2025-11-17T10:40:59-06:00 2024-12-31 351178661 BLUE & CO LLC 500 N MERIDIAN ST SUITE 200 INDIANAPOLIS IN 46204 990 2024-01-01 310645626 FAIRFIELD MEDICAL CENTER FAIR 7406878051 401 NORTH EWING STREET LANCASTER OH 431303371 JOHN R JANOSO JR PRESIDENT & CEO 7406878051 2025-11-17 1 1 EMILIE M KNIERIEM CPA P01330194 3176334705 2025-11-17 2024 2025-03-06 01:10:19Z JOHN R JANOSO JR 401 NORTH EWING STREET LANCASTER OH 431303371 372555663 0 X WWW.FMCHEALTH.ORG X 1982 OH FAIRFIELD MEDICAL CENTER DELIVERS OUTSTANDING HEALTHCARE FOR OUR PATIENTS, THEIR FAMILIES AND OUR COMMUNITIES. 14 12 2003 158 260675 200141 140 9979953 315876820 328471491 1771994 5963393 6689161 7215559 324338115 351630396 3500 0 0 0 130688141 135408713 0 0 0 192757290 201055939 323448931 336464652 889184 15165744 284488383 281919969 176068285 180992213 108420098 100927756 FAIRFIELD MEDICAL CENTER DELIVERS OUTSTANDING HEALTHCARE FOR OUR PATIENTS, THEIR FAMILIES AND OUR COMMUNITIES. 0 0 266594968 332525781 A) PATIENT CARE: INPATIENT MEDICAL, SURGICAL, EMERGENCY, MATERNITY, ICU, AND NURSING SERVICES (76,041 DISCHARGES, PROCEDURES & VISITS) B) PATIENT CARE: LABORATORY, CARDIOVASCULAR, RADIOLOGY, THERAPY, PHARMACY, AND MEDICAL SUPPLY SERVICES (7,709,374 PROCEDURES & DOSAGES) C) PATIENT CARE: NUTRITIONAL SERVICES (447,394 MEALS SERVED) PATIENT CARE: LAUNDRY SERVICES (952,058 POUNDS) PATIENT CARE: PLANT ENGINEERING, POLICE, HOUSEKEEPING, CENTRAL TRANSPORT, INTEREST & DEPRECIATION (746,212 SQUARE FEET) 266594968 1 1 0 1 0 0 0 0 0 0 1 0 0 1 1 1 0 0 0 0 1 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 121 0 1 2003 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 14 12 1 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 1 1 OH X JOHN R JANOSO JR 7406896825 401 NORTH EWING STREET LANCASTER OH 431303371 JOHN R JANOSO JR DIRECTOR, PRESIDENT, & CEO 55.00 1.00 X X 873627 0 194924 BRADLEY HEDGES PHD CHAIR 3.00 0.00 X X 0 0 0 MATTHEW WIDEMAN VICE CHAIR 3.00 0.00 X X 0 0 0 LAURI LACH SECRETARY 2.00 0.00 X X 0 0 0 RON BURRIS DIRECTOR 2.00 1.00 X 0 0 0 DAN FRUTH DIRECTOR 2.00 1.00 X 0 0 0 ANGELA KRILE DIRECTOR 2.00 0.00 X 0 0 0 MIKE LIEBER DIRECTOR 2.00 0.00 X 0 0 0 LAURIANNE SCOTT DO DIRECTOR 2.00 0.00 X 0 0 0 STEPHEN SWICK DIRECTOR 2.00 0.00 X 0 0 0 LAURA TUSSING DIRECTOR 3.00 1.00 X 0 0 0 MARIE WARD PHD DIRECTOR 2.00 0.00 X 0 0 0 THERESA DYAR DO DIRECTOR/RESIDENCY PROGRAM 28.00 0.00 X 182050 0 9103 NATALIE FURNISS DIRECTOR 2.00 0.00 X 0 0 0 ALAN F GREENSLADE CIO, TREASURER 40.00 2.00 X 447280 0 56001 