2017-11-14T10:11:40-06:00 2016-12-31 351178661 Blue & Co LLC 8800 Lyra Drive Suite 450 Columbus OH 43240 990 2016-01-01 344430716 Fisher-Titus Medical Center FISH 4196688101 272 Benedict Avenue Norwalk OH 44857 steven fries senior vp of finance & cfo 4196688101 2017-11-06 1 NANCY L KIRCHNER P00386751 6148852583 2017-11-06 38.109.186.2 2017-11-06 08:29:00 ES P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 CBCE996F475CA3740CE88356C52AB1B9FF3D8150 2016 2021-01-29 14:40:06Z Lorna Strayer 272 Benedict Avenue Norwalk OH 44857 142008131 0 X WWW.FTMC.COM X 1911 OH PROVIDE QUALITY HEALTHCARE IN A COST EFFECTIVE MANNER, WHILE RESPECTING THE DIGNITY AND UNIQUENESS OF EACH INDIVIDUAL WE SERVE. 12 7 1215 195 850361 -73922 271405 30390 123757150 133206163 1220312 2554951 1045012 1038442 126293879 136829946 252381 240070 0 0 62875762 68366203 0 0 0 55993569 60439577 119121712 129045850 7172167 7784096 203784452 208101384 59144651 62144406 144639801 145956978 X Provide quality healthcare in a cost effective manner, while respecting the dignity and uniqueness of each individual we serve. 0 0 105805440 240070 125334071 SEE SCHEDULE O 5218608 0 7468336 see schedule o 111024048 1 1 0 1 0 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 1 0 0 0 0 0 0 0 0 1 1 0 0 0 0 1 1 1 1 0 0 1 105 0 1 1215 1 1 1 0 0 0 0 0 0 0 0 0 X 12 7 0 0 1 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 1 1 OH X DAVID V WILSON MBACMA 4196688101 272 Benedict Avenue Norwalk OH 44857 matt gross chairman 15.00 3.00 X X 0 0 0 thomas c bleile Director 8.00 2.00 X 0 0 0 perry dryden treasurer 11.00 3.00 X X 0 0 0 REV FRED WIECHERS SECRETARY 7.00 2.00 X X 0 0 0 john d payne cpa director/vice chairman 10.00 4.00 X X 0 0 0 Leslie D Stoneham director 4.00 2.00 X 0 0 0 Eric Schmidt MD DIRECTOR 4.00 2.00 X 0 0 0 GLENN TRIPPE MD Director - End September 2016 8.00 2.00 X 0 0 0 lorna strayer PRESIDENT 49.50 10.50 X X 440114 0 128986 Ellen Heinz director 4.00 2.00 X 0 0 0 Dennis Doughty Director/Vice Chairman 10.00 2.00 X X 0 0 0 Richard Pohl Director - Start July 2016 4.00 2.00 X 0 0 0 James Gerken Director- Start October 2016 5.00 2.00 X 0 0 0 duane woods Senior VP of Finance & CFO - End August 2016 44.00 6.00 X 264569 0 30086 laurie S Delgado SR VP Operations 45.00 X 235650 0 43240 Steven Fries Senior VP of Finance & CFO - Start Aug 2016 40.00 10.00 X 68511 0 5031 cherie m spragg VP POPULATION HEALTH 50.00 X 212271 0 76292 PHILLIP J ANNARINO senior VP HUMAN RESOURCES 45.00 X 229128 0 64148 john britton senior vp information services 45.00 X 207825 0 38602 george b elmer VP Ambulatory & Facility Services 50.30 4.70 X 195626 0 38352 Dr Shankar Kurra Senior VP Medical Affairs 45.00 X 340443 0 76728 Lori Lill Corporate Safety Officer 40.00 X 149107 0 52624 Donald L Smith Jr Physician 40.00 X 523362 0 44728 Gregory P Cook Physician 40.00 X 678642 0 34812 Patrick R Waters Physician 40.00 X 630710 0 42448 Robert W Rice Physician 40.00 X 579020 0 44728 4754978 0 720805 36 0 1 0 cerner CORPORATION 2800 ROCKCREEK PATHWAY KANSAS CITY MO 64117 HEALTHCARE INFORMATION TECHNOLOGY 3040305 Cleveland Clinic Foundation PO BOX 931760 CLEVELAND OH 44193 Spine Center & Cardiology 1690158 THE ROBINS & MORTON GROUP 5500 MARYLAND WAY SUITE 100 BRENTWOOD TN 37027 BUILDING CONTRACTOR 1354012 Janotta & Herner 309 Monroe Street Monroeville OH 44847 BuiLDING CONTRACTOR 1285982 National Physicians Locum 1461 Summerwood Drive Broadview Heights OH 44147 Hospitalists Professional Fees 676800 21 410 29525 455 4525 30390 HOSPITAL NET PATIENT SERVICES 900099 121202436 121202436 NURSING HOME & ASSISTED LIVING RE 900099 7468336 7468336 medical laboratory 621500 440460 440460 Kaiser Pharmacy 446110 403756 403756 health and allied services 621990 6145 6145 3685030 3685030 133206163 1858228 1858228 56 56 5873268 1584 5077495 100690 795773 -99106 696667 696667 CAFETERIA SALES 722210 424596 424596 OTHER HOSPITAL REVENUE 900099 309376 309376 AUXILIARY SALES 453220 304470 304470 1038442 136829946 132355802 850361 3593393 240070 240070 2855316 1567892 1287424 48858731 42166462 6692269 2763078 2384614 378464 10278753 8880854 1397899 3610325 3115812 494513 277137 207853 69284 125407 62704 62703 107573 107573 10114983 7889383 2225600 590712 572540 18172 4566036 2843853 1722183 4460130 3183435 1276695 2213264 1538620 674644 134525 123149 11376 419399 167031 252368 1180982 1123581 57401 9962851 9487001 475850 346073 141004 205069 ubi income tax -9555 -9555 MEDICAL SUPPLIES 18161763 18155478 6285 BAD DEBT EXPENSES 4316973 4316973 ohio hospital tax & sn 1979734 1979734 1491590 885560 606030 129045850 111024048 18021802 0 5375 5375 4521785 6273762 11827667 13050848 646245 0 2482762 2966745 1981449 2109999 196436420 88632326 110605100 107804094 65793770 69813263 2158138 2239885 193542 372233 3568619 3465180 203784452 208101384 31388163 34082751 226488 204597 27530000 25128000 0 2729058 59144651 62144406 X 144621430 145938581 18371 18397 144639801 145956978 203784452 208101384 7784096 1792438 -8259358 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 1 0 1 7226 7226 0 Part II-B, Line 1: board members and EXECUTIVE MEMBERS OF THE ORGANIZATION, ON AN OCCASIONAL BASIS, MAY WRITE OR SPEAK TO LEGISLATIVE MEMBERS CONCERNING PROPOSED LEGISLATION THAT MIGHT IMPACT THE LOCAL DELIVERY OF HEALTHCARE SERVICES. THE MEDICAL CENTER HAS MEMBERSHIPS IN VARIOUS HEALTHCARE RELATED ASSOCIATIONS, WHICH PROVIDE STATE AND NATIONAL LEADERSHIP ON LEGAL, REGULATORY, QUALITY AND ACCREDITATION ISSUES. AS A PART OF THAT LEADERSHIP ROLE THESE ORGANIZATIONS DO CONTACT LEGISLATORS TO EXPRESS THEIR ASSOCIATION'S POSITIONS ON MATTERS IMPORTANT TO THEIR MEMBERSHIP. THE FOLLOWING ORGANIZATIONS LISTED BELOW SHOW THE PERCENTAGE OF THE DUES THAT REFLECT LOBBYING AS DETERMINED BY THE IRS: OHIO HEALTH CARE ASSOCIATION - 16.78% OF DUES; OHIO HOSPITAL ASSOCIATION - 3.5% OF DUES AND AMERICAN HOSPITAL ASSOCIATION - 21.78% OF DUES. 0 1601785 1601785 139693265 54761157 84932108 46829750 29964345 16865405 8311620 3906824 4404796 107804094 Capital Lease Obligations 2414405 Due to Affiliated Entities 314653 2729058 X 134030699 1792438 -4128878 -2336440 136367139 462807 462807 136829946 132093385 3496673 3496673 128596712 449138 449138 129045850 Part X, Line 2: Management has analyzed the tax positions taken by these entities, and has concluded that as of December 31, 2016 and 2015, there are no uncertain positions taken or expected to be taken that would require, recognition of a liability or disclosure in the accompanying consolidated financial statements. Fisher-Titus Medical Center individual accrued uncertain tax position was $0.00 Part XI, Line 2d - Other Adjustments: health promotions of norwalk revenue 607,290. ADJUSTMENT TO RECOGNIZE FASB #158 (CHANGE IN PENSION LIABILITY) -3,033,127. FISHER-TITUS PAIN MANAGEMENT LLC REVENUE 4,062,190. transers to various affiliated entities -5,850,578. Profit sharing related to the Pain Management Joint Venture 27,907. change in interest swap value 57,440. Part XI, Line 4b - Other Adjustments: HOSPITAL AUXIIARY REVENUE 304,908. HOSPITAL EXPENSE ADJUSTMENTS TO REVENUES 157,899. Part XII, Line 2d - Other Adjustments: HEALTH PROMOTIONS OF NORWALK EXPENSES 520,814. FISHER-TITUS PAIN MANAGEMENT LLC EXPENSES 2,975,859. Part XII, Line 4b - Other Adjustments: HOSPITAL AUXILIARY EXPENSES 291,239. HOSPITAL EXPENSE ADJUSTMENTS TO REVENUES 157,899. 