRecordsMaintainedInd

Grants Other Asst To Indiv In US GrantsOtherAsstToIndivInUSGrp

FieldValueIRS element (for citing)
Grant TypeCOLLEGE TUITION GRANTS TO MARKETING CONTEST WINNERSGrantTypeTxt
Recipient2RecipientCnt
Cash Grant$10,000CashGrantAmt

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferencePART I, LINE 2:FormAndLineReferenceDesc
ExplanationIN COOPERATION WITH LAKELAND COMMUNITY COLLEGE AND LAKE ERIE COLLEGE, TUITION GRANTS WERE AWARDED TO THE FIRST BABY BORN AT EACH LOCATION OF LAKE HEALTH IN THE NEWLY RENOVATED LABOR AND DELIVERY WINGS. THE GRANTS ARE MONITORED THROUGH SUBMISSION OF INFORMATION SUPPORTING THE RELEASE OF FUNDS OVER A FOUR YEAR PERIOD DIRECTLY TO AN INSTITUTION OF HIGHER LEARNING FOR BENEFIT OF THE WINNERS.ExplanationTxt

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Club Dues Or FeesYes (X)ClubDuesOrFeesInd
Written Policy Ref T And E ExpnssYes (1)WrittenPolicyRefTAndEExpnssInd
Substantiation RequiredYes (1)SubstantiationRequiredInd
Compensation CommitteeYes (X)CompensationCommitteeInd
Independent ConsultantYes (X)IndependentConsultantInd
Form990 Of Other OrganizationsYes (X)Form990OfOtherOrganizationsInd
Compensation SurveyYes (X)CompensationSurveyInd
Board Or Committee ApprovalYes (X)BoardOrCommitteeApprovalInd
Severance Payment0SeverancePaymentInd
Supplemental Nonqual Rtr PlanYes (1)SupplementalNonqualRtrPlanInd
Equity Based Comp Arrngm0EquityBasedCompArrngmInd
Comp Based On Revenue Of Flng Org0CompBasedOnRevenueOfFlngOrgInd
Comp Bsd On Rev Related Orgs0CompBsdOnRevRelatedOrgsInd
Comp Bsd Net Earns Flng Org0CompBsdNetEarnsFlngOrgInd
Comp Bsd Net Earns Rltd Orgs0CompBsdNetEarnsRltdOrgsInd
Any Non Fixed PaymentsYes (1)AnyNonFixedPaymentsInd
Initial Contract Exception0InitialContractExceptionInd

Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (12 entries)

TitleTitleTxtBase Compensation Filing OrgBaseCompensationFilingOrgAmtCompensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmtBonus Filing OrganizationBonusFilingOrganizationAmountBonus Related OrganizationsBonusRelatedOrganizationsAmtOther Compensation Filing OrgOtherCompensationFilingOrgAmtOther Compensation Rltd OrgsOtherCompensationRltdOrgsAmtDeferred Compensation Flng OrgDeferredCompensationFlngOrgAmtDeferred Comp Rltd OrgsDeferredCompRltdOrgsAmtNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmtNontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmtTotal Compensation Filing OrgTotalCompensationFilingOrgAmtTotal Compensation Rltd OrgsTotalCompensationRltdOrgsAmtComp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmtComp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt
CYNTHIA MOORE-HARDY
PRESIDENT AND CEO$808,496$0$0$0$42,627$0$14,417$0$11,723$0$877,263$0$0$0
ROBERT TRACZ
SR. VP/CFO$426,265$0$0$0$10,941$0$14,305$0$10,609$0$462,120$0$0$0
JOHN BANIEWICZ MD
SR VP, MEDICAL AFFAIRS$451,868$0$0$0$10,095$0$14,250$0$15,032$0$491,245$0$0$0
STEVE R KARNS
SR VP, ADMINISTRATIVE SERV (THROUGH$267,652$0$382,260$0$8,537$0$13,565$0$8,396$0$680,410$0$0$0
RICHARD D CICERO
SR VP, MARKETING & BUSINES$298,528$0$160,080$0$10,194$0$13,580$0$7,199$0$489,581$0$0$0
MARY L OGRINC
CHIEF NURSING OFFICER$330,341$0$269,100$0$13,190$0$13,937$0$5,467$0$632,035$0$0$0
JOYCE A TAYLOR
VP, QUALITY SERVICES, CQO$199,507$0$0$0$7,205$0$4,085$0$5,762$0$216,559$0$0$0
CYNTHIA J RACER
VP, CLINICAL SERVICES$179,685$0$0$0$5,823$0$5,654$0$8,611$0$199,773$0$0$0
DAVID HERMAN
VP, FINANCE$188,934$0$0$0$4,782$0$4,751$0$11,668$0$210,135$0$0$0
PHIL BROOKS
VP, REVENUE CYCLE$175,081$0$0$0$38,789$0$2,397$0$10,696$0$226,963$0$0$0
CRAIG GHIDOTTI
VP, HUMAN RESOURCES$172,802$0$0$0$6,027$0$5,529$0$6,244$0$190,602$0$0$0
JERROLD M PETERS
VP, INFORMATION TECH/CIO$167,341$0$0$0$5,767$0$1,320$0$5,539$0$179,967$0$0$0

