2019-11-14T07:02:20-06:00 2018-12-31 381357951 PLANTE & MORAN PLLC 250 S HIGH ST SUITE 100 COLUMBUS OH 43215 990 2018-01-01 341425870 LAKE HOSPITAL SYSTEM INC LAKE 4403541991 7590 AUBURN ROAD CONCORD OH 44077 ROBERT TRACZ SENIOR VP & CFO 4403541991 2019-11-05 1 BERNIE OSTROWSKI P00366367 6148493000 2019-11-05 67.59.56.33 2019-11-05 09:22:30 ES P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 6C9B1A35775087DBDB8A6D25ECA509C7F6C27838 2018 2020-04-17 16:48:07Z LAKE HEALTH CYNTHIA MOORE-HARDY 7590 AUBURN ROAD CONCORD OH 44077 484404109 0 X WWW.LAKEHEALTH.ORG X 1983 OH TO PROVIDE COMPREHENSIVE HEALTH CARE SERVICES TO THE RESIDENTS OF LAKE COUNTY AND NEIGHBORING COMMUNITIES IN PARTNERSHIP WITH THOSE WHO SHARE A COMMITMENT TO LOCAL ACCESS, HEALING WITH COMPASSION, AND SUPERIOR QUALITY. 11 11 3330 871 2551934 0 2246424 1903511 367307188 380077771 5721441 9039337 17646600 23495360 392921653 414515979 0 10000 0 0 180076116 189506079 0 0 0 211660742 215546363 391736858 405062442 1184795 9453537 549215936 532511689 311984993 301182681 237230943 231329008 X IT 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. 0 0 356255897 10000 398785079 AS 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. 356255897 1 1 0 1 0 0 0 0 0 1 1 0 0 0 1 1 0 1 0 0 1 0 0 0 0 0 1 1 0 1 1 1 0 0 0 0 0 0 0 1 0 0 1 0 0 0 1 1 1 1 0 0 1 263 0 1 3330 1 1 1 1 CJ 0 0 0 0 0 0 0 0 0 0 X 11 11 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 1 1 X LISA MOTHERSBAUGH 4403541984 7590 AUBURN ROAD CONCORD OH 44077 MICHAEL E MAYHER CHAIR 5.00 0.00 X X 0 0 0 DAVID STEIGER MD VICE CHAIR 5.00 0.00 X X 0 0 0 LISA KLAMMER ESQ SECRETARY 2.00 0.00 X X 0 0 0 BRETT HIMES TREASURER 2.00 0.00 X X 0 0 0 THOMAS P JUBECK TRUSTEE 2.00 0.00 X 0 0 0 I JAMES HACKENBERG ESQ TRUSTEE 1.00 0.00 X 0 0 0 FRANK JEVNIKAR MD TRUSTEE 1.00 0.00 X 0 0 0 JOHN F PLATZ TRUSTEE 1.00 0.00 X 0 0 0 ROBERT G SCHIEBLI TRUSTEE 1.00 0.00 X 0 0 0 STEPHEN C ELLIS TRUSTEE 1.00 0.00 X 0 0 0 RODNEY HOWELL TRUSTEE 1.00 0.00 X 0 0 0 RAYMOND SINES TRUSTEE 1.00 0.00 X 0 0 0 CYNTHIA MOORE-HARDY PRESIDENT AND CEO 55.00 10.00 X 851123 0 26140 ROBERT TRACZ SR. VP/CFO 50.00 10.00 X 437206 0 24914 JOHN BANIEWICZ MD SR VP, MEDICAL AFFAIRS 45.00 10.00 X 461963 0 29282 STEVE R KARNS SR VP, ADMINISTRATIVE SERV (THROUGH OCT) 55.00 0.00 X 658449 0 21961 RICHARD D CICERO SR VP, MARKETING & BUSINES 45.00 10.00 X 468802 0 20779 MARY L OGRINC CHIEF NURSING OFFICER 55.00 10.00 X 612631 0 19404 JOYCE A TAYLOR VP, QUALITY SERVICES, CQO 40.00 0.00 X 206712 0 9847 CYNTHIA J RACER VP, CLINICAL SERVICES 40.00 0.00 X 185508 0 14265 DAVID HERMAN VP, FINANCE 40.00 10.00 X 193716 0 16419 PHIL BROOKS VP, REVENUE CYCLE 40.00 5.00 X 213870 0 13093 CRAIG GHIDOTTI VP, HUMAN RESOURCES 40.00 5.00 X 178829 0 11773 JERROLD M PETERS VP, INFORMATION TECH/CIO 40.00 0.00 X 173108 0 6859 4641917 0 214736 99 0 1 0 COMMUNITY HOSPITALISTS LLC 30680 BAINBRIDGE ROAD SOLON OH 44139 MEDICAL PROVIDERS 5971286 CROTHALL