1 1 X 1 X 1 X 1 1 0 1 1 1 2087 1435483 1381801 53682 0.00040 1 16807208 15759601 1047607 0.00810 2 2087 18242691 17141402 1101289 0.00850 34 57969 838283 51371 786912 0.00610 3 108 159713 4290 155423 0.00120 1 1187941 367551 820390 0.00640 6 4373 238031 238031 0.00180 44 62450 2423968 423212 2000756 0.01550 46 64537 20666659 17564614 3102045 0.02400 1 185 1256 1256 0.00000 1 11820 11820 0.00010 2 19044 19044 0.00010 1 215 6291 6291 0.00000 1 3174 3174 0.00000 6 400 41585 41585 0.00020 1 4316973 1079243 29944998 36076365 -6131367 X 1 1 1 NORTH CENTRAL CARENET PHYSICIAN-HOSPITAL ORGANIZATION 0.50000 0.04650 0.45350 2 FISHER-TITUS PAIN MANAGEMENT LLC PAIN MANAGEMENT 0.51000 0.49000 1 1 FISHER-TITUS MEMORIAL HOSPITAL 272 BENEDICT AVENUE NORWALK OH 44857 https://www.fisher-titus.org X X X FISHER-TITUS MEMORIAL HOSPITAL 1 0 0 1 X X X X X X X X X 14 1 1 1 1 X www.fisher-titus.org/community-services X http://www.hcno.org/community X 1 14 1 www.fisher-titus.org/community-services 0 1 X 200.000000000000 300.000000000000 X X 1 1 X X X 1 X www.fisher-titus.org/community-services X WWW.FISHER-TITUS.ORG/community-services X www.fisher-titus.org/community-services X X X X 1 X 0 X X X 1 X 0 0 FISHER-TITUS MEMORIAL HOSPITAL Part V, Section B, Line 5: HURON COUNTY CONTRACTED WITH THE HOSPITAL COUNCIL OF NORTHWEST OHIO, A NON-PROFIT HOSPITAL ASSOCIATION LOCATED IN TOLEDO, OHIO TO COORDINATE AND MANAGE THE HEALTH ASSESSMENT PROCESS. THE PROJECT COORDINATOR FROM THE HOSPITAL COUNCIL OF NW OHIO CONDUCTED A SERIES OF MEETINGS WITH THE PLANNING COMMITTEE FROM HURON COUNTY. DURING THESE MEETINGS, BANKS OF POTENTIAL SURVEY QUESTIONS FROM THE BEHAVIORAL RISK FACTOR SURVEILLANCE, YOUTH RISK FACTOR BEHAVIOR SURVEILLANCE AND THE NATIONAL SURVEY OF CHILDREN'S HEALTH WERE REVIEWED AND DISCUSSED. BASED ON INPUT FROM THE HURON COUNTY PLANNING COMMITTEE, THE PROJECT COORDINATOR COMPOSED DRAFTS OF SURVEYS CONTAINING 111 ITEMS FOR THE ADULT SURVEY WITH AN ADDITIONAL 30 QUESTIONS FOR PARENTS OF 0-11 YEAR OLDS, AND 77 ITEMS FOR THE ADOLESCENT SURVEY. THE DRAFTS WERE APPROVED BY HEALTH EDUCATION REASEARCHERS AT THE UNIVERSITY OF TOLEDO. THE HOSPITAL COUNCIL OF NW OHIO COLLECTED THE DATA, GUIDED THE HEALTH ASSESSMENT PROCESS AND INTERGRATED SOURCES OF PRIMARY AND SECONDARY DATA INTO THE FINAL REPORT. THE NEEDS OF THE POPULATION, ESPECIALLY THOSE WHO ARE MEDICALLY UNDERSERVED, LOW-INCOME, MINORITY POPULATIONS AND POPULATIONS WITH CHRONIC DISEASE NEEDS WERE TAKEN INTO ACCOUNT THROUGH THE SAMPLE METHODOLOGY THAT SURVEYED THESE POPULATIONS. IN ADDITION, THE ORGANIZATIONS THAT SERVE THESE POPULATIONS PARTICIPATED IN THE HEALTH ASSESSMENT PROCESS. THE PARTICIPANTS WHO HAVE A (PH) AFTER THEIR NAME INDICATES THEY WORK IN THE PUBLIC HEALTH FIELD. THE PARTICIPANTS INCLUDED: TIMOTHY HOLLINGER (PH), KATIE SPAAR (PH), ELAINE BARMAN, (PH), KATHERINE SABOURIN, (PH) ALL FROM HURON PUBLIC HEALTH; LORNA STRAYER (PH), MICHELE SKINN (PH), FISHER-TITUS MEDICAL CENTER; JULIE LANDOLL, (PH), MERCY HOSPITAL OF WILLARD; JOANN VENTURA, (PH), MANDI ARTINO, (PH), THE BELLEVUE HOSPITAL; JEAN KING, (PH), HURON COUNTY BOARD OF MENTAL HEALTH AND ADDICTION SERVICES. KIM SCHUBERT, BELLEVUE CITY SCHOOLS; KAREN MALCOLM, IMMACULATE CONCEPTION SCHOOL; GREGG ELCHERT, MONROEVILLE LOCAL SCHOOLS; BRAD RAMANO, NEW LONDON LOCAL SCHOOLS; WAYNE BABCANEC, NORWALK CATHOLIC SCHOOLS; DENNIS DOUGHTY, NORWALK CITY SCHOOLS; DAVID BRAND, SOUTH CENTRAL SCHOOLS; RODGE WILSON, WESTERN RESERVE LOCAL SCHOOLS; JEFF RITZ, WILLARD CITY SCHOOLS; DEBRA FISHER, CAC OF ERIE, HURON & RICHLAND COUNTIES; RENEE GEROME, (PH), FIRELANDS COUNSELLING & RECOVERY; BOB PATUSKY, CITY OF NORWALK. FISHER-TITUS MEMORIAL HOSPITAL Part V, Section B, Line 6a: MERCY HOSPITAL OF WILLARD, THE BELLEVUE HOSPITAL, FIRELANDS REGIONAL HOSPITAL (COUNSELING & RECOVERY CENTER), HURON COUNTY PUBLIC HEALTH AND HURON COUNTY BOARD OF MENTAL HEALTH AND ADDICTION services. FISHER-TITUS MEMORIAL HOSPITAL Part V, Section B, Line 11: Each of the health needs listed below is important and is being addressed by numerous programs and initiatives supported by Fisher-Titus Medical Center and other community partners of the hospital. The Medical Center does not address these needs listed below as part of this Implementation Plan due to limited financial and human resources and the need to allocate significant resources on the priority health needs listed in the Implementation Plan. Needs not addressed: 1. 14% of Huron County adults have been diagnosed with Asthma;2. 22 % of Huron County adults are diagnosed with arthritis;3. In 2014, only two-thirds (69%) of Huron Country youth in grades 6-12 had visited a dentist for check-up exam, teeth cleaning or other dental work over the past 12 months;4. Insects and mold were reported as the two most threatening environmental health issues by respondents;5. 40% of adults had not visited a dentist or dental clinic in the past year. PART V, SECTION B line 22d THE DISCOUNT RATE FOR SELF-PAY PATIENTS WAS SET TO MATCH THE RATE OF OUR TWO PREDOMINANT COMMERCIAL INSURANCE CONTRACTS WHICH MAKE UP 2/3 OF OUR POPULATION COVERED BY THIRD PARTY INSURANCE. 