Supplemental Information Detail SupplementalInformationDetail (3 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
PART I, LINE 1ALAKE HOSPITAL SYSTEM, INC.'S CEO, CYNTHIA MOORE-HARDY, RECEIVED THE FOLLOWING TAXABLE BENEFIT IN 2018: -SOCIAL CLUB DUES OF $12,230
PART I, LINE 4BTHE FOLLOWING INDIVIDUALS PARTICIPATED IN A 457(F) NON-QUALIFIED DEFERRED COMPENSATION ARRANGEMENT : CYNTHIA MOORE-HARDY : $80,850 ROBERT TRACZ : $10,000
PART I, LINE 7DISCRETIONARY BONUS MAY BE AWARDED BASED ON PERFORMANCE. THOSE BONUSES ARE DETERMINED BY THE STRATEGIC LEADERSHIP TEAM. THE FOLLOWING INDIVDUALS RECEIVED THESE BONUSES: - RICHARD CICERO: $160,080 - STEVE KARNS: $382,260 - MARY OGRINC: $269,100

Schedule K IRS990ScheduleK

Tax Exempt Bonds Issues TaxExemptBondsIssuesGrp (3 entries)

Bond ReferenceBondReferenceCdBond Issuer EINBondIssuerEINCUSIPCUSIPNumBond IssuedBondIssuedDtIssue PriceIssuePriceAmtPurposePurposeDescDefeasedDefeasedIndOn Behalf Of IssuerOnBehalfOfIssuerIndPool FinancingPoolFinancingInd
COUNTY OF LAKE OHIO SERIES 2008
A34600161850943PBL22008-06-26$187,820,719SEE PART VIYes (1)00
COUNTY OF LAKE OHIO SERIES 2015
B34600161850943PCC12015-08-03$69,960,181SEE PART VI000
COUNTY OF LAKE OHIO SERIES 2017
C3460016182017-12-19$138,445,000SEE PART VI000

Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp (3 entries)

Bond ReferenceBondReferenceCdRetiredRetiredAmtTotal ProceedsTotalProceedsAmtIn Reserve FundInReserveFundAmtIssuance Costs From ProceedsIssuanceCostsFromProceedsAmtCredit EnhancementCreditEnhancementAmtOther Spent ProceedsOtherSpentProceedsAmtSubstantial CompletionSubstantialCompletionYrRefunding Tax Exempt BondsRefundingTaxExemptBondsIndRefunding Taxable BondsRefundingTaxableBondsIndFinal Allocation MadeFinalAllocationMadeIndAdequate Books And Rec MaintAdequateBooksAndRecMaintIndCapital ExpendituresCapitalExpendituresAmt
A$189,235,000$193,619,630$998,658$1,808,396$57,940$190,754,6372009Yes (1)0Yes (1)Yes (1)
B$69,994,708$268,650$50,535,79820160Yes (1)Yes (1)Yes (1)$19,190,260
C$1,635,000$138,445,000$138,445,0002017Yes (1)0Yes (1)Yes (1)