HEALTHCARE INC 13028 COLLECTIONS CENTER DR CHICAGO IL 60693 HOUSEKEEPING 4056549 SODEXO INC AND AFFILIATES PO BOX 360170 PITTSBURG PA 152516170 NUTRITION SERVICES 3415174 CERNER HEALTH SERVICES INC PO BOX 959167 ST LOUIS MO 631959167 INFO TECH CONSULTING 2618855 PAYMED SOLUTIONS INC 3250 W MARKET ST SUITE 304 AKRON OH 44333 CONSULTING 1831405 236 1327511 576000 79086 1903511 PATIENT CARE 621110 380077771 380076770 1001 380077771 7191976 7191976 29728 29728 2480902 0 2480902 2480902 382929 2097973 71512380 193383 69337794 550336 2174586 -356953 1817633 1817633 RELATED SALES AND SERVICES 621110 8628527 6322378 2168004 138145 PURCHASE DISCOUNTS 621110 5558140 5558140 MWC FITNESS CENTER 713940 3811340 3811340 3016451 3016451 21014458 414515979 398785079 2551934 11275455 10000 10000 3632654 3632654 161858670 142442298 19416372 1880290 1635852 244438 13055734 12515268 540466 9078731 7814279 1264452 1601192 1576342 24850 526535 470364 56171 86103 86103 978944 978944 39270576 34965524 4305052 1755964 782035 973929 3627613 2510332 1117281 10319189 981889 9337300 13946577 13941854 4723 264978 199184 65794 591982 454803 137179 7271687 7258180 13507 23366185 16255440 7110745 4351506 3910315 441191 MEDICAL SUPPLIES 69275229 69275186 43 BAD DEBT 31861444 31861444 HOSPITAL FRANCHISE FEE 5402955 5402955 MEMBERSHIP DUES 1042304 1008009 34295 5400 5400 405062442 356255897 48806545 0 790747 3746710 41977123 42181954 4372097 4817443 10319114 15817061 509861434 292787820 225754125 217073614 240970947 223182453 25031783 25692454 549215936 532511689 39241076 38563829 393298 601912 219712975 215679977 52637644 46336963 311984993 301182681 X 237230943 231329008 237230943 231329008 549215936 532511689 X 9453537 -17047705 1692233 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 6940 6940 0 PART II-B, LINE 1: LINE 1I: MEMBERSHIP DUES PAID TO HOSPITAL INDUSTRY ASSOCIATIONS AND ORGANIZATIONS, THE PERCENTAGE OF WHICH IS REPORTED UNDER IRS RULES AS LOBBYING EXPENSE. 6834614 829389 -207803 26377 1157701 6272122 6265843 1432011 434510 30544 1267206 6834614 4930675 1469849 235080 5200 364561 6265843 4498522 848337 98143 10200 504127 4930675 4690654 318956 123314 13500 620902 4498522 0.01120 0.45510 0.53370 0 1 1 13668329 13668329 206923699 78295370 128628329 8153092 2624899 5528193 257896912 201004395 56892517 23219402 10863156 12356246 217073614 THIRD PARTY SETTLEMENTS 3962293 WORKERS COMPENSATION LIABILITY 1277968 DEFERRED COMPENSATION 6005087 LEASE OBLIGATION 162924 ACCRUED SELF-INSURANCE 833789 MARKETING LIABILITY 10000 INTEREST RATE SWAP 34084902 46336963 X 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. CENTRAL AMERICA AND THE CARIBBEAN - ANTIGUA & BARBUDA, ARUBA, BAHAMAS, 0 0 PROGRAM SERVICES PROGRAM-RELATED INVESTMENTS 19760884 CENTRAL AMERICA AND THE CARIBBEAN - ANTIGUA & BARBUDA, ARUBA, BAHAMAS, 0 0 PROGRAM SERVICES MANAGEMENT FEES RELATED TO LHS ASSURANCE, LTD. 161321 0 0 0 0 0 0 19922205 