2 1 - norwalk memorial home 272 benedict avenue norwalk OH 44857 Intermediate & Skilled Nursing Facility 2 - the carriage house of fisher-titus 175 shady LANE DRIVE NOrwalk OH 44857 ASSISTED LIVING FACILITY Part I, Line 7: the costing methodology used for the charity care segment of the line 7 table was the irs worksheet 1, "charity care at costs" in the instructions. cost to charge ratios were carried over from the irs worksheet 2 as a basis to estimate expenses and was applied to the gross patient chariy care charges recorded in 2016. the costing methodology used for the unreimbursed medicaid segment on the line 7 table were calculated using a cost to charge ratio extracted from the medicaid cost report data. the costing methodology used for the "other benefits" segment of the line 7 table were calculated using a combination of direct costs and our cost accounting system which takes into consideration all patient types and segment. Part II, Community Building Activities: In 2016, Fisher-Titus's community building activities benefits provided $8.4 million to support programs that impacted the overall health of our communities and the quality of life of our residents. While hospital-based medical services are the most obvious way we help, FTMC fulfills the health-care needs of our area with community health screenings, education classes, patient assistance programs and support of health-related activities. FTMC employees serve on community and civic boards, health-oriented organizations and are involved in economic development activities throughout the county. FTMC also works with schools; work sites and safety net providers to promote health and wellness and prevent disease. Fisher-Titus is a leader in environmental stewardship, having earned numerous state and national awards. Part III, Line 2: THE COSTING METHODOLOGY USED FOR COMPLETING THE SCHEDULE H PART III, LINE 2 is derived from the bad debt expense included in the audited financial statements adjusted by the amount of the write-offs of the accounts that went to bad debt. PART III, LINE 3 AS A TAX-EXEMPT HOSPITAL, NOT-FOR-PROFIT ORGANIZATION, WE MUST PROVIDE NECESSARY MEDICAL CARE TO ALL, REGARDLESS OF THE PATIENT'S ABILITY TO PAY FOR THE SERVICES PROVIDED. MAKING QUALITY PATIENT CARE AVAILABLE TO ALL IN OUR COMMUNITY, REGARDLESS OF THEIR ECONOMIC MEANS, QUALIFIES BAD DEBT AS COMMUNITY BENEFIT. THE IDENTIFICATION OF PATIENTS ELIGIBLE FOR CHARITY CARE IS SOLELY BASED ON THE COOPERATION OF THE PATIENT TO PROVIDE THE ORGANIZATION ENOUGH FAMILY AND FINANCIAL INFORMATION TO DETERMINE ELIGIBILTY TO MATCH OUR PROGRAMS. HISTORICALLY, IN ADDITION TO THE INTERNALLY IDENTIFIED CHARITY, 10-13% OF THE ACCOUNT BALANCES TURNED TO COLLECTION WERE SUBSEQUENTLY IDENTIFIED BY THE AGENCY AS CHARITY AND RETURNED. THIS CHARITY IS RECORDED ONLY WHEN IT HAS BEEN IDENTIFIED THROUGH VERIFICATION OF INABILITY TO PAY. WE DO BELIEVE THERE IS A SECOND, RELATIVELY EQUAL SEGMENT OF THE BAD DEBT THAT WOULD QUALIFY FOR CHARITY. PATIENTS WITH POOR CREDIT RATINGS AND MULTIPLE CREDITORS MAKING COLLECTION EFFORT FINDS LITTLE VALUE IN COMPLETING THE CHARITY APPLCIATION PROCESS TO ONLY ELIMINATE ONE CREDITOR AND HAVE NO IMPROVEMENT TO THEIR FINANCIAL STATUS.WE ESTIMATE THAT UNDER THE CURRENT ECONOMIC CONDITIONS UNIDENTIFIED CHARITY IN BAD DEBT EXPENSE IS ESTIMATED TO BE AN ADDITIONAL $1,079,243 OR 25% OF BAD DEBT. SINCE THIS CALCUALTION IS ON AN ACCRUAL BASIS, WE BELEIVE ESTIMATING 10% FOR CHARITY TO BE IDENTIFIED IN FUTURE YEARS AND AN ADDITIONAL 15% FOR BALANCES NEVER IDENTIFIED AS CHARITY IS A VERY CONSERVATIVE AND REASONABLE ESTIMATE OF THIS CHARITY CARE VALUE. PART III, LINE 4 FOOTNOTE "ALLOWANCES FOR UNCOLLECTIBLE ACCOUNTS": THE PROVISION FOR BAD DEBTS IS BASED UPON MANAGEMENT'S ASSESSMENT OF HISTORICAL AND EXPECTED NET COLLECTIONS CONSIDERING BUSINESS AND ECONOMIC CONDITIONS, TRENDS IN THE HEALTHCARE COVERAGE AND OTHER COLLECTION INDICATORS. PERIODICALLY THROUGHOUT THE YEAR, MANAGEMENT ASSESSES THE ADEQUACY OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS BASED UPON SPECIFIC ACCOUNTS, HISTORICAL WRITE OFF EXPERIENCE AND CURRENT MARKET CONDITIONS. THE RESULTS OF THIS REVIEW ARE THEN USED TO MAKE ANY MODIFICATIONS TO THE PROVISION FOR BAD DEBTS TO ESTABLISH THE MOST UP TO DATE APPROPRIATE ALLOWANCE FOR UNCOLLECTIBLE RECEIVABLES. PART III, LINE 8: FISHER-TITUS MEDICAL CENTER'S MEDICARE ALLOWABLE COSTS WERE CALCULATED USING A COST TO CHARGE RATIO EXTRACTED FROM THE MEDICARE COST REPORT DATA. THE MEDICAL CENTER BELIEVES THAT ALL OF THE $6.1 MILLION DOLLAR SHORTFALL SHOULD BE CONSIDERED AS COMMUNITY BENEFIT, BECAUSE OUR MISSION IS TO PROMOTE HEALTH IN THE COMMUNITY AND WE DO NOT LIMIT THE CARE AVAILABLE TO ANY PATIENTS, INCLUDING THOSE COVERED BY MEDICARE. THE IRS COMMUNITY BENEFIT STANDARD INCLUDES THE PROVISION OF CARE TO THE ELDERLY. THIS YEAR, MEDICARE ACCOUNTED FOR 43% OF HOSPITAL REVENUES AND THESE MEDICARE BENEFICIARIES WERE PROVIDED CARE IN SPITE OF THIS SHORTFALL. CARING FOR THE MEDICARE BENEFICIARIES RELIEVES THE FEDERAL GOVERNMENT OF THE BURDEN OF PAYING THE TRUE COST FOR THEIR CARE AS THESE PATIENTS TYPICALLY HAVE LOW AND/OR FIXED INCOMES. TAX EXEMPT HOSPITALS ARE ALSO EXPECTED TO PARTICIPATE IN THE MEDICARE PROGRAM. MEDICARE SHORTFALLS MUST BE ABSORBED BY THE MEDICAL CENTER IN ORDER TO CONTINUE TREATING THE ELDERLY IN OUR COMMUNITY. PART III, LINE 9B THE CHARITY POLICY IS A SUBSET OF THE OVERALL COLLECTION POLICY. WHEN PATIENTS ARE IDENTIFIED AS QUALIFYING FOR ANY OF THE CHARITY CATEGORIES WE SEARCH ACCOUNTS RECEIVABLE AND ACCOUNTS PLACED WITH COLLECTION AGENCIES AND PACKAGE THEM WITH THE APPLICATION. IN ADDITION, CHARITY INFORMATION IS SHARED WITH OUR RELATED ORGANIZATIONS AND FORMS THE BASIS FOR THEIR CHARITY ADJUSTMENTS. IN ADDITION, WITH PATIENT APPROVAL, WE MAY CONTACT LOCAL PHYSICIAN PRACTICES WITH THE INFORMATION AS MANY WILL ADJUST THEIR BALANCES BASED UPON THE INFORMATION PROVIDED. Part VI, Line 2: FISHER-TITUS SPONSORED AND COLLABORATED WITH THE HURON COUNTY PUBLIC HEALTH AND OTHER HEALTH ORGANIZATIONS, SCHOOLS, NON-PROFITS AND BUSINESSES (CALLED HURON COUNTY HEALTH PARTNERS) TO DEVELOP AND FUND THE HURON COUNTY HEALTH NEEDS ASSESSMENT IN 2014. LOCAL COMMUNITY AGENCIES WERE INVITED TO PARTICIPATE IN THE HEALTH ASSESSMENT PROCESS, INCLUDING CHOOSING QUESTIONS FOR THE SURVEYS, PROVIDING GOVERNMENT DATA, REVIEWING DRAFT REPORTS AND PLANNING THE COMMUITY RELEASE OF THE DATA AND SETTING PRIORITIES. THERE WERE OVER 50 KEY LEADERS FROM THE COMMUNITY THAT REPRESENTED PUBLIC HEALTH, LAW ENFORCEMENT, SCHOOLS, CHURCHES, LOCAL OFFICIALS, SOCIAL AGENCIES AND OTHER VARIOUS COMMUNITY MEMBERS IN ATTENDANCE AT THE PUBLIC RELEASE OF THE COMMUNITY HEALTH NEEDS ASSESSMENT. AT THE EVENT, PARTICIPANTS, PARTICIPATED IN FOCUS GROUPS AND PRIORITIES WERE CHOOSEN FOR AREAS OF HEALTH CONCERN FOR HURON COUNTY TO FOCUS ON OVER THE NEXT FEW YEARS. FTMC USED THIS INFORMATION TO ADD AND EXPAND SERVICES AND TO RECRUIT PHYSICIANS TO MEET THE THEN IDENTIFIED MEDICAL NEEDS OF OUR COMMUNITY. FROM THESE PRIORITIES, FTMC HAS DEVELOPED NUMEROUS PROGRAMS TARGETING THE COUNTY'S HIGH RATE OF ADULTS WHO ARE OVERWEIGHT OR OBESE; HAVE