2014-11-17T10:31:42-06:00 2013-12-31 990 2013-01-01 340718390 LODI COMMUNITY HOSPITAL LODI 3309485501 225 ELYRIA STREET LODI OH 44254 SUE J MCCARTHY TREASURER 3309485501 2014-11-17 2013 2015-11-30 17:44:51Z THOMAS WHELAN 225 ELYRIA STREET LODI OH 44254 17357204 0 X WWW.LODIHOSPITAL.COM X 1920 OH TO IMPROVE THE HEALTH AND LIVES OF THE PEOPLE AND COMMUNITIES WE SERVE. 13 9 165 40 0 0 0 22000 19127924 17280092 215 581 116193 17328 19244332 17320001 4268 4648 0 0 7895004 7363998 0 0 0 9198385 8110652 17097657 15479298 2146675 1840703 9718029 11413182 2802911 3132331 6915118 8280851 LODI COMMUNITY HOSPITAL'S MISSION IS TO IMPROVE THE HEALTH AND LIVES OF THE PEOPLE AND COMMUNITIES WE SERVE. 0 0 2590967 3526410 LODI COMMUNITY HOSPITAL IS A 25 BED HOSPITAL OFFERING INPATIENT SERVICES FOR MEDICAL AND SURGICAL PATIENTS. 10100328 13746952 LODI COMMUNITY HOSPITAL OFFERS A VARIETY OF OUTPATIENT SERVICES. OUTPATIENT SERVICES OFFERED TO PATIENTS INCLUDE RADIOLOGY, PHYSICAL THERAPY, CARDIAC, SURGERY, MAMMOGRAPHY, SLEEP CENTER, LAB SERVICES AND EMERGENCY SERVICES. 4945 4648 6730 LODI COMMUNITY HOSPITAL OFFERS COMMUNITY HEALTH AND EDUCATIONAL SERVICES TO THE LOCAL AND SURROUNDING COMMUNITIES. 12696240 1 1 0 1 0 0 0 0 0 1 1 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 18 0 1 165 1 0 0 0 0 0 0 0 0 0 0 X 13 9 0 0 0 0 1 1 1 1 1 0 1 1 1 1 1 1 1 1 1 1 0 OH X DEBBIE GORBACH 3303446603 1 AKRON GENERAL AVENUE AKRON OH 44307 ALAN PAPA PRESIDENT, COO, DIRECTOR 7.00 61.00 X X 0 409022 129578 THOMAS STOVER MD DIRECTOR 0.40 69.60 X 0 720420 79350 ROBERT KAMIENSKI MD DIRECTOR 0.20 40.00 X 0 401301 50026 TODD BREAUX MD DIRECTOR 1.50 X 0 0 0 WILLIAM FRANTZ DIRECTOR 0.20 0.20 X 0 0 0 MARY BETH C CARROLL DIRECTOR 1.10 X 0 0 0 SONIA ALEMAGNO DIRECTOR BEG 4/12/13 1.10 X 0 0 0 THERESA CARTER DIRECTOR 0.20 X 0 0 0 BRET TREIER DIRECTOR 0.20 0.20 X 0 0 0 JOHN BAKER DIRECTOR 0.20 X 0 0 0 MARLENE BARKHEIMER DIRECTOR 0.20 X 0 0 0 JAMES RICE DIRECTOR 0.20 X 0 0 0 HAROLD YOUNG DIRECTOR 0.80 X 0 0 0 CRAIG M BABBITT SECRETARY 1.10 68.00 X 0 344971 109819 DEBORAH L GORBACH ASST TREASURER 0.60 59.40 X 0 197355 114975 SUE MCCARTHY TREASURER 1.10 56.20 X 0 422670 20101 THOMAS WHELAN PRESIDENT COMMUNITY/SPECIALTY HOSP 50.70 X 136266 73374 59274 136266 2569113 563123 1 0 1 0 SIMONSON CONSTRUCTION SERVICE INC 2112 TROY ROAD ASHLAND OH 44805 CONSTRUCTION SERVICES 1353222 EPMG OF OHIO INC PA 2000 GREEN RD SUITE 300 ANN ARBOR MI 481051571 ER PHYSICIANS 663498 RESPIRATORY SUPPORT SERVICES 328 BOSTON MILLS ROAD HUDSON OH 44236 CARDIOPULMONARY SERVICES 388233 ALLIANCE HEALTHCARE SERVICES PO BOX 96485 CHICAGO IL 606936485 MRI SERVICES 185625 ARAMARK 115 NORTH FIRST STREET BURBANK CA 91502 LINEN SERVICES 112494 5 12000 10000 22000 NET PATIENT REVENUE 900099 14655343 14655343 MEDICARE/MEDICAID PAYM 900099 2618019 2618019 COMMUNITY HEALTH/EDUCA 900099 6730 6730 17280092 581 581 19440 37203 -17763 -17763 -17763 CAFETERIA 900099 41302 41302 CHANGE IN INTEREST-FOU 900099 -38043 -38043 31832 31832 35091 17320001 17280092 0 17909 X 1148 1148 3500 3500 174686 174686 5964946 