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FAIRFIELD MEDICAL CENTER: Form 990, tax year 2013

View the entire original 990 at ProPublica ↗

Organization
FAIRFIELD MEDICAL CENTER (EIN 31-0645626)
Tax period
2013-01-01 to 2013-12-31
Filed
2014-08-15
IRS object ID
201422279349304007
Schema version
2013v3.1
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Return2014-08-15T03:37:20-00:00ReturnTs
Tax Period End2013-12-31TaxPeriodEndDt
Return Type990ReturnTypeCd
Tax Period Begin2013-01-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN310645626EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1Fairfield Medical CenterBusinessNameLine1
FieldValueIRS element (for citing)
Business Name ControlFAIRBusinessNameControlTxt
Phone7406878000PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1401 North Ewing StreetAddressLine1
CityLancasterCity
StateOHState
ZIP Code431303371ZIPCode

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonSky L GettysPersonNm
Person TitleCFO TreasurerPersonTitleTxt
Phone7406878011PhoneNum
Signature2014-08-15SignatureDt
Discuss With Paid PreparerfalseDiscussWithPaidPreparerInd
FieldValueIRS element (for citing)
Tax2013TaxYr
Build TS2015-11-30 17:44:51ZBuildTS

Form 990 IRS990

Principal Ofcr Business Address PrincipalOfcrBusinessAddress

FieldValueIRS element (for citing)
Business Name Line1Mina H UbbingBusinessNameLine1

US Address USAddress

FieldValueIRS element (for citing)
Address Line1401 North Ewing StreetAddressLine1
CityLancasterCity
StateOHState
ZIP Code43130ZIPCode
FieldValueIRS element (for citing)
Gross Receipts$259,740,803GrossReceiptsAmt
Group Return For AffiliatesfalseGroupReturnForAffiliatesInd
Organization501c3Yes (X)Organization501c3Ind
Website Addresswww.fmchealth.orgWebsiteAddressTxt
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Formation1982FormationYr
Legal Domicile StateOHLegalDomicileStateCd
Activity Or MissionOur mission is to provide efficient, compassionate, safe, high quality healthcare for patients and their families. Fairfield Medical Center provides this care to all patients regardless of race, creed, sex, national origin, handicap, age or ability to pay.ActivityOrMissionDesc
Voting Members Governing Body15VotingMembersGoverningBodyCnt
Voting Members Independent15VotingMembersIndependentCnt
Total Employee2377TotalEmployeeCnt
Total Volunteers220TotalVolunteersCnt
Total Gross UBI$352,871TotalGrossUBIAmt
PY Contributions Grants$497,848PYContributionsGrantsAmt
CY Contributions Grants$293,840CYContributionsGrantsAmt
PY Program Service Revenue$203,944,056PYProgramServiceRevenueAmt
CY Program Service Revenue$224,105,357CYProgramServiceRevenueAmt
PY Investment Income$1,855,604PYInvestmentIncomeAmt
CY Investment Income$2,724,692CYInvestmentIncomeAmt
PY Other Revenue$6,505,323PYOtherRevenueAmt
CY Other Revenue$5,992,542CYOtherRevenueAmt
PY Total Revenue$212,802,831PYTotalRevenueAmt
CY Total Revenue$233,116,431CYTotalRevenueAmt
CY Grants And Similar Paid$0CYGrantsAndSimilarPaidAmt
CY Benefits Paid To Members$0CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$100,726,632PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$107,142,906CYSalariesCompEmpBnftPaidAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$0CYTotalFundraisingExpenseAmt
PY Other Expenses$98,468,771PYOtherExpensesAmt
CY Other Expenses$105,561,521CYOtherExpensesAmt
PY Total Expenses$199,195,403PYTotalExpensesAmt
CY Total Expenses$212,704,427CYTotalExpensesAmt
PY Revenues Less Expenses$13,607,428PYRevenuesLessExpensesAmt
CY Revenues Less Expenses$20,412,004CYRevenuesLessExpensesAmt
Total Assets BOY$207,783,812TotalAssetsBOYAmt
Total Assets EOY$262,521,097TotalAssetsEOYAmt
Total Liabilities BOY$92,223,240TotalLiabilitiesBOYAmt
Total Liabilities EOY$131,499,494TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$115,560,572NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$131,021,603NetAssetsOrFundBalancesEOYAmt
MissionOur mission is to provide efficient, compassionate, safe, high quality healthcare for patients and their families. Fairfield Medical Center provides this care to all patients regardless of race, creed, sex, national origin, handicap, age or ability to pay.MissionDesc
Significant New Program SrvcfalseSignificantNewProgramSrvcInd
Significant ChangefalseSignificantChangeInd
Expense$76,396,996ExpenseAmt
Revenue$95,061,119RevenueAmt
DescPatient Care Inpatient Medical, Surgical, Emergency, Maternity, ICU, Psychiatry, and Nursing Services 72,913 admissions, procedures visitsDesc

Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp

FieldValueIRS element (for citing)
Expense$73,669,130ExpenseAmt
Revenue$130,612,536RevenueAmt
DescPatient Care Laboratory, Cardiovascular, Radiology, Therapy, Pharmacy, and Medical Supply Services 2,605,974 procedures dosagesDesc