DIABETES AND/OR CARDIOVASCULAR ISSUES. PROGRAMS INCLUDING NUTRITION AND EXERCISE EDUCATION IN KINDERGARTENS THROUGHOUT HURON COUNTY; WALK WITH A DOC AND WELLNESS WALKS THAT PROVIDE NOT ONLY EXERCISE, BUT ALSO EDUCATION; GLUCOSE AND BLOOD PRESSURE SCREENINGS WHERE ABNORMAL RESULTS ARE SHARED WITH THE INDIVIDUAL'S PRIMARY CARE PHYSICIANS. Part VI, Line 3: PATIENTS ARE INTERVIEWED AFTER REGISTRATION TO ASSIST THEM IN DETERMINING EACH PATIENT'S ELIGIBILITY FOR FINANCIAL ASSISTANCE PROGRAMS AVAILABLE INTERNALLY AND EXTERNALLY. ftmc has bilingual SIGNAGE POSTED IN THE ADMITTING/REGISTRATION AREAS, BILLING OFFICE AND FINANCIAL COUNSELING OFFICES, AND IN THE INPATIENT GUIDES IN ALL PATIENT ROOMS. THE FTMC WEBSITE HAS A SECTION ABOUT THE FINANCIAL ASSISTANCE PROGRAM AND CONTRACT INFORMATION. A MESSAGE ABOUT FINANCIAL ASSISTANCE AND CHARITY CARE ALSO IS INCLUDED ON THE BILLS THAT ARE SENT TO THE PATIENTS. MANY MATERIALS ARE BILINGUAL AND INTERPRETATION SERVICES ARE AVAILABLE. THE MEDICAL CENTER SUPPORTS AN OUTSIDE COUNSELOR DEDICATED TO HELPING PATIENTS BECOME QUALIFIED FOR MEDICAID OR OTHER GOVERNMENT PROGRAMS. THEY ALSO REFER PATIENTS WHO DON'T QUALIFY FOR THOSE PROGRAMS TO OUR FTMC FINANCIAL COUNSELORS FOR ASSISTANCE WITH H.C.A.P., FISHER-TITUS CHARITY AND FISHER-TITUS COMMUNITY ASSISTANCE PROGRAMS. OUR SOCIAL SERVICES DEPARTMENT REGULARLY REFERS PATIENTS IN NEED TO OUR FINANCIAL COUNSELORS FOR ASSISTANCE. WE ALSO TAKE REFERRALS FROM THE LOCAL COUNTY HUMAN SERVICES AGENCIES, VICTIMS OF VIOLENT CRIMES, LOCAL HEALTH DEPARTMENTS, LOCAL LAW ENFORCEMENT AGENCIES, CHURCHES, ETC. FTMC IS VERY PROACTIVE IN TAKING THE MESSAGE TO OUR COMMUNITY. BROCHURES ARE AVAILABLE AT COMMUNITY OUTREACH EVENTS HELD IN THE HOSPITAL AND AT OUTSIDE COMMUNITY EVENTS. FTMC COMMUNICATES THE INFORMATION ABOUT CHARITY CARE PROGRAMS THROUGH ITS COMMUNITY NEWSLETTER AND LOCAL NEWS MEDIA. Part VI, Line 4: THE FISHER-TITUS MEDICAL CENTER PROVIDES COMPREHENSIVE STATE-OF-THE ART HEALTH CARE SERVICES TO THE RESIDENTS OF HURON AND ERIE AS WELL AS PORTIONS OF OTHER CONTIGUOUS COUNTIES WITH THE LATEST MEDICAL ADVANCEMENTS. FISHER-TITUS'S PRIMARY AREA IS THE GREATER HURON COUNTY AREA IN NORTH CENTRAL OHIO, WHICH IS HOME TO AROUND 58,500 RESIDENTS. FTMC'S 50 ACRE CAMPUS IS IN THE COUNTY SEAT OF NORWALK, WHICH IS THE LARGEST CITY IN THE COUNTY WITH OVER 16,800 RESIDENTS. FTMC HAS NUMEROUS MEDICAL OFFICES THROUGHOUT THE COUNTY TO PROVIDE EASY ACCESS TO PHYSICIANS FOR COMMUNITY RESIDENTS. huron county had the 20th highest level of unemployment with an average of 6.5% in 2016. THE LARGEST PERCENTAGE OF RESIDENTS ARE CHILDREN UNDER 18 WITH THOSE 65 AND OLDER MAKING UP 16.6% OF THE POPULATION. 91% OF THE RESIDENTS ARE CAUCASIAN WITH 6.3% OF THE POPULATION BEING HISPANIC OR LATINO (OF ANY RACE). IN 2014, THE MEDIAN HOUSEHOLD INCOME (FAMILIES) WAS $49,315 COMPARED TO OHIO'S MEDIAN HOUSEHOLD INCOME OF $48,849. IN 2015, 13.5% OF INDIVIDUALS WERE LIVING IN POVERTY WITH THOSE UNDER THE AGE OF 18 LIVING IN POVERTY ESTIMATED TO BE 20%. Part VI, Line 5: THE BOARD OF DIRECTORS IS COMPOSED OF AREA RESIDENTS INCLUDING BUSINESS AND COMMUNITY LEADERS, PHYSICIANS AND OTHER INTERESTED PERSONS. THESE VOLUNTEERS GIVE COUNTLESS HOURS OF SERVICE TO THE MEDICAL CENTER IN THEIR OVERSIGHT ROLE. THEY ARE INVOLVED IN THE COMMUNITY NEEDS ASSESSMENT PROCESS, IN FUNDRAISING, AND IN GENERAL STEWARDSHIP. FTMC'S MEDICAL STAFF IS OPEN AND PRIVILEGES ARE GRANTED TO ALL QUALIFIED PHYSICIANS WHO APPLY AND MEET THE STANDARDS OF THE MEDICAL CENTER PRIVILEGING PROCESS. THE MEDICAL CENTER UTILIZES SURPLUS FUNDS TO MAINTAIN ACCESS TO PATIENT SERVICES AND TO EXPAND ACCESS POINTS OF CARE TO PATIENTS THROUGHOUT THE COMMUNITY INCLUDING, BUT NOT LIMITED TO THE FOLLOWING:1. EDUCATIONAL PROGRAMS THAT PROVIDE CLASSES AND INFORMATION ON TOBACCO CESSATION, HEALTHY AGING, CHILDBIRTH, INFANT CARE, EARLY PREGNANCY AND MORE.2. FREE BLOOD PRESSURE AND DIABETES SCREENINGS, AND MAMMOGRAMS TO QUALIFYING INDIVIDUALS, FREE OR LOW-COST SCREENINGS FOR BREAST, PROSTATE, SKIN AND COLORECTAL CANCERS AS WELL AS OSTEOPOROSIS ASSESSMENTS. 1 City of norwalk 100 republic st Norwalk OH 44857 Section 115 5000 Grant for Healthy Behaviour Events NORWALK CATHOLIC SCHOOLS 93 E MAIN ST Norwalk OH 44875 Section 115 5000 FRINDS OF THE FUTURE CAMPAIGN AMERICAN CANCER SOCIETY 10501 EUCLID AVE CLEVELAND OH 44106 131788491 501(C)(3) 5000 RELAY FOR LIFE WALK SPONSORSHIP Teen Leadership Corps 26 E Cedar Point Road Sandusky OH 44870 260324010 501(C)(3) 5500 Contributions to Teen Leadership Classes NORWALK AREA FRIENDS OF YOUTH SPONSORS 20 Baneberry Lane NORWALK OH 44857 472930548 501(C)(3) 5000 SUPPORT FOR AREA YOUTH SPORTS CENTER SHELBY CHRISTIAN ALLIANCE CHURCH 105 e smiley ave shelby OH 44875 341354574 501(C)(3) 54857 fmv MISC. MEDICAL AND OPERATING SUPPLIES SUPPLIES TO AID IN CARRYING OUT THE ORGANIZATION'S CHARITABLE PURPOSE Shelby christian ALLIANCE church 105 e smiley ave Shelby OH 44875 341354574 501(C)(3) 61213 FMV MISC. CATH LAb MEDICAL SUPPLIES SUPPLIES TO AID IN CARRYING OUT THE ORGANIZATION'S CHARITABLE PURPOSE fisher-titus foundation 272 benedict ave norwalk OH 44857 341476934 501(C)(3) 77000 help TO purchase equipment norwalk economic development 12 BENEDICT AVE norwalk OH 44857 341787391 501(C)(3) 11500 CONTRIBUTion TO HELP THE LOCAL COMMUNITY BGSU FOUNDATION INC MILETI ALUMNI CENTER BOWLING GREEN OH 43403 346007199 501(C)(3) 10000 ALLIED HEALTH & SCIENCE PROJECT 8 2 Part I, Line 2: THE MEDICAL CENTER REVIEWS EACH GRANT OR DONATION REQUEST BEFORE the grant or donation IS MADE. X X X X X X 0 1 0 0 0 0 0 0 0 lorna strayer PRESIDENT 353925 0 83654 0 2535 0 110417 0 18569 0 569100 0 0 0 duane woods Senior VP of Finance & CFO - End Aug 205526 0 58669 0 374 0 13531 0 16555 0 294655 0 24178 0 laurie S Delgado SR VP Operations 204750 0 30161 0 739 0 35307 0 7933 0 278890 0 0 0 cherie m spragg VP POPULATION HEALTH 189862 0 20482 0 1927 0 65280 0 11012 0 288563 0 0 0 PHILLIP J ANNARINO senior VP HUMAN RESOURCES 166269 0 46629 0 16230 0 35374 0 28774 0 293276 0 18813 0 john britton senior vp information services 181669 0 25888 0 268 0 38602 0 0 0 246427 0 0 0 george b elmer VP Ambulatory & Facility Services 176442 0 18038 0 1146 0 12074 0 26278 0 233978 0 0 0 Dr Shankar Kurra Senior VP Medical Affairs 295270 0 44445 0 728 0 50450 0 26278 0 417171 0 0 0 Lori Lill Corporate Safety Officer 132926 0 15342 0 839 0 33964 0 18660 0 201731 0 0 0 Donald L Smith Jr Physician 386732 0 105721 0 30909 0 15900 0 28828 0 568090 0 0 0 Gregory P Cook Physician 530477 0 111680 0 36485 0 