Tax Exempt Bonds Private Bus Use TaxExemptBondsPrivateBusUseGrp (3 entries)

Bond ReferenceBondReferenceCdOwning Bond Financed PropertyOwningBondFinancedPropertyIndAny Lease ArrangementsAnyLeaseArrangementsIndMgmt Contract Bond Fincd PropMgmtContractBondFincdPropIndEngage Bond Counsel ContractsEngageBondCounselContractsIndAny Research AgreementsAnyResearchAgreementsIndPrivate Bus Use By OthersPrivateBusUseByOthersPctPrivate Bus Concerning UBIPrivateBusConcerningUBIPctTotal Private Business UseTotalPrivateBusinessUsePctBond Iss Meet Prvt Sec Pymt TestBondIssMeetPrvtSecPymtTestIndChange In Use Bond Financed PropChangeInUseBondFinancedPropIndProcs Nonqualified Bond RemdtdProcsNonqualifiedBondRemdtdInd
A00Yes (1)Yes (1)00.000000.000000.0000000Yes (1)
B00Yes (1)Yes (1)00.000000.000000.0000000Yes (1)
C00Yes (1)Yes (1)00.000000.000000.0000000Yes (1)

Tax Exempt Bonds Arbitrage TaxExemptBondsArbitrageGrp (3 entries)

Bond ReferenceBondReferenceCdForm8038 T FiledForm8038TFiledIndRebate Not Due YetRebateNotDueYetIndException To RebateExceptionToRebateIndNo Rebate DueNoRebateDueIndVariable Rate IssueVariableRateIssueIndHedge Identified In Bks And RecHedgeIdentifiedInBksAndRecIndGross Proceeds Invested In GICGrossProceedsInvestedInGICIndGross Proceeds InvestedGrossProceedsInvestedIndWritten Proc To Monitor ReqsWrittenProcToMonitorReqsIndSuperintegrated HedgeSuperintegratedHedgeIndHedge TerminatedHedgeTerminatedInd
A000Yes (1)Yes (1)000Yes (1)
B0Yes (1)000000Yes (1)
C0Yes (1)00Yes (1)Yes (1)00Yes (1)00

Procedures Corrective Action ProceduresCorrectiveActionGrp (3 entries)

Bond ReferenceBondReferenceCdProcedures Corrective ActionProceduresCorrectiveActionInd
AYes (1)
BYes (1)
CYes (1)

