2014-11-11T09:32:08-06:00 2013-12-31 381357951 PLANTE & MORAN PLLC 65 EAST STATE ST STE 600 COLUMBUS OH 43215 990 2013-01-01 341883284 LIMA MEMORIAL JOINT OPERATING COMPANY LIMA 4192283335 1001 BELLEFONTAINE AVENUE LIMA OH 45804 ERIC D POHJALA VICE PRESIDENT OF FINANCE 4192283335 2014-10-30 1 BERNIE OSTROWSKI P00366367 6148493000 2013 2015-11-30 17:44:51Z LIMA MEMORIAL HEALTH SYSTEM MICHAEL SWICK 1001 BELLEFONTAINE AVENUE LIMA OH 45804 179728514 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 9 1588 306 1286182 -15914 55854 75281 171576480 169440717 954395 5563006 2121616 4559812 174708345 179638816 421361 397969 0 0 72417822 70289580 4705 6115 168254 88135063 89995943 160978951 160689607 13729394 18949209 241603603 256259984 83792469 77681956 157811134 178578028 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 134922969 397969 172714347 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 2013, 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 2013 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 134922969 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 0 1 0 0 0 0 0 0 1 1 1 0 0 1 219 0 1 1588 1 1 1 0 0 0 0 0 0 0 0 0 X 11 9 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 121 W HIGH ST LIMA OH 45801 JOHN H JOHNSON CHAIRPERSON 1.00 0.00 X X 0 0 0 BARBARA STEELE VICE-CHAIR 1.00 0.00 X X 0 0 0 KERMIT STROH TREASURER 1.00 1.00 X X 0 0 0 BARRETT 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 525650 15064 DEBRA MCCURDY PHD 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 RAFAEL A NIVAR MD BOARD MEMBER 1.00 0.00 X 0 0 0 KATHLEEN M KRUGER BOARD MEMBER 1.00 0.00 X 0 0 0 SUSAN E PAYDEN SECRETARY 1.00 0.00 X X 0 0 0 MICHAEL SWICK PRESIDENT/CEO (SEE SCH J) 34.00 6.00 X 524536 0 219826 ROBERT E ARMSTRONG JR SENIOR VP/COO (SEE SCH J) 30.00 10.00 X 311577 0 102432 ERIC D POHJALA VP OF FINANCE/CFO (SEE SCH 34.00 6.00 X 296053 0 105669 CHARLES LYNN THOMPSON MD VICE PRESIDENT/CMO (SEE SC 20.00 20.00 X 336806 0 107663 KHA H TRAN MD VP OF MEDICAL AFFAIRS (SEE SCH J) 20.00 20.00 X 107645 88716 50287 ANN-MARIE JEAN POHL VICE PRESIDENT/CNO (SEE SC 40.00 0.00 X 210411 0 55281 ANITA GOOD ADMINISTRATIVE DIRECTOR (S 40.00 0.00 X 141532 0 26582 MARK RECKER DIRECTOR OF PHARMACY 40.00 0.00 X 145513 0 15562 LYNN CARPENTER ADMINISTRATIVE DIRECTOR 4.00 36.00 X 155309 0 23297 CHERYL HOMAN ADMINISTRATIVE DIRECTOR 40.00 0.00 X 138445 0 19063 KYLE J ERFORD ADMINISTRATIVE DIRECTOR 40.00 0.00 X 132719 0 4115 2500546 614366 744841 38 0 1 0 LIMA ANESTHESIA & PAIN TREATMENT PC PO BOX 33058 PALM BEACH GARDENS FL 33420 MEDICAL SERVICES 3542865 EMERGENCY PHYSICIANS OF NORTHWEST OHIO PO BOX 12490 TOLEDO OH 43606 MEDICAL SERVICES 1319898 NORTH CENTRAL OHIO PHYSICIAN SERVICES 1005 BELLEFONTAINE AVE LIMA OH 45804 MEDICAL SERVICES 1025000 APOGEE MEDICAL MANAGEMENT INC 2525 E CAMELBACK RD PHOENIX AZ 85016 MEDICAL SERVICES 1010058 MAYO COLLABORATIVE SERVICES PO BOX 4100 ROCHESTER MN 55903 MEDICAL SERVICES 1004961 40 56932 18349 75281 PATIENT SERVICE REV 621110 168467632 168467632 RENT FROM AFFILIATE 900099 973085 973085 169440717 5558328 5558328 734677 0 734677 