15900 0 18912 0 713454 0 0 0 Patrick R Waters Physician 564912 0 28866 0 36932 0 15900 0 26548 0 673158 0 0 0 Robert W Rice Physician 474294 0 88320 0 16406 0 15900 0 28828 0 623748 0 0 0 Part I, Line 4b INCLUDED IN MS. STRAYER'S TOTAL CONTRIBUTION TO DEFERRED COMPENSATION OF $110,417 REPORTED IN COLUMN C IS $50,046 OF VESTED DEFERRED WAGES AND QUALIFIED RETIREMENT PLAN CONTRIBUTIONS AND $60,371 FOR THE CURRENT YEAR ACCRUAL OF A NON-VESTED, NON-QUALIFIED RETIREMENT PLAN. THIS PLAN PROVIDES AN ADDITIONAL BENEFIT BASED ON YEARS OF ELIGIBLE SERVICE AND VESTED STATUS AND REMAINS SUBJECT TO A SUBSTANTIAL RISK OF FORFEITURE. INCLUDED IN MR. WOOD'S TOTAL W-2 COMPENSATION OF $264,569 IS $24,178 WHICH REPRESENTS THE CURRENT YEAR PAYMENT OF DEFERRED COMPENSATION FROM A NON-QUALIFIED RETIREMENT PLAN WHICH WAS DEFERRED ON A PRIOR FORM 990. INCLUDED IN MS. DELGADO'S TOTAL CONTRIBUTION TO DEFERRED COMPENSATION OF $35,307 IN COLUMN C IS $13,517 OF VESTED DEFERRED WAGES AND QUALIFIED RETIREMENT PLAN CONTRIBUTIONS AND $21,790 FOR THE CURRENT YEAR OF A NON-VESTED, NON-QUALIFIED RETIREMENT PLAN. THIS PLAN PROVIDES AN ADDITIONAL RETIREMENT BENEFIT BASED ON YEARS OF ELIGIBLE SERVICE AND VESTED STATUS AND REMAINS SUBJECT TO A SUBSTANTIAL RISK OF FORFEITURE. INCLUDED IN MR. KURRA'S TOTAL CONTRIBUTION TO DEFERRED COMPENSATION OF $50,450 IN COLUMN C IS $15,900 OF VESTED DEFERRED WAGES AND QUALIFIED RETIREMENT PLAN CONTRIBUTIONS AND $34,550 FOR THE CURRENT YEAR OF A NON-VESTED, NON-QUALIFIED RETIREMENT PLAN. THIS PLAN PROVIDES AN ADDITIONAL RETIREMENT BENEFIT BASED ON YEARS OF ELIGIBLE SERVICE AND VESTED STATUS AND REMAINS SUBJECT TO A SUBSTANTIAL RISK OF FORFEITURE. INCLUDED IN MR. ANNARINO'S TOTAL W-2 COMPENSATION OF $229,128 IS $18,813 WHICH REPRESENTS THE CURRENT YEAR PAYMENT OF DEFERRED COMPENSATION FROM A NON-QUALIFIED RETIREMENT PLAN WHICH WAS DEFERRED ON A PRIOR FORM 990. INCLUDED IN THE TOTAL CONTRIBUTION TO DEFERRED COMPENSATION OF $35,374 IN COLUMN C IS $13,564 OF VESTED DEFERRED WAGES AND QUALIFIED RETIREMENT PLAN CONTRIBUTIONS AND $21,810 FOR THE CURRENT YEAR OF A NON-VESTED, NON-QUALIFIED RETIREMENT PLAN. THIS PLAN PROVIDES AN ADDITIONAL RETIREMENT BENEFIT BASED ON YEARS OF ELIGIBLE SERVICE AND VESTED STATUS AND REMAINS SUBJECT TO A SUBSTANTIAL RISK OF FORFEITURE. INCLUDED IN MR. BRITTON'S TOTAL CONTRIBUTION TO DEFERRED COMPENSATION OF $38,602 REPORTED IN COLUMN C IS $18,568 OF VESTED DEFERRED WAGES AND QUALIFIED RETIREMENT PLAN CONTRIBUTIONS AND $20,034 FOR THE CURRENT YEAR ACCRUAL OF A NON-VESTED, NON-QUALIFIED RETIREMENT PLAN. THIS PLAN PROVIDES AN ADDITIONAL BENEFIT BASED ON YEARS OF ELIGIBLE SERVICE AND VESTED STATUS AND REMAINS SUBJECT TO A SUBSTANTIAL RISK OF FORFEITURE. Part 1 line 3 RESPONSIBILITY FOR DETERMINING AND RECOMMENDING EXECUTIVE COMPENSATION RESTS WITH THE PERSONNEL COMMITTEE OF THE FISHER-TITUS Heath, Inc. board. THE COMMITTEE RETAINS AN INDEPENDENT EXECUTIVE COMPENSATION CONSULTANT TO HELP ESTABLISH CASH COMPENSATION TARGET RANGES AND IDENTIFY REASONABLE AND CUSTOMARY BENEFIT PROGRAMS FOR EXECUTIVES. THE INDEPENDANT CONSULTANT REPORTS TO THE PERSONNEL COMMITTEE ON RELEVANT PEER GROUPS, CASH COMPENSATION REPORTED IN AVAILABLE SALARY SURVEYS FOR THE PEER GROUP, AND TRENDS IN BENEFITS AND PERQUISITE PROGRAMS CUSTOMARILY AVAILABLE AMONG THE PEER GROUP FOR EXECUTIVES. RECOMMENDATIONS BY THE CONSULTANT ARE PRESENTED TO THE PERSONNEL COMMITTEE WHICH PREPARES MINUTES OF ITS DELIBERATIONS REGARDING EXECUTIVE COMPENSATION INCLUDING RECOMMENDATIONS THAT ARE PROVIDED TO EACH OF THE DIRECTORS OF Fisher-Titus Health. THE RECOMMENDATIONS TO BE ACTED ON MUST BE APPROVED first BY THE PERSONNEL COMMITTEE AND THEN BY THE Fisher-Titus Health's BOARD OF DIRECTORS. THE MINUTES OF EACH BOARD MEETING WHERE ACTION IS TAKEN REFLECT SUCH ACTION. THE PROCESS IS PERFORMED ANNUALLY IN THE SPRING AND WAS LAST DONE IN MARCH 2016. A COUNTY OF HURON OHIO 346400672 447540CC7 2007-06-28 28622597 SEE PART VI BELOW 0 0 0 B county of HURON OHIO 346400672 2015-04-01 9420000 see PART VI BELOW 0 0 0 A 28838308 564200 7215711 21058397 2008 1 0 1 1 B 9420000 50000 9370000 2015 1 0 1 1 A 0 0 0 1 1 0 0 0 B 0 0 0 1 1 0 0 0 A 0 0 1 0 0 0 0 0 1 B 0 1 0 0 1 1 PNC 6.800000000000 1 0 0 0 1 A 1 B 1 PART I, LINE A SERIES 2007A BONDS - PURPOSE WAS TO ACQUIRE, CONSTRUCT AND INSTALL A VASCULAR HEART ADDITION TO THE HOSPITAL'S MAIN CAMPUS AS WELL AS SUPPORT SERVICES AND THE RENOVATION OF THE EXISTING EMERGENCY ROOM. part i, line b Series 2015A bonds - purpose was to refund the hospital's county of huron revenue bonds, series 2003a bonds. Part II line 11 INCLUDED IN THE TOTAL PROCEEDS OF $28,838,308 is investment earnings of $215,711 part ii, line 11, column b INCLUDED IN COLUMN B $9,370,000 OF THE PROCEEDS WERE USED TO REFUND THE HOSPITAL'S COUNTY OF HURON REVENUE GONDS, SERIES 2003A BONDS PART II, COLUMN A, LINE 11 Included in column a $21,058,397 of the proceeds were used to refund the hospital's county of huron revenue bonds, series 1966b and a portion of series 2003a bonds MS JOHN BRITTON SPOUSE OF KEY EMPLOYEE 56900 EMPLOYMENT 0 Mr Fries Family member of officer, Steven Fries 56852 Employment 0 ms schwab family member of officer, lorna strayer 66550 employment 0 ms riley family member of director, matt gross 31990 employment 0 battles insurance agency see PART V 600000 vendor 0 PART IV Part IV line 2 - Ms. Schwab has a family relationship with Officer Lorna StrayerPart IV Line 3 - Ms. Riley has a family relationship, with a board member Matt GrossPart IV Line 4 - Mr. Fries has a family relationship with Officer Steven FriesPart IV Line 5 - Perry Dryden, board member is president of Battles Insurance Agency and 50% owner. FORM 990, PART III, LINE 4A STATEMENT OF PROGRAM SERVICE ACCOMPLISHMENTS FISHER-TITUS MEDICAL CENTER (FTMC) IS AN INDEPENDENT NON-PROFIT COMMUNITY HEALTHCARE ORGANIZATION GOVERNED BY A BOARD OF DIRECTORS COMPOSED OF AREA RESIDENTS INCLUDING BUSINESS AND COMMUNITY LEADERS, PHYSICIANS AND OTHER INTERESTED INDIVIDUALS. FTMC IS COMPOSED OF THE FOLLOWING FIVE OPERATING DIVISIONS: FISHER-TITUS MEMORIAL HOSPITAL THE HOSPITAL PROVIDES INPATIENT AND OUTPATIENT HEALTHCARE SERVICES TO THE RESIDENTS OF HURON, ERIE AND THE ADJACENT COUNTIES OF SANDUSKY, CRAWFORD, LORAIN, ASHLAND AND RICHLAND. IN 2016, THE HOSPITAL PROVIDED 12,614 DAYS OF INPATIENT CARE TO 3,898 PATIENTS. THE HOSPITAL ALSO PROVIDED 91,044 PATIENTS WITH 146,567 OUTPATIENT AND 30,461 EMERGENCY ROOM VISITS DURING THE YEAR. THE NORWALK MEMORIAL HOME THE NORWALK MEMORIAL HOME PROVIDES SKILLED AND LONG-TERM CARE