Supplemental Information Detail SupplementalInformationDetail (11 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
DATE REBATE COMPUTATION PERFORMEDISSUER NAME: COUNTY OF LAKE, OHIO SERIES 2008 DATE THE REBATE COMPUTATION WAS PERFORMED: 06/26/2018
SCHEDULE K, PART I, BOND ISSUES:(A) ISSUER NAME: COUNTY OF LAKE, OHIO SERIES 2008 (B) ISSUER NAME: COUNTY OF LAKE, OHIO SERIES 2015 (C) ISSUER NAME: COUNTY OF LAKE, OHIO SERIES 2017
SCHEDULE K, PART I, LINE A, COLUMN (F) DESCRIPTION OF PURPOSE:CONSTRUCT A HOSPITAL; REFUNDING OF SERIES 2004 (ISSUED ON 11/23/2004) AND SERIES 2007 (ISSUED ON 07/19/2007).
SCHEDULE K, PART I, LINE B, COLUMN (F) DESCRIPTION OF PURPOSE:CONSTRUCTION, REMODELING, IMPROVEMENT, AND EQUIPPING OF HOSPITAL FACILITIES; PARTIAL REFUNDING OF SERIES 2008C (ISSUED ON 06/26/2008).
SCHEDULE K, PART I, LINE C, COLUMN (F) DESCRIPTION OF PURPOSE:REFUNDING OF SERIES 2012A (ISSUED ON 06/15/2012) AND SERIES 2012C (ISSUED ON 06/15/2012), REISSUANCE FOR FEDERAL INCOME TAX PURPOSES OF SERIES 2012B (ISSUED ON 06/15/2012).
SCHEDULE K, PART I, COLUMN (E) & SCHEDULE K, PART, II, LINE 3:THE DIFFERENCE BETWEEN ISSUE PRICE IN PART I, COLUMN (E) AND THE TOTAL PROCEEDS OF ISSUE IN PART II, LINE 3 IS INVESTMENT INCOME EARNED ON BOND FUNDS BEFORE THE BOND PROCEEDS WERE EXPENDED.
SCHEDULE K, PART II, COLUMN B LINE 10 - CAPITAL EXPENDITURES FROM PROCEEDS:LINE INCLUDES $24,000 OF INTEREST ON THE 2015 BONDS, AND INVESTMENT EARNINGS IN THE AMOUNT OF $242.
SCHEDULE K, PART II, COLUMN A, LINE 11 - OTHER SPENT PROCEEDS:THESE BOND PROCEEDS WERE USED TO REFUND PRIOR DEBT, AS NOTED IN THE NOTES FOR PART I.
SCHEDULE K, PART II, COLUMN B, LINE 11 - OTHER SPENT PROCEEDS:OTHER SPENT PROCEEDS - THESE BOND PROCEEDS WERE USED TO ADVANCE REFUND PRIOR DEBT, AS NOTED IN THE NOTES FOR PART I, AND THAT PRIOR DEBT WAS CALLED FOR REDEMPTION 08/15/2018.
SCHEDULE K, PART II, COLUMN C, LINE 11:OTHER SPENT PROCEEDS - THESE BOND PROCEEDS WERE USED TO CURRENT REFUND PRIOR DEBT, AS NOTED IN THE NOTES FOR PART I. IN ADDITION, THE SERIES 2012B BONDS WERE REISSUED FOR FEDERAL INCOME TAX PURPOSES ON THE DATE OF ISSUE OF THE SERIES 2017 BONDS, AND THOSE REISSUED SERIES 2012B BONDS ARE PART OF A SINGLE ISSUE OF OBLIGATIONS WITH THE SERIES 2017 BONDS.
SCHEDULE K, PART IV, COLUMN C, LINES 4B AND 4C:SERIES 2017 PROVIDER KEYBANK, NATIONAL ASSOCIATION, TERM 20.48 YEARS; SERIES 2017 PROVIDER PNC BANK, TERM 28.81 YEARS; AND SERIES 2017 PROVIDER PNC BANK, TERM 29.15 YEARS.

Schedule L IRS990ScheduleL

Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp (2 entries)

Relationship DescriptionRelationshipDescriptionTxtTransactionTransactionAmtTransactionTransactionDescSharing Of RevenuesSharingOfRevenuesInd
MATT J CICERO
FAMILY MEMBER OF KEY EMPLOYEE, RICHARD D. CICERO$58,757SEE PART V0
JAMESON PRITCHARD
FAMILY MEMBER OF KEY EMPLOYEE, MARY OGRINC$52,142SEE PART V0

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferencePART IV, COLUMN DFormAndLineReferenceDesc
ExplanationMATT J. CICERO, WHO HAS A FAMILY RELATIONSHIP WITH RICHARD D. CICERO, SERVED AS A HOSPITAL EMPLOYEE DURING 2018 AND RECEIVED COMPENSATION.JAMESON PRITCHARD, WHO HAS A FAMILY RELATIONSHIP WITH MARY OGRINC, SERVED AS A HOSPITAL EMPLOYEE DURING 2018 AND RECEIVED COMPENSATION.ExplanationTxt

Schedule M IRS990ScheduleM

Other Non Cash Contri Table OtherNonCashContriTableGrp (4 entries)

Non Cash CheckboxNonCashCheckboxIndDescDescContributionContributionCntNoncash Contributions Rpt F990NoncashContributionsRptF990AmtMethod Of Determining RevenuesMethodOfDeterminingRevenuesTxt
Yes (X)MENTOR WELLNESS8$36,444RETAIL VALUE
Yes (X)WALKWAY ITEMS12$33,835RETAIL VALUE
Yes (X)DESK1$4,709RETAIL VALUE
Yes (X)MISCELLANEOUS ITEMS PERRICO CAMPUS2$4,099RETAIL VALUE
FieldValueIRS element (for citing)
Any Property That Must Be Held0AnyPropertyThatMustBeHeldInd
Review Process Unusual NC GiftsYes (1)ReviewProcessUnusualNCGiftsInd
Third Parties UsedYes (1)ThirdPartiesUsedInd