0 19922205 0 0 1 0 0 0 1 1 X 1 X 250.000000000000 1 X 1 1 0 1 1 2701047 2408690 292357 0.00070 59621704 33980328 25641376 0.06330 62322751 36389018 25933733 0.06400 387615 387615 0.00100 2378500 2378500 0.00590 1649062 1649062 0.00410 4415177 4415177 0.01100 66737928 36389018 30348910 0.07500 1 31861444 0 80699546 85659835 -4960289 X 1 1 1 MENTOR SURGERY CENTER LLC OUTPATIENT SURGICAL CENTER 0.42000 0.00000 0.58000 2 LAKE WEST MEDICAL SPECIALISTS MEDICAL OFFICE BUILDING 0.12000 0.00000 0.88000 3 CONCORD MEDICAL CAMPUS PHYSICIAN BUILDING LLC MEDICAL OFFICE BUILDING 0.51470 0.00000 0.48530 4 MENTOR MEDICAL CAMPUS PHYSICIAN BUILDING LLC MEDICAL OFFICE BUILDING 0.40390 0.00000 0.39610 5 LAKE PHO INC PHYSICIAN SERVICES 0.50000 0.00000 0.50000 6 LAKE WILLOUGHBY PROPERTIES LLC MEDICAL OFFICE BUILDING 0.35000 0.00000 0.65000 7 NEW MANNA CLG LLC MEDICAL OFFICE BUILDING 0.51000 0.00000 0.49000 2 1 WEST MEDICAL CENTER 36000 EUCLID AVENUE WILLOUGHBY OH 44094 WWW.LAKEHEALTH.ORG X X X 2 TRIPOINT MEDICAL CENTER 7590 AUBURN ROAD CONCORD OH 44077 WWW.LAKEHEALTH.ORG X X X WEST MEDICAL CENTER 1 0 0 1 X X X X X X X X X 16 1 1 0 1 X HTTPS://LAKEHEALTH.ORG/ABOUT/HEALTH-NEEDS-ASSESSMENT X 1 16 1 HTTPS://LAKEHEALTH.ORG/ABOUT/HEALTH-NEEDS-ASSESSMENT 0 1 X 250.000000000000 400.000000000000 X X X X X X 1 1 X X X X 1 X HTTPS://LAKEHEALTH.ORG/PATIENTS/FINANCIAL-INFORMATION/FINANCIAL-AID X HTTPS://LAKEHEALTH.ORG/PATIENTS/FINANCIAL-INFORMATION/FINANCIAL-AID X HTTPS://LAKEHEALTH.ORG/PATIENTS/FINANCIAL-INFORMATION X X X X X 1 X 0 X X X X 1 X 0 0 TRIPOINT MEDICAL CENTER 2 0 0 1 X X X X X X X X X 16 1 1 0 1 X HTTPS://LAKEHEALTH.ORG/ABOUT/HEALTH-NEEDS-ASSESSMENT X 1 16 1 HTTPS://LAKEHEALTH.ORG/ABOUT/HEALTH-NEEDS-ASSESSMENT 0 1 X 250.000000000000 400.000000000000 X X X X X X 1 1 X X X X 1 X HTTPS://LAKEHEALTH.ORG/PATIENTS/FINANCIAL-INFORMATION/FINANCIAL-AID X HTTPS://LAKEHEALTH.ORG/PATIENTS/FINANCIAL-INFORMATION/FINANCIAL-AID X HTTPS://LAKEHEALTH.ORG/PATIENTS/FINANCIAL-INFORMATION X X X X X 1 X 0 X X X X 1 X 0 0 WEST MEDICAL CENTER PART V, SECTION B, LINE 5: LAKE HEALTH IDENTIFIED COMMUNITY HEALTH NEEDS BY UNDERGOING A NEEDS ASSESSMENT PROCESS. THIS PROCESS INCORPORATED A COMPREHENSIVE REVIEW BY LAKE HEALTH'S SENIOR LEADERSHIP TEAM ALONG WITH SECONDARY AND PRIMARY DATA INPUT COMPILED USING THE EXPERTISE OF DIXON HUGHES GOODMAN, LLP ("DHG") AND ARTOWER ADVISORY SERVICES, LLC ("ARTOWER"). THE COLLECTIVE COMMUNITY HEALTH NEEDS ASSESSMENT ("CHNA")TEAM REVIEWED SEVERAL SOURCES OF QUANTITATIVE HEALTH, AS WELL AS SOCIAL AND DEMOGRAPHIC DATA SPECIFIC TO LAKE HEALTH'S SERVICE AREA. LAKE HEALTH ALSO TOOK ADVANTAGE OF THIS OPPORTUNITY TO COLLABORATE WITH ITS ADMINISTRATORS, PHYSICIANS, PUBLIC HEALTH AGENCIES, AND LOCAL ORGANIZATIONS IN IDENTIFYING AND ADDRESSING THE NEEDS OF THE COMMUNITY. TRIPOINT MEDICAL CENTER PART V, SECTION B, LINE 5: LAKE HEALTH IDENTIFIED COMMUNITY HEALTH NEEDS BY UNDERGOING A NEEDS ASSESSMENT PROCESS. THIS