IN ITS TRANSITIONAL AND EXTENDED CARE UNITS. DURING 2016, THE HOME SERVED 382 RESIDENTS AND PROVIDED 23,525 DAYS OF CARE. THE HOME HEALTH CENTER HOME HEALTH AGENCY THE HOME HEALTH CENTER PROVIDED 16,525 HOME VISITS TO 385 DIFFERENT PATIENTS IN 2016. The Carriage House of Fisher-Titus Opened in 1998, the Carriage House is a 48-unit assisted living facility, which provided 16,694 days of assisted living care to 67 residents in 2016. Kaiser Community Pharmacy and Home Medical Equipment Opened in 1941, Kaiser-Wells Pharmacy is a community local pharmacy and medical equipment store. In Nov-2016, Kaiser-Wells was acquired by Fisher-Titus Medical Center. PROGRAM EXPANSIONS, IMPROVEMENTS, AND ACCREDITATIONS: RANKED MOST WIRED FOR FIFTH CONSECUTIVE YEAR In 2016, Fisher-Titus was named one of HealthCare's Top 100 Most Wired U.S. hospitals for the fifth consecutive year. The award recognizes Fisher-Titus for its accomplishments as the nation's first All-Digital Smart Community Hospital and continued advancements in patient-focused technology aimed at providing the highest level of clinical quality, patient safety, and coordination of care. ELECTRONIC MEDICAL RECORDS FISHER-TITUS MEDICAL CENTER ALSO IS RANKED AT HIMSS LEVEL 6 (THE HIGHEST LEVEL BEING LEVEL 7) FOR ELECTRONIC MEDICAL RECORD (EMR) ADOPTION BY THE HEALTH INFORMATION AND MANAGEMENT SYSTEMS SOCIETY. FACILITY AND PROGRAM EXPANSIONS Phase 2 of a $6.9 million Renovation Project for the Main Laboratory, located in one of the oldest parts of the Medical Center, and was completed in January 2016. The project tripled the size of the lab to 6,400 square feet and includes the Blood Bank, Microbiology, Hematology, Urinalysis, Coagulation, Serology, Point of Care, Molecular, Chemistry, and Phlebotomy. The Fisher-Titus Weight Loss Center opened in April providing a medically supervised weight loss program. The program is under the medical director of Dr. Kersey-Barrett, a primary care physician who specializes in weight loss. Fisher-Titus Medical Care, employed provider group, continued to grow in 2016 with the addition of several more specialty practitioners representing gastroenterology and digestive health, pediatrics, and endocrinology. A second Convenient Care location opened in Willard to provide walk-in primary care services to area residents. National Rural ACO 14, LLC, of which Fisher-Titus Medical Center is a member, was selected as one of 100 new Medicare Shared Savings Program Accountable Care Organizations (ACOs). Kaiser Wells Pharmacy and Homecare joined Fisher-Titus Medical Center to form Kaiser Community Pharmacy & Home Medical Equipment. Working with Fisher-Titus, the pharmacy will continue its 70-year tradition of offering area residents high quality personal care and services. EDUCATION AND RESEARCH - To ensure that we have the quality workforce we need to care for our community in the future, we are committed to the education of current and future caregivers, and we work with EHOVE Career Center, Ashland University, Bowling Green State University Firelands campus, Lorain County Community College, North Central State College, Terra Community College, The Ohio State University, and Ohio University and more to provide internships, instructors, classroom space, and clinical training. We are pleased to be able to offer a comprehensive learning experience utilizing our state-of-the-art facilities and advanced technology. EXCELLENT PHYSICIANS: In 2016, 32 new members were added to the Fisher-Titus Medical Staff including 30 physicians and two allied health professionals. The Medical Staff is composed of both independent practitioners as well as physicians and providers employed by Fisher-Titus Medical Care LLC. Fisher-Titus actively recruits specialists to serve the needs of the service area. Joining the Medical staff in 2016 were Cardiologist Chetan Hampole, M.D., Family Practitioner Jakleen Labbad, M.D., Neurologist Bernadette Borte, M.D., and Anesthesiologist Richard Mahon, D.O. Fisher-Titus medical staff represents 24 medical specialties. AWARDS AND ACCREDITATIONS - Throughout the years Fisher-Titus has been highly successful in meeting the challenges of an increasingly complex health-care industry and has provided exceptional service quality to members of the surrounding communities. In 2016, the Medical Center was reaccredited by the Healthcare Facilities Accreditation Program (HFAP). Fisher-Titus also is a Level 3 Trauma Center, Primary Stroke Center, a fully accredited Chest Pain Center, and has also been accredited by the Commission on Cancer since 1989. FORM 990, PART III, LINE 4A PROGRAM SERVICE ACCOMPLISHMENTS CONTINUED THE MEDICAL CENTER'S FOCUS ON QUALITY CARE AND EXCEPTIONAL SERVICE IS EVIDENCED BY THE MANY HOSPITAL AND DEPARTMENTAL ACCREDITATIONS, AWARDS, AND RECOGNITIONS RECEIVED IN 2016: -"A" HOSPITAL SAFETY SCORE FOR FALL 2016, RANKING THE MEDICAL CENTER AMONG THE SAFEST HOSPITALS IN THE UNITED STATES BY THE LEAPFROG GROUP, A NATIONAL PATIENT SAFETY WATCHDOG. -FISHER-TITUS HOME HEALTH WAS NAMED A TOP AGENCY OF THE 2016 HOMECARE ELITE, A RECOGNITION OF THE TOP-PERFORMING HOME HEALTH AGENCIES IN THE UNITED STATES. -RECEIVED HEALTHCARE'S MOST WIRED AWARD FOR THE FIFTH CONSECUTIVE YEAR. -PRIMARY STROKE CENTER -MATERNITY, OHIO DEPARTMENT OF HEALTH SURVEY -AMERICAN COLLEGE OF RADIOLOGY ACCREDITATION FOR CT -NORWALK MEMORIAL HOME AND CARRIAGE HOUSE ASSISTED LIVING, OHIO DEPARTMENT OF HEALTH -KAISER COMMUNITY PHARMACY, RESPIRATORY CARE, CHAP -AMERICAN ASSOCIATION OF RESPIRATORY CARE, QUALITY RESPIRATORY CARE AWARD IN ADDITION, THE MEDICAL CENTER MAINTAINS THE FOLLOWING ONGOING ACCREDITATIONS: -AMERICAN ASSOCIATION OF CARDIOVASCULAR AND PULMONARY REHABILITATION ACCREDITATION -OHIO DEPARTMENT OF HEALTH MAMMOGRAPHY QUALITY STANDARDS -AMERICAN COLLEGE OF RADIOLOGY ACCREDITATION FOR MAGNETIC RESONANCE IMAGING -AMERICAN COLLEGE OF RADIOLOGY ACCREDITATION FOR NUCLEAR MEDICINE -INTERSOCIETY COMMISSION FOR THE ACCREDITATION OF VASCULAR LAB -AMERICAN DIABETES ASSOCIATION EDUCATION RECOGNITION CERTIFICATE -COLLEGE OF PATHOLOGISTS (CAP) ACCREDITATION - DEPARTMENT OF PATHOLOGY & LABORATORY SERVICES & BLOOD GAS LAB -COLLEGE OF PATHOLOGISTS (CAP) PULMONARY MEDICINE -INTERSOCIETAL ACCREDITATION COMMISSION (IAC) - ECHO COMMUNITY HEALTH AND OUTREACH PROGRAMS: FISHER-TITUS MEDICAL CENTER'S COMMUNITY BENEFITS EXTEND OUTSIDE OUR WALLS TO FAMILIES, BUSINESS, SCHOOLS, CHURCHES AND NEIGHBORHOODS THROUGH OUTREACH PROGRAMS AND OTHER COORDINATED CARE ACTIVITIES THAT MAKE OUR COMMUNITIES HEALTHIER PLACES