MARK T DARNELL MD CMO 40.00 0.00 X 489981 0 38477 LAURA MOORE CHIEF BUSINESS STRATEGY & 40.00 0.00 X 433697 0 47985 MARK E VANDERHOFF CHIEF NURSING OFFICER 40.00 0.00 X 355634 0 50627 MARY NASH CHIEF HUMAN RESOURCES OFFICER 40.00 0.00 X 296988 0 24360 JULIE GROW CFO 40.00 0.00 X 408219 0 21242 CAROLINE V SEGELKEN STAFF PHARMACIST 41.00 0.00 X 179383 0 31743 ELIZABETH BRENDSEL STAFF PHARMACIST 40.00 0.00 X 170892 0 38169 JULIE THARP STAFF PHARMACIST 43.00 0.00 X 170830 0 41110 TROY HAMPTON RESIDENCY PROGRAM DIRECTOR 26.00 0.00 X 169150 0 11030 CHARLES DELLICK DIRECTOR INFO. 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ACCORDINGLY, NO PROVISION FOR FEDERAL INCOME TAXES HAS BEEN MADE IN THE CONSOLIDATED FINANCIAL STATEMENTS FOR THE YEARS ENDING DECEMBER 31, 2024 AND 2023. CENTRAL AMERICA AND THE CARIBBEAN 0 0 INVESTMENTS 15146776 0 0 0 0 0 0 15146776 0 15146776 1 0 0 0 0 0 1 1 1 X 1 X 1 1 0 1 1 1821242 1362055 459187 0.00140 37608592 35297831 2310761 0.00690 39429834 36659886 2769948 0.00830 14 6 895342 29250 866092 0.00260 3 5364043 3871518 1492525 0.00440 1 3931792 5835334 0 0.00000 3 82874 82874 0.00020 21 6 10274051 9736102 2441491 0.00720 21 6 49703885 46395988 5211439 0.01550 1 9578 9578 0.00000 1 5100 5100 0.00000 1 8291 8291 0.00000 1 12047 12047 0.00000 4 35016 35016 0.00000 1 15982587 56604286 58405162 -1800876 X 1 1 FAIRFIELD MEDICAL CENTER 401 NORTH EWING STREET LANCASTER OH 43130 WWW.FMCHEALTH.ORG 1167 X X X X FAIRFIELD MEDICAL CENTER 1 0 0 1 X X X X X X X X X 22 1 1 1 1 X WWW.FMCHEALTH.ORG/ARTICLES-EVENTS-RESOURCES/COMMUNITY-SERVICES/ X 1 22 1 FMCHEALTH.ORG 0 1 X 200.000000000000 300.000000000000 X X X 1 1 X X X X 1 X HTTPS://WWW.FMCHEALTH.ORG/PATIENTS-VISITORS/BILLING-FINANCIAL-ASSISTANCE/ X HTTPS://WWW.FMCHEALTH.ORG/PATIENTS-VISITORS/BILLING-FINANCIAL-ASSISTANCE/ X HTTPS://WWW.FMCHEALTH.ORG/PATIENTS-VISITORS/BILLING-FINANCIAL-ASSISTANCE/ X X X X X 1 X 0 X X X 1 X 0 0 FAIRFIELD MEDICAL CENTER PART V, SECTION B, LINE 5: THE 2022 FAIRFIELD COUNTY COMMUNITY HEALTH NEEDS ASSESSMENT IS A COLLABORATIVE EFFORT OF FAIRFIELD MEDICAL CENTER, FAIRFIELD COUNTY HEALTH DEPARTMENT, FAIRFIELD COMMUNITY HEALTH CENTER, ADAMH BOARD AND THE UNITED WAY WHICH IS CONDUCTED EVERY THREE YEARS. AN INDEPENDENT MARKET RESEARCH FIRM, ILLUMINOLOGY, WAS CONTRACTED TO CONDUCT THE ASSESSMENT.THE 2022 ASSESSMENT, STARTED IN FEBRUARY OF 22 AND WAS COMPLETED IN THE FALL, WAS BASED ON INPUT FROM 30 COMMUNITY ORGANIZATIONS WHO PARTICIPATED IN GROUP DISCUSSIONS AND/OR ONE-ON-ONE INTERVIEWS. PARTICIPATING ORGANIZATIONS INCLUDE:ALZHEIMER'S ASSOCIATION CENTRAL OHIO CHAPTERBALTIMORE VILLAGEBLOOM-CARROLL LOCAL SCHOOL DISTRICTFAIRFIELD COMMUNITY HEALTH CENTERFAIRFIELD COUNTY 211FAIRFIELD COUNTY ADAMH BOARDFAIRFIELD COUNTY BOARD OF COMMISSIONERSFAIRFIELD COUNTY BOARD OF HEALTHFAIRFIELD COUNTY EMERGENCY MANAGEMENTFAIRFIELD COUNTY FAMILY, ADULT AND CHILDREN FIRST COUNCILFAIRFIELD COUNTY FOUNDATIONFAIRFIELD COUNTY HEALTH DEPARTMENTFAIRFIELD COUNTY JOB AND FAMILY SERVICESFAIRFIELD COUNTY LIBRARYFAIRFIELD COUNTY PROTECTIVE SERVICESFAIRFIELD MEDICAL CENTERJUVENILE COURTLANCASTER CITY SCHOOLSLANCASTER-FAIRFIELD COMMUNITY ACTION AGENCYMAJOR CRIMES UNITMEALS ON WHEELSMOUNT CARMEL HEALTH SYSTEMNEW HORIZONSOHIOGUIDESTONEOSU EXTENSION OFFICEPICKERINGTON LOCAL SCHOOL DISTRICTROBERT K. FOX FAMILY YMCASOUTHEASTERN OHIO CENTER FOR INDEPENDENT LIVINGUNITED WAYVIOLET TOWNSHIP FIRE DEPARTMENTIN ADDITION TO COMMUNITY ORGANIZATIONS AND LEADERS, 700 AREA RESIDENTS PROVIDED INPUT IN A MAIL SURVEY CONDUCTED IN APRIL OF 2022. FAIRFIELD MEDICAL CENTER PART V, SECTION B, LINE 6A: ONE OTHER HOSPITAL PARTICIPATED IN THE CHNA: MOUNT CARMEL HEALTH SYSTEM (DILEY RIDGE MEDICAL CENTER FACILITY IS IN FAIRFIELD COUNTY) FAIRFIELD MEDICAL CENTER PART V, SECTION B, LINE 6B: OTHER ORGANIZATIONS THAT CONDUCTED THE CHNA ARE: FAIRFIELD COUNTY HEALTH DEPARTMENT, FAIRFIELD COMMUNITY HEALTH CENTER, ADAMH BOARD AND THE UNITED WAY. FAIRFIELD MEDICAL CENTER PART V, SECTION B, LINE 11: FAIRFIELD MEDICAL CENTER REVIEWED THE HEALTH NEEDS IDENTIFIED IN THE CHNA PROCESS AND DEVELOPED A COMMUNITY HEALTH IMPROVEMENT PLAN (CHIP) TO ADDRESS AREAS OF NEED THAT MOST CLOSELY ALIGN WITH OUR MISSION, RESOURCES AND STRATEGIC INITIATIVES: 1) CARDIOVASCULAR DISEASE 2) ACCESS TO CARE 3) CANCER CARE. THE CHIP OUTLINES TACTICS, AN IMPLEMENTATION TIMELINE, RESOURCES AND MEASURES OF SUCCESS FOR EACH AREA. THE CHIP IS UPDATED ANNUALLY TO MONITOR PROGRESS TOWARDS GOALS AND SHARED WITH THE HOSPITAL BOARD AND POSTED ON THE FMC WEBSITE.FMC ACKNOWLEDGES THE WIDE RANGE OF HEALTH ISSUES IMPACTING OUR COMMUNITY THAT WERE IDENTIFIED DURING THE COMMUNITY HEALTH NEEDS ASSESSMENT PROCESS. ALTHOUGH OUR FOCUS IS ON THE ITEMS LISTED ABOVE, THERE ARE OTHER NEEDS IN OUR COMMUNITY. FMC WILL NOT BE TAKING THE LEAD ON THESE INITIATIVES BUT WILL PARTNER WITH OTHER AREA AGENCIES WHO HAVE THE RESOURCES TO ADDRESS. THESE INCLUDE:-SUBSTANCE USE TREATMENT AND PREVENTION--WHILE NOT AN AREA OF FOCUS, WE WILL: ENSURE PATIENTS ARE REFERRED TO RESOURCES IN THE COMMUNITY, CONTINUE TO PARTNER WITH THE FAIRFIELD HEALTH DEPARTMENT ON PROJECT DAWN, PARTICIPATE IN THE OARRS PRESCRIPTION REPORTING SYSTEM AND COLLABORATE WITH ADAHM.-MENTAL HEALTHCARE--WHILE NOT AN AREA OF FOCUS, WE WILL CONTINUE TO PROVIDE INPATIENT AND OUTPATIENT MENTAL HEALTH SERVICE FOR THE COMMUNITY AND EAP SERVICES FOR OUR EMPLOYEES, MAINTAIN CHAPLAINS AND BEHAVIORAL HEALTH COUNSELORS IN THE EMERGENCY DEPARTMENT AND PROVIDE SUPPORT TO OTHER ORGANIZATIONS ADDRESSING THIS NEED.-TRANSPORTATION--WHILE NOT AN AREA OF FOCUS FOR FMC, WE WILL WORK WITH LANCASTER TRANSIT, PERRY COUNTY TRANSIT, FUN BUS AND OTHER AGENCIES TO FACILITATE TRANSPORTATION FOR PATIENTS IN NEED AND WILL PROVIDE TELEHEALTH APPOINTMENTS FOR PATIENTS WITH TRANSPORTATION ISSUES AS APPROPRIATE.-OBESITY-WHILE NOT AN AREA OF FOCUS, WE WILL CONTINUE TO OFFER EDUCATION AND COUNSELING ON NUTRITION, WEIGHT LOSS AND FITNESS. 4 1 - FAIRFIELD MEDICAL CENTER RIVER VALLEY 2384 N MEMORIAL DR LANCASTER OH 43130 OUTPATIENT, EMERGENCY, LABS, IMAGING 2 - FAIRFIELD MEDICAL CENTER NEW LEXINGTON 775 CARROLL ST NEW LEXINGTON OH 43764 LAB SERVICES, LABS, IMAGING 3 - MEDICAL OFFICE PAVILION 135 N EWING ST LANCASTER OH 43130 INFUSION SERVICES 4 - RIVER VIEW SURGERY CENTER 2401 N COLUMBUS ST LANCASTER OH 43130 OUTPATIENT SURGERY, ENDOSCOPY PART II, COMMUNITY BUILDING ACTIVITIES: KNOWING THAT A STRONG ECONOMY CAN HELP BUILD STRONG PEOPLE, WE HAVE DEDICATED OURSELVES TO HELPING OUR LOCAL ECONOMY THROUGH DONATIONS TO ORGANIZATIONS HELPING TO DRAW MORE BUSINESS TO THE AREA AND BY PARTICIPATING IN LOCAL CHAMBERS OF COMMERCE. FAIRFIELD MEDICAL CENTER (FMC) SUPPORTS OUR COMMUNITIES WITH POLICE ASSISTANCE AND BY EMERGENCY PLANNING WITH OTHER COMMUNITY ORGANIZATIONS. GOOD LEADERS ARE IMPORTANT TO THE FUTURE OF OUR COMMUNITY, SO WE ARE ACTIVELY INVOLVED IN LEADERSHIP DEVELOPMENT AND TRAINING. WE ALSO RECOGNIZE THE IMPORTANCE OF RECYCLING AS A WAY TO IMPROVE THE HEALTH OF OUR PLANET, AND THEREFORE OUR PEOPLE, WITH ENVIRONMENTAL IMPROVEMENTS. PARTICIPATION WITH OTHER COMMUNITY ENTITIES BY COALITION BUILDING ALSO HELPS US TO KEEP OUR PULSE ON THE HEALTH OF THE COMMUNITY THROUGH GRASSROOTS INVOLVEMENT. PART III, LINE 2: AN ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS IS ESTABLISHED ON AN AGGREGATE BASIS BY USING HISTORICAL WRITE-OFF FACTORS APPLIED TO UNPAID ACCOUNTS BASED ON AGING. LOSS RATE FACTORS ARE BASED ON HISTORICAL LOSS EXPERIENCE AND ADJUSTED FOR ECONOMIC CONDITIONS AND OTHER TRENDS AFFECTING THE CENTER'S ABILITY TO COLLECT OUTSTANDING AMOUNTS. UNCOLLECTIBLE AMOUNTS ARE WRITTEN OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS IN THE PERIOD THEY ARE DETERMINED TO BE UNCOLLECTIBLE. PART III, LINE 4: SEE PAGE 13 OF THE DECEMBER 31, 2024 AUDITED FINANCIAL STATEMENTS. PART III, LINE 8: ALL MEDICARE SHORTFALL IS CONSIDERED COMMUNITY BENEFIT BECAUSE FAIRFIELD MEDICAL CENTER TREATS ALL PATIENTS, REGARDLESS OF ABILITY TO PAY AND REGARDLESS OF SUPPLEMENTAL INSURANCE COVERAGE, IN THE CASE OF MEDICARE PATIENTS. IT IS FOR THE BETTERMENT OF THE COMMUNITY THAT WE TREAT MEDICARE PATIENTS, REGARDLESS OF THE SHORTFALL OR SURPLUS.THE TOTAL FOR MEDICARE COST IS TAKEN DIRECTLY FROM THE MEDICARE COST REPORT. PART III, LINE 9B: IN ALL INSTANCES OF DEBT COLLECTION, PATIENTS ARE GIVEN INFORMATION REGARDING FINANCIAL ASSISTANCE AVAILABLE. IN ADDITION, PATIENTS ARE MADE AWARE OF THE AVAILABILITY OF FINANCIAL ASSISTANCE WITH AN ACKNOWLEDGEMENT LETTER OF SERVICES RENDERED, REGARDLESS OF ABILITY TO PAY OR PAYMENT SOURCE. FMC WILL DO EVERYTHING POSSIBLE TO HELP THOSE WHO QUALIFY FOR CHARITY CARE TO BE MADE AWARE OF THE ASSISTANCE AVAILABLE. WE ALSO PROVIDE FINANCIAL COUNSELORS TO ASSIST PATIENTS IN FILLING OUT THE NECESSARY FORMS FOR ASSISTANCE. THE FOLLOWING OPTIONS ARE AVAILABLE:A. PAYMENT IN THE FORM OF CASH, CREDIT CARD OR CHECKS. A DISCOUNT IS OFFERED WITH PAYMENT AT THE TIME OF SERVICE AND WITHIN 10 DAYS OF RECEIVING THE HOSPITAL BILL. B. H.E.L.P. BANK FINANCIAL PROGRAMC. HOSPITAL PAYMENT PROGRAM D. ASSISTANCE WITH APPLICATION TO MEDICARE OR MEDICAIDE. HOSPITAL CARE ASSURANCE PROGRAM (HCAP) F. HOSPITAL ASSISTANCE PROGRAM SUMMARYDEFINING FAIRFIELD MEDICAL CENTER'S FINANCIAL OPPORTUNITIES. G. ASSISTANCE FOR THE UNINSURED PATIENT. PART VI, LINE 2: IN ADDITION TO THE COMMUNITY HEALTH NEEDS ASSESSMENT FOR FAIRFIELD COUNTY AS REPORTED IN PART V, SECTION B, FAIRFIELD MEDICAL CENTER ASSESSES THE HEALTH CARE NEEDS OF THE BROADER COMMUNITY WE SERVE BY PARTICIPATING IN THE PERRY COUNTY COMMUNITY HEALTH NEEDS ASSESSMENTS AND COMMUNITY HEALTH IMPROVEMENT PLAN. ADDITIONALLY, WE PARTICIPATE IN LOCAL HEALTH NETWORKS FOR PERRY, HOCKING AND FAIRFIELD COUNTIES WHICH MEET ON A MONTHLY BASIS TO DISCUSS EVOLVING HEALTH ISSUES AND CONCERNS. WE ALSO PARTICIPATE IN THE LOGAN, PERRY AND LANCASTER CHAMBER OF COMMERCE AS WELL AS NUMEROUS GROUPS OR NETWORKS FOCUSING ON SPECIFIC POPULATIONS INCLUDING THE ELDERLY (OLDER ADULT NETWORK, ADULT FAMILY CHILD FIRST COUNCIL), CHILDREN (SAFE KIDS/SAFE COMMUNITIES, YMCA) AND MENTAL HEALTH (INNERSYSTEMS). ADDITIONALLY, FMC'S STRATEGIC PLANNING PROCESS ASSESSES NEW SERVICES, TECHNOLOGIES AND PROVIDERS THAT FMC CAN OFFER LOCALLY SO THAT RESIDENTS DO NOT HAVE TO LEAVE THE COMMUNITY AND TRAVEL LONG DISTANCES TO RECEIVE NECESSARY SERVICES. PART VI, LINE 3: THE FINANCIAL SERVICES OFFICE WAS RECENTLY CREATED TO MAKE THE FINANCIAL JOURNEY EASIER FOR PATIENTS AND THOSE WHO MAY BE BILLED FOR PATIENT CARE BY CO-LOCATING ALL BILLING AND FINANCIAL ASSISTANCE SERVICES. AT THE OFFICE, PATIENTS CAN SPEAK TO A PUBLIC BENEFITS SPECIALIST, FINANCIAL NAVIGATOR OR FINANCIAL COUNSELOR IN PERSON OR ON THE PHONE TO RECEIVE HELP WITH HCAP, FINANCIAL ASSISTANCE AND MEDICAID APPLICATIONS. IN ADDITION, FINANCIAL NAVIGATORS AND THE PUBLIC BENEFITS SPECIALISTS MEET WITH ALL HOSPITAL PATIENTS PRIOR TO DISCHARGE TO INFORM PATIENTS OF OUR FINANCIAL POLICIES AND HELP THOSE ELIGIBLE FOR FINANCIAL ASSISTANCE WITH THE APPLICATION PROCESS. IN ADDITION, REGISTRATION AREAS IN THE HOSPITAL, OUTPATIENT CENTERS AND PHYSICIAN OFFICES HAVE PROMINENT SIGNAGE REGARDING FINANCIAL ASSISTANCE PROGRAMS AND COPIES OF VARIOUS APPLICATION FORMS. PART VI, LINE 4: FAIRFIELD MEDICAL CENTER SERVES A THREE COUNTY AREA IN SOUTH EASTERN OHIO COMPRISED OF FAIRFIELD, HOCKING AND PERRY COUNTIES. THE TOTAL POPULATION IS 224,000 WITH 35% OF THE POPULATION LIVING IN A RURAL AREA. THE SOUTHERN PORTION OF PERRY COUNTY IS A LARGELY UNDERSERVED REGION IN THE RURAL HILLS OF APPALACHIA. PART VI, LINE 5: FAIRFIELD MEDICAL CENTER HAS AN OPEN MEDICAL STAFF, COMMUNITY BOARD AND FOUNDATION WHICH PLAY A VITAL ROLE IN SUPPORTING ACCESS TO MEDICAL CARE AND WELLNESS PROGRAMS THROUGHOUT FAIRFIELD, HOCKING AND PERRY COUNTIES. WE SPONSOR NUMEROUS SEMINARS, EDUCATIONAL SESSIONS, SCREENINGS AND FIRST AID STATIONS TO PROMOTE THE HEALTH AND WELLNESS OF OUR COMMUNITY. WE ALSO SPONSOR COMMUNITY HEART WATCH WHICH IS A COLLABORATIVE EFFORT OF AREA EMS/FIRE DEPARTMENTS, BUSINESSES, SCHOOLS, PUBLIC HEALTH AND OTHER ORGANIZATIONS DEDICATED TO IMPROVING SURVIVAL FROM CARDIAC ARREST BY PROVIDING CPR TRAINING AND ACCESS TO LIFE-SAVING AEDS TO PREPARE THE COMMUNITY TO RESPOND TO CARDIAC EMERGENCIES. PART VI, LINE 7: OH X X X X 1 1 0 0 0 0 0 0 0 JOHN R JANOSO JR DIRECTOR, PRESIDENT, & CEO 661947 0 192023 0 19657 0 164195 0 30729 0 1068551 0 0 0 MARK T DARNELL MD CMO 390221 0 98584 0 1176 0 10350 0 28127 0 528458 0 0 0 ALAN F GREENSLADE CIO, TREASURER 356080 0 90037 0 1163 0 20700 0 35301 0 503281 0 0 0 LAURA MOORE CHIEF BUSINESS STRATEGY & 345267 0 87260 0 1170 0 20700 0 27285 0 481682 0 0 0 JULIE GROW CFO 322779 0 84256 0 1184 0 20700 0 542 0 429461 0 0 0 MARK E VANDERHOFF CHIEF NURSING OFFICER 281485 0 72976 0 1173 0 20700 0 29927 0 406261 0 0 0 MARY NASH CHIEF HUMAN RESOURCES OFFICER 183064 0 0 0 113924 0 15912 0 8448 0 321348 0 0 0 JULIE THARP STAFF PHARMACIST 169600 0 0 0 1230 0 10784 0 30326 0 211940 0 0 0 CAROLINE V SEGELKEN STAFF PHARMACIST 179239 0 0 0 144 0 11139 0 20604 0 211126 0 0 0 ELIZABETH BRENDSEL STAFF PHARMACIST 168756 0 0 0 2136 0 15718 0 22451 0 209061 0 0 0 CHARLES DELLICK DIRECTOR INFO. SERVICES 162625 0 0 0 916 0 15487 0 28266 0 207294 0 0 0 THERESA DYAR DO DIRECTOR/RESIDENCY PROGRAM 182000 0 0 0 50 0 9103 0 0 0 191153 0 0 0 TROY HAMPTON RESIDENCY PROGRAM DIRECTOR 168998 0 0 0 152 0 11030 0 0 0 180180 0 0 0 PART I, LINES 4A-B JONATHAN KELLY RECEIVED SEVERANCE PAYMENTS TOTALING $80,769 & MARY NASH RECEIVED SEVERANCE PAYMENTS TOTALING $113,924 DURING THE YEAR. JOHN JANOSO PARTICIPATED IN A 457F PLAN DURING THE YEAR. CONTRIBUTIONS TO THE PLAN WERE $143,495. A COUNTY OF FAIRFIELD OHIO 316400066 304286AM9 2013-06-27 98511516 TO REFUND PRIOR ISSUE AND TO FUND NEW SURGICAL UNIT 0 0 0 A 22666516 98511516 6320525 926511 35000000 56264480 2015 1 0 0 1 A 0 0 0 0 0 0 1 A 0 0 1 0 0 0 0 0 1 A 1 FORM 990, PART VI, SECTION A, LINE 2 VARIOUS MEMBERS OF THE BOARD OF DIRECTORS ARE KEY EMPLOYEES AND/OR OFFICERS OF ORGANIZATIONS THAT MAY CONDUCT NORMAL, ARMS LENGTH TRANSACTIONS WITH ONE ANOTHER. FORM 990, PART VI, SECTION B, LINE 11B THE 990 IS REVIEWED BY THE FINANCE BOARD AND AUDIT COMMITTEE OF THE ORGANIZATION AFTER REVIEW BY THE CHIEF FINANCIAL OFFICER. THEN, IT IS MADE AVAILABLE FOR BOARD MEMBER REVIEW PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C DIRECTORS, PRESIDENT, VICE PRESIDENTS, MANAGERS, CASE MANAGEMENT EMPLOYEES, CONTRACTS & COLLECTIONS EMPLOYEES, EMPLOYEES WITH DIRECT PURCHASING RESPONSIBILITIES, EMPLOYED PHYSICIANS, AND EMPLOYEES WHO ARE CONTRACTED OR SHARED WITH OTHER ORGANIZATIONS ARE REQUIRED TO COMPLETE AN ANNUAL QUESTIONNAIRE DISCLOSING POTENTIAL CONFLICTS OF INTEREST. IF A KNOWN OR PERCEIVED CONFLICT OF INTEREST ARISES, THE COMPLIANCE OFFICER INVESTIGATES, DOCUMENTS, AND WORKS TO RESOLVE THE CONFLICT OF INTEREST. FORM 990, PART VI, SECTION B, LINE 15 ANNUALLY, THE COMPENSATION COMMITTEE COMPARES OFFICER AND KEY EMPLOYEE COMPENSATION TO REGIONAL INDUSTRY AVERAGES. THIS COMMITTEE CONSISTS OF INDEPENDENT MEMBERS OF THE BOARD OF DIRECTORS. COMPENSATION ADJUSTMENT RECOMMENDATIONS ARE SUBMITTED, TO BE INCLUDED IN THE BUDGET, TO THE FINANCE AND AUDIT COMMITTEE. COMPENSATION ADJUSTMENTS ARE TAKEN TO THE BOARD OF DIRECTORS FOR FINAL APPROVAL, AND IF APPROVED ARE THEN IMPLEMENTED. FORM 990, PART VI, SECTION C, LINE 19 THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST, AND FINANCIALS ARE MADE AVAILABLE TO THE PUBLIC BY REQUEST MADE TO FMC MANAGEMENT. FORM 990, PART IX, LINE 11G PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 19,152,377. MANAGEMENT AND GENERAL EXPENSES 13,821,422. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 32,973,799. PHYSICIAN FEES: PROGRAM SERVICE EXPENSES 18,087,281. MANAGEMENT AND GENERAL EXPENSES 7,466,998. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 25,554,279. CONSULTANT FEES: PROGRAM SERVICE EXPENSES 196,304. MANAGEMENT AND GENERAL EXPENSES 81,041. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 277,345. FORM 990, PART XI, LINE 9: ASSET TRANSFER TO AFFILIATES -22,422,217. CHANGE IN INTEREST OF NET ASSETS OF FOUNDATION -694,514. FORM 990, PART XII, LINE 2C: THE PROCESS OF SELECTING AN INDEPENDENT ACCOUNTANT AND OVERSIGHT OF THE AUDIT HAS NOT CHANGED FROM THE PRIOR YEAR. FORM 990 PART IX LINE 11G OTHER FEES FOR SERVICES INCLUDE LAB TESTING, ADMINISTRATIVE CONSULTING, OUTSOURCED BIOMEDICAL SERVICES, OUTSOURCED COLLECTION SERVICES, OUTSOURCED IT SERVICES AND OTHER GENERAL PURCHASED SERVICES. FORM 990 PART XI LINE 9 THE OTHER CHANGE IN NET ASSETS REPORTED REPRESENTS INTERCOMPANY TRANSFERS BETWEEN FAIRFIELD MEDICAL CENTER AND RELATED ORGANIZATIONS (SEE SCHEDULE R) FOR FIXED ASSET PURCHASES, SHARED EMPLOYEES, EXPENSES AND OTHER INTERCOMPANY TRANSACTIONS. FAIRFIELD HEALTHCARE PROFESSIONALS INC 401 NORTH EWING LANCASTER OH 43130 311425884 PHYSICIAN PRACTICES OH 501(C)(3) LINE 11 FAIRFIELD MEDICAL CENTER 1 FAIRFIELD MEDICAL CENTER FOUNDATION 401 NORTH EWING LANCASTER OH 43130 208952945 FUNDRAISING OH 501(C)(3) LINE 7 N/A 0 FAIRFIELD MEDICAL CENTER TWIG II 1724 E MAIN STREET LANCASTER OH 43130 237146033 SUPPORT FAIRFIELD MEDICAL CENTER OH 501(C)(3) LINE 12D, III-O N/A 0 ZANE PROPERTIES CORPORATION 401 NORTH EWING STREET LANCASTER OH 43130 311202009 HOLDING COMPANY OH FAIRFIELD MEDICAL CENTER C 62624 2857345 1.00000 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 1 FAIRFIELD HEALTHCARE PROFESSIONALS INC P 2137532 FMV FAIRFIELD HEALTHCARE PROFESSIONALS INC R 27467110 FMV ZANE PROPERTIES CORPORATION Q 64009 FMV ZANE PROPERTIES CORPORATION R 240000 FMV