Supplemental Information Detail SupplementalInformationDetail (2 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
PART I, LINE 32B:ALL GIFT DONATIONS ARE RECEIVED BY THE RELATED ORGANIZATION LAKE HEALTH FOUNDATION AND FOLLOW THE GIFT POLICY OF THAT RELATED ENTITY.
PART I, LINE 33:PART I, COLUMN (B) IS THE NUMBER OF CONTRIBUTIONS.

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (6 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
FORM 990, PART VI, SECTION B, LINE 11BTHE PROCESS FOLLOWED BEFORE FILING THE LAKE HOSPITAL SYSTEMS, INC. FORM 990 INCLUDES A DETAILED REVIEW COMPLETED BY AN INDEPENDENT OUTSIDE CPA FIRM, PRESENTATION TO AND REVIEW BY THE LHS CFO AND CEO, PRESENTATION AND REVIEW BY THE LHS FINANCE COMMITTEE, AND PRESENTATION TO THE LHS BOARD OF TRUSTEES.
FORM 990, PART VI, SECTION B, LINE 12CTHE LAKE HOSPITAL SYSTEM, INC. BOARD OF TRUSTEES COMPLETE A CONFLICT OF INTEREST QUESTIONNAIRE ANNUALLY, WHICH IS THEN 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 15THE 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. IN ADDITION, THE PROCEDURE FOR OTHER OFFICERS AND KEY EMPLOYEES INCLUDES REVIEW BY THE CEO. THE REVIEW WAS LAST CONDUCTED IN NOVEMBER 2018.
FORM 990, PART VI, SECTION C, LINE 19LAKE 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). LAKE HOSPITAL SYSTEM, INC. MAKES AVAILABLE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS TO THE PUBLIC UPON REQUEST, FOR THE SAME PERIOD OF TIME AS SET FORTH IN THE INTERNAL REVENUE CODE SECTION 6104(D), IN ADDITION TO FILING QUARTERLY FINANCIAL INFORMATION WITH NATIONALLY RECOGNIZED MUNICIPAL SECURITIES INFORMATION REPOSITORIES FOR COMPLIANCE WITH BOND ISSUES AND ANNUAL FINANCIAL INFORMATION WITH THE ATTORNEY GENERAL OF THE STATE OF OHIO. GOVERNING DOCUMENTS FOR LHS ARE AVAILABLE THROUGH THE WEBSITE OF THE OHIO SECRETARY OF STATE.
FORM 990, PART XI, LINE 9:NET GAIN FROM AFFILIATED ENTITIES 19,041. DERIVATIVE INSTRUMENTS GAIN 2,948,150. NET CHANGE IN UNREALIZED GAIN/LOSS ON TRADING INVESTMENTS -973,606. UNDERWRITING SUPPORT OF FOUNDATION -345,176. PHYSICIAN LOAN RECOVERY 43,824. REVERSAL OF ACCRUAL
FORM 990, PART XII, LINE 2C:LAKE HEALTH'S BOARD OF DIRECTORS OVERSEES THE AUDIT PROCESS AND APPROVES THE INDEPENDENT AUDIT FIRM. THIS PROCESS HAS NOT CHANGED FROM PRIOR YEAR.