PROCESS INCORPORATED A COMPREHENSIVE REVIEW BY LAKE HEALTH'S SENIOR LEADERSHIP TEAM ALONG WITH SECONDARY AND PRIMARY DATA INPUT COMPILED USING THE EXPERTISE OF DIXON HUGHES GOODMAN, LLP ("DHG") AND ARTOWER ADVISORY SERVICES, LLC ("ARTOWER"). THE COLLECTIVE COMMUNITY HEALTH NEEDS ASSESSMENT ("CHNA")TEAM REVIEWED SEVERAL SOURCES OF QUANTITATIVE HEALTH, AS WELL AS SOCIAL AND DEMOGRAPHIC DATA SPECIFIC TO LAKE HEALTH'S SERVICE AREA. LAKE HEALTH ALSO TOOK ADVANTAGE OF THIS OPPORTUNITY TO COLLABORATE WITH ITS ADMINISTRATORS, PHYSICIANS, PUBLIC HEALTH AGENCIES, AND LOCAL ORGANIZATIONS IN IDENTIFYING AND ADDRESSING THE NEEDS OF THE COMMUNITY. WEST MEDICAL CENTER PART V, SECTION B, LINE 6A: AS ALLOWED BY IRS GUIDELINES, LAKE HEALTH DECIDED TO PRODUCE A JOINT CHNA REPORT FOR ITS TWO LAKE COUNTY HOSPITALS, WEST MEDICAL CENTER AND TRIPOINT MEDICAL CENTER. GUIDELINES STATE THAT COLLABORATING FACILITIES MUST DEFINE THEIR COMMUNITIES TO BE THE SAME AND CONDUCT A JOINT CHNA PROCESS. TRIPOINT MEDICAL CENTER PART V, SECTION B, LINE 6A: AS ALLOWED BY IRS GUIDELINES, LAKE HEALTH DECIDED TO PRODUCE A JOINT CHNA REPORT FOR ITS TWO LAKE COUNTY HOSPITALS, WEST MEDICAL CENTER AND TRIPOINT MEDICAL CENTER. GUIDELINES STATE THAT COLLABORATING FACILITIES MUST DEFINE THEIR COMMUNITIES TO BE THE SAME AND CONDUCT A JOINT CHNA PROCESS. WEST MEDICAL CENTER PART V, SECTION B, LINE 11: IN ACKNOWLEDGING THE WIDE RANGE OF PRIORITY HEALTH ISSUES THAT EMERGED FROM THE CHNA PROCESS, LAKE HEALTH WILL FOCUS ON THOSE MOST WITHIN ITS IMMEDIATE ABILITY TO INFLUENCE. TRIPOINT MEDICAL CENTER PART V, SECTION B, LINE 11: IN ACKNOWLEDGING THE WIDE RANGE OF PRIORITY HEALTH ISSUES THAT EMERGED FROM THE CHNA PROCESS, LAKE HEALTH WILL FOCUS ON THOSE MOST WITHIN ITS IMMEDIATE ABILITY TO INFLUENCE. WEST MEDICAL CENTER PART V, SECTION B, LINE 15E: THE CONTACT INFORMATION FOR SOURCES OF ASSISTANCE WITH FAP APPLICATIONS IS ON THE LAKE HEALTH WEBSITE BUT NOT CURRENTLY ON THE FAP OR FAP APPLICATION. TRIPOINT MEDICAL CENTER PART V, SECTION B, LINE 15E: THE CONTACT INFORMATION FOR SOURCES OF ASSISTANCE WITH FAP APPLICATIONS IS ON THE LAKE HEALTH WEBSITE BUT NOT CURRENTLY ON THE FAP OR FAP APPLICATION. PART V, SECTION B, LINE 22D UNINSURED PATIENTS WHO DO NOT QUALIFY FOR LAKE HEALTH'S FINANCIAL ASSISTANCE PROGRAM ARE BILLED FOR GROSS CHARGES AND ARE OFFERED A 30% PROMPT PAY DISCOUNT IF PAYMENT IS RECEIVED WITHIN 30 DAYS OF THE FIRST PATIENT STATEMENT OR A PAYMENT PLAN IS AGREED UPON. THEMAXIMUM AMOUNTS THAT CAN BE CHARGED TO FAP-ELIGIBLE INDIVIDUALS FOR EMERGENCY OR OTHER MEDICALLY NECESSARY CARE ARE THE AMOUNTS GENERALLY BILLED TO INDIVIDUALS WHO HAVE INSURANCE COVERING SUCH CARE. 55 1 - MENTOR MEDICAL CAMPUS 9485 MENTOR AVENUE SUITE 101 MENTOR OH 44060 GENERAL MEDICAL & SURGICAL OUTPATIENT 2 - MADISON MEDICAL CAMPUS 6270 NORTH RIDGE RD MADISON OH 44057 GENERAL MEDICAL & EMERGENCY DEPARTMENT 3 - LAKE COUNTY FAMILY PRACTICE 9500 MENTOR AVENUE