734677 734677 94376 89698 4678 4678 4678 REFERENCE LAB 541380 1286182 1286182 EDUCATIONAL SERVICES 621110 28097 28097 LMHS WOMEN'S HEALTH CO-MGMT K-1 525990 -3903 -3903 2514759 2514759 3825135 179638816 172714347 1286182 5563006 X 397969 397969 1564200 1564200 54766562 43692741 10923185 150636 1564182 1251346 312836 8250003 6600002 1650001 4144633 3315706 828927 903101 722481 180620 94395 75516 18879 6115 6115 25697046 20557637 5139409 380191 303735 75934 522 6452822 5155002 1288750 9070 2265079 1812063 453016 583408 465241 116310 1857 2051569 1641255 410314 10832006 8665605 2166401 876176 700941 175235 MEDICAL SUPPLIES 26004358 26004358 BAD DEBT EXPENSE 12137310 12137310 RECRUITING 986367 838412 147955 EDUCATION & REWARDS 396979 317551 79388 40 335136 268098 67024 14 160689607 134922969 25598384 168254 8239350 11995985 6308008 6288237 23787677 24630159 4147448 5266685 3495729 3385055 3266442 3083356 224790248 133948853 94639299 90841395 30458030 33764111 1703202 2414862 65558418 74590139 241603603 256259984 14956552 15076457 44433750 42763751 2790032 2026106 21612135 17815642 83792469 77681956 X 157730557 178375424 80577 202604 157811134 178578028 241603603 256259984 X 18949209 1462486 20 355179 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 10127 10127 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. 4222316 4222316 137913194 92819031 45094163 80306833 40161973 40144860 2347905 967849 1380056 90841395 BOND ISSUE COSTS 646131 INVESTMENTS IN AFFILIATED ORG. 73944008 74590139 ACCRUED PENSION LIABILITY 2696119 PROFESSIONAL LIABILITY RESERVE 524000 FIN 47 ASBESTOS LIABILITY 2895113 THIRD PARTY PAYOR SETTLEMENTS 4089161 MINORITY INTEREST IN CONSOLIDATED SUBS 29301 FAIR VALUE OF INTEREST RATE SWAP AG 7581948 17815642 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, 2013, 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 2010. 1 1 X 1 X 1 X 1 1 0 1 1 7368399 2696703 4671696 0.03140 19048693 13827823 5220870 0.03510 26417092 16524526 9892566 0.06650 10887299 0 10887299 0.07330 76211 0 76211 0.00050 10963510 10963510 0.07380 37380602 16524526 20856076 0.14030 0 12137310 1092538 39219191 44762287 -5543096 X 1 1 2 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 1 X X X X X X X X X 13 1 0 1 X WWW.LIMAMEMORIAL.ORG X X X X X X X X 0 0 1 1 200.000000000000 1 300.000000000000 1 X X X X X X 1 1 X X X X X 1 0 X X X X 1 X 0 0 LIMA MEMORIAL HEALTH SYSTEM PART V, SECTION B, LINE 3: 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 WAS 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 LIMAYMCAIN ADDITION, LEADERS, REPRESENTATIVES, OR MEMBERS OF MEDICALLY UNDERSERVED, LOW-INCOME AND MINORITY POPULATIONS AND POPULATIONS WITH CHRONIC DISEASE NEEDS WERE CONTACTED. LIMA MEMORIAL HEALTH SYSTEM PART V, SECTION B, LINE 7: 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. LIMA MEMORIAL HEALTH SYSTEM PART V, SECTION B, LINE 20D: 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% WHICH IS LARGER THAN THE AVERAGE COMMERICAL CSA. 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 $12,137,310. 