Prog Srvc Accom Acty3 ProgSrvcAccomActy3Grp

FieldValueIRS element (for citing)
Expense$19,785,225ExpenseAmt
Revenue$968,765RevenueAmt
DescPatient Care Nutritional Services 495,327 meals served Patient Care Laundry Services 1,603,149 pounds Patient Care Plant Engineering, Police, Housekeeping, Central Transport, Interest Depreciation 500,075 square feetDesc
FieldValueIRS element (for citing)
Total Program Service Expenses$169,851,351TotalProgramServiceExpensesAmt
Described In Section501c3Yes (true)DescribedInSection501c3Ind
Schedule B RequiredYes (true)ScheduleBRequiredInd
Political Campaign ActyfalsePoliticalCampaignActyInd
Lobbying ActivitiesfalseLobbyingActivitiesInd
Subject To Proxy TaxfalseSubjectToProxyTaxInd
Donor Advised FundfalseDonorAdvisedFundInd
Conservation EasementsfalseConservationEasementsInd
Collections Of ArtfalseCollectionsOfArtInd
Credit CounselingfalseCreditCounselingInd
Temp Or Permanent EndowmentsfalseTempOrPermanentEndowmentsInd
Report Land Building EquipmentYes (true)ReportLandBuildingEquipmentInd
Report Investments Other SecfalseReportInvestmentsOtherSecInd
Report Program Related InvstfalseReportProgramRelatedInvstInd
Report Other AssetsYes (true)ReportOtherAssetsInd
Report Other LiabilitiesYes (true)ReportOtherLiabilitiesInd
Include FIN48 FootnotefalseIncludeFIN48FootnoteInd
Independent Audit Fincl StmtfalseIndependentAuditFinclStmtInd
Consolidated Audit Fincl StmtYes (true)ConsolidatedAuditFinclStmtInd
School OperatingfalseSchoolOperatingInd
Foreign OfficefalseForeignOfficeInd
Foreign ActivitiesfalseForeignActivitiesInd
More Than5000 K To OrgfalseMoreThan5000KToOrgInd
More Than5000 K To IndividualsfalseMoreThan5000KToIndividualsInd
Professional FundraisingfalseProfessionalFundraisingInd
Fundraising ActivitiesfalseFundraisingActivitiesInd
Gaming ActivitiesfalseGamingActivitiesInd
Operate HospitalYes (true)OperateHospitalInd
Audited Financial Stmt AttYes (true)AuditedFinancialStmtAttInd
Grants To OrganizationsYes (true)GrantsToOrganizationsInd
Grants To IndividualsfalseGrantsToIndividualsInd
Schedule J RequiredYes (true)ScheduleJRequiredInd
Tax Exempt BondsYes (true)TaxExemptBondsInd
Invest Tax Exempt BondsfalseInvestTaxExemptBondsInd
Escrow AccountYes (true)EscrowAccountInd
On Behalf Of IssuerfalseOnBehalfOfIssuerInd
Engaged In Excess Benefit TransfalseEngagedInExcessBenefitTransInd
PY Excess Benefit TransfalsePYExcessBenefitTransInd
Loan OutstandingfalseLoanOutstandingInd
Grant To Related PersonfalseGrantToRelatedPersonInd
Business Rln With Org MemfalseBusinessRlnWithOrgMemInd
Business Rln With Fam MemfalseBusinessRlnWithFamMemInd
Business Rln With Officer EntfalseBusinessRlnWithOfficerEntInd
Deductible Non Cash ContrifalseDeductibleNonCashContriInd
Deductible Art ContributionfalseDeductibleArtContributionInd
Terminate OperationsfalseTerminateOperationsInd
Partial LiquidationfalsePartialLiquidationInd
Disregarded EntityYes (true)DisregardedEntityInd
Related EntityYes (true)RelatedEntityInd
Related Organization Ctrl EntYes (true)RelatedOrganizationCtrlEntInd
Transaction With Control EntYes (true)TransactionWithControlEntInd
Trnsfr Exmpt Non Chrtbl Rltd OrgYes (true)TrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted PrtshpfalseActivitiesConductedPrtshpInd
Schedule O RequiredYes (true)ScheduleORequiredInd
IRP Document145IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Backup Wthld ComplianceYes (true)BackupWthldComplianceInd
Employee2377EmployeeCnt
Employment Tax Returns FiledYes (true)EmploymentTaxReturnsFiledInd
Unrelated Bus Incm Over LimitYes (true)UnrelatedBusIncmOverLimitInd
Form990 T FiledYes (true)Form990TFiledInd
Foreign Financial AccountfalseForeignFinancialAccountInd
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTransInd
Taxable Party NotificationfalseTaxablePartyNotificationInd
Nondeductible ContributionsfalseNondeductibleContributionsInd
Quid Pro Quo ContributionsfalseQuidProQuoContributionsInd
Form8282 Property Disposed OffalseForm8282PropertyDisposedOfInd
Rcv Fnds To Pay Prsnl Bnft CntrctfalseRcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft CntrctfalsePayPremiumsPrsnlBnftCntrctInd
Indoor Tanning ServicesfalseIndoorTanningServicesInd
Info In Schedule O Part VIYes (X)InfoInScheduleOPartVIInd
Governing Body Voting Members15GoverningBodyVotingMembersCnt
Independent Voting Member15IndependentVotingMemberCnt
Family Or Business RlnYes (true)FamilyOrBusinessRlnInd
Delegation Of Mgmt DutiesfalseDelegationOfMgmtDutiesInd
Change To Org DocumentsfalseChangeToOrgDocumentsInd
Material Diversion Or MisusefalseMaterialDiversionOrMisuseInd
Members Or StockholdersfalseMembersOrStockholdersInd
Election Of Board MembersfalseElectionOfBoardMembersInd
Decisions Subject To ApprovafalseDecisionsSubjectToApprovaInd
Minutes Of Governing BodyYes (true)MinutesOfGoverningBodyInd
Minutes Of CommitteesYes (true)MinutesOfCommitteesInd
Officer Mailing AddressfalseOfficerMailingAddressInd
Local ChaptersfalseLocalChaptersInd
Form990 Provided To Gvrn BodyfalseForm990ProvidedToGvrnBodyInd
Conflict Of Interest PolicyYes (true)ConflictOfInterestPolicyInd
Annual Disclosure Covered PrsnYes (true)AnnualDisclosureCoveredPrsnInd
Regular Monitoring EnfrcYes (true)RegularMonitoringEnfrcInd
Whistleblower PolicyYes (true)WhistleblowerPolicyInd
Document Retention PolicyYes (true)DocumentRetentionPolicyInd
Compensation Process CEOYes (true)CompensationProcessCEOInd
Compensation Process OtherYes (true)CompensationProcessOtherInd
Investment In Joint VentureYes (true)InvestmentInJointVentureInd
Written Policy Or ProcedureYes (true)WrittenPolicyOrProcedureInd
States Where Copy Of Return Is FldOHStatesWhereCopyOfReturnIsFldCd
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

FieldValueIRS element (for citing)
PersonSky L GettysPersonNm
Phone7406878011PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1401 North Ewing StreetAddressLine1
CityLancasterCity
StateOHState
ZIP Code431303371ZIPCode