SUITE 100 MENTOR OH 44060 PHYSICIAN OFFICE 4 - WILLOWICK URGENT CARE 29804 LAKESHORE BLVD WILLOWICK OH 44095 URGENT CARE CENTER 5 - TYLER URGENT CARE 7956 TYLER BLVD MENTOR OH 44060 URGENT CARE CENTER 6 - LHPG OBGYN WOMEN'S HEALTH SPECIALIST 35040 CHARDON RD BLDG VII SUITE 205 WILLOUGHBY HILLS OH 44094 PHYSICIAN OFFICE 7 - WILLOUGHBY HILLS 34600 CHARDON RD UNIT H WILLOUGHBY HILLS OH 44094 DIAGNOSTIC CENTER 8 - LHPG MENTOR IMED 9485 MENTOR AVENUE SUITE 210 MENTOR OH 44060 PHYSICIAN OFFICE 9 - LHPG MENTOR PEDIATRICS 9485 MENTOR AVENUE SUITE 101 MENTOR OH 44060 PHYSICIAN OFFICE 10 - LHPG NORTH COAST FAMILY PRACTICE 7580 AUBURN RD SUITE 202 CONCORD OH 44077 PHYSICIAN OFFICE 11 - CHARDON URGENT CARE 510 FIFTH AVENUE CHARDON OH 44024 URGENT CARE CENTER 12 - LHPG MADISON FAMILY PRACTICE 6270 NORTH RIDGE RD MADISON OH 44057 PHYSICIAN OFFICE 13 - LHPG OBGYN - WILLOW MEDICAL 36001 EUCLID AVENUE SUITE C-10 WILLOUGHBY OH 44094 PHYSICIAN OFFICE 14 - LHPG WILLOUGHBY IMED 36001 EUCLID AVENUE SUITE C 240 260 WILLOUGHBY OH 44094 PHYSICIAN OFFICE 15 - LAKE WELLNESS AND REHABILITATION 9170 MENTOR AVENUE MENTOR OH 44060 REHABILITATION CLINIC 16 - LHPG WILLOUGHBY PEDIATRICS 36100 EUCLID AVENUE SUITE 300 WILLOUGHBY OH 44094 PHYSICIAN OFFICE 17 - LHPG MADISON PEDIATRICS 6270 NORTH RIDGE RD MADISON OH 44057 PHYSICIAN OFFICE 18 - LHPG WILLOUGHBY HILLS IMED 2747 SOM CENTER RD UNIT D WILLOUGHBY HILLS OH 44094 PHYSICIAN OFFICE 19 - LHPG CHARDON FAMILY PRACTICE 510 FIFTH AVENUE SUITE 130 CHARDON OH 44024 PHYSICIAN OFFICE 20 - LHPG MENTOR FAMILY PRACTICE 6990 LINDSAY DRIVE 3 MENTOR OH 44060 PHYSICIAN OFFICE 21 - LHPG MENTOR GENERAL SURGERY 9500 MENTOR AVENUE SUITE 300 MENTOR OH 44060 PHYSICIAN OFFICE 22 - LHPG WILLOWICK FAMILY PRACTICE 29804 LAKESHORE BLVD WILLOWICK OH 44095 PHYSICIAN OFFICE 23 - LHPG PLASTIC SURGERY 9500 MENTOR AVENUE SUITE 200 MENTOR OH 44060 PHYSICIAN OFFICE 24 - LHPG GENERAL SURGERY 36060 EUCLID AVENUE SUITE 204 WILLOUGHBY OH 44094 PHYSICIAN OFFICE 26 - LHPG CHARDON PEDIATRICS 510 FIFTH AVENUE CHARDON OH 44024 PHYSICIAN OFFICE 27 - LAKE WELLNESS AND REHABILITATION 34881 EUCLID AVE WILLOUGHBY OH 44060 REHABILITATION CLINIC 28 - LHPG ORTHOPEDIC SURGERY 36060 EUCLID AVENUE SUITE 203 WILLOUGHBY OH 44094 PHYSICIAN OFFICE 29 - PAINESVILLE QUICK CLINIC 74 S PARK PLACE PAINESVILLE OH 44077 QUICK CLINIC 31 - LHPG WEST CARDIO ELECTROPHYSIOLOGY 36100 EUCLID AVENUE SUITE 400 WILLOUGHBY OH 44094 PHYSICIAN OFFICE 32 - LHPG WEST IMED 36100 EUCLID AVENUE SUITE 210 WILLOUGHBY OH 44094 PHYSICIAN OFFICE 33 - LHPG MENTOR OBGYN 9485 MENTOR AVENUE SUITE 202 MENTOR OH 44060 PHYSICIAN OFFICE 34 - PAINESVILLE IMED 1223 MENTOR AVE PAINESVILLE OH 44077 PHYSICIAN OFFICE 35 - LHPG SPORTS MEDICINE & REHAB 36060 EUCLID AVENUE SUITE 105 WILLOUGHBY OH 44094 PHYSICIAN OFFICE 36 - LHPG INTEGRATIVE MEDICINE 9500 MENTOR AVENUE SUITE 360 MENTOR OH 44060 PHYSICIAN OFFICE 37 - MENTOR MEDICAL PHYSICIAN BUILDING 9485 MENTOR AVENUE