Schedule R IRS990ScheduleR

Id Disregarded Entities IdDisregardedEntitiesGrp

Disregarded Entity Name DisregardedEntityName

FieldValueIRS element (for citing)
Business Name Line1LAKE HEALTH IPHEBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line17590 AUBURN RDAddressLine1Txt
CityCONCORDCityNm
State AbbreviationOHStateAbbreviationCd
ZIP44077ZIPCd
FieldValueIRS element (for citing)
Primary ActivitiesPHYSICIAN SERVICESPrimaryActivitiesTxt
Legal Domicile StateOHLegalDomicileStateCd
Total Income$0TotalIncomeAmt
End Of Year Assets$0EndOfYearAssetsAmt

Direct Controlling Entity Name DirectControllingEntityName

FieldValueIRS element (for citing)
Business Name Line1LAKE HOSPITAL SYSTEM INCBusinessNameLine1Txt

Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (3 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdExempt Code SectionExemptCodeSectionTxtPublic Charity StatusPublicCharityStatusTxtDirect Controlling NADirectControllingNACdControlled OrganizationControlledOrganizationIndBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Txt
LAKE HEALTH UNIVERSITY HOSPITALS SEIDMAN CANCER CENTER
9485 MENTOR AVENUEMENTOROH44060311565964TREATMENT OF CANCER PATIENTSOH501(C)(3)LINE 3N/A0
LAKE HOSPITAL FOUNDATION INC DBA LAKE HEALTH FOUNDATION
7590 AUBURN RDCONCORDOH44077341425872FUNDRAISING FOR BENEFIT OF LAKE HOSPITAL SYSTEM, INC.OH501(C)(3)LINE 12A, IYes (1)LAKE HOSPITAL SYSTEM INC DBA LAKE HEALTH
PRIMEHEALTH INC
7590 AUBURN RDCONCORDOH44077341778204PHYSICIAN CORPORATIONOH501(C)(3)LINE 3Yes (1)LAKE HOSPITAL SYSTEM INC DBA LAKE HEALTH

Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp (6 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdDirect Controlling NADirectControllingNACdPredominant Income TypePredominantIncomeTypeTxtShare Of Total IncomeShareOfTotalIncomeAmtShare Of EOY AssetsShareOfEOYAssetsAmtDisproportionate AllocationsDisproportionateAllocationsIndGeneral Or Managing PartnerGeneralOrManagingPartnerIndOwnershipOwnershipPctBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Txt
CONCORD MEDICAL CAMPUS PHYSICIAN BUILDING LLC
7580 AUBURN ROADCONCORDOH44077260550261OFFICE SPACEOHN/AEXCLUDED$216,812$1,740,697000.51470
LAKE WEST MEDICAL SPECIALISTS LLC
36000 EUCLID AVENUEWILLOUGHBYOH44094341964657OFFICE SPACEOHN/AEXCLUDED$32,400$390,3030Yes (1)0.12000
MENTOR MEDICAL CAMPUS PHYSICIAN BUILDING LLC
9485 MENTOR AVENUEMENTOROH44060341958475OFFICE SPACEOHN/AUBI$76,312$2,299,133000.40390
MENTOR SURGERY CENTER LLC
9485 MENTOR AVENUEMENTOROH44060341863257OUTPATIENT SURGERYOHN/ARELATED$469,795$1,384,6830Yes (1)0.42210
LAKE WILLOUGHBY PROPERTIES LLC
4166 CHILLICOTHE ROADWILLOUGHBYOH44094364837155OFFICE SPACEOHN/AUBI$47,833$662,211000.35000
NEW MANNA CLG LLC DBA LAKE HEALTH BEACHWOOD MEDICAL CENTER
24651 CENTER RIDGE ROAD SUITE 350WESTLAKEOH44145371848577INVESTMENT IN FUTURE SITEOHUBI$9,868,034000.51000YES

Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (2 entries)