5094746 870200 70815 60715 10100 787754 669919 117835 365797 324936 40861 40189 40189 441 441 2325576 1963422 362154 84925 84925 523623 334874 188749 88956 76268 12688 818739 701964 116775 32238 18122 14116 5176 5176 8605 7378 1227 617542 317227 300315 57491 49291 8200 PROVISION FOR BAD DEBTS 2206377 2206377 MEDICAL SUPPLIES 602264 602264 MGMT FEE TO AGHS 375574 375574 OHIO FRANCHISE FEE 291265 291265 31671 4478 27193 15479298 12696240 2783058 0 648572 1216076 2331618 2235896 51001 47159 156391 110798 15727911 8957380 5386953 6770531 1143494 1032722 9718029 11413182 1075366 1048664 920 1726625 2083667 2802911 3132331 X 6135344 7575058 779774 705793 6915118 8280851 9718029 11413182 X 1840703 -474970 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 1 441 0 0 0 441 0 PART II-B, LINE 1: PART II-B, LINE 1 (F), GRANTS TO OTHER ORGANIZATIONS FOR LOBBYING PURPOSES: LODI COMMUNITY HOSPITAL IS A DUES PAYING MEMBER OF THE OHIO HOSPITAL ASSOCIATION (OHA). A PORTION OF OUR DUES ($441) IS USED BY OHA FOR LOBBYING ACTIVITIES. 779774 8901 81322 164204 705793 683304 34659 70646 -8835 779774 336802 343021 3481 683304 132986 200000 3816 336802 148776 15790 132986 1.00000 0 1 1 98793 98793 10182031 4862330 5319701 5447087 4095050 1352037 6770531 INTEREST IN FOUNDATION NET ASSETS 1031470 RECEIVABLE FROM AFFILIATE 1252 1032722 ESTIMATED MEDICARE SETTLEMENT DUE 432645 ACCRUED SELF INSURANCE CLAIMS PAYABLE 128403 ASSET RETIREMENT OBLIGATION 188026 PAYABLE TO AFFILIATES 1334593 2083667 X 14772638 -2584566 -2584566 17357204 -37203 -37203 17320001 15138312 37203 37203 15101109 378189 378189 15479298 PART X, LINE 2: . PART XI, LINE 2D - OTHER ADJUSTMENTS: MANAGEMENT FEE -375,574. EXPENSES RECORDED IN REVENUE -2,615. BAD DEBT -2,206,377. PART XI, LINE 4B - OTHER ADJUSTMENTS: RENTAL EXPENSES -37,203. PART XII, LINE 2D - OTHER ADJUSTMENTS: RENTAL EXPENSES 37,203. PART XII, LINE 4B - OTHER ADJUSTMENTS: MANAGEMENT FEE 375,574. EXPENSES RECORDED IN REVENUE 2,615. 1 1 X 1 X 1 X 1 1 1 0 0 500721 0 500721 0.03770 2358091 1342805 1015286 0.07650 2858812 1342805 1516007 0.11420 165339 12755 152584 0.01150 69823 69823 0.00530 20401 20401 0.00150 255563 12755 242808 0.01830 3114375 1355560 1758815 0.13250 23389 23389 23389 23389 1 810120 3350019 3274949 75070 X 1 1 1 1 LODI COMMUNITY HOSPITAL 225 ELYRIA ST LODI OH 44254 X X X X LODI COMMMUNITY HOSPITAL 1 1 X X X X X X X X X 13 1 1 1 X WWW.AKRONGENERAL.ORG X X X X X X X X X 0 0 1 1 200.000000000000 1 400.000000000000 1 X X 1 1 X X X X X X X 1 0 X X X X 1 X 0 0 LODI COMMMUNITY HOSPITAL PART V, SECTION B, LINE 3: IN CONDUCTING ITS 2013 COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA), THE FACILITY TOOK INTO ACCOUNT INPUT FROM PERSONS WHO REPRESENT THE COMMUNITY BY INTERVIEWING COMMUNITY LEADERS, INCLUDING THOSE WITH SPECIALIZED KNOWLEDGE IN THE AREA OF PUBLIC HEALTH, AND BY CONDUCTING FOCUS GROUPS WITH RESIDENTS IN THE COMMUNITY TO SOLICIT THEIR VIEWS OF THE SIGNIFICANT HEALTH NEEDS OF THE COMMUNITY. A LIST OF THE COMMUNITY LEADERS INTERVIEWED - IDENTIFIED BY ORGANIZATION AND TITLE - CAN BE FOUND