TO LIVE, WORK AND WORSHIP. OUR GOAL IS TO HELP ALL RESIDENTS EQUALLY ACCESS THE CARE THEY NEED, AND HELP THEM LEARN TO MANAGE THEIR CONDITIONS AND LIVE HEALTHIER, SAFER LIVES. IN 2014 A NEW HURON COUNTY HEALTH NEEDS ASSESSMENT WAS COMPLETED AND PUBLISHED. FISHER-TITUS WAS A LEADER IN THE PROCESS AND PARTNERED WITH HEALTH-RELATED AND CIVIC ORGANIZATIONS THROUGHOUT THE COUNTY TO BOTH FUND THE PROJECT AND ASSIST IN THE ASSESSMENT PROCESS. FROM THAT REPORT, THE BOARD OF DIRECTORS OF FISHER-TITUS MEDICAL CENTER DETERMINED THAT CERTAIN HEALTH NEEDS IDENTIFIED IN THE ASSESSMENT SHOULD BE ADDRESSED AS THE HIGHEST PRIORITY THROUGH AN IMPLEMENTATION STRATEGY. THE PRIORITIES INCLUDE: SUPPORTING INITIATIVES GEARED TO HEALTHY WEIGHT; IMPROVING ACCESS TO MENTAL HEALTH SERVICES; REDUCING SUBSTANCE ABUSED THROUGH PREVENTION, SCREENING AND TREATMENT; IMPROVING ACCESS TO CARE; AND IMPROVING THE PUBLIC HEALTH INFRASTRUCTURE. FISHER-TITUS SUPPORTS OTHER AREA NON-PROFIT COMMUNITY ORGANIZATIONS THAT ARE COMMITTED TO COMMUNITY HEALTH IMPROVEMENT THROUGH FINANCIAL INVESTMENTS, IN-KIND SERVICE AND EMPLOYEE VOLUNTEERISM. MANY OF OUR COMMUNITY BENEFIT PROGRAMS ARE ORGANIZED TO WORK COLLABORATIVELY WITH COMMUNITY GROUPS, SCHOOLS AND GOVERNMENT ORGANIZATIONS TO EFFECTIVELY LEVERAGE RESOURCES AND ADDRESS IDENTIFIED COMMUNITY NEEDS. IN 2015, WE OFFERED COMMUNITY HEALTH EDUCATION PROGRAMS, INCLUDING SCHOOL-BASED PROGRAMS, SUPPORT GROUPS, COMMUNITY-BASED HEALTH FAIRS AND SCREENINGS, AND WALKING AND FITNESS PROGRAMS THAT IMPACTED OUR RESIDENTS THROUGH 62,450 ENCOUNTERS. AUXILIARY AND VOLUNTEER SERVICE: DURING 2016, OUR 183 CARING VOLUNTEERS DONATED 45,231 HOURS OF AUXILIARY AND VOLUNTEER SERVICES TO THE MEDICAL CENTER. VOLUNTEERS PROVIDE A VARIETY OF SERVICES INCLUDING HELPING FAMILY MEMBERS, PROVIDING TRANSPORTATION, ASSISTING AT COMMUNITY HEALTH PROGRAMS, DELIVERING REFRESHMENTS, MAIL AND FLOWERS TO HOSPITAL PATIENTS AND RESIDENTS OF THE NORWALK MEMORIAL HOME PLUS ESCORTING PATIENTS THROUGHOUT THE BUILDING. THEY ALSO PERFORM CLERICAL DUTIES, STAFF THE MEDICAL CENTER'S GIFT SHOP AND ORGANIZE SEVERAL FUND-RAISING EVENTS THROUGHOUT THE YEAR. VOLUNTEER "AMBASSADORS" HAVE INSTRUCTED PATIENTS SINCE APRIL, 2010 ON THE USE OF THE TELEVISION/COMPUTER SCREENS LOCATED IN EACH PATIENT ROOM. VOLUNTEERS WORKING IN THIS CAPACITY ARE AT FISHER-TITUS MEDICAL CENTER SEVEN DAYS PER WEEK EACH MORNING FOR 2 HOURS. AMONG THE ITEMS PATIENTS ARE INSTRUCTED ON ARE HOW TO ACCESS THE DAY'S MENU, MEDICAL INFORMATION PERTAINING TO THE PERSON'S HEALTH PROBLEMS, ACCESSING THE INTERNET, PLAYING GAMES, OBTAINING THE NAMES OF CAREGIVERS AS THEY ENTER THE PATIENT'S ROOM, CHOOSING MOVIES, ETC. THE PATIENT THEN MAY USE A REMOTE CONTROL OR A WIRELESS KEYBOARD TO ACCESS THIS INFORMATION. INFORMATION SERVICES PROVIDES ALL COMPUTER TRAINING FOR VOLUNTEERS THAT WORK IN THIS CAPACITY. COMMUNITY HEALTH IMPROVEMENT SERVICES: NUMEROUS HEALTH SCREENINGS ARE OFFERED THROUGHOUT THE YEAR AT THE MEDICAL CENTER AND AT VARIOUS COMMUNITY LOCATIONS AND EVENTS THROUGHOUT OUR SERVICE AREA. THESE PROGRAMS INCLUDE SCREENING FOR BLOOD PRESSURE, BLOOD GLUCOSE, CHOLESTEROL LEVELS, SKIN CANCER, PROSTATE CANCER, OSTEOPOROSIS AND SCREENING MAMMOGRAMS. IN ADDITION, THE MEDICAL CENTER SPONSORS NUMEROUS SUPPORT GROUPS TO PROVIDE EDUCATION, CARE AND EMOTIONAL SUPPORT TO INDIVIDUALS AND FAMILIES AFFECTED BY DISABILITIES AND CHRONIC MEDICAL CONDITIONS. FTMC'S HEALTH MINISTRY PROGRAM, FORMED IN 2000, HAS BEEN A VERY EFFECTIVE GRASSROOTS INITIATIVE TO GATHER INFORMATION AND PROVIDE HEALTH PROGRAMS THROUGHOUT HURON COUNTY. CURRENTLY 50 AREA CONGREGATIONS ARE MEMBERS OF THE FTMC HEALTH MINISTRY PROGRAM WHICH PROVIDES HEALTH AND WELLNESS INFORMATION AND PROGRAMS IN AREA CHURCHES. THE MEDICAL CENTER IN PARTNERSHIP WITH ITS PHYSICIANS AND OTHER COMMUNITY ORGANIZATIONS PROVIDES PUBLIC FORUMS AND EDUCATIONAL SESSIONS ON A VARIETY OF TOPICS, WHICH ARE SOMETIMES HELD IN TANDEM WITH THE HEALTH SCREENINGS PROVIDED. WE ALSO PROVIDE NUMEROUS HEALTH FAIRS DURING THE YEAR IN SEVERAL LOCATIONS THROUGHOUT THE COUNTY AND SURROUNDING COMMUNITIES IN OUR SERVICE AREA. THESE COMMUNITY HEALTH IMPROVEMENT SERVICES BENEFITED 57,969 PEOPLE IN 2016 AT A COST OF $786,912. PROFESSIONAL MEDICAL EDUCATION: THE MEDICAL CENTER SUPPORTS THE FAMILY PRACTICE RESIDENCY PROGRAM AT FIRELANDS REGIONAL MEDICAL CENTER TO ENHANCE THE AVAILABILITY OF FAMILY PRACTICE PHYSICIANS WITHIN THE LOCAL COMMUNITY. FTMC FUNDS THE COST OF A FAMILY PRACTICE RESIDENT THAT SHARES TIME BETWEEN THE HOSPITAL'S EMERGENCY ROOM AND THE COUNTY HEALTH DEPARTMENT CARING FOR THE UNDERSERVED. IN ADDITION, FTMC SUPPORTS AND STAFFS SEVERAL CLASSES FOR HEALTH PROFESSIONALS INCLUDING HEALTHCARE PROVIDER CPR, ADVANCED CARDIAC LIFE SUPPORT, BASIC LIFE SUPPORT INSTRUCTOR COURSE AND PEDIATRIC ADVANCE LIFE SUPPORT. THE TOTAL COST OF PROFESSIONAL MEDICAL EDUCATION PROVIDED TO 108 PARTICIPANTS WAS $155,423. SUBSIDIZED HEALTH SERVICES: THE MEDICAL CENTER ALSO SUBSIDIZES CERTAIN HEALTH SERVICES AND PROCESSES IN ORDER TO ADDRESS SPECIFIC HEALTH ISSUES IN THE COMMUNITY, PROVIDE CARE TO THE UNDERSERVED, OR ENHANCE THE OVERALL QUALITY OF HEALTHCARE WITHIN THE COMMUNITY. ALSO, THE MEDICAL CENTER SUBSIDIZED THE COST OF ELECTRONIC MEDICAL RECORD SOFTWARE USED BY PHYSICIANS IN OUR SERVICE AREA. THE SOFTWARE ENHANCES THE ACCURACY AND SPEED OF MEDICAL INFORMATION AVAILABLE TO HEALTHCARE PROVIDERS WITHIN THE AREA AND TO ASSIST THE COMMUNITY IN MOVING TOWARD A REGIONAL HEALTH INFORMATION DATABASE. THE COST ASSOCIATED WITH THE HEALTH SERVICES AND ELECTRONIC MEDICAL RECORDS SYSTEM IN 2016 WAS $820,390. DONATIONS AND COMMUNITY SUPPORT: THE MEDICAL CENTER MAKES CASH AND NON-CASH CONTRIBUTIONS ANNUALLY TO LOCAL NON-PROFIT ORGANIZATIONS THAT BENEFIT THE HEALTH AND DEVELOPMENT OF OUR LOCAL COMMUNITY AND ITS RESIDENTS. IN ADDITION, THE MEDICAL CENTER SUPPORTS AREA SCHOOLS BY AWARDING SPECIAL HEALTH EDUCATION GRANTS TO SCHOOL DISTRICTS IN OUR SERVICE TERRITORY TO FUND INNOVATIVE PROGRAMS IN THE AREAS OF SCIENCE, MATH, HEALTH AND HEALTH RELATED EDUCATION. THE TOTAL COST OF THESE DONATIONS AND SUPPORT IN 2016 WAS $235,531. Form 990, Part VI, Section A, line 4 THE FISHER TITUS MEDICAL CENTER'S CODE OF CONDUCT WAS UPDATED JULY-2016 TO REFLECT THE CHANGES TO THE POWERS RESERVED TO THE MEMBER (FISHER TITUS HEALTH) AND CHANGES TO THE BOARD OF DIRECTORS WHO SHALL BE COMPOSED OF THOSE INDIVIDUALS WHO ARE VOTING DIRECTORS OF THE MEMBER AT ANY TIME, AS DETERMINED UNDER THE CODE OF REGULATIONS OF THE MEMBER (FISHER TITUS HEALTH). Form 990, Part