Form990 Part VII Section A Form990PartVIISectionAGrp (26 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndOfficerOfficerIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmtAverage Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRtKey EmployeeKeyEmployeeIndHighest Compensated EmployeeHighestCompensatedEmployeeInd
Carol Seubert Marx
Chair003.00Yes (X)Yes (X)$0$0$0
Debra Smith
Vice Chair003.00Yes (X)Yes (X)$0$0$0
Ron Burris
Secretary003.00Yes (X)Yes (X)$0$0$0
James Christian
Director002.00Yes (X)$0$0$0
Adam Custer
Director002.00Yes (X)$0$0$0
Joseph Ginty MD
Director002.00Yes (X)$0$0$0
Dave Oehlers
Director002.00Yes (X)$0$0$0
Barry Ritchey
Director002.00Yes (X)$0$0$0001.00
Linda Sheridan
Director002.00Yes (X)$0$0$0
Susan Nixon Stoughton
Director002.00Yes (X)$0$0$0001.00
Milt Taylor Jr
Director002.00Yes (X)$0$0$0
Louis Varga
Director002.00Yes (X)$0$0$0
Renee Wagner
Director002.00Yes (X)$0$0$0
William Yaple
Director002.00Yes (X)$0$0$0
Jeffrey Yenchar MD
Director002.00Yes (X)$0$0$0
Mina H Ubbing
President CEO055.00Yes (X)$562,873$0$32,912001.00
Sky L Gettys
CFO, Treasurer048.00Yes (X)$288,937$0$30,582002.00
Steven D Cox MD
VP - CMO042.00$318,807$120,673$32,058005.00Yes (X)
Howard Sniderman
Chief Operating Officer045.00$263,547$0$31,928Yes (X)
Cynthia Pearsall
VP - CNO050.00$213,571$0$15,124Yes (X)
Jean L Robertson MD
Chief Med. Info. Officer024.00$144,593$0$14,669Yes (X)
Grant R Brame
Physicians Assistant040.00$180,957$0$26,800Yes (X)
Heather B Schultz
Advanced Practice Nurse040.00$161,810$0$11,303Yes (X)
Jeffrey M Ayers MD
Residency Prog. Dir.043.00$159,866$0$24,266001.00Yes (X)
Betsy L Winsley
Pharmacy Supervisor043.00$153,038$0$11,014Yes (X)
Randy L Brown
Pharmacy Manager043.00$151,759$0$23,037Yes (X)
FieldValueIRS element (for citing)
Total Reportable Comp From Org$2,599,758TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org$120,673TotReportableCompRltdOrgAmt
Total Other Compensation$253,693TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K45IndivRcvdGreaterThan100KCnt
Former Ofcr Employees ListedfalseFormerOfcrEmployeesListedInd
Total Comp Greater Than150 KYes (true)TotalCompGreaterThan150KInd
Compensation From Other SrcsfalseCompensationFromOtherSrcsInd

Contractor Compensation ContractorCompensationGrp (5 entries)

Address Line1ContractorAddress/USAddress/AddressLine1CityContractorAddress/USAddress/CityStateContractorAddress/USAddress/StateZIP CodeContractorAddress/USAddress/ZIPCodeServicesServicesDescCompensationCompensationAmt
McKesson
PO Box 98347ChicagoIL606930001Information Technology Services$3,234,939
Aramark Healthcare
12483 Collections Center DriveChicagoIL60693Biomedical Services$2,520,440
Renovo Solutions
1801 E Parkcourt Place Bldg D SuiteSanta AnaCA92701Biomedical Services$765,995
Fairfield Emergency Physicians
401 North Ewing StreetLancasterOH43130Physician Services$730,040
Central Ohio Orthopedic Consultants
2405 N Columbus Street Suite 120LancasterOH43130Physician Services$528,925
FieldValueIRS element (for citing)
Cntrct Rcvd Greater Than100 K14CntrctRcvdGreaterThan100KCnt
All Other Contributions$293,840AllOtherContributionsAmt
Total Contributions$293,840TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp

FieldValueIRS element (for citing)
DescPatient Service Revenue NetDesc
Total Revenue Column$224,105,357TotalRevenueColumnAmt
Related Or Exempt Func Income$224,105,357RelatedOrExemptFuncIncomeAmt
FieldValueIRS element (for citing)
Total Program Service Revenue$224,105,357TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$1,151,201TotalRevenueColumnAmt
Exclusion$1,151,201ExclusionAmt

Gross Rents GrossRentsGrp

FieldValueIRS element (for citing)
Real$649,652RealAmt

Less Rental Expenses LessRentalExpensesGrp

FieldValueIRS element (for citing)
Real$439,933RealAmt

Rental Income Or Loss RentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Real$209,719RealAmt

Net Rental Income Or Loss NetRentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Total Revenue Column$209,719TotalRevenueColumnAmt

Gross Amount Sales Assets GrossAmountSalesAssetsGrp

FieldValueIRS element (for citing)
Securities$27,707,593SecuritiesAmt
Other$50,337OtherAmt

Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp

FieldValueIRS element (for citing)
Securities$25,725,421SecuritiesAmt
Other$459,018OtherAmt

Gain Or Loss GainOrLossGrp

FieldValueIRS element (for citing)
Securities$1,982,172SecuritiesAmt
Other-$408,681OtherAmt

Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp

FieldValueIRS element (for citing)
Total Revenue Column$1,573,491TotalRevenueColumnAmt

Other Revenue Misc OtherRevenueMiscGrp (3 entries)

DescDescTotal Revenue ColumnTotalRevenueColumnAmtExclusionExclusionAmtBusinessBusinessCdUnrelated Business RevenueUnrelatedBusinessRevenueAmt
Cafeteria Sales$863,025$863,025
Patronage Dividends$544,003$544,003900099
Outside Reference Lab$306,247621500$306,247

Miscellaneous Revenue MiscellaneousRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$4,069,548TotalRevenueColumnAmt
Related Or Exempt Func Income$4,022,924RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$46,624UnrelatedBusinessRevenueAmt
FieldValueIRS element (for citing)
Other Revenue Total$5,782,823OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$233,116,431TotalRevenueColumnAmt
Related Or Exempt Func Income$228,128,281RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$352,871UnrelatedBusinessRevenueAmt
Exclusion$2,558,229ExclusionAmt

Grants To Domestic Orgs GrantsToDomesticOrgsGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Grants To Domestic Individuals GrantsToDomesticIndividualsGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Foreign Grants ForeignGrantsGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Benefits To Members BenefitsToMembersGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

FieldValueIRS element (for citing)
Total$1,956,712TotalAmt
Program Services$1,038,831ProgramServicesAmt
Management And General$917,881ManagementAndGeneralAmt

Comp Disqual Persons CompDisqualPersonsGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

FieldValueIRS element (for citing)
Total$82,286,632TotalAmt
Program Services$71,868,561ProgramServicesAmt
Management And General$10,418,071ManagementAndGeneralAmt

Pension Plan Contributions PensionPlanContributionsGrp

FieldValueIRS element (for citing)
Total$4,627,537TotalAmt
Program Services$4,288,980ProgramServicesAmt
Management And General$338,557ManagementAndGeneralAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

FieldValueIRS element (for citing)
Total$12,128,136TotalAmt
Program Services$8,206,575ProgramServicesAmt
Management And General$3,921,561ManagementAndGeneralAmt

Payroll Taxes PayrollTaxesGrp

FieldValueIRS element (for citing)
Total$6,143,889TotalAmt
Program Services$5,238,716ProgramServicesAmt
Management And General$905,173ManagementAndGeneralAmt