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 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 ACCOUNTS 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.PART III, SECTION A, LINE 3: BAD DEBT ATTRIBUTABLE TO PATIENTS IDENTIFIED UNDER CHARITY CARE WAS ESTIMATED BY A THIRD PARTY THROUGH THE SCREENING OF BAD DEBT PATIENTS AT POVERTY LEVEL. THE HOSPITAL APPLIES ANY DISCOUNTS/PAYMENTS RECEIVED AGAINST PATIENT ACCOUNTS BEFORE DETERMINING BAD DEBT EXPENSE. PART III, LINE 8: SECTION B: BASED ON A COST TO CHARGE RATIO DETERMINED IN ACCORDANCE WITH MEDICARE COST REPORT REQUIREMENTS, THE COSTS OF PROVIDING CARE TO THE MEDICARE POPULATION IN 2013 WAS $44,762,287. THE PAYMENTS RELATED TO THESE SERVICES WERE $39,219,191. LEAVING A MEDICARE SHORTFALL OF $5,543,096 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. 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 2009 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 2009. 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 2013, 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 SUMMARYWHEN ASKED TO RANK COMMUNITY PROBLEMS FROM A PREPARED LIST, 43% OF RESPONDENTS NOTED UNEMPLOYMENT AS THE SINGLE MOST IMPORTANT PROBLEM FACING LOCAL FAMILIES. RESIDENTS IDENTIFY JOB TRAINING & EMPLOYMENT SERVICES AS THE SINGLE MOST IMPORTANT SERVICE NEEDED IN THE COUNTY IN 2009. CRIME PREVENTION SERVICES WERE RANKED THE SECOND MOST IMPORTANT/MOST NEEDED SERVICE IN THE 2009 SURVEY.OTHER IMPORTANT AND EMERGING COMMUNITY PROBLEMS INCLUDE DOMESTIC VIOLENCE, QUALITY OF LIFE AND PARENTING. OTHER IMPORTANT SERVICES INCLUDED HEALTHCARE SERVICES, YOUTH PROGRAMS AND CARE OF THE ELDERLY. ALMOST ONE-QUARTER (24%) OF ALLEN COUNTY ADULTS REPORTED IN 2009 THAT THEY HAD ATTEMPTED TO GET ASSISTANCE FROM A SOCIAL SERVICE AGENCY. 58% OF THOSE ADULTS DID RECEIVE ASSISTANCE AND 1% OF ADULTS REPORTED THEY DID NOT KNOW WHERE TO LOOK FOR ASSISTANCE.HIGH BLOOD PRESSURE AND EXCESSIVE BODY WEIGHT ARE TWO HEALTH CHALLENGES THAT HAVE INCREASED IN OCCURRENCE SINCE THE 2002 SURVEY. THESE ARE CONSIDERABLY ABOVE STATE AND NATIONAL RATES. APPROXIMATELY 3 OUT OF 4 ALLEN COUNTY ADULTS ARE CONSIDERED OVERWEIGHT OR OBESE BY BODY MASS INDEX STANDARDS (BMI). IMPROVEMENTS WERE NOTED INCLUDING AN INCREASE IN PHYSICAL ACTIVITY AND A REDUCTION IN THE NUMBER OF CIGARETTE SMOKERS. HEALTHCARE WAS IDENTIFIED AS ONE OF THE TOP THREE MOST IMPORTANT SERVICES IN ALLEN COUNTY AND THE MAJORITY OF ADULTS (86%) REPORT HAVING COVERAGE. DESPITE THIS, FEWER WOMEN ARE PARTICIPATING IN SCREENINGS FOR EARLY DETECTION OF CANCER. A NOTABLE IMPROVEMENT FROM 2002 WAS THE PERCENTAGE OF ADULTS WHO VISITED A DENTIST IN THE PAST YEAR, THOUGH REPORTED DENTAL VISITS WITHIN THE PAST YEAR ARE STILL LOWER IN ALLEN COUNTY COMPARED TO STATE AND NATIONAL RATES. LIFESTYLE CHARACTERISTICS THAT CORRESPOND WITH REDUCED RISK FOR CHRONIC DISEASE INCLUDE A HEALTHY BODY WEIGHT, ADEQUATE FRUIT AND VEGETABLE CONSUMPTION, REGULAR LEISURE-TIME PHYSICAL ACTIVITY, AND NOT SMOKING, YET ONLY 0.8% OF ALLEN COUNTY ADULTS ENGAGE IN ALL FOUR HEALTHY LIFESTYLE CHARACTERISTICS.SOME OF THE HEALTH ISSUES FACING ALLEN COUNTY YOUTH INCLUDE EARLY SEXUAL ACTIVITY AND TEEN PREGNANCY, BULLYING, LACK OF SAFETY HABITS SUCH AS AND LACK OF REGULAR SEATBELT USE. 