Address Line1ForeignAddress/AddressLine1TxtCityForeignAddress/CityNmCountryForeignAddress/CountryCdEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile Foreign CountryLegalDomicileForeignCountryCdBusiness Name Line1DirectControllingEntityName/BusinessNameLine1TxtEntity TypeEntityTypeTxtShare Of Total IncomeShareOfTotalIncomeAmtShare Of EOY AssetsShareOfEOYAssetsAmtOwnershipOwnershipPctControlled OrganizationControlledOrganizationIndAddress Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdLegal Domicile StateLegalDomicileStateCdDirect Controlling NADirectControllingNACd
LHS ASSURANCE LTD
23 LIME TREE BAY AVENUEGRAND CAYMANCJ980456229INSURANCE COMPANYCJLAKE HOSPITAL SYSTEM INC DBA LAKE HEALTHC-$103,689$22,634,0551.00000Yes (1)
LAKE PHO INC DBA LAKE HEALTH PHYSICIAN HOSPITAL ORGANIZATION
341696001PHYSICIAN SERVICESC$123,375$2,885,0610.5000007590 AUBURN ROADCONCORDOH44077OHN/A
FieldValueIRS element (for citing)
Receipt Of Int Annts Rnts Rylts0ReceiptOfIntAnntsRntsRyltsInd
Gift Grnt Or Cap Contri To Oth OrgYes (1)GiftGrntOrCapContriToOthOrgInd
Gift Grnt Cap Contri From Oth OrgYes (1)GiftGrntCapContriFromOthOrgInd
Loans Or Guarantees To Other OrgYes (1)LoansOrGuaranteesToOtherOrgInd
Loans Or Guarantees From Oth Org0LoansOrGuaranteesFromOthOrgInd
Div Related OrganizationYes (1)DivRelatedOrganizationInd
Asset Sale To Other Org0AssetSaleToOtherOrgInd
Asset Purchase From Other Org0AssetPurchaseFromOtherOrgInd
Asset Exchange0AssetExchangeInd
Rental Of Facilities To Oth OrgYes (1)RentalOfFacilitiesToOthOrgInd
Rental Of Fclts From Oth OrgYes (1)RentalOfFcltsFromOthOrgInd
Perform Of Services For Oth OrgYes (1)PerformOfServicesForOthOrgInd
Perform Of Services By Other OrgYes (1)PerformOfServicesByOtherOrgInd
Sharing Of FacilitiesYes (1)SharingOfFacilitiesInd
Paid Employees SharingYes (1)PaidEmployeesSharingInd
Reimbursement Paid To Other OrgYes (1)ReimbursementPaidToOtherOrgInd
Reimbursement Paid By Other OrgYes (1)ReimbursementPaidByOtherOrgInd
Transfer To Other OrgYes (1)TransferToOtherOrgInd
Transfer From Other Org0TransferFromOtherOrgInd

Transactions Related Org TransactionsRelatedOrgGrp (17 entries)

Transaction TypeTransactionTypeTxtInvolvedInvolvedAmtMethod Of Amount DeterminationMethodOfAmountDeterminationTxt
PRIMEHEALTH INC
P$28,727,856BOOK VALUE
LHS ASSURANCE LTD
C$500,000BOOK VALUE
LAKE HEALTH FOUNDATION
C$477,515BOOK VALUE
LAKE HEALTH FOUNDATION
M$345,175BOOK VALUE
LAKE WEST MEDICAL SPECIALISTS LLC
K$355,530BOOK VALUE
LHUH SEIDMAN CANCER CENTER
J$850,869BOOK VALUE
MENTOR SURGERY CENTER LLC
F$488,518BOOK VALUE
MENTOR SURGERY CENTER LLC
J$480,804BOOK VALUE
MENTOR MEDICAL CAMPUS PHYSICIAN BUILDING LLC
F$64,616BOOK VALUE
MENTOR MEDICAL CAMPUS PHYSICIAN BUILDING LLC
J$84,999BOOK VALUE
MENTOR MEDICAL CAMPUS PHYSICIAN BUILDING LLC
K$606,935BOOK VALUE
CONCORD MEDICAL CAMPUS PHYSICIAN BUILDING LLC
J$101,235BOOK VALUE
CONCORD MEDICAL CAMPUS PHYSICIAN BUILDING LLC
K$1,396,809BOOK VALUE
LAKE WILLOUGHBY PROPERTIES LLC
K$722,669BOOK VALUE
CONCORD MEDICAL CAMPUS PHYSICIAN BUILDING LLC
D$175,712BOOK VALUE
NEW MANNA CLG LLC
L$179,534BOOK VALUE
MENTOR MEDICAL CAMPUS PHYSICIAN BUILDING LLC
D$183,204BOOK VALUE