Fees For Services Management FeesForServicesManagementGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Fees For Services Legal FeesForServicesLegalGrp

FieldValueIRS element (for citing)
Total$604,927TotalAmt
Management And General$604,927ManagementAndGeneralAmt

Fees For Services Accounting FeesForServicesAccountingGrp

FieldValueIRS element (for citing)
Total$96,575TotalAmt
Management And General$96,575ManagementAndGeneralAmt

Fees For Services Lobbying FeesForServicesLobbyingGrp

FieldValueIRS element (for citing)
Total$0TotalAmt
FieldValueIRS element (for citing)
Fees For Services Prof FundraisingFeesForServicesProfFundraising

Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Fees For Services Other FeesForServicesOtherGrp

FieldValueIRS element (for citing)
Total$20,282,811TotalAmt
Program Services$9,223,245ProgramServicesAmt
Management And General$11,059,566ManagementAndGeneralAmt

Advertising AdvertisingGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Information Technology InformationTechnologyGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Royalties RoyaltiesGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Occupancy OccupancyGrp

FieldValueIRS element (for citing)
Total$3,680,090TotalAmt
Program Services$3,339,284ProgramServicesAmt
Management And General$340,806ManagementAndGeneralAmt

Travel TravelGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Pymt Travel Entrtnmnt Pub Ofcl PymtTravelEntrtnmntPubOfclGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Conferences Meetings ConferencesMeetingsGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Interest InterestGrp

FieldValueIRS element (for citing)
Total$3,104,005TotalAmt
Program Services$2,824,645ProgramServicesAmt
Management And General$279,360ManagementAndGeneralAmt

Payments To Affiliates PaymentsToAffiliatesGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Depreciation Depletion DepreciationDepletionGrp

FieldValueIRS element (for citing)
Total$12,515,117TotalAmt
Program Services$8,288,655ProgramServicesAmt
Management And General$4,226,462ManagementAndGeneralAmt

Insurance InsuranceGrp

FieldValueIRS element (for citing)
Total$1,095,195TotalAmt
Management And General$1,095,195ManagementAndGeneralAmt

Other Expenses OtherExpensesGrp (3 entries)

DescDescTotalTotalAmtProgram ServicesProgramServicesAmtManagement And GeneralManagementAndGeneralAmt
Supplies$45,234,354$44,980,651$253,703
Physician Fees$7,710,220$7,546,045$164,175
Other Expenses$11,238,227$3,007,163$8,231,064

All Other Expenses AllOtherExpensesGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$212,704,427TotalAmt
Program Services$169,851,351ProgramServicesAmt
Management And General$42,853,076ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$14,096,893BOYAmt
EOY$8,833,417EOYAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

FieldValueIRS element (for citing)
BOY$9,971,448BOYAmt
EOY$47,925,724EOYAmt

Accounts Receivable AccountsReceivableGrp

FieldValueIRS element (for citing)
BOY$22,080,093BOYAmt
EOY$24,785,317EOYAmt

Inventories For Sale Or Use InventoriesForSaleOrUseGrp

FieldValueIRS element (for citing)
BOY$3,640,422BOYAmt
EOY$3,872,371EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

FieldValueIRS element (for citing)
BOY$3,556,960BOYAmt
EOY$3,704,573EOYAmt
FieldValueIRS element (for citing)
Land Bldg Equip Cost Or Other Bss$226,205,778LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec$139,953,087LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
BOY$84,508,237BOYAmt
EOY$86,252,691EOYAmt

Investments Pub Traded Sec InvestmentsPubTradedSecGrp

FieldValueIRS element (for citing)
BOY$44,534,619BOYAmt
EOY$55,696,669EOYAmt

Intangible Assets IntangibleAssetsGrp

FieldValueIRS element (for citing)
BOY$4,515,499BOYAmt
EOY$4,515,499EOYAmt

Other Assets Total OtherAssetsTotalGrp

FieldValueIRS element (for citing)
BOY$20,879,641BOYAmt
EOY$26,934,836EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$207,783,812BOYAmt
EOY$262,521,097EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$15,510,410BOYAmt
EOY$14,101,009EOYAmt

Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$61,700,147BOYAmt
EOY$98,479,656EOYAmt

Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp

FieldValueIRS element (for citing)
BOY$1,137,601BOYAmt
EOY$1,684,695EOYAmt

Other Liabilities OtherLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$13,875,082BOYAmt
EOY$17,234,134EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$92,223,240BOYAmt
EOY$131,499,494EOYAmt
FieldValueIRS element (for citing)
Organization Follows SFAS117Yes (X)OrganizationFollowsSFAS117Ind

Unrestricted Net Assets UnrestrictedNetAssetsGrp

FieldValueIRS element (for citing)
BOY$115,560,572BOYAmt
EOY$131,021,603EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$115,560,572BOYAmt
EOY$131,021,603EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$207,783,812BOYAmt
EOY$262,521,097EOYAmt
FieldValueIRS element (for citing)
Info In Schedule O Part XIYes (X)InfoInScheduleOPartXIInd
Reconcilation Revenue Expnss$20,412,004ReconcilationRevenueExpnssAmt
Net Unrlzd Gains Losses Invst$4,898,310NetUnrlzdGainsLossesInvstAmt
Other Changes In Net Assets-$9,849,283OtherChangesInNetAssetsAmt
Method Of Accounting AccrualYes (X)MethodOfAccountingAccrualInd
Accountant Compile Or ReviewfalseAccountantCompileOrReviewInd
FS AuditedYes (true)FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

FieldValueIRS element (for citing)
Consolidated Basis Fincl StmtYes (X)ConsolidatedBasisFinclStmtInd
FieldValueIRS element (for citing)
Audit CommitteeYes (true)AuditCommitteeInd
Federal Grant Audit RequiredfalseFederalGrantAuditRequiredInd

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
HospitalYes (X)HospitalInd
Public Support CY1700.00000PublicSupportCY170Pct
Public Support CY5090.00000PublicSupportCY509Pct
Investment Income CY0.00000InvestmentIncomeCYPct

Schedule B IRS990ScheduleB

Contributor Information ContributorInformationGrp

FieldValueIRS element (for citing)
ContributorRESTRICTEDContributorNum

Contributor Business Name ContributorBusinessName

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor US Address ContributorUSAddress

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Total ContributionsRESTRICTEDTotalContributionsAmt

Schedule D IRS990ScheduleD

FieldValueIRS element (for citing)
Incl Escrow Custodial Acct LiabfalseInclEscrowCustodialAcctLiabInd

Land LandGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$5,439,732OtherCostOrOtherBasisAmt
Book Value$5,439,721BookValueAmt