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, HOSPITAL PERSONNEL INQUIRIES, ETC. INFORMATION REGARDING THE HOSPITAL'S CHARITY CARE IS ALSO FOUND ON LIMA MEMORIAL HOSPITAL'S WEBSITE. STATEMENTS GOING TO PATIENTS ALSO IDENTIFY THIS PROGRAM. PART VI, LINE 4: 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 MORE THAN 38,000. 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 PAIN MANAGEMENT. BEYOND THE NUMBERS: KEY COMMUNITY BENEFITS ACTIVITIES OF 2013LIMA 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 2013 WAS IN THE AREA OF CHARITABLE CARE. THIS ENABLED THOSE WITHOUT INSURANCE OR WITH LIMITED INSURANCE TO ACCESS MEDICAL CARE. 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 2013, LIMA MEMORIAL HEALTH SYSTEM PROVIDED AND/OR PARTICIPATED IN NUMEROUS COMMUNITY HEALTH SERVICE PROGRAMS. INCLUDED IN THIS CATEGORY ARE INCLUDING HEALTH AND WELLNESS EDUCATION, HEALTH SCREENINGS, COMMUNITY DEVELOPMENT AND SERVICES TO HELP PEOPLE ADOPT HEALTHY LIFE-STYLE CHANGES. ALSO INCLUDED ARE THE MYRIAD OF SUPPORT GROUP ACTIVITIES THAT HELP PATIENTS AND THEIR FAMILIES MANAGE CHRONIC HEALTH CONDITIONS. KEY INITIATIVES THIS 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 INFORMATION 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 ON-GOING EDUCATION FOR PHYSICIANS, NURSES, TECHNICIANS, AND OTHER CLINICIANS, THE HEALTH SYSTEM SUPPORTED NUMEROUS SPECIAL INITIATIVES IN 2013 TO FURTHER THE CAPABILITIES OF AREA MEDICAL PERSONNEL.OUR SCHOOLS OF NURSING PROGRAM PROVIDED A TRAINING SITE FOR OVER 450 NURSING STUDENTS IN 2013. LIMA MEMORIAL HEALTH SYSTEM ALSO PROVIDES EDUCATIONAL SUPPORT IN THE MEDICAL COMMUNITY BY PROVIDING HUNDREDS OF HOURS OF TRAINING FOR AREA EMTS AND PARAMEDICS. FINANCIAL CONTRIBUTIONSLIMA MEMORIAL PROVIDES BOTH CASH AND IN-KIND SUPPORT TO INDIVIDUALS AND OTHER COMMUNITYORGANIZATIONS. THE SPONSORSHIP FUND PROVIDES FUNDING SUPPORT TO WEST CENTRAL OHIO PROGRAMS THAT ADDRESS IDENTIFIED COMMUNITY NEEDS AND SERVE VULNERABLE POPULATIONS. IN 2013, LIMA MEMORIAL CONTRIBUTED TO MORE THAN 55 ORGANIZATIONS INCLUDING THE MARCH OF DIMES, YMCA OF LIMA, AMERICAN CANCER SOCIETY, THE UNITED WAY AND THE AMERICAN RED CROSS. COMMUNITY BENEFIT OPERATIONSFOR 2013, COMMUNITY BENEFITS EXPENSES RECORDED THE STAFF HOURS NEEDED TO TRACK AND INPUT THE INFORMATION. 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.GOVERNMENT SPONSORED HEALTHCAREPAYMENT SHORTFALLS FOR PUBLIC INSURANCE PROGRAMS, INCLUDING MEDICAID AND MEDICARE, WERE$10,763,966 IN 2013. 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 14000 COMMUNITY DEVELOPMENTCOMMUNITY DEVELOPMENT/HEALTH AND WELLNESS LIMA AREA FAMILY YMCA 345 S ELIZABETH ST LIMA OH 45801 344431173 501(C)3 262994 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 LIMA AREA CHAMBER OF COMMERCE 144 S MAIN ST LIMA OH 45801 344179070 501(C)3 6500 COMMUNITY DEVELOPMENT/HEALTH AND WELLNESS LIMA AREA CHAMBER FOUNDATION - STATE OF THE STATE SPONSORSHIP 144 S MAIN ST LIMA OH 45801 344179071 501(C)3 5000 COMMUNITY DEVELOPMENT/HEALTH AND