SUITES 200 203 MENTOR OH 44060 PHYSICIAN OFFICE 39 - LHPG OBGYN 36001 EUCLID SUITE C-7 WILLOUGHBY OH 44094 PHYSICIAN OFFICE 40 - LHPG BARIATRIC SURGERY 36100 EUCLID AVENUE SUITE 170 WILLOUGHBY OH 44094 PHYSICIAN OFFICE 42 - BARIATRIC SURGERY 34600 CHARDON RD UNIT G WILLOUGHBY HILLS OH 44094 PHYSICIAN OFFICE 43 - CHARDON RADIOLOGY 510 FIFTH AVE SUITE 110 CHARDON OH 44024 PHYSICIAN OFFICE 44 - LAKE AMBULATORY BLDG REFERENCE LAB 9500 MENTOR AVE SUITE 120 MENTOR OH 44060 DIAGNOSTIC CENTER 45 - LAKE AMBULATORY BLDG PHLEBOTOMIST 9500 MENTOR AVE SUITE 220 MENTOR OH 44060 DIAGNOSTIC CENTER 46 - LHPG NEWBURY FAMILY PRACTICE 10780 KINSMAN RD NEWBURY OH 44065 PHYSICIAN OFFICE 48 - LAKE WEST MEDICAL CENTER REFERENCE LAB 36100 EUCLID AVE SUITE 190 WILLOUGHBY OH 44094 DIAGNOSTIC CENTER 49 - EASTSIDE IMAGING 2785 SOM CENTER RD WILLOUGHBY HILLS OH 44094 DIAGNOSTIC CENTER 50 - LAKE WELLNESS & REHAB PT (WILLOUGHBY FI 37100 EUCLID AVE WILLOUGHBY OH 44094 REHABILITATION CLINIC 51 - LHPG NORTHEAST OHIO HEART ASSOCIATES 36100 EUCLID AVENUE SUITE 120 WILLOUGHBY OH 44077 PHYSICIAN OFFICE 52 - LHPG NORTHEAST OHIO HEART ASSOCIATES 7580 AUBURN ROAD SUITE 106 CONCORD OH 44077 PHYSICIAN OFFICE 53 - LHPG SPORTS MEDICINE 7580 AUBURN ROAD SUITE 214 CONCORD OH 44077 PHYSICIAN OFFICE 54 - BEACON HEALTH 36100 EUCLID AVENUE SUITE 120 WILLOUGHBY OH 44094 PHYSICIAN OFFICE 55 - OPHTHALMOLOGY ASSOCIATES 36100 EUCLID AVE SUITE 450 WILLOUGHBY OH 44094 PHYSICIAN OFFICE 56 - MENTOR MEDICAL PHYSICAL FITNESS CENTER 8655 MARKET STREET MENTOR MENTOR OH 44060 MEDICAL FITNESS CENTER 57 - PERRICO HEALTH CENTER 4176 STATE ROUTE 306 WILLOUGHBY OH 44060 PHYSICIAN OFFICE 58 - ARTHRITIS ASSOCIATES 34500 CHARDON ROAD SUITE 2 WILLOUGHBY HILLS OH 44094 PHYSICIAN OFFICE 59 - NORTH SHORE RESPIRATORY AND SLEEP SERVIC 4212 CHILLICOTHE ROAD SUITE 110 WILLOUGHBY OH 44094 PHYSICIAN OFFICE 60 - PULMONARY CARE 4212 CHILLICOTHE ROAD SUITE 110 WILLOUGHBY OH 44094 PHYSICIAN OFFICE 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 STATES OH 1 COLLEGE TUITION GRANTS TO MARKETING CONTEST WINNERS 2 10000 PART I, LINE 2: IN 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. X 1 1 X X X X X 0 1 0 0 0 0 0 1 0 CYNTHIA MOORE-HARDY PRESIDENT AND CEO 808496 0 0 0 42627 0 14417 0 11723 0 877263 0 0 0 ROBERT TRACZ SR. VP/CFO 426265 0 0 0 10941 0 14305 0 10609 0 462120 0 0 0 JOHN BANIEWICZ MD SR VP, MEDICAL AFFAIRS 451868 0 0 0 10095 0 14250 0 15032 0 491245 0 0 0 STEVE R KARNS SR VP, ADMINISTRATIVE SERV (THROUGH 267652 0 382260 0 8537 0 13565 0 8396 0 680410 0 0 0 RICHARD D CICERO SR VP, MARKETING & BUSINES 298528 0 160080 0 10194 0 13580 0 7199 0 489581 0 0 0 MARY L OGRINC CHIEF NURSING OFFICER 330341 0 269100 0 13190 0 13937 0 5467 0 632035 0 0 0 JOYCE A TAYLOR VP, QUALITY SERVICES, CQO 199507 0 0 0 7205 0 4085 0 5762 0 216559 0 0 0 CYNTHIA J RACER VP, CLINICAL SERVICES 179685 0 0 0 5823 0 5654 0 8611 0 199773 0 0 0 DAVID HERMAN VP, FINANCE 188934 0 0 0 4782 