Buildings BuildingsGrp

FieldValueIRS element (for citing)
Investment Cost Or Other Basis$87,455InvestmentCostOrOtherBasisAmt
Other Cost Or Other Basis$93,621,396OtherCostOrOtherBasisAmt
Depreciation$52,129,553DepreciationAmt
Book Value$41,579,298BookValueAmt

Leasehold Improvements LeaseholdImprovementsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$3,207,382OtherCostOrOtherBasisAmt
Depreciation$3,068,116DepreciationAmt
Book Value$139,266BookValueAmt

Equipment EquipmentGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$115,898,355OtherCostOrOtherBasisAmt
Depreciation$81,664,768DepreciationAmt
Book Value$34,233,587BookValueAmt

Other Land Buildings OtherLandBuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$7,951,458OtherCostOrOtherBasisAmt
Depreciation$3,090,639DepreciationAmt
Book Value$4,860,819BookValueAmt
FieldValueIRS element (for citing)
Total Book Value Land Buildings$86,252,691TotalBookValueLandBuildingsAmt

Other Securities OtherSecuritiesGrp (2 entries)

DescDesc
Financial derivatives and other financial products
Closely-held equity interests

Other Assets Org OtherAssetsOrgGrp (6 entries)

DescDescBook ValueBookValueAmt
Unamortized bond financing expense$1,069,780
Due from related organizations$6,173,073
Notes receivable/income guarantee$2,123,226
Investment in subsidiary$11,775,669
Other receivables$2,252,619
Third party settlements$3,540,469
FieldValueIRS element (for citing)
Total Book Value Other Assets$26,934,836TotalBookValueOtherAssetsAmt

Other Liabilities Org OtherLiabilitiesOrgGrp (2 entries)

DescDescAmtAmt
Federal income taxes
Accrued payroll and benefits$17,234,134
FieldValueIRS element (for citing)
Total Liability$17,234,134TotalLiabilityAmt

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Financial Assistance PolicyYes (true)FinancialAssistancePolicyInd
Written PolicyYes (true)WrittenPolicyInd
FPG Reference Free CareYes (true)FPGReferenceFreeCareInd
Percent100Yes (X)Percent100Ind
FPG Reference Discounted CareYes (true)FPGReferenceDiscountedCareInd
Percent200 DYes (X)Percent200DInd
Free Care Medically IndigentYes (true)FreeCareMedicallyIndigentInd
Financial Assistance BudgetYes (true)FinancialAssistanceBudgetInd
Expenses Exceed BudgetfalseExpensesExceedBudgetInd
Annual Community Bnft ReportYes (true)AnnualCommunityBnftReportInd
Report Publically AvailableYes (true)ReportPublicallyAvailableInd

Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp

FieldValueIRS element (for citing)
Total Community Benefit Expns$5,199,227TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$2,881,438DirectOffsettingRevenueAmt
Net Community Benefit Expns$2,317,789NetCommunityBenefitExpnsAmt
Total Expense0.01090TotalExpensePct

Unreimbursed Medicaid UnreimbursedMedicaidGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$26,708,323TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$20,595,029DirectOffsettingRevenueAmt
Net Community Benefit Expns$6,113,294NetCommunityBenefitExpnsAmt
Total Expense0.02870TotalExpensePct

Total Financial Assistance Typ TotalFinancialAssistanceTyp

FieldValueIRS element (for citing)
Total Community Benefit Expns$31,907,550TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$23,476,467DirectOffsettingRevenueAmt
Net Community Benefit Expns$8,431,083NetCommunityBenefitExpnsAmt
Total Expense0.03960TotalExpensePct

Community Health Services CommunityHealthServicesGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$2,396,481TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$78,637DirectOffsettingRevenueAmt
Net Community Benefit Expns$2,317,844NetCommunityBenefitExpnsAmt
Total Expense0.01090TotalExpensePct

Health Professions Education HealthProfessionsEducationGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$2,042,325TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$1,750DirectOffsettingRevenueAmt
Net Community Benefit Expns$2,040,575NetCommunityBenefitExpnsAmt
Total Expense0.00960TotalExpensePct

Subsidized Health Services SubsidizedHealthServicesGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$16,197,829TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$10,863,258DirectOffsettingRevenueAmt
Net Community Benefit Expns$5,334,571NetCommunityBenefitExpnsAmt
Total Expense0.02510TotalExpensePct

Research ResearchGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$6,923TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$6,923NetCommunityBenefitExpnsAmt

Cash And In Kind Contributions CashAndInKindContributionsGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$243,859TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$243,859NetCommunityBenefitExpnsAmt
Total Expense0.00110TotalExpensePct

Total Other Benefits TotalOtherBenefitsGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$20,887,417TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$10,943,645DirectOffsettingRevenueAmt
Net Community Benefit Expns$9,943,772NetCommunityBenefitExpnsAmt
Total Expense0.04670TotalExpensePct

Total Community Benefits TotalCommunityBenefitsGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$52,794,967TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$34,420,112DirectOffsettingRevenueAmt
Net Community Benefit Expns$18,374,855NetCommunityBenefitExpnsAmt
Total Expense0.08630TotalExpensePct

Economic Development EconomicDevelopmentGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$27,883TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$27,883NetCommunityBenefitExpnsAmt
Total Expense0.00010TotalExpensePct

Community Support CommunitySupportGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$5,685TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$5,685NetCommunityBenefitExpnsAmt

Environmental Improvements EnvironmentalImprovementsGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$11,481TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$11,481NetCommunityBenefitExpnsAmt
Total Expense0.00010TotalExpensePct

Leadership Development LeadershipDevelopmentGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$121,219TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$121,219NetCommunityBenefitExpnsAmt
Total Expense0.00060TotalExpensePct

Coalition Building CoalitionBuildingGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$2,509TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$2,509NetCommunityBenefitExpnsAmt

Total Communtity Building Acty TotalCommuntityBuildingActyGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$168,777TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$168,777NetCommunityBenefitExpnsAmt
Total Expense0.00080TotalExpensePct
FieldValueIRS element (for citing)
Bad Debt Expense ReportedYes (true)BadDebtExpenseReportedInd
Bad Debt Expense$9,032,426BadDebtExpenseAmt
Bad Debt Expense Attributable$1,029,697BadDebtExpenseAttributableAmt
Reimbursed By Medicare$56,273,473ReimbursedByMedicareAmt
Cost Of Care Reimbursed By Medcr$55,342,936CostOfCareReimbursedByMedcrAmt
Medicare Surplus Or Shortfall$930,537MedicareSurplusOrShortfallAmt