WELLNESS TUTTLE CONSTRUCTION - SAFETY CITY 880 SHAWNEE ROAD LIMA OH 45805 344446567 501(C)3 14443 COMMUNITY DEVELOPMENT/HEALTH AND WELLNES MARCH OF DIMES 375 STEWART ROAD WILKES BARRE PA 18706 131846366 501(C)3 8500 COMMUNITY DEVELOPMENT/HEALTH AND WELLNES LIMA ALLEN CO REGIONAL PLANNING COMMISSION 130 W NORTH STREET LIMA OH 45801 341162237 GOVT 5000 COMMUNITY DEVELOPMENT/HEALTH AND WELLNES UNITED WAY 616 S COLLETT ST SUITE 101 LIMA OH 45805 344466356 501(C)3 15033 COMMUNITY DEVELOPMENT 8 2 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 525650 0 0 0 0 0 7650 0 7414 0 540714 0 0 MICHAEL SWICK PRESIDENT/CEO (SEE SCH J) 327480 0 184854 0 12202 0 201292 0 18534 0 744362 0 0 0 ROBERT E ARMSTRONG JR SENIOR VP/COO (SEE SCH J) 215542 0 90343 0 5692 0 83898 0 18534 0 414009 0 0 0 ERIC D POHJALA VP OF FINANCE/CFO (SEE SCH 207144 0 83340 0 5569 0 77847 0 27822 0 401722 0 0 0 CHARLES LYNN THOMPSON MD VICE PRESIDENT/CMO (SEE SC 227558 0 96587 0 12661 0 92836 0 14827 0 444469 0 0 0 KHA H TRAN MD VP OF MEDICAL AFFAIRS (SEE SCH J) 104941 79738 0 8978 2704 0 20016 2448 16230 11593 143891 102757 0 0 ANN-MARIE JEAN POHL VICE PRESIDENT/CNO (SEE SC 146295 0 59351 0 4765 0 55281 0 0 0 265692 0 0 0 ANITA GOOD ADMINISTRATIVE DIRECTOR (S 122878 0 17351 0 1303 0 4324 0 22258 0 168114 0 0 0 MARK RECKER DIRECTOR OF PHARMACY 132526 0 12243 0 744 0 4433 0 11129 0 161075 0 0 0 LYNN CARPENTER ADMINISTRATIVE DIRECTOR 131055 0 18243 0 6011 0 4763 0 18534 0 178606 0 0 0 CHERYL HOMAN ADMINISTRATIVE DIRECTOR 118639 0 17087 0 2719 0 4236 0 14827 0 157508 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 $37,397 ROBERT ARMSTRONG $43,448 MIKE SWICK $160,842 C. LYNN THOMPSON $48,486 ANN-MARIE JEAN POHL $17,560 A CITY OF LIMA-2007 BONDS 346400789 532567DH4 2007-07-18 25000000 HOSPITAL FACILITIES 0 0 0 B CITY OF LIMA-2003 BONDS 346400789 532567DG6 2003-04-10 10000000 HOSPITAL FACILITIES 0 0 0 C VILLAGE OF FT SHAWNEE 346006426 2007-06-07 6160000 HOSPITAL FACILITIES 0 0 0 D VILLAGE OF ELIDA 346407983 2007-05-22 7040000 HOSPITAL FACILITIES 0 0 0 A 25000000 2008 0 0 1 1 B 535000 10000000 2004 0 0 1 1 C 867500 6160000 2000 1 1 1 1 D 37500 7040000 2003 1 1 1 1 A 0 0 1 1 0 0.00000 0.00000 0.00000 0 0 1 B 0 0 1 1 0 0.00000 0.00000 0.00000 0 0 1 C 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 D 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 A 0 0 1 0 1 0 0 0 1 B 0 0 1 0 1 0 0 0 1 C 0 0 1 0 0 0 0 0 1 D 1 0 0 0 0 1 A 1 B 1 C 1 D 1 JJ JOHNSON J.J. JOHNSON IS THE SON OF BOARD MEMBER JOHN JOHNSON 51485 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 2013. 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 TRAVEL AGENCY FEE: PROGRAM SERVICE EXPENSES 25,296. MANAGEMENT AND GENERAL EXPENSES 6,324. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 31,620. PURCHASED SERVICES FEE: PROGRAM SERVICE EXPENSES 13,143,002. MANAGEMENT AND GENERAL EXPENSES 3,285,751. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 16,428,753. MAINTENANCE FEE: PROGRAM SERVICE EXPENSES 4,444. MANAGEMENT AND GENERAL EXPENSES 1,111. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 5,555. CONSULTING FEE: PROGRAM SERVICE EXPENSES 124,981. MANAGEMENT AND GENERAL EXPENSES 31,245. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 156,226. COLLECTIONS FEE: PROGRAM SERVICE EXPENSES 827,504. MANAGEMENT AND GENERAL EXPENSES 206,876. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,034,380. EQUIPMENT RENTAL FEE: PROGRAM SERVICE EXPENSES 1,401,164. MANAGEMENT AND GENERAL EXPENSES 350,291. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,751,455. FREIGHT: PROGRAM SERVICE EXPENSES 227,333. MANAGEMENT AND GENERAL EXPENSES 56,833. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 284,166. WASTE REMOVAL: PROGRAM SERVICE EXPENSES 26,982. MANAGEMENT AND GENERAL EXPENSES 6,745. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 33,727. COURTESY TRANSPORTATION FEE: PROGRAM SERVICE EXPENSES 121,330. MANAGEMENT AND GENERAL EXPENSES 30,333. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 151,663. CLEANING FEE: PROGRAM SERVICE EXPENSES 147,742. MANAGEMENT AND GENERAL EXPENSES 36,936. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 184,678. PHYSICIAN FEE: PROGRAM SERVICE EXPENSES 2,633,181. MANAGEMENT AND GENERAL EXPENSES 658,295. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,291,476. CORPORATE FEE: PROGRAM SERVICE EXPENSES 118,374. MANAGEMENT AND GENERAL EXPENSES 29,593. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 147,967. CONTINGENCY FEE: PROGRAM SERVICE EXPENSES 774. MANAGEMENT AND GENERAL EXPENSES 194. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 968. FRANCHISE FEE: PROGRAM SERVICE EXPENSES 1,755,530. MANAGEMENT AND GENERAL EXPENSES 438,882. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,194,412. FORM 990, PART XI, LINE 9: IMPLEMENTATION OF NEW ACCOUNTING PRONOUNCEMENT 82,990. INVESTMENT IN LMHS WOMEN'S HEALTH CO-MANAGEMENT K-1 3,903. RESTRICTED CONTRIBUTIONS 268,286. 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 $13,800,398 LMP $(9,553,115) ELM TREE $(213,835) TOTAL GAIN (LOSS) FROM OPERATIONS $4,033,448 NON-OPERATING REVENUES, NET $1,904,442 INTEREST RATE SWAP $4,712,270 AUDITED EXCESS REVENUE $10,650,160 NET ASSETS RELEASED FROM RESTRICTION $ - PPA $22 NET $10,650,182 OTHER 990 ADJUSTMENTS WOMEN'S HEALTH K-1 $(3,903) UNREALIZED GAIN/LOSS $(1,462,486) ADA MEDICAL K-1 $39,284 CARDINAL HEALTH K-1 $(81,624) TOTAL OTHER 990 ADJUSTMENTS $(1,508,729) NET $9,141,453 LMJOC 990 PART 1, LINE 19 $18,949,209 LLP 990 PART 1, LINE 19 $(9,551,580) ELM TREE 1120 LINE 30 $(213,836) LMH 990EZ PART 1, LINE 18 $(42,340) NET TAX RETURNS $9,141,453 DIFFERENCE: FINANCIAL STATEMENTS VS TAX RETURN $ - 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 -3903 74143 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 694602 6480652 1.00000 1 0 0 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 LIMA MEMORIAL HOSPITAL FOUNDATION S 264988 EQUITY TRANSFER LIMA MEMORIAL PROFESSIONAL CORPORATION R 9379512 EQUITY TRANSFER LIMA MEMORIAL PROFESSIONAL CORPORATION J 973085 LEASE CONTRACT ELM TREE FOUNDATION K 140433 LEASE CONTRACT LIMA MEMORIAL PROFESSIONAL CORPORATION P 310578 CASH TRANSACTION ELM TREE FOUNDATION Q 150000 CASH TRANSACTION