0 4751 0 11668 0 210135 0 0 0 PHIL BROOKS VP, REVENUE CYCLE 175081 0 0 0 38789 0 2397 0 10696 0 226963 0 0 0 CRAIG GHIDOTTI VP, HUMAN RESOURCES 172802 0 0 0 6027 0 5529 0 6244 0 190602 0 0 0 JERROLD M PETERS VP, INFORMATION TECH/CIO 167341 0 0 0 5767 0 1320 0 5539 0 179967 0 0 0 PART I, LINE 1A LAKE HOSPITAL SYSTEM, INC.'S CEO, CYNTHIA MOORE-HARDY, RECEIVED THE FOLLOWING TAXABLE BENEFIT IN 2018: -SOCIAL CLUB DUES OF $12,230 PART I, LINE 4B THE FOLLOWING INDIVIDUALS PARTICIPATED IN A 457(F) NON-QUALIFIED DEFERRED COMPENSATION ARRANGEMENT : CYNTHIA MOORE-HARDY : $80,850 ROBERT TRACZ : $10,000 PART I, LINE 7 DISCRETIONARY BONUS MAY BE AWARDED BASED ON PERFORMANCE. THOSE BONUSES ARE DETERMINED BY THE STRATEGIC LEADERSHIP TEAM. THE FOLLOWING INDIVDUALS RECEIVED THESE BONUSES: - RICHARD CICERO: $160,080 - STEVE KARNS: $382,260 - MARY OGRINC: $269,100 A COUNTY OF LAKE OHIO SERIES 2008 346001618 50943PBL2 2008-06-26 187820719 SEE PART VI 1 0 0 B COUNTY OF LAKE OHIO SERIES 2015 346001618 50943PCC1 2015-08-03 69960181 SEE PART VI 0 0 0 C COUNTY OF LAKE OHIO SERIES 2017 346001618 2017-12-19 138445000 SEE PART VI 0 0 0 A 189235000 193619630 998658 1808396 57940 190754637 2009 1 0 1 1 B 69994708 268650 19190260 50535798 2016 0 1 1 1 C 1635000 138445000 138445000 2017 1 0 1 1 A 0 0 1 1 0 0.00000 0.00000 0.00000 0 0 1 B 0 0 1 1 0 0.00000 0.00000 0.00000 0 0 1 C 0 0 1 1 0 0.00000 0.00000 0.00000 0 0 1 A 0 0 0 1 1 0 0 0 1 B 0 1 0 0 0 0 0 0 1 C 0 1 0 0 1 1 0 0 0 0 1 A 1 B 1 C 1 DATE REBATE COMPUTATION PERFORMED ISSUER 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. MATT J CICERO FAMILY MEMBER OF KEY EMPLOYEE, RICHARD D. CICERO 58757 SEE PART V 0 JAMESON PRITCHARD FAMILY MEMBER OF KEY EMPLOYEE, MARY OGRINC 52142 SEE PART V 0 PART IV, COLUMN D MATT J. CICERO, WHO HAS A FAMILY RELATIONSHIP WITH RICHARD D. CICERO, SERVED AS A HOSPITAL EMPLOYEE DURING 2018 AND RECEIVED COMPENSATION.JAMESON PRITCHARD, WHO HAS A FAMILY RELATIONSHIP WITH MARY OGRINC, SERVED AS A HOSPITAL EMPLOYEE DURING 2018 AND RECEIVED COMPENSATION. X MENTOR WELLNESS 8 36444 RETAIL VALUE X WALKWAY ITEMS 12 33835 RETAIL VALUE X DESK 1 4709 RETAIL VALUE X MISCELLANEOUS ITEMS PERRICO CAMPUS 2 4099 RETAIL VALUE 0 1 1 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. FORM 990, PART VI, SECTION B, LINE 11B THE 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 12C THE 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 15 THE PROCESS FOR DETERMINING COMPENSATION OF THE LAKE HOSPITAL SYSTEM, INC. CEO, OTHER OFFICERS, AND KEY EMPLOYEES INCLUDES MARKET RESEARCH, REVIEW, AND ASSESSMENT BY AN INDEPENDENT CONSULTING FIRM TO MAKE A RECOMMENDATION TO THE LHS BOARD OF DIRECTORS. THE BOARD REVIEWS THE REPORT PROVIDED IN CONJUNCTION WITH PERFORMANCE ASSESSMENTS, AND UTILIZES THIS INFORMATION TO DETERMINE COMPENSATION LEVEL. 