Costing Methodology Used CostingMethodologyUsedGrp

FieldValueIRS element (for citing)
Cost Accounting SystemYes (X)CostAccountingSystemInd
FieldValueIRS element (for citing)
Written Debt Collection PolicyYes (true)WrittenDebtCollectionPolicyInd
Financial Assistance PrvsnYes (true)FinancialAssistancePrvsnInd

Management Co And Jnt Ventures ManagementCoAndJntVenturesGrp

Entity Name EntityName

FieldValueIRS element (for citing)
Business Name Line1Southeast Ohio Sleep DisordersBusinessNameLine1
FieldValueIRS element (for citing)
Primary ActivitiesSleep LabPrimaryActivitiesTxt
Org Profit Or Ownership0.51000OrgProfitOrOwnershipPct
Physicians Profit Or Ownership0.49000PhysiciansProfitOrOwnershipPct
FieldValueIRS element (for citing)
Hospital Facilities1HospitalFacilitiesCnt

Hospital Facilities HospitalFacilitiesGrp

FieldValueIRS element (for citing)
Facility1FacilityNum

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1Fairfield Medical CenterBusinessNameLine1

US Address USAddress

FieldValueIRS element (for citing)
Address Line1401 North Ewing StreetAddressLine1
CityLancasterCity
StateOHState
ZIP Code43130ZIPCode
FieldValueIRS element (for citing)
Website Addresswww.fmchealth.orgWebsiteAddressTxt
Licensed HospitalYes (X)LicensedHospitalInd
General Medical And SurgicalYes (X)GeneralMedicalAndSurgicalInd
Emergency Room24 HrsYes (X)EmergencyRoom24HrsInd
Facility Reporting Group1FacilityReportingGroupCd

Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp

Hospital Facility Name HospitalFacilityName

FieldValueIRS element (for citing)
Business Name Line11BusinessNameLine1
FieldValueIRS element (for citing)
CHNA ConductedYes (true)CHNAConductedInd
Community DefinitionYes (X)CommunityDefinitionInd
Community DemographicsYes (X)CommunityDemographicsInd
Existing ResourcesYes (X)ExistingResourcesInd
How Data ObtainedYes (X)HowDataObtainedInd
Community Health NeedsYes (X)CommunityHealthNeedsInd
Other Health IssuesYes (X)OtherHealthIssuesInd
Community Hlth Needs Id ProcessYes (X)CommunityHlthNeedsIdProcessInd
Consulting ProcessYes (X)ConsultingProcessInd
Information GapsYes (X)InformationGapsInd
CHNA Conducted13CHNAConductedYr
Take Into Account Others InputYes (true)TakeIntoAccountOthersInputInd
CHNA Conducted With Other FcltsfalseCHNAConductedWithOtherFcltsInd
CHNA Report Widely AvailableYes (true)CHNAReportWidelyAvailableInd
Rpt Available On Own WebsiteYes (X)RptAvailableOnOwnWebsiteInd
Own Website URLfmchealth.orgOwnWebsiteURLTxt
Rpt Available Upon RequestYes (X)RptAvailableUponRequestInd
Rpt Available Thru Other MethodYes (X)RptAvailableThruOtherMethodInd
Adopt Implementation StrategyYes (X)AdoptImplementationStrategyInd
Exec Implementation StrategyYes (X)ExecImplementationStrategyInd
Develop Community Wide PlanYes (X)DevelopCommunityWidePlanInd
Exec Community Wide PlanYes (X)ExecCommunityWidePlanInd
Include Operational PlanYes (X)IncludeOperationalPlanInd
Adopt BudgetYes (X)AdoptBudgetInd
Prioritize Health NeedsYes (X)PrioritizeHealthNeedsInd
All Needs AddressedfalseAllNeedsAddressedInd
Organization Incur Excise TaxfalseOrganizationIncurExciseTaxInd
Elig Criteria ExplainedYes (true)EligCriteriaExplainedInd
FPG Used Deter Elig Free CareYes (true)FPGUsedDeterEligFreeCareInd
FPG Family Incm Lmt Free Care0000000001.000000000000FPGFamilyIncmLmtFreeCarePct
FPG Used Determ Elig Dscnt CareYes (true)FPGUsedDetermEligDscntCareInd
FPG Family Incm Lmt Dscnt Care0000000002.000000000000FPGFamilyIncmLmtDscntCarePct
Explained BasisYes (true)ExplainedBasisInd
Income LevelYes (X)IncomeLevelInd
Medical IndigencyYes (X)MedicalIndigencyInd
Insurance StatusYes (X)InsuranceStatusInd
Uninsured DiscountYes (X)UninsuredDiscountInd
App Financial Asst ExplnYes (true)AppFinancialAsstExplnInd
Includes Publicity MeasuresYes (true)IncludesPublicityMeasuresInd
Posted On WebsiteYes (X)PostedOnWebsiteInd
Attached To InvoiceYes (X)AttachedToInvoiceInd
Posted In Emergency RoomYes (X)PostedInEmergencyRoomInd
Posted In Admission OfficeYes (X)PostedInAdmissionOfficeInd
Provided On AdmissionYes (X)ProvidedOnAdmissionInd
Available On RequestYes (X)AvailableOnRequestInd
FAP Actions On NonpaymentYes (true)FAPActionsOnNonpaymentInd
Collection ActivitiesfalseCollectionActivitiesInd
FAP Notified Upon AdmissionYes (X)FAPNotifiedUponAdmissionInd
FAP Notified Before DischargeYes (X)FAPNotifiedBeforeDischargeInd
FAP Notified All PatientsYes (X)FAPNotifiedAllPatientsInd
Documented Elig DeterminationYes (X)DocumentedEligDeterminationInd
Nondis Emergency Care PolicyYes (true)NondisEmergencyCarePolicyInd
Average Negotiated RatesYes (X)AverageNegotiatedRatesInd
Amounts Generally BilledfalseAmountsGenerallyBilledInd
Gross ChargesfalseGrossChargesInd

Supplemental Information SupplementalInformationGrp (2 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
Group Fairfield Medical Center Line Part V, Section B, Line 5dFairfield Medical Center presented the CHNA to various organizations in the community during 2013.
Group Fairfield Medical Center Line Part V, Section B, Line 7While most of the issues were addressed in multiple ways, due to funding issues we were not able to address the problems of sexual behavior, pregnancy outcomes or possession of firearms in the home.