ON PAGE 7 OF THE CHNA REPORT, AVAILABLE ON OUR WEBSITE, WWW.AKRONGENERAL.ORG. LODI COMMMUNITY HOSPITAL PART V, SECTION B, LINE 4: IN PREPARING ITS OWN COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA), LODI COMMUNITY HOSPITAL PARTICIPATED IN A COMMUNITY WIDE COLLABORATIVE THAT INCLUDED MEDINA HOSPITAL AND WADSWORTH RITTMAN HOSPITAL. LODI COMMMUNITY HOSPITAL PART V, SECTION B, LINE 6I: IN ADDITION TO THE ITEMS INDICATED FOR LINE 6, LODI COMMUNITY HOSPITAL ALSO PREPARED AN IMPLEMENTATION STRATEGY WHICH OUTLINES FURTHER STEPS IT IS TAKING TO ADDRESS THE SIGNIFICANT HEALTH NEEDS OF THE COMMUNITY IT SERVES. THAT DOCUMENT MAY BE FOUND AT WWW.AKRONGENERAL.ORG LODI COMMMUNITY HOSPITAL PART V, SECTION B, LINE 7: LODI COMMUNITY HOSPITAL (LCH) ADDRESSES EACH CATEGORY OF SIGNIFICANT NEED IDENTIFIED IN ITS COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA). IN ITS CHNA, LCH DOES IDENTIFY AS "NEEDS NOT ADDRESSED" SEVERAL TYPES OF HEALTH SCREENINGS. THOSE SCREENINGS ARE:HIV SCREENINGSCHILD ANEMIACHILD ELEVATED LEAD THE REASON LCH DOES NOT ADDRESS THESE PARTICULAR SCREENING IS BECAUSE THE MEDINA COUNTY HEALTH DEPARTMENT IS ADDRESSING THESE SCREENINGS. LODI COMMMUNITY HOSPITAL PART V, SECTION B, LINE 12I: FEES FOR PATIENTS ELIGIBLE UNDER THE HOSPITAL FACILITY'S FINANCIAL ASSISTANCE POLICY (FAP) BEGIN WITH THE AMOUNT GENERALLY BILLED (AGB) WHICH IS DETERMINED USING THE MEDICARE LOOK BACK METHOD DESCRIBED IN THE PROPOSED TREASURY REGULATIONS UNDER SECTION 1.501(R)-5(B)(1). FEES FOR FAP INDIVIDUALS ARE DETERMINED USING A SLIDING SCALE DISCOUNT BASED ON THE FPG AND APPLIED TO THE AGB. LODI COMMMUNITY HOSPITAL PART V, SECTION B, LINE 14G: FOR UNINSURED AND UNDERINSURED PATIENTS, OUR FINANCIAL COUNSELORS OR ELIGIBILITY VENDOR STAFF REACH OUT UPON ADMISSION, OR AS SOON AS POSSIBLE THEREAFTER, TO EXPLAIN THE PROGRAMS FOR FREE OR DISCOUNTED CARE AND TO ASSESS ELIGIBILITY FOR MEDICAID AND OTHER VARIOUS PROGRAMS (VETERAN'S ADMINISTRATION, COBRA, OTHER LOCAL PROGRAMS, ETC.).FOR SCHEDULED OUTPATIENT SERVICES, FINANCIAL COUNSELORS ATTEMPT TO CONTACT THE PATIENT PRIOR TO SERVICE TO SCREEN UNINSURED PATIENTS FOR POSSIBLE ASSISTANCE/PAYMENT SOLUTIONS. IF UNABLE TO CONTACT PATIENT PRIOR TO THE SERVICE, WE ATTEMPT TO SCREEN ON THE DAY OF SERVICE OR AS SOON THEREAFTER AS POSSIBLE.FOR UNSCHEDULED EMERGENCY SERVICES, SCREENING MAY BE COMPLETED DURING THE VISIT WHEN PATIENT IS ABLE. OTHERWISE, ATTEMPTS TO CONTACT THE PATIENT ARE MADE BY THE FINANCIAL COUNSELING STAFF.IN EITHER CASE, IF WE ARE UNABLE TO CONTACT THE PATIENT, THE FINANCIAL ASSISTANCE INFORMATION IS ON EACH BILLING STATEMENT SENT TO THE PATIENT.IF THE PATIENT IS DETERMINED TO BE LIKELY ELIGIBLE FOR MEDICAID, THE ELIGIBILITY VENDOR STAFF ASSIST AND REPRESENT THE PATIENT THROUGHOUT THE APPLICATION PROCESS (UPON APPROVAL FROM THE PATIENT). IN ADDITION TO SIGNAGE, BROCHURES EXPLAINING OUR PROGRAMS ARE IN ALL OF OUR REGISTRATION AREAS. OUR WELCOME PACKETS ALSO INCLUDE INFORMATION AS DOES OUR WEBSITE. ALL STATEMENTS MAILED TO PATIENTS INCLUDE A NOTICE THAT OUR FINANCIAL ASSISTANