2015-10-29T13:05:44-05:00 2014-12-31 381357951 PLANTE & MORAN PLLC 65 EAST STATE ST STE 600 COLUMBUS OH 43215 990 2014-01-01 341883284 LIMA MEMORIAL JOINT OPERATING COMPANY LIMA 4192283335 1001 BELLEFONTAINE AVENUE LIMA OH 45804 MICHAEL D SWICK PRESIDENT/CEO 4192283335 2015-10-26 1 BERNIE OSTROWSKI P00366367 6148493000 2014 2016-04-25 22:37:26Z LIMA MEMORIAL HEALTH SYSTEM MICHAEL D SWICK 1001 BELLEFONTAINE AVENUE LIMA OH 45804 176194468 0 X WWW.LIMAMEMORIAL.ORG X 1999 OH WE ARE HERE TO IMPROVE THE QUALITY OF LIFE IN OUR COMMUNITIES THROUGH COMPREHENSIVE HEALTH SERVICES. 11 11 1521 310 528985 -173266 75281 82939 169440717 172522595 5563006 920762 4559812 2668172 179638816 176194468 397969 376858 0 0 70289580 70698228 6115 0 209660 89995943 97091982 160689607 168167068 18949209 8027400 256259984 282148520 77681956 95266557 178578028 186881963 X AS ONE OF THE LARGEST NOT-FOR-PROFIT HEALTH CARE ORGANIZATIONS IN WEST CENTRAL OHIO, LIMA MEMORIAL HEALTH SYSTEM IS COMMITTED TO IMPROVING THE QUALITY OF LIFE IN OUR COMMUNITIES THROUGH COMPREHENSIVE HEALTH SERVICES. LIMA MEMORIAL IS CONTINUALLY IMPROVING ITS SERVICES AND FACILITIES BY KEEPING UP WITH THE LATEST TECHNOLOGIES, PROVIDING CONTINUING EDUCATION TO OUR HEALTH CARE TEAM AND UPDATING OUR FACILITIES. OUR PATIENT SATISFACTION NUMBERS CONTINUE TO IMPROVE AND WE CONTINUALLY ACHIEVE QUALITY SCORES THAT ARE BETTER THEN THE STATE AND NATIONAL AVERAGES. 0 0 141529747 376858 174311925 AS ONE OF THE LARGEST NOT-FOR-PROFIT HEALTHCARE ORGANIZATIONS IN WEST CENTRAL OHIO, LIMA MEMORIAL HEALTH SYSTEM IS COMMITTED TO IMPROVING THE QUALITY OF LIFE IN OUR COMMUNITIES THROUGH COMPREHENSIVE HEALTH SERVICES. LIMA MEMORIAL IS CONTINUALLY IMPROVING ITS SERVICES AND FACILITIES BY KEEPING UP WITH THE LATEST TECHNOLOGIES, PROVIDING CONTINUING EDUCATION TO OUR HEALTHCARE TEAM AND UPDATING OUR FACILITIES. OUR PATIENT SATISFACTION NUMBERS CONTINUE TO IMPROVE AND WE CONTINUALLY ACHIEVE QUALITY SCORES THAT ARE BETTER THAN STATE AND NATIONAL AVERAGES.THE HEALTH SYSTEM PROVIDES COMPREHENSIVE HEALTHCARE THAT ALLOWS US TO CARE FOR PATIENTS FROM BIRTH THROUGH ELDER YEARS. THESE SERVICES INCLUDE, BUT ARE NOT LIMITED TO:- 24-HOUR EMERGENCY SERVICES INCLUDING LEVEL II TRAUMA- CHEST PAIN CENTER WITH PCI- THE HEART AND VASCULAR INSTITUTE- ORTHOPAEDICS- OBSTETRICS AND PEDIATRICS- WOMEN'S HEALTH CENTER- RADIOLOGY- LABORATORY- INPATIENT AND OUTPATIENT REHABILITATION SERVICES- NEUROLOGY- UROLOGYIN 2014, LIMA MEMORIAL CONTRIBUTED AN ESTIMATED $30 MILLION IN COMMUNITY VALUE IN TERMS OF COMMUNITY BENEFIT EXPENDITURES, CHARITY CARE AND GOVERNMENT-SPONSORED HEALTH CARE. THIS NUMBER NOT ONLY INDICATES OUR COMMITMENT TO OUR COMMUNITIES, BUT ALSO FULFILLS OUR PURPOSE AS A NOT-FOR-PROFIT ORGANIZATION BY POSITIVELY IMPACTING THE MEMBERS OF OUR COMMUNITIES. THOUSANDS OF PEOPLE HAVE BENEFITED FROM THE COMPASSION, CARE AND EXPERTISE OF OUR PHYSICIANS, NURSES, ASSOCIATES AND VOLUNTEERS.EXAMPLES OF PROGRAMS BENEFITING THE BROADER COMMUNITY INCLUDE, BUT ARE NOT LIMITED TO:- COMMUNITY WELLNESS DAY- GO RED - HEART HEALTH AWARENESS FOR WOMEN EVENTS- JOURNEY TO REMEMBER WOMEN'S HEALTH BENEFIT- KIDS CLINIC- CHILDREN'S DEVELOPMENTAL CENTER- BABY FAIR- CHEST PAIN CENTER- BONE DENSITY SCREENINGS- CARDIAC RISK ASSESSMENT SCREENINGS- PROSTATE SCREENINGS- SKIN CANCER SCREENINGS- CANCER RESOURCE CENTER- MEDICARE ELIGIBILITY PROGRAM- BREAST CANCER SURVIVOR SUPPORT GROUP- FAMILY BIRTH CLINICS- WOMEN'S RESOURCE CENTER- TV AND RADIO PSAS- BREASTFEEDING CLASS AND CLINIC- SMOKING SESSION- BLOOD DRIVESAS HEALTHCARE CONTINUES TO CHANGE, LIMA MEMORIAL WILL CONTINUE TO PROVIDE THE HIGHEST QUALITY OF CARE IN A FAMILY ATMOSPHERE TO OUR PATIENTS BY CONTINUALLY ADVANCING OUR SERVICES AND FACILITIES. IN ADDITION, THE HEALTH SYSTEM SUPPORTS OUR COMMUNITIES, NOT ONLY THROUGH COMPREHENSIVE HEALTHCARE, BUT THROUGH OUTREACH ACTIVITIES SUCH AS HEALTHCARE AWARENESS AND PREVENTION PROGRAMS, FREE PUBLIC HEALTH SCREENINGS, FINANCIAL SUPPORT FOR MANY COMMUNITY ORGANIZATIONS, AND OUTREACH TO THE UNDERSERVED.COMMUNITY BENEFIT DEFINITIONSLIMA MEMORIAL HEALTH SYSTEM'S 2014 COMMUNITY BENEFIT REPORT WAS PREPARED IN ACCORDANCE WITH THE REPORTING GUIDELINES PUBLISHED BY THE CATHOLIC HEALTH ASSOCIATION. COMMUNITY BENEFITS REPORTED BY THE HEALTH SYSTEM RESPOND TO AN IDENTIFIED COMMUNITY NEED AND MEET AT LEAST ONE OF THE FOLLOWING CRITERIA:- GENERATE A LOW OR NEGATIVE MARGIN;- RESPOND TO THE NEEDS OF SPECIAL POPULATIONS, SUCH AS MINORITIES, FRAIL, ELDERLY, POOR PERSONS WITH DISABILITIES, THE CHRONICALLY MENTALLY ILL, AND PERSONS WITH AIDS; AND-SUPPLY SERVICES OR PROGRAMS THAT WOULD LIKELY BE DISCONTINUED IF THE DECISION WERE MADE ON A PURELY FINANCIAL BASIS.THESE SERVICES INCLUDE:- COMMUNITY HEALTH SERVICES- HEALTH PROFESSIONS EDUCATION- SUBSIDIZED HEALTH SERVICES- RESEARCH ACTIVITIES- FINANCIAL CONTRIBUTIONS- COMMUNITY BUILDING ACTIVITIES- COMMUNITY BENEFIT OPERATIONS- COST OF CHARITY CARE- GOVERNMENT SPONSORED HEALTH CARE 141529747 1 1 0 1 0 0 0 0 0 0 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 1 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 1 1 1 0 0 1 254 0 1 1521 1 1 1 0 0 0 0 0 0 0 0 0 X 11 11 0 0 0 0 1 0 0 1 1 0 0 1 1 1 1 1 1 1 1 1 1 OH X MERI FOSTER 4192265197 1001 BELLEFONTAINE AVENUE LIMA OH 45804 JOHN H JOHNSON CHAIR 1.00 1.00 X X 0 0 0 KERMIT F STROH TREASURER 1.00 1.00 X X 0 0 0 BARRETT P RYDELL BOARD MEMBER 1.00 0.00 X 0 0 0 LAWRENCE D BELL MD BOARD MEMBER (SEE SCH J) 1.00 39.00 X 0 285246 12127 DEBRA MCCURDY BOARD MEMBER 1.00 0.00 X 0 0 0 ROBERT L THOMPSON BOARD MEMBER 1.00 0.00 X 0 0 0 PHILLIP R BUELL BOARD MEMBER 1.00 0.00 X 0 0 0 KATHLEEN M KRUGER BOARD MEMBER 1.00 0.00 X 0 0 0 JAMES F BLAIR BOARD MEMBER 1.00 0.00 X 0 0 0 PRAVEEN K MALHOTRA BOARD MEMBER 1.00 0.00 X 0 0 0 SUSAN E PAYDEN BOARD MEMBER 1.00 0.00 X 0 0 0 KEVIN C WEBB BOARD MEMBER 1.00 0.00 X 0 0 0 MICHAEL D SWICK PRESIDENT/CEO (SEE SCH J) 34.00 6.00 X 541307 0 227860 ROBERT E ARMSTRONG JR SENIOR VP/COO (SEE SCH J) 30.00 10.00 X 319547 0 107477 ERIC D POHJALA VP OF FINANCE/CFO (SEE SCH 34.00 6.00 X 303163 0 106947 KHA H TRAN MD VP OF MEDICAL AFFAIRS (SEE 20.00 20.00 X 233393 0 81307 ANN-MARIE JEAN POHL VICE PRESIDENT/CNO (SEE SC 40.00 0.00 X 220443 0 58264 ANITA GOOD ADMINISTRATIVE DIRECTOR 39.00 1.00 X 145640 0 25186 MARK W RECKER DIRECTOR OF PHARMACY 40.00 0.00 X 150815 0 14949 LYNN C CARPENTER ADMINISTRATIVE DIRECTOR 40.00 0.00 X 154418 0 26404 CHERYL V HOMAN ADMINISTRATIVE DIRECTOR 40.00 0.00 X 141126 0 21630 VICKI J SUNDERLAND ADMINISTRATIVE DIRECTOR 40.00 0.00 X 137514 0 21559 2347366 285246 703710 38 0 1 0 LIMA ANESTHESIA & PAIN TREATMENT PC PO BOX 33058 PALM BEACH GARDENS FL 33420 MEDICAL SERVICES 3223340 EMERGENCY PHYSICIANS OF NORTHWEST OHIO PO BOX 12490 TOLEDO OH 43606 MEDICAL SERVICES 1225542 SODEXO INC & AFFILIATES 9801 WASHINGTONIAN BLVD GAITHERSBURG MD 20878 DIETARY/CAFETERIA SERVICES 1181460 NORTH CENTRAL OHIO PHYSICIAN SERVICES 1005 BELLEFONTAINE AVE LIMA OH 45804 MEDICAL SERVICES 1000000 CAREFUSION SOLUTIONS LLC 3750 TORREY VIEW COURT SAN DIEGO CA 92130 MEDICAL SERVICES 987950 37 51870 31069 82939 PATIENT SERVICE REV 621110 170430579 170430579 RENT FROM AFFILIATE 900099 1074379 1074379 PHARMACY 900099 798327 798327 CLINIC REVENUE 621110 187604 187604 WELLNESS CENTER 900099 18480 18480 13226 13226 172522595 857164 857164 107182 4375 0 0 107182 4375 111557 111557 63598 0 63598 63598 63598 MEANINGFUL USE REVENUE 900099 1655511 1655511 UBI- REFERENCE LAB 621500 528985 528985 CAFETERIA SALES 900099 289460 289460 82659 22262 60397 2556615 176194468 174311925 528985 1270619 X 376858 376858 1622295 1622295 52415598 45059205 7199276 157117 1814958 1285414 525062 4482 10602009 8840428 1730755 30826 4243368 3538309 692721 12338 835813 835813 94392 94392 22356438 12763049 9593389 5716253 5182861 530327 3065 2580943 2230967 348427 1549 242400 104111 138289 9682751 9682751 10990796 9500444 1490352 1135698 663121 472577 MEDICAL SUPPLIES 24921195 24921195 BAD DEBT EXPENSE 12567647 12567647 RECRUITING 469074 436401 32673 EDUCATION & REWARDS 382716 111149 271284 283 5115866 4265837 850029 168167068 141529747 26427661 209660 11995985 21753378 6288237 322102 24630159 18315613 5266685 1854001 3385055 3620238 3083356 7707302 238608453 143226223 90841395 95382230 33764111 45586680 2414862 4062519 74590139 83544457 256259984 282148520 15076457 16320742 0 132000 42763751 50215000 2026106 2639479 17815642 25959336 77681956 95266557 X 178375424 186679359 202604 202604 178578028 186881963 256259984 282148520 X 8027400 75137 378 201020 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 9952 9952 0 PART II-B, LINE 1: LOBBYING EXPENSES ARE INCURRED IN CONNECTION WITH THE DUES PAID TO THE OHIO HOSPITAL ASSOCIATION AND THE AMERICAN HOSPITAL ASSOCIATION. 4057257 4057257 144687176 95517864 49169312 88212431 46412267 41800164 1651589 1296092 355497 95382230 BOND ISSUE COSTS 490903 INVESTMENTS IN AFFILIATED ORG. 83053554 83544457 ACCRUED PENSION LIABILITY 3232087 PROFESSIONAL LIABILITY RESERVE 497000 FIN 47 ASBESTOS LIABILITY 2929837 THIRD PARTY PAYOR SETTLEMENTS 4519702 MINORITY INTEREST IN CONSOLIDATED SUBS 93992 FAIR VALUE OF INTEREST RATE SWAP AG 14686718 25959336 X PART X, LINE 2: ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA REQUIRE MANAGEMENT TO EVALUATE TAX POSITIONS TAKEN BY THE HOSPITAL AND RECOGNIZE A TAX LIABILITY IF THE HOSPITAL HAS TAKEN AN UNCERTAIN POSITION THAT MORE LIKELY THAN NOT WOULD NOT BE SUSTAINED UPON EXAMINATION BY THE IRS OR OTHER APPLICABLE TAXING AUTHORITIES. MANAGEMENT HAS ANALYZED THE TAX POSITIONS TAKEN BY THE HOSPITAL AND HAS CONCLUDED THAT AS OF DECEMBER 31, 2014, THERE ARE NO UNCERTAIN POSITIONS TAKEN OR EXPECTED TO BE TAKEN THAT WOULD REQUIRE RECOGNITION OF A LIABILITY OR DISCLOSURE IN THE CONSOLIDATED FINANCIAL STATEMENTS. THE HOSPITAL IS SUBJECT TO ROUTINE AUDITS BY TAXING JURISDICTIONS; HOWEVER, THERE ARE CURRENTLY NO AUDITS FOR ANY TAX PERIODS IN PROGRESS. MANAGEMENT BELIEVES IT IS NO LONGER SUBJECT TO INCOME TAX EXAMINATIONS FOR YEARS PRIOR TO 2011. 1 1 X 1 X 1 X 1 1 0 0 4186406 2826091 1360315 0.00920 21756476 14268332 7488144 0.05040 25942882 17094423 8848459 0.05960 11500354 0 11500354 0.07740 11500354 11500354 0.07740 37443236 17094423 20348813 0.13700 0 12567647 1131088 39925636 45383348 -5457712 X 1 1 1 LMHS WOMEN'S HEALTH CO-MANAGEMENT COMPANY LLC CO-MANAGEMENT 0.50000 0.50000 1 1 LIMA MEMORIAL HEALTH SYSTEM 1001 BELLEFONTAINE AVE LIMA OH 45804 X X X LIMA MEMORIAL HEALTH SYSTEM 1 0 0 1 X X X X X X X X X 13 1 0 0 1 X WWW.LIMAMEMORIAL.ORG 1 14 1 WWW.LIMAMEMORIAL.ORG 0 0 1 X 200.000000000000 300.000000000000 X X X X X 1 1 X 1 X X X 0 0 X X X X 1 X 0 0 LIMA MEMORIAL HEALTH SYSTEM PART V, SECTION B, LINE 5: COMMUNITY MEMBERS FROM THE GROUPS, ORGANIZATIONS, AND SECTORS ESTABLISHED THE COMMUNITY SUSTAINABILITY ADVISORY COMMITTEE UNDER THE LIMA-ALLEN COUNTY REGIONAL PLANNING COMMISSION. THE COMMUNITY SUSTAINABILITY ADVISORY COMMITTEE WAS RESPONSIBLE FOR THE IMPLEMENTATION OF THE HEALTHY COMMUNITIES INSTITUTE SOFTWARE, WHICH HAS BEEN USED AS THE BASIS FOR THE COMMUNITY HEALTH NEEDS ASSESSMENT. THE HEALTHY COMMUNITIES INSTITUTE WEBSITE PROVIDED A LIST OF IDENTIFIED HEALTH CONDITIONS AND RELATED INDICATORS FOR ALLEN COUNTY. THE INFORMATION FOR AUGLAIZE AND PUTNAM COUNTIES WAS ANALYZED UNDER THE SAME QUARTILE SYSTEM.ORGANIZATION'S CONTACTED:ALLEN COUNTY ECONOMIC DEVELOPMENT GROUPALLEN COUNTY HEALTH DEPARTMENTLIMA/ALLEN COUNTY CHAMBER OF COMMERCESHAWNEE TOWNSHIP POLICEST. RITA'S MEDICAL CENTERUNITED WAY OF GREATER LIMA AND YMCAIN ADDITION, LEADERS, REPRESENTATIVES, OR MEMBERS OF MEDICALLY UNDERSERVED, LOW-INCOME AND MINORITY POPULATIONS AND POPULATIONS WITH CHRONIC DISEASE NEEDS WERE CONTACTED. THE HOSPITAL ALSO DERIVES ADDITIONAL INFORMATION FROM THE COMMUNITY HEALTH IMPROVEMENT PLAN COMMITTEE AND THE HEALTHY PEOPLE 2020 COMMITTEE. LIMA MEMORIAL HEALTH SYSTEM PART V, SECTION B, LINE 11: THE HOSPITAL HAS ADOPTED AN IMPLEMENTATION STRATEGY FOR 2014-2016 THAT ADDRESSES THE COMMUNITY HEALTH NEEDS IDENTIFIED IN THE COMMUNITY HEALTH NEEDS ASSESSMENT. THIS REPORT IS POSTED ON THE HOSPITAL'S WEBSITE WWW.LIMAMEMORIAL.ORG WHICH IS PAIRED WITH THE HEALTH SYSTEM'S STRATEGIC PLAN. LIMA MEMORIAL HEALTH SYSTEM PART V, SECTION B, LINE 22D: ALL PATIENTS REGARDLESS OF THEIR ABILITY TO PAY ARE CHARGED THE SAME AMOUNT. THE FACILITY ATTEMPTS TO SCREEN ALL SELFPAY PATIENTS AND PROVIDES INFORMATION TO THEM CONCERNING CHARITY POLICIES. AT TIMES, PATIENTS ARE REQUESTED TO PROVIDE PROOF OF INCOME. OF THOSE PATIENTS THAT ARE NOT SCREENED AND DO NOT RETURN THE REQUIRED PAPERWORK, THEY ARE CHARGED FULL PRICE FOR THEIR SERVICE UNTIL PROOF OR A COMPLETED AND SIGNED APPLICATION IS RECEIVED. THE LEAST DISCOUNT RECEIVED IS 40% WHCIH IS LARGER THAN THE AVERAGE COMMERCIAL CSA. PART V, SECTION B, LINE 16 FINANCIAL ASSISTANCE POLICY WEBSITE AVAILABILITY LIMA MEMORIAL HEALTH SYSTEM PART V, SECTION B, LINE 16B WEBSITE: WWW.LIMAMEMORIAL.ORG 2 MEDICAL PARK 525 EASTOWN RD LIMA OH 45807 MRI, CT YMCA - WELLNESS CENTER 345 S ELIZABETH ST LIMA OH 45801 WELLNESS CENTER PART I, LINE 7: COLUMN C, LINE 7A & 7B: THE HOSPITAL USED A COST-TO-CHARGE COSTING METHODOLOGY TO CALCULATE THE AMOUNTS REPORTED IN LINE 7. THE HOSPITAL DERIVED THE COST-TO-CHARGE RATIO FROM THE USE OF WORKSHEET 2.PART I, LINE 7E:IN ADDITION TO LIMA MEMORIAL JOINT OPERATING COMPANY'S COMMUNITY HEALTH IMPROVEMENT SERVICES AND COMMUNITY BENEFIT OPERATIONS, THIS LINE AMOUNT ALSO INCLUDES COMMUNITY BENEFIT PROVIDED BY LIMA MEMORIAL PROFESSIONAL CORPORATION, WHICH IS A RELATED ENTITY, IN AS MUCH AS LIMA MEMORIAL PROFESSIONAL CORPORATION'S ACTIVITY, ARE CARRIED ON IN A MANNER CONSISTENT WITH AND DIRECTLY IN CONNECTION WITH THE TAX EXEMPT PURPOSE OF LIMA MEMORIAL JOINT OPERATING COMPANY. PART I, LN 7 COL(F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 24B, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE OF THIS COLUMN IS $12,567,647. PART II, COMMUNITY BUILDING ACTIVITIES: LIMA MEMORIAL HEALTH SYSTEM PROMOTES THE HEALTH OF OUR COMMUNITIES BY PROVIDING SERVICE REGARDLESS OF ABILITY TO PAY, FUNDING THROUGH SPONSORSHIP, HEALTH SCREENINGS AND EDUCATION. WE WORK WITH A NUMBER OF ORGANIZATIONS THROUGHOUT THE REGION, INCLUDING THE CHAMBER OF COMMERCE, TO PROMOTE THE ECONOMIC GROWTH OF THE COMMUNITY. WE CONTINUE TO WORK WITH THE SCHOOL OF NURSING, CONTINUING EDUCATION AND TRAINING FOR EMT'S AND PARAMEDICS. PART III, LINE 2: LIMA MEMORIAL JOINT OPERATING COMPANY COMPUTES THE AMOUNT OF BAD DEBT BASED DIRECTLY ON GROSS CHARGES. PART III, LINE 4: SECTION A: ACCOUNTS RECEIVABLE FOR PATIENTS, INSURANCE COMPANIES AND GOVERNMENTAL AGENCIES ARE BASED ON GROSS CHARGES. AN ALLOWANCE FOR CONTRACTUAL ADJUSTMENTS AND INTERIM PAYMENT ADVANCES IS BASED ON EXPECTED PAYMENT RATES FROM PAYORS BASED ON CURRENT REIMBURSEMENT METHODOLOGIES. THIS AMOUNT ALSO INCLUDES AMOUNTS RECEIVED AS INTERIM PAYMENTS AGAINST UNPAID CLAIMS BY CERTAIN PAYORS. THE ALLOWANCE FOR CONTRACTUAL ADJUSTMENTS IS REPORTED AS PART OF THE PATIENT ACOUNTS RECEIVABLE AMOUNT ON THE CONSOLIDATED BALANCE SHEET. AN ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS IS ESTABLISHED ON AN AGGREGATE BASIS BY USING HISTORICAL WRITE-OFF RATE 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 HOSPITAL'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.SECTION A, LINE 3: BAD DEBT IS ATTRIBUTABLE TO PATIENTS IDENTIFIED UNDER CHARITY CARE WAS ESTIMATED BY A THIRD PARTY THROUGH SCREENING OF BAD DEBT PATIENTS AT POVERTY LEVEL. THE HOSPITAL APPLIES ANY DISCOUNTS/PAYMENTS RECEIVED AGAINST PATIENTS ACCOUNTS BEFORE DETERMINING BAD DEBT EXPENSE. PART III, LINE 8: SECTION B: BASED ON A COST-TO-CHARGE RATIO DETERMINED IN ACCORDANCE WITH THE MEDICARE COST REPORT REQUIREMENTS, THE COSTS OF PROVIDING CARE TO THE MEDICARE POPULATION IN 2014 WAS $45,383,348. THE PAYMENTS RELATED TO THESE SERVICES WERE $39,925,636. LEAVING A MEDICARE SHORTFALL OF $5,457,712 FOR THE YEAR. THE MEDICARE SHORTFALL IS A COMMUNITY BENEFIT BECAUSE PROVIDING SERVICES TO THE ELDERLY IS A TAX EXEMPT PURPOSE CONSISTENT WITH LIMA MEMORIAL JOINT OPERATING COMPANY'S OVERALL EXEMPT STATUS, AND THE HOSPITAL ACCEPTS THESE PATIENTS REGARDLESS OF ITS IMPACT ON OVERALL PROFITABILITY. PART III, LINE 9B: SECTION C: PATIENTS DO NOT RECEIVE ANY NOTICE FROM LMH UNTIL BALANCES ARE DETERMINED TO BE THE PATIENT'S RESPONSIBILITY. ONCE AN FAP APPLICATION IS RECEIVED THE COLLECTION PROCESS IS PUT ON HOLD UNTIL ELIGIBILITY IS DETERMINED. PRIMARY SELF-PAY ACCOUNTS ARE REFERRED TO AN OUTSIDE AGENCY AS AN EXTENSION OF THE BUSINESS OFFICE AT DAY 45. ACCOUNTS REMAIN WITH THE AGENCY UNTIL IT IS AT A ZERO BALANCE OR 150 DAYS. AT 150 DAYS THE ACCOUNT IS CLOSED BACK AND GIVEN TO THE SUBSEQUENT AGENCY FOR REGULAR COLLECTION FOLLOW UP. BALANCE AFTER INSURANCE ACCOUNTS ARE REFERRED TO AN OUTSIDE AGENCY ONCE ANY MONEY IS MOVED INTO SELF-PAY. THE ACCOUNT IS KEPT FOR A MINIMUM OF 90 DAYS AND THEN REFERRED TO A COLLECTION AGENCY. PART VI, LINE 2: LIMA MEMORIAL HEALTH SYSTEM (LMHS) REGULARLY PARTICIPATES IN COMPREHENSIVE COMMUNITY HEALTH NEEDS ASSESSMENTS TO IDENTIFY FAR-REACHING HEALTH NEEDS FACED BY PEOPLE IN THE COMMUNITIES SERVED BY THE HEALTH SYSTEM. ASSESSMENT RESULTS ARE EVALUATED OVER TIME AND SERVE AS THE BASIS TO DEVELOP NEW OR EXPANDED PLANS TO ADDRESS SERVICES IN RESPONSE TO NEEDS.LMHS JOINED OTHER AREA ORGANIZATIONS TO DEVELOP, IMPLEMENT AND UTILIZE THE 2014 ALLEN COUNTY COMMUNITY HEALTH NEEDS ASSESSMENT. THE NEEDS ASSESSMENT COLLECTED DATA FOR ALLEN COUNTY ADULTS (AGES 19 YEARS OF AGE AND OLDER) AND YOUTH (AGES 12 THROUGH 18) WHO PARTICIPATED IN A COUNTY-WIDE ASSESSMENT SURVEY DURING 2013-2014. THE FINDINGS ARE BASED ON SELF-ADMINISTERED SURVEYS USING A STRUCTURED QUESTIONNAIRE. THE QUESTIONS WERE MODELED AFTER SURVEY INSTRUMENTS USED BY THE CENTERS FOR DISEASE CONTROL AND PREVENTION FOR THEIR NATIONAL AND STATE BEHAVIORAL RISK FACTOR SURVEILLANCE SYSTEM AND YOUTH RISK BEHAVIOR SURVEILLANCE SYSTEM.THE SURVEY ASSESSED THE FOLLOWING AREAS: COMMUNITY CONCERNS AND SERVICES, PHYSICAL HEALTH ISSUES AND BEHAVIORAL HEALTH ISSUES. FOR AREAS OUTSIDE OF ALLEN COUNTY, LIMA MEMORIAL UTILIZES DATA FROM ADDITIONAL COUNTY-BASED NEEDS ASSESSMENT WHEN AVAILABLE. SURVEY RESULTS ARE BEING USED TO SHAPE COMMUNITY OUTREACH EFFORTS.IN 2014, LIMA MEMORIAL WAS INVOLVED WITH PIONEERING HEALTHY COMMUNITIES THROUGH PARTICIPATION AND FUNDING IN CONJUNCTION WITH THE CITY OF LIMA AND THE ALLEN COUNTY YMCA. A PORTION OF THIS PROGRAM IS DEDICATED TO REVIEWING THE NEEDS AND RISKS OF ALLEN COUNTY. OBESITY, ESPECIALLY CHILDHOOD OBESITY, WAS DETERMINED TO BE A SIGNIFICANT HEALTH RISK. LIMA MEMORIAL HEALTH SYSTEM IS PART OF THE COMMUNITY SUSTAINABILITY ADVISORY COMMITTEE, WHICH ADDRESSES A VARIETY OF HEALTH-RELATED NEEDS IN THE COMMUNITIES WE SERVE. THIS COMMITTEE'S GOAL IS TO INCREASE THE NUMBER OF ADULTS WHO ARE AT A HEALTHY WEIGHT BY AT LEAST TWO PERCENTAGE POINTS BY 2020.ASSESSMENT SUMMARYDESIRED OUTCOMES FOR ALLEN COUNTY RESIDENTS: REDUCE RISK FOR CHRONIC DISEASE, REDUCE POOR BIRTH OUTCOMES (E.G. LOW BIRTHWEIGHT AND PRETERM DELIVERIES), REDUCE INFANT MORTALITY, REDUCE SUICIDE RATE, REDUCE SUBSTANCE ABUSE, AND INCREASE ACCESS TO HEALTH CARE. PART VI, LINE 3: ALL PATIENTS OF LIMA MEMORIAL HOSPITAL ARE EDUCATED ON THE HOSPITAL'S CHARITY CARE PROGRAM DURING THE REGISTRATION PROCESS VIA WALL-POSTED STATEMENTS, HOSPTIAL PERSONNEL INQUIRIES, ETC. INFORMATION REGARDING THE HOSPITIAL'S CHARITY CARE IS ALSO FOUND ON LIMA MEMORIAL'S WEBSITE. STATEMENTS GOING TO PATIENTS ALSO IDENTIFY THIS PROGRAM. PART VI, LINE 4: AS OF THE CENSUS OF 2000, THERE WERE 108,473 PEOPLE, 40,646 HOUSEHOLDS, AND 28,208 FAMILIES RESIDING IN THE COUNTY. THE POPULATION DENSITY WAS 268 PEOPLE PER SQUARE MILE. THERE WERE 44,245 HOUSING UNITS AT AN AVERAGE DENSITY OF 109 PER SQUARE MILE. THE RACIAL MAKEUP OF THE COUNTY WAS 84.95% CAUCASIAN, 12.19% AFRICAN AMERICAN, 0.21% NATIVE AMERICAN, 0.55% ASIAN, 0.01% PACIFIC ISLANDER, 0.63% FROM OTHER RACES, AND 1.45% FROM TWO OR MORE RACES. 1.42% OF THE POPULATION WERE HISPANIC/LATINO, 33.8% WERE GERMAN, 14.2% AMERICAN, 8.8% IRISH AND 6.6% ENGLISH ANCESTRY ACCORDING TO THE CENSUS 2000. THERE WERE 40,646 HOUSEHOLDS OUT OF WHICH 32.9% HAD CHILDREN UNDER THE AGE OF 18 LIVING WITH THEM, 53% WERE MARRIED COUPLES LIVING TOGETHER, 12.4% HAD A FEMALE HOUSEHOLDER WITH NO HUSBAND PRESENT AND 30.6% WERE NON-FAMILIES. 26.3% OF ALL HOUSEHOLDS WERE MADE UP OF INDIVIDUALS AND 11.2% HAD SOMEONE LIVING ALONE WHO WAS 65 YEARS OF AGE OR OLDER. THE AVERAGE HOUSEHOLD SIZE WAS 2.52 AND THE AVERAGE FAMILY SIZE WAS 3.05. IN THE COUNTY THE POPULATION WAS SPREAD OUT WITH 25.9% UNDER THE AGE OF 18, 9.9% FROM 18 TO 24, 27.6% FROM 25 TO 44, 22.4% FROM 45 TO 64, AND 14.2% WHO WERE 65 YEARS OF AGE OR OLDER. THE MEDIAN AGE WAS 36 YEARS. FOR EVERY 100 FEMALES THERE WERE 100 MALES. FOR EVERY 100 FEMALES AGE 18 AND OVER THERE WERE 98 MALES. THE MEDIAN INCOME FOR A HOUSEHOLD IN THE COUNTY WAS $37,048 AND THE MEDIAN INCOME FOR A FAMILY WAS $44,723. MALES HAD A MEDIAN INCOME OF $35,546 VERSUS $23,537 FOR FEMALES. THE PER CAPITA INCOME FOR THE COUNTY WAS $17,511. ABOUT 9.6% OF FAMILIES AND 12.1% OF THE POPULATION WERE BELOW THE POVERTY LINE, INCLUDING 17% OF THOSE UNDER AGE 18 AND 9.6% OF THOSE AGE 65 OR OVER. LIMA MEMORIAL HEALTH SYSTEM SERVES A 10 COUNTY AREA THAT INCLUDES MORE THAN 475,000 PEOPLE. THE COUNTIES INCLUDE ALLEN, AUGLAIZE, PUTNAM, HANCOCK, MERCER, HARDIN, LOGAN, SHELBY, PAULDING AND VAN WERT. THE MEDIAN HOUSEHOLD INCOME FOR THE REGION IS $44,300. 24% OF RESIDENTS ARE UNDER 18 YEARS OLD, WHILE 14.5% OF RESIDENTS ARE 65 YEARS OLD OR OLDER. 95.4% OF OUR ENTIRE SERVICE AREA IS CAUCASIAN, WHILE 2.75% ARE AFRICAN AMERICAN. IN OUR PRIMARY SERVICE AREA OF ALLEN COUNTY 85.6% ARE CAUCASIAN, WHILE 11.7% ARE AFRICAN AMERICAN. THE REGION IS PRIMARILY RURAL WITH SMALL COMMUNITIES. THE LARGEST CITY IN THE REGION IS LIMA WITH A POPULATION OF 38,771. PART VI, LINE 5: LIMA MEMORIAL HEALTH SYSTEM CONTINUES TO INCREASE OUR COMMUNITY INVESTMENT THROUGH PARTICIPATION AND SPONSORSHIP OF LOCAL AND REGIONAL EVENTS THAT PROMOTE HEALTHY LIFESTYLE CHOICES, PREVENTATIVE CARE AND CHRONIC DISEASE MANAGEMENT.BEYOND THE NUMBERS: KEY COMMUNITY BENEFIT ACTIVITIES OF 2014LIMA MEMORIAL HEALTH SYSTEM DEVELOPS PROGRAMS AND SERVICES TO ADDRESS COMMUNITY HEALTH NEEDS AND MAKES INVESTMENTS IN INITIATIVES THAT ALIGN WITH OUR MISSION, VISION AND VALUES. MUCH OF LIMA MEMORIAL HEALTH SYSTEM'S COMMUNITY BENEFIT INVESTMENT FOR 2014 WAS IN THE AREA OF CHARITABLE CARE AND WELLNESS. THIS ENABLED THOSE WITHOUT INSURANCE OR WITH LIMITED INSURANCE TO ACCESS MEDICAL CARE AND SCREENING HEALTH TESTS.BEYOND THAT FOCUS ARE PROGRAMS AND SERVICES THAT BENEFIT EVERY RESIDENT AND SUPPORT THE FAR REACHING GOAL OF A HEALTHIER WEST CENTRAL OHIO. LIMA MEMORIAL HEALTH SYSTEM CANNOT MEET ALL OF THE HEALTHCARE NEEDS WITHOUT THE ENGAGEMENT AND SUPPORT OF KEY STAKEHOLDERS INCLUDING OUR MEDICAL STAFF AND OTHER COMMUNITY ORGANIZATIONS.COMMUNITY HEALTH SERVICESIN 2014, LIMA MEMORIAL HEALTH SYSTEM PROVIDED AND/OR PARTICIPATED IN NUMEROUS COMMUNITY HEALTH SERVICE PROGRAMS. INCLUDED IN THIS CATEGORY ARE HEALTH AND WELLNESS EDUCATION, HEALTH SCREENINGS, COMMUNITY DEVELOPMENT AND SERVICES TO HELP PEOPLE ADOPT HEALTHY LIFESTYLE CHANGES. ALSO INCLUDED ARE THE MYRIAD OF SUPPORT GROUP ACTIVITIES THAT HELP PATIENTS AND THEIR FAMILIES MANAGE CHRONIC HEALTH CONDITIONS.KEY INIATIVES THE PAST YEAR INCLUDE DIAGNOSTIC HEART AND VASCULAR SCREENINGS FOR AT-RISK ADULTS, CHILDHOOD DIABETES EDUCATION IN AREA SCHOOLS, INJURY PREVENTION AND AWARENESS, BREAST AND LUNG SCREENINGS AND HEALTHY EATING EVENTS.A THIRD SUBSET OF THIS CATEGORY INCLUDES HEALTH CARE SUPPORT SERVICES, OR THOSE SERVICES THAT ARE PROVIDED TO ASSIST COMMUNITY MEMBERS IN ACCESSING BOTH INFORMATOIN AND THE MEDICAL CARE THAT THEY NEED. CHIEF AMONG THE HEALTH SYSTEM'S SUPPORT INITIATIVES ARE THE FINANCIAL COUNSELORS THAT ENSURE THAT PATIENTS WHO ARE STRUGGLING FINANCIALLY AND/OR LACK MEDICAL INSURANCE ARE AFFORDED THE CARE THAT THEY NEED.HEALTH PROFESSIONS EDUCATIONLIMA MEMORIAL HEALTH SYSTEM BELIEVES THAT HAVING HIGHLY TRAINED MEDICAL PERSONNEL BENEFITS EVERYONE IN THE COMMUNITY. BEYOND ONGOING EDUCATION FOR PHYSICIANS, NURSES, TECHNICIANS, AND OTHER CLINICIANS, THE HEALTH SYSTEM SUPPORTED NUMEROUS SPECIAL INITIATIVES IN 2014 TO FURTHER CAPABILITIES OF AREA MEDICAL PERSONNEL.OUR SCHOOLS OF NURSING PROGRAM PROVIDED A TRAINING SITE FOR OVER 450 NURSING STUDENTS IN 2014. LIMA MEMORIAL HEALTH SYSTEM ALSO PROVIDES EDUCATIONAL SUPPORT IN THE MEDICAL COMMUNITY BY PROVIDING HUNDREDS OF HOURS OF TRAINING FOR AREA EMT'S AND PARAMEDICS. FINANCIAL CONTRIBUTIONSLIMA MEMORIAL PROVIDES BOTH CASH AND IN-KIND SUPPORT TO INDIVIDUALS AND OTHER COMMUNITY ORGANIZATIONS. THE SPONSORSHIP FUND PROVIDES FUNDING SUPPORT TO WEST CENTRAL OHIO PROGRAMS THAT ADDRESS IDENTIFIED COMMUNITY NEEDS AND SERVE VULNERABLE POPULATIONS. IN 2014, LIMA MEMORIAL CONTRIBUTED TO MORE THAN 55 ORGANIZATIONS INCLUDING MARCH OF DIMES, YMCA OF LIMA, AMERICAN CANCER SOCIETY, THE UNITED WAY AND THE AMERICAN RED CROSS.COMMUNITY BENEFIT OPERATIONSFOR 2014, COMMUNITY BENEFITS EXPENSES RECORDED INCLUDES THE REPORT ON THE HEALTH SYSTEM'S COMMUNITY BENEFIT INVESTMENT. THE APPLICABLE COSTS FOR STAFF ENGAGING IN ACTUAL COMMUNITY BENEFIT SERVICES AND PROGRAMMING ARE REPORTED WITHIN SPECIFIC INITIATIVES AND ACTIVITIES.CHARITY CAREIN ACCORDANCE WITH REPORTING REQUIREMENTS, LIMA MEMORIAL'S CHARITY CARE EXPENSE IS BASED UPON COSTS VERSUS CHARGES. CHARITY CARE INCLUDES LIMA MEMORIAL'S TRADITIONAL INPATIENT AND EMERGENCY SERVICES. UPON APPROVAL FOR FINANCIAL ASSISTANCE, ALL HOSPITAL CARE IN THE ENSUING SIX MONTH PERIOD IS INCLUDED. THIS APPROACH ENSURES THAT ASSISTANCE IS PORTABLE AND THAT PATIENTS HAVE ACCESS TO NEEDED MEDICAL SERVICES BY MAKING A SINGLE APPLICATION.A KEY GOAL IS TO IDENTIFY COMMUNITY MEMBERS IN NEED SOONER. THE RESULT IS MORE CHARITY CARE AND FEWER BAD DEBTS.GOVERNEMENT SPONSORED HEALTHCAREPAYMENT SHORTFALLS FOR PUBLIC INSURANCE PROGRAMS, INCLUDING MEDICAID AND MEDICARE, WERE $12,945,856 IN 2014. PART VI, LINE 6: LIMA MEMORIAL HEALTH SYSTEM DEVELOPS PROGRAMS AND SERVICES TO ADDRESS COMMUNITY HEALTH NEEDS TO SUPPORT THE GOAL OF A HEALTHIER WEST CENTRAL OHIO. PART VI, LINE 7, REPORTS FILED WITH STATES OH 1 ALLEN COUNTY VISIONARIES PO BOX 176 LIMA OH 45802 341740545 501(C)3 5000 COMMUNITY DEVELOPMENTCOMMUNITY DEVELOPMENT/HEALTH AND WELLNESS LIMA AREA FAMILY YMCA 345 S ELIZABETH ST LIMA OH 45801 344431173 501(C)3 266744 COMMUNITY DEVELOPMENT/HEALTH AND WELLNESS LIMA SYMPHONY ORCHESTRA 133 N ELIZABETH ST LIMA OH 45807 344465022 501(C)3 5800 COMMUNITY DEVELOPMENT SUPPORTING ARTS AMERICAN RED CROSS 610 S COLLET ST LIMA OH 45805 530196605 501(C)3 10000 COMMUNITY DEVELOPMENT/HEALTH AND WELLNESS LIMA MEMORIAL FOUNDATION 1001 BELLEFONTAINE AVE LIMA OH 45804 341707570 501(C)3 10000 HEALTH INITIATIVE ALLEN COUNTY AGRICULTURAL SOCIETY 2750 HARDING HIGHWAY LIMA OH 45804 346570403 501(C)3 15950 COMMUNITY DEVELOPMENT ALLEN LIMA LEADERSHIP 144 S MAIN ST SUITE 100 LIMA OH 45801 341536300 501(C)3 10000 COMMUNITY DEVELOPMENT LIMA ALLEN CO REGIONAL PLANNING COMMISSION 130 W NORTH STREET LIMA OH 