Supplemental Information Detail SupplementalInformationDetail (10 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
Part III Line 3Bad debt expense represents total estimated uncollected charges. Fairfield Co has 11.5 of the population living below the poverty level, so that percentage was applied in order to approximate Charitable Bad Debt. Because we cant require patients to disclose their income, we were not able to determine exact amounts, but we believe our methodology to be reasonable and supportable. Since we do not choose our patients, we consider it fair to include bad debt as a part of Community Benefit.
Part III Line 4An 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 Centers 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. The information can be found on page 8 of the financial statements.
Part III Line 8The total for Medicare Cost is taken directly from the Medicare Cost Report.
Part III Line 9bIn 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.
Part III Line 9bWe do all we can to work with the patient and have the following options 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 15 days. B. H.E.L.P. Bank Financial Program C. Hospital Payment Program D. Assistance with application to Medicare or Medicaid E. Hospital Care Assurance Program HCAP F. Hospital Assistance Program summary defining Fairfield Medical Centers financial opportunities. G. Assistance for the uninsured patient.
Part VI Line 2During 2013, a Community Health Needs Assessment CHNA was conducted to assess the health care needs of the community. This was conducted through a collaboration with The Hospital Council of Northwest Ohio and public health researchers at The University of Toledo. The local collaborators were theFairfield Department of Health, Fairfield Medical Center, Fairfield Community Health Center and the United Way of Fairfield County.
Part VI Line 3An employee from Contracts and Collections meets with patients before discharge to discuss the many options available under the organizations charity care policy. Those policies are also posted throughout the hospital and go into the billing envelopes.
Part VI Line 4Fairfield Medical Center serves Fairfield County and surrounding counties. The demographics include the edge of the Appalacian community. We stay in touch with community organizations of all kinds to keep current on the needs of the community. A committee meets regularly to keep in touch with the perceptions of the community in order to better serve our constituents.
Part VI Line 5Fairfield Medical Center actively promotes community health through education at community groups, newspaper articles and collaboration with other community groups.
Part VI, Line 7OH

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Grant Records MaintainedYes (true)GrantRecordsMaintainedInd

Recipient Table RecipientTable

Recipient Business Name RecipientBusinessName

FieldValueIRS element (for citing)
Business Name Line1Fairfield Medical Center FoundationBusinessNameLine1

US Address USAddress

FieldValueIRS element (for citing)
Address Line1401 North Ewing StreetAddressLine1
CityLancasterCity
StateOHState
ZIP Code43130ZIPCode
FieldValueIRS element (for citing)
Recipient EIN208952945RecipientEIN
IRC Section501c3IRCSectionDesc
Cash Grant$220,975CashGrantAmt
FieldValueIRS element (for citing)
Total501c3 Org1Total501c3OrgCnt

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Compensation CommitteeYes (X)CompensationCommitteeInd
Independent ConsultantYes (X)IndependentConsultantInd
Written Employment ContractYes (X)WrittenEmploymentContractInd
Board Or Committee ApprovalYes (X)BoardOrCommitteeApprovalInd
Severance PaymentfalseSeverancePaymentInd
Supplemental Nonqual Rtr PlanYes (true)SupplementalNonqualRtrPlanInd
Equity Based Comp ArrngmfalseEquityBasedCompArrngmInd
Comp Based On Revenue Of Flng OrgfalseCompBasedOnRevenueOfFlngOrgInd
Comp Bsd On Rev Related OrgsfalseCompBsdOnRevRelatedOrgsInd
Comp Bsd Net Earns Flng OrgfalseCompBsdNetEarnsFlngOrgInd
Comp Bsd Net Earns Rltd OrgsfalseCompBsdNetEarnsRltdOrgsInd
Any Non Fixed PaymentsYes (true)AnyNonFixedPaymentsInd
Initial Contract ExceptionfalseInitialContractExceptionInd

Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (11 entries)

TitleTitleTxtBase Compensation Filing OrgBaseCompensationFilingOrgAmtBonus Filing OrganizationBonusFilingOrganizationAmountOther Compensation Filing OrgOtherCompensationFilingOrgAmtDeferred Compensation Flng OrgDeferredCompensationFlngOrgAmtNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmtTotal Compensation Filing OrgTotalCompensationFilingOrgAmt
Mina H Ubbing
President CEO$438,642$51,197$73,034$17,850$15,062$595,785
Sky L Gettys
CFO, Treasurer$250,276$37,461$1,200$17,850$12,732$319,519
Steven D Cox MD
VP - CMO$275,527$42,080$1,200$17,850$14,208$350,865
Howard Sniderman
Chief Operating Officer$230,781$31,566$1,200$17,850$14,078$295,475
Cynthia Pearsall
VP - CNO$188,688$23,683$1,200$14,586$538$228,695
Jean L Robertson MD
Chief Med. Info. Officer$140,498$4,095$10,383$4,286$159,262
Grant R Brame
Physicians Assistant$100,488$80,469$13,032$13,768$207,757
Heather B Schultz
Advanced Practice Nurse$102,513$59,297$11,303$173,113
Jeffrey M Ayers MD
Residency Prog. Dir.$159,866$11,304$12,962$184,132
Betsy L Winsley
Pharmacy Supervisor$151,895$1,143$10,618$396$164,052
Randy L Brown
Pharmacy Manager$149,270$1,889$600$10,847$12,190$174,796

Schedule K IRS990ScheduleK

Tax Exempt Bonds Issues TaxExemptBondsIssuesGrp

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd

Issuer Name IssuerName

FieldValueIRS element (for citing)
Business Name Line1County of Fairfield OhioBusinessNameLine1
FieldValueIRS element (for citing)
Bond Issuer EIN316400066BondIssuerEIN
CUSIP304286AM9CUSIPNum
Bond Issued2013-06-27BondIssuedDt
Issue Price$98,511,516IssuePriceAmt
PurposeTo refund prior issue and to fund new surgical unit.PurposeDesc

Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd
Retired$56,264,480RetiredAmt
In Reserve Fund$6,320,525InReserveFundAmt
Issuance Costs From Proceeds$926,511IssuanceCostsFromProceedsAmt
Capital Expenditures$35,000,000CapitalExpendituresAmt
Current RefundingYes (true)CurrentRefundingInd
Advance RefundingfalseAdvanceRefundingInd
Final Allocation MadefalseFinalAllocationMadeInd
Adequate Books And Rec MaintYes (true)AdequateBooksAndRecMaintInd

Tax Exempt Bonds Private Bus Use TaxExemptBondsPrivateBusUseGrp

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd
Owning Bond Financed PropertyfalseOwningBondFinancedPropertyInd
Any Lease ArrangementsfalseAnyLeaseArrangementsInd
Mgmt Contract Bond Fincd PropfalseMgmtContractBondFincdPropInd
Any Research AgreementsfalseAnyResearchAgreementsInd