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 19 LAKE HOSPITAL SYSTEM, INC. MAKES ITS FORM 990, FORM 990-T, AND FORM 1023 AVAILABLE TO THE PUBLIC UPON REQUEST, FOR THE SAME PERIOD OF TIME AS SET FORTH IN THE INTERNAL REVENUE CODE SECTION 6104(D). 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. LAKE HEALTH IPHE 7590 AUBURN RD CONCORD OH 44077 PHYSICIAN SERVICES OH 0 0 LAKE HOSPITAL SYSTEM INC LAKE HEALTH UNIVERSITY HOSPITALS SEIDMAN CANCER CENTER 9485 MENTOR AVENUE MENTOR OH 44060 311565964 TREATMENT OF CANCER PATIENTS OH 501(C)(3) LINE 3 N/A 0 LAKE HOSPITAL FOUNDATION INC DBA LAKE HEALTH FOUNDATION 7590 AUBURN RD CONCORD OH 44077 341425872 FUNDRAISING FOR BENEFIT OF LAKE HOSPITAL SYSTEM, INC. OH 501(C)(3) LINE 12A, I LAKE HOSPITAL SYSTEM INC DBA LAKE HEALTH 1 PRIMEHEALTH INC 7590 AUBURN RD CONCORD OH 44077 341778204 PHYSICIAN CORPORATION OH 501(C)(3) LINE 3 LAKE HOSPITAL SYSTEM INC DBA LAKE HEALTH 1 CONCORD MEDICAL CAMPUS PHYSICIAN BUILDING LLC 7580 AUBURN ROAD CONCORD OH 44077 260550261 OFFICE SPACE OH N/A EXCLUDED 216812 1740697 0 0 0.51470 LAKE WEST MEDICAL SPECIALISTS LLC 36000 EUCLID AVENUE WILLOUGHBY OH 44094 341964657 OFFICE SPACE OH N/A EXCLUDED 32400 390303 0 1 0.12000 MENTOR MEDICAL CAMPUS PHYSICIAN BUILDING LLC 9485 MENTOR AVENUE MENTOR OH 44060 341958475 OFFICE SPACE OH N/A UBI 76312 2299133 0 0 0.40390 MENTOR SURGERY CENTER LLC 9485 MENTOR AVENUE MENTOR OH 44060 341863257 OUTPATIENT SURGERY OH N/A RELATED 469795 1384683 0 1 0.42210 LAKE WILLOUGHBY PROPERTIES LLC 4166 CHILLICOTHE ROAD WILLOUGHBY OH 44094 364837155 OFFICE SPACE OH N/A UBI 47833 662211 0 0 0.35000 NEW MANNA CLG LLC DBA LAKE HEALTH BEACHWOOD MEDICAL CENTER 24651 CENTER RIDGE ROAD SUITE 350 WESTLAKE OH 44145 371848577 INVESTMENT IN FUTURE SITE OH YES UBI 9868034 0 0 0.51000 LHS ASSURANCE LTD 23 LIME TREE BAY AVENUE GRAND CAYMAN CJ 980456229 INSURANCE COMPANY CJ LAKE HOSPITAL SYSTEM INC DBA LAKE HEALTH C -103689 22634055 1.00000 1 LAKE PHO INC DBA LAKE HEALTH PHYSICIAN HOSPITAL ORGANIZATION 7590 AUBURN ROAD CONCORD OH 44077 341696001 PHYSICIAN SERVICES OH N/A C 123375 2885061 0.50000 0 0 1 1 1 0 1 0 0 0 1 1 1 1 1 1 1 1 1 0 PRIMEHEALTH INC P 28727856 BOOK VALUE LHS ASSURANCE LTD C 500000 BOOK VALUE LAKE HEALTH FOUNDATION C 477515 BOOK VALUE LAKE HEALTH FOUNDATION M 345175 BOOK VALUE LAKE WEST MEDICAL SPECIALISTS LLC K 355530 BOOK VALUE LHUH SEIDMAN CANCER CENTER J 850869 BOOK VALUE MENTOR SURGERY CENTER LLC F 488518 BOOK VALUE MENTOR SURGERY CENTER LLC J 480804 BOOK VALUE MENTOR MEDICAL CAMPUS PHYSICIAN BUILDING LLC F 64616 BOOK VALUE MENTOR MEDICAL CAMPUS PHYSICIAN BUILDING LLC J 84999 BOOK VALUE MENTOR MEDICAL CAMPUS PHYSICIAN BUILDING LLC K 606935 BOOK VALUE CONCORD MEDICAL CAMPUS PHYSICIAN BUILDING LLC J 101235 BOOK VALUE CONCORD MEDICAL CAMPUS PHYSICIAN BUILDING LLC K 1396809 BOOK VALUE LAKE WILLOUGHBY PROPERTIES LLC K 722669 BOOK VALUE CONCORD MEDICAL CAMPUS PHYSICIAN BUILDING LLC D 175712 BOOK VALUE NEW MANNA CLG LLC L 179534 BOOK VALUE MENTOR MEDICAL CAMPUS PHYSICIAN BUILDING LLC D 183204 BOOK VALUE