45801 341162237 GOVT 5000 COMMUNITY DEVELOPMENT/HEALTH AND WELLNESS UNITED WAY 616 S COLLETT ST SUITE 101 LIMA OH 45805 344466356 501(C)3 14051 COMMUNITY DEVELOPMENT 8 1 PART I, LINE 2: IN MOST CASES THE EFFECTIVE USE OF FUNDS IS EVIDENT THROUGH THE POSITIVE RESULTS OF THE PROGRAMS WE FUND. IN ADDITION, LIMA MEMORIAL HAS BOARD REPRESENTATION ON MOST OF THE ORGANIZATIONS WE SUPPORT. IF THIS IS NOT THE CASE WE DO ASK FOR THEIR BUSINESS PLAN AND A LIST OF EXPENDITURES. PART II LIMA ALLEN COUNTY REGIONAL PLANNING COMMISSION IS A GOVERNMENTAL ENTITY. X 1 1 X X X X X 0 1 0 0 0 0 0 0 0 LAWRENCE D BELL MD BOARD MEMBER (SEE SCH J) 0 285246 0 0 0 0 0 7800 0 4327 0 297373 0 0 MICHAEL D SWICK PRESIDENT/CEO (SEE SCH J) 335785 0 191032 0 14490 0 206223 0 21637 0 769167 0 0 0 ROBERT E ARMSTRONG JR SENIOR VP/COO (SEE SCH J) 221237 0 92028 0 6282 0 85840 0 21637 0 427024 0 0 0 ERIC D POHJALA VP OF FINANCE/CFO (SEE SCH 211804 0 85715 0 5644 0 81021 0 25926 0 410110 0 0 0 KHA H TRAN MD VP OF MEDICAL AFFAIRS (SEE 184659 0 42543 0 6191 0 55381 0 25926 0 314700 0 0 0 ANN-MARIE JEAN POHL VICE PRESIDENT/CNO (SEE SC 151825 0 63784 0 4834 0 58264 0 0 0 278707 0 0 0 ANITA GOOD ADMINISTRATIVE DIRECTOR 126613 0 17659 0 1368 0 4446 0 20740 0 170826 0 0 0 MARK W RECKER DIRECTOR OF PHARMACY 137380 0 12639 0 796 0 4579 0 10370 0 165764 0 0 0 LYNN C CARPENTER ADMINISTRATIVE DIRECTOR 129815 0 18566 0 6037 0 4767 0 21637 0 180822 0 0 0 CHERYL V HOMAN ADMINISTRATIVE DIRECTOR 120895 0 17388 0 2843 0 4320 0 17310 0 162756 0 0 0 VICKI J SUNDERLAND ADMINISTRATIVE DIRECTOR 120383 0 15923 0 1208 0 4249 0 17310 0 159073 0 0 0 PART I, LINE 1A LIMA MEMORIAL JOINT OPERATING COMPANY PROVIDES SOCIAL CLUB DUES TO THE CEO; THEY ARE TREATED AS TAXABLE COMPENSATION. PART I, LINE 4B THE FOLLOWING INDIVIDUALS PARTICIPATED IN AN IRC 457(F) NON-QUALIFIED DEFERRED COMPENSATION PLAN. THIS PLAN IS FUNDED BY THE HOSPITAL AND VESTS WITH SERVICE THEREFORE IS SUBJECT TO RISK OF FORFEITURE. ERIC D. POHJALA: $40,121 ROBERT E. ARMSTRONG, JR.: $44,940 MICHAEL D. SWICK:$165,323 KHA H. TRAN, MD: $15,508 ANN-MARIE JEAN POHL: $19,555 A OHIO HIGHER EDUCATION FACILITY COMM 346849674 2014-02-20 50215000 CONSTRUCTION OF HOSPITAL FACILITIES 0 0 0 A 50215000 1385653 7183784 41645563 2014 1 0 0 1 A 0 1 1 1 0 0.01900 0.00000 0.01900 0 0 1 A 0 0 1 0 1 1 PNC BANK NATIONAL ASSOCIATION 30.400000000000 0 0 0 0 0 A 1 JJ JOHNSON J.J. JOHNSON IS THE SON OF BOARD MEMBER JOHN JOHNSON 56935 EMPLOYMENT 0 FORM 990, PART VI, SECTION A, LINE 6 THE MEMBERS ARE LIMA MEMORIAL HOSPITAL AND PH VENTURES, INC., WHOSE SOLE MEMBER IS PROMEDICA HEALTH SYSTEM, BOTH OHIO NONPROFIT CORPORATIONS. FORM 990, PART VI, SECTION B, LINE 11 THE AUDIT COMMITTEE OF THE BOARD REVIEWS AND APPROVES THE FORM 990, AND A COPY OF THE FORM 990 IS PROVIDED TO THE BOARD, PRIOR TO FILING. THIS PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. FORM 990, PART VI, SECTION B, LINE 12C EACH TRUSTEE, PRINCIPAL OFFICER, AND MEMBER OF A COMMITTEE WITH BOARD-DELEGATED POWERS SHALL ANNUALLY SIGN A STATEMENT WHICH AFFIRMS THAT SUCH PERSON: 1) HAS RECEIVED A COPY OF THE CONFLICTS OF INTEREST POLICY; 2) HAS READ AND UNDERSTANDS THE POLICY; 3) HAS AGREED TO COMPLY WITH THE POLICY; AND 4) UNDERSTANDS THAT THE CORPORATION IS A CHARITABLE ORGANIZATION AND THAT IN ORDER TO MAINTAIN ITS FEDERAL TAX EXEMPTION, IT MUST ENGAGE PRIMARILY IN ACTIVITIES WHICH ACCOMPLISH ONE OR MORE OF ITS TAX-EXEMPT PURPOSES. IF THE BOARD OR COMMITTEE HAS REASONABLE CAUSE TO BELIEVE THAT A MEMBER HAS FAILED TO DISCLOSE ACTUAL OR POSSIBLE CONFLICTS OF INTEREST, IT SHALL INFORM THE MEMBER OF THE BASIS FOR SUCH BELIEF AND AFFORD THE MEMBER AN OPPORTUNITY TO EXPLAIN THE ALLEGED FAILURE TO DISCLOSE. IF, AFTER HEARING THE RESPONSE OF THE MEMBER AND MAKING SUCH FURTHER INVESTIGATION AS MAY BE WARRANTED IN THE CIRCUMSTANCES, THE BOARD OR COMMITTEE DETERMINES THAT THE MEMBER HAS IN FACT FAILED TO DISCLOSE AN ACTUAL OR POSSIBLE CONFLICT OF INTEREST, IT SHALL TAKE APPROPRIATE DISCIPLINARY AND CORRECTIVE ACTION. FORM 990, PART VI, SECTION B, LINE 15 THE PROCESS FOR DETERMINING THE ORGANIZATION'S CEO, OTHER OFFICERS AND KEY EMPLOYEES' COMPENSATION INCLUDES: 1) REVIEW AND APPROVAL BY THE COMPENSATION COMMITTEE; 2) THE UTILIZATION OF AN INDEPENDENT COMPENSATION CONSULTANT; 3) COMPARABLE DATA; AND 4) CONTEMPORANEOUS DOCUMENTATION. THIS PROCESS WAS LAST COMPLETED IN 2014. FORM 990, PART VI, SECTION C, LINE 19 THE GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE CURRENTLY NOT AVAILABLE TO THE PUBLIC. THE FINANCIAL STATEMENTS ARE FILED WITH THE RETURN AS REQUIRED. FORM 990, PART IX, LINE 11G PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 8,556,819. MANAGEMENT AND GENERAL EXPENSES 7,069,900. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 15,626,719. MAINTENANCE FEES: PROGRAM SERVICE EXPENSES 4,576. MANAGEMENT AND GENERAL EXPENSES 21. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 4,597. TRAVEL AGENCY FEES: PROGRAM SERVICE EXPENSES 474. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 474. CONSULTING FEES: PROGRAM SERVICE EXPENSES 20,395. MANAGEMENT AND GENERAL EXPENSES 161,939. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 182,334. COLLECTION FEES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 1,069,935. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,069,935. EQUIPMENT RENTAL FEES: PROGRAM SERVICE EXPENSES 975,284. MANAGEMENT AND GENERAL EXPENSES 733,192. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,708,476. FREIGHT: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 292,087. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 292,087. WASTE REMOVAL: PROGRAM SERVICE EXPENSES 608. MANAGEMENT AND GENERAL EXPENSES 50,560. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 51,168. COURTESY TRANSPORTATION FEES: PROGRAM SERVICE EXPENSES 144,217. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 144,217. CLEANING FEES: PROGRAM SERVICE EXPENSES 127,198. MANAGEMENT AND GENERAL EXPENSES 66,638. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 193,836. PHYSICIAN FEES: PROGRAM SERVICE EXPENSES 2,748,439. MANAGEMENT AND GENERAL EXPENSES 149,117. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,897,556. CORPORATE FEES: PROGRAM SERVICE EXPENSES 185,039. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 185,039. FORM 990, PART XI, LINE 9: IMPLEMENTATION OF NEW ACCOUNTING PRONOUNCEMENT -121,345. INVESTMENT IN LMHS WOMEN'S HEALTH CO-MANAGEMENT K-1 -9,292. RESTRICTED CONTRIBUTIONS 331,657. FORM 990, PART XI, LINE 2C EXPLANATION: THE AUDIT COMMITTEE ASSUMES RESPONSIBILITY FOR THE OVERSIGHT OF THE AUDIT AND THE SELECTION OF THE INDEPENDENT ACCOUNTANT. THIS PROCESS HAS NOT CHANGE FROM THE PRIOR YEAR. FORM 990, SUPPLEMENTAL FINANCIAL INFORMATION THE CALCULATION RECONCILES THE ORGANIZATION'S OPERATIONS TO THE LIMA MEMORIAL HEALTH SYSTEM'S CONSOLIDATED FINANCIAL STATEMENTS. GAIN (LOSS) FROM OPERATIONS LMH $ 14,430,862 LMP $(10,218,214) ELM TREE $( 106,204) TOTAL GAIN (LOSS) FROM OPERATIONS $ 4,106,444 NON-OPERATING REVENUES, NET* $ 768,536 INTEREST RATE SWAP $(7,104,769) AUDITED EXCESS REVENUE $(2,229,789) NET ASSETS RELEASED FROM RESTRICTION $ - PPA $( 377) NET $(2,230,166) OTHER 990 ADJUSTMENTS WOMEN'S HEALTH K-1 $ 9,292 UNREALIZED GAIN/LOSS $(75,137) ADA MEDICAL K-1 $ - CARDINAL HEALTH K-1 $(71,942) TOTAL OTHER 990 ADJUSTMENTS $( 137,787) NET $(2,367,953) LMJOC 990 PART 1, LINE 19 $ 8,027,400 LLP 990 PART 1, LINE 19 $(10,217,214) ELM TREE 1120 LINE 30 $( 106,197) LMH 990EZ PART 1, LINE 18 $( 71,942) NET TAX RETURNS $(2,367,953) DIFFERENCE: FINANCIAL STATEMENTS VS TAX RETURN $ - * INCLUDES UNREALIZED GAIN/LOSS OF $75,137 LIMA MEMORIAL HOSPITAL 1001 BELLEFONTAINE AVENUE LIMA OH 45804 344434676 HEALTHCARE OH 501(C)(3) 170(B)(1)(A)(III) LIMA MEMORIAL JOINT OPERATING COMPANY 1 LIMA MEMORIAL HOSPITAL FOUNDATION 1001 BELLEFONTAINE AVENUE LIMA OH 45804 341707570 SUPPORTING ORGANIZATION FOR LIMA MEMORIAL HOSPITAL OH 501(C)(3) 509(A)(3) LIMA MEMORIAL JOINT OPERATING COMPANY 1 LIMA MEMORIAL HOSPITAL AUXILIARY 1001 BELLEFONTAINE AVENUE LIMA OH 45804 341694632 SUPPORTING ORGANIZATION FOR LIMA MEMORIAL HOSPITAL OH 501(C)(3) 509(A)(3) LIMA MEMORIAL JOINT OPERATING COMPANY 1 LIMA MEMORIAL PROFESSIONAL CORPORATION 1001 BELLEFONTAINE AVENUE LIMA OH 45804 341935236 HEALTHCARE OH 501(C)(3) 170(B)(1)(A)(III) LIMA MEMORIAL JOINT OPERATING COMPANY 1 LMHS WOMEN'S HEALTH CO-MANAGEMENT COMPANY LLC 1001 BELLEFONTAINE AVE LIMA OH 45804 271023520 WOMEN'S HEALTH CO-MANAGEMENT OH LIMA MEMORIAL JOINT OPERATING COMPANY RELATED 9292 83435 0 1 0.50000 ELM TREE FOUNDATION 1220 EAST ELM STREET LIMA OH 45804 341417720 RENTAL REAL ESTATE OH LIMA MEMORIAL JOINT OPERATING COMPANY C 824683 6287882 1.00000 1 0 1 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 LIMA MEMORIAL HOSPITAL FOUNDATION S 331657 EQUITY TRANSFER LIMA MEMORIAL PROFESSIONAL CORPORATION R 9964890 EQUITY TRANSFER LIMA MEMORIAL PROFESSIONAL CORPORATION J 1074379 LEASE CONTRACT ELM TREE FOUNDATION K 230043 LEASE CONTRACT ELM TREE FOUNDATION Q 150000 CASH TRANSACTION