Tax Exempt Bonds Arbitrage TaxExemptBondsArbitrageGrp

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd
Form8038 T FiledfalseForm8038TFiledInd
Rebate Not Due YetfalseRebateNotDueYetInd
Exception To RebatefalseExceptionToRebateInd
No Rebate DuefalseNoRebateDueInd
Variable Rate IssuefalseVariableRateIssueInd
Hedge Identified In Bks And RecfalseHedgeIdentifiedInBksAndRecInd
Gross Proceeds Invested In GICfalseGrossProceedsInvestedInGICInd
Gross Proceeds InvestedfalseGrossProceedsInvestedInd
Written Proc To Monitor ReqsfalseWrittenProcToMonitorReqsInd

Procedures Corrective Action ProceduresCorrectiveActionGrp

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd
Procedures Corrective ActionfalseProceduresCorrectiveActionInd

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (6 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
Form 990, Part VI, Section A, Line 2Various 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 11bThe 990 is reviewed by the President and Treasurer of the organization after review by the Controller. Then it is made available for Board Member review prior to filing.
Form 990, Part VI, Section B, Line 12cDirectors, 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 a bAnnually, 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 19The governing documents, conflict of interest, and financials are made available to the public by requests made to FMC management.
Form 990, Part XI, Line 9The 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, loss on early extinguishment of debt related to the refunding of bond debt, and the recognition of future employee separation agreement liability amounts as required by Generally Accepted Accounting Principles.

Schedule R IRS990ScheduleR

Id Disregarded Entities IdDisregardedEntitiesGrp

Disregarded Entity Name DisregardedEntityName

FieldValueIRS element (for citing)
Business Name Line1Home Health ResourcesBusinessNameLine1

US Address USAddress

FieldValueIRS element (for citing)
Address Line1401 North Ewing StreetAddressLine1
CityLancasterCity
StateOHState
ZIP Code43130ZIPCode
FieldValueIRS element (for citing)
EIN311159707EIN
Primary ActivitiesDurable Med. Equip.PrimaryActivitiesTxt
Legal Domicile StateOHLegalDomicileStateCd

Direct Controlling Entity Name DirectControllingEntityName

FieldValueIRS element (for citing)
Business Name Line1Zane Properties CorporationBusinessNameLine1

Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (2 entries)

Address Line1USAddress/AddressLine1CityUSAddress/CityStateUSAddress/StateZIP CodeUSAddress/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdExempt Code SectionExemptCodeSectionTxtPublic Charity StatusPublicCharityStatusTxtBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Controlled OrganizationControlledOrganizationIndDirect Controlling NADirectControllingNACd
Fairfield Healthcare Professionals Inc
401 North Ewing StreetLancasterOH43130311425884Physician PracticesOH501c311aFairfield Medical Centerfalse
Fairfield Medical Center Foundation
401 North Ewing StreetLancasterOH43130208952945FundraisingOH501c37falseN/A

Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp (2 entries)

Address Line1USAddress/AddressLine1CityUSAddress/CityStateUSAddress/StateZIP CodeUSAddress/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Predominant Income TypePredominantIncomeTypeTxtDisproportionate AllocationsDisproportionateAllocationsIndGeneral Or Managing PartnerGeneralOrManagingPartnerIndOwnershipOwnershipPct
Southeast Ohio Sleep Disorders Center LLC
135 North Ewing Street FL 3LancasterOH43130311639116Sleep disorder trmtOHFairfield Medical CenterRelatedfalseYes (true)0.51000
Simplified Healthcare Solutions LLC
5980 Wilcox Place Suite FDublinOH43016201720030Claims review/processingOHFairfield Medical CenterRelatedfalseYes (true)1.00000

Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp

Related Organization Name RelatedOrganizationName

FieldValueIRS element (for citing)
Business Name Line1Zane Properties CorporationBusinessNameLine1

US Address USAddress

FieldValueIRS element (for citing)
Address Line1401 North Ewing StreetAddressLine1
CityLancasterCity
StateOHState
ZIP Code43130ZIPCode
FieldValueIRS element (for citing)
EIN311202009EIN
Primary ActivitiesHolding CompanyPrimaryActivitiesTxt
Legal Domicile StateOHLegalDomicileStateCd

Direct Controlling Entity Name DirectControllingEntityName

FieldValueIRS element (for citing)
Business Name Line1Fairfield Medical CenterBusinessNameLine1
FieldValueIRS element (for citing)
Entity TypeC CorpEntityTypeTxt
Ownership1.00000OwnershipPct
Controlled OrganizationfalseControlledOrganizationInd
FieldValueIRS element (for citing)
Receipt Of Int Annts Rnts RyltsYes (true)ReceiptOfIntAnntsRntsRyltsInd
Gift Grnt Or Cap Contri To Oth OrgfalseGiftGrntOrCapContriToOthOrgInd
Gift Grnt Cap Contri From Oth OrgfalseGiftGrntCapContriFromOthOrgInd
Loans Or Guarantees To Other OrgfalseLoansOrGuaranteesToOtherOrgInd
Loans Or Guarantees From Oth OrgfalseLoansOrGuaranteesFromOthOrgInd
Div Related OrganizationfalseDivRelatedOrganizationInd
Asset Sale To Other OrgYes (true)AssetSaleToOtherOrgInd
Asset Purchase From Other OrgYes (true)AssetPurchaseFromOtherOrgInd
Asset ExchangefalseAssetExchangeInd
Rental Of Facilities To Oth OrgfalseRentalOfFacilitiesToOthOrgInd
Rental Of Fclts From Oth OrgYes (true)RentalOfFcltsFromOthOrgInd
Perform Of Services For Oth OrgfalsePerformOfServicesForOthOrgInd
Perform Of Services By Other OrgYes (true)PerformOfServicesByOtherOrgInd
Sharing Of FacilitiesfalseSharingOfFacilitiesInd
Paid Employees SharingYes (true)PaidEmployeesSharingInd
Reimbursement Paid To Other OrgYes (true)ReimbursementPaidToOtherOrgInd
Reimbursement Paid By Other OrgYes (true)ReimbursementPaidByOtherOrgInd
Transfer To Other OrgYes (true)TransferToOtherOrgInd
Transfer From Other OrgfalseTransferFromOtherOrgInd

Transactions Related Org TransactionsRelatedOrgGrp (11 entries)

Transaction TypeTransactionTypeTxtInvolvedInvolvedAmt
Southeast Ohio Sleep Disorders Center LLC
a$47,220
Fairfield Healthcare Professionals Inc
a$12,000
Fairfield Healthcare Professionals Inc
g$247,286
Zane Properties Corporation
h$689,200
Zane Properties Corporation
k$192,540
Simplified Healthcare Solutions LLC
m$268,542
Fairfield Healthcare Professionals Inc
o$5,085,587
Zane Properties Corporation
p$225,801
Fairfield Healthcare Professionals Inc
r$2,860,000
Fairfield Healthcare Professionals Inc
q$2,393,495
Zane Properties Corporation
q$629,577