VI, Section A, line 6 The sole member of Fisher-Titus Medical Center is the parent company Norwalk Area Health Systems, Inc., an Ohio nonprofit corporation. Effective July-01-2016, the name of the System Parent for Fisher-Titus Medical Center was changed from Norwalk Area Health Systems, Inc. to Fisher-Titus Health. Form 990, Part VI, Section A, line 7a The board of directors shall be composed of those individuals who are voting directors of the Member at any time, as determined under the code of Regulations of the Member (Fisher-Titus Health). Form 990, Part VI, Section A, line 7b The following powers are reserved exclusively to the member (Fisher-Titus Health): a) to amend or repeal the articles of incorporation and the code of regulations; b) to approve any merger of the corporation or any sale of substantially all of its assets; to dissolve or terminate the existence of the corporation and to determine the distribution of assets upon such termination. Form 990, Part VI, Section B, line 11b THE BOARD OF DIRECTORS OF THE FISHER-TITUS MEDICAL CENTER DELEGATED THE RESPONSIBILITY FOR THE REVIEW OF THE MEDICAL CENTER'S FORM 990, PLUS ALL REQUIRED SCHEDULES AND ATTACHMENTS, TO THE Fisher-Titus AUDIT COMMITTEE. THE MEMBERS OF THIS COMMITTEE HAVE A STRONG BACKGROUND IN ACCOUNTING, LEGAL, FINANCE, AND BUSINESS AND HAVE THE TECHNICAL EXPERTISE TO PERFORM A SUBSTANTIVE REVIEW. THE AUDIT COMMITTEE REVIEWED THE MEDICAL CENTER'S FORM 990 PRIOR TO FILING AND REPORTED TO THE MEDICAL CENTER'S BOARD OF DIRECTORS REGARDING THE RESULTS OF THEIR REVIEW. IN ADDITION, EACH MEMBER OF THE MEDICAL CenTER'S BOARD OF DIRECTORS HAD ACCESS TO A COPY OF THE FORM 990 FOR VIEWING PRIOR TO FILING VIA A SECURE INTERNET WEBSITE AND A PAPER COPY WAS AVAILABLE FOR REVIEW AT THE BOARD MEETINGS. Form 990, Part VI, Section B, line 12c ALL OF OUR AFFILIATED CORPORATE BOARD MEMBERS ARE REQUIRED TO COMPLETE A CONFLICT OF INTEREST STATEMENT UPON JOINING THE BOARD AND ANNUALLY THROUGHOUT THEIR TENURE. THESE ARE RETAINED BY ADMINISTRATION. AREAS OF CONFLICT ARE REVIEWED AND ADDRESSED AS NECESSARY TO THE TRANSACTIONS OF THE BOARD. IF AN AREA OF CONFLICT ARISES, BOARD MEMBERS ARE EXCUSED AND PROHIBITED FROM PARTICIPATING IN THE BOARD'S DELIBERATIONS AND DISCUSSIONS REGARDING THE AREA OF CONFLICT. Form 990, Part VI, Section B, line 15 Responsibility for determining and recommending executive compensation rests with the Personnel Committee of the Fisher-Titus Health board. The committee retains an independent executive compensation consultant to help establish cash compensation target ranges and identify reasonable and customary benefit programs for executives. The independent consultant reports to the Personnel Committee on relevant peer groups, cash compensation reported in available salary surveys for the peer group, and trends in benefits and perquisite programs customarily available among the peer group for executives. Recommendations by the consultant are presented to the Personnel Committee which prepares minutes of its deliberations regarding executive compensation including recommendations that are provided to each of the directors of Fisher-Titus Health. The recommendations to be acted on must be approved first by the Joint Personnel Committee and then by the Fisher-Titus Health's Board of Directors. The minutes of each board meeting where action is taken reflect such action. The process is performed annually in the spring and was last done in March 2016. Form 990, Part VI, Section C, line 19 WE ISSUE AN ANNUAL REPORT TO THE COMMUNITY THAT IS PLACED IN THE LOCAL NEWSPAPER AND ON OUR WEBSITE THAT PROVIDES OUR OPERATING FINANCIAL STATEMENT, COMMUNITY BENEFIT FIGURES BROKEN DOWN BY CHARITY CARE & FINANCIAL ASSISTANCE, UPAID COSTS OF MEDICAID, COMMUNITY HEALTH & OUTREACH PROGRAMS, DONATIONS & COMMUNITY SUPPORT, SUBSIDIZED HEALTH SERVICES & PROFESSIONAL MEDICAL EDUCATION, & UNPAID COSTS OF MEDICARE & BAD DEBT. AS REQUIRED, WE OFFER A TIMELY RESPONSE TO WRITTEN REQUESTS FOR COPIES OF THE 990S AS WELL AS HAVING THE 990S AVAILABLE UPON THE PREMISES FOR THE PUBLIC TO REVIEW AND ON THE GUIDESTAR INTERNET WEBSITE. ADDITIONALLY, OUR CONFLICT OF INTEREST POLICY, CODE OF REGULATIONS, AND GOVERNING DOCUMENTS ARE ALSO AVAILABLE UPON WRITTEN REQUEST. FORM 990, PART VI, SECTION A, LINE 1B INFORMATION RELATING TO FAMILY MEMBERS OF SOME OF THE ORGANIZATION'S GOVERNING BODY COMPENSATED BY THE ORGANIZATION OR INVOLVED IN BUSINESS TRANSACTIONS WITH THE ORGANIZATION IS INCLUDED IN PART IV OF SCHEDULE L, TRANSACTIONS WITH INTERESTED PRESONS. HOWEVER, MEMBERS OF THE ORGANIZATION'S GOVERNING BODY ARE PROMINENT CITIZENS IN THE COMMUNITIES SERVED BY THE ORGANIZATION FOR PURPOSES OF SATISFYING THE COMMUNITY BENEFIT STANDARD ESTABLISHED BY REVENUE RULING 69-545, 1962-2 C.B. 117. Form 990 Part XI, Line 9 Other Changes in Net Assets include: 1. Adjustment to recognize FASB #158 (change in pension liability) of negative ($3,033,127); 2. An inter-system transfer of funds between affiliated 501(c)(3) organizations of negative ($5,850,576); 3. Change in bond interest swap value of $57,440; 4. Profit sharing related to Pain Management of $27,907; and 5. Pain management joint venture dividend payments to Fisher-Titus Medical Center of $539,000. FTMC HOLDING 265 LLC 265 BENEDICT AVENUE NORWALK OH 44857 344430716 REAL ESTATE OH 49500 1054551 FISHER TITUS MEDICAL CENTER NORTH CENTRAL HOLDING LLC 272 BENEDICT AVENUE NORWALK OH 44857 344430716 REAL ESTATE OH FISHER TITUS MEDICAL CENTER Executive Urology 272 BENEDICT AVENUE NORWALK OH 44857 Physician Group OH 3685030 702010 Fisher TITUS MEDICAL CENTER Kaiser Community Pharmacy 251 Benedict Avenue NORWALK OH 44857 812899103 Pharmacy and Medical Home Equipment OH 403756 1799266 FISHER TITUS MEDICAL CENTER FISHER-TITUS HEALTH 272 BENEDICT AVENUE NORWALK OH 44857 341476935 SYSTEM PARENT OH 501(c)(3) Line 12c, III-FI N/A 0 FISHER-TITUS FOUNDATION 272 BENEDICT AVENUE NORWALK OH 44857 341476937 FOUNDATION OH 501(c)(3) Line 7 FISHER-TITUS HEALTH 0 FISHER-TITUS AFFILIATED SERVICES 272 BENEDICT AVENUE NORWALK OH 44857 341476934 AMBULANCE OH 501(c)(3) Line 10 FISHER-TITUS HEALTH 0 FISHER-TITUS PAIN MANAGEMENT LLC 272 BENEDICT AVENUE NORWALK OH 44857 271471272 PAIN MANAGEMENT OH FISHER TITUS MEDICAL CENTER RELATED 554028 649203 0 0 0.51000 HEALTH PROMOTIONS OF NORWALK 272 BENEDICT AVENUE NORWALK OH 44857 341502102 SUPPORT PROF. OH FISHER TITUS MEDICAL CENTER C 122393 896781 1.00000 0 0 1 0 0 1 1 0 0 0 0 0 1 0 0 1 0 1 1 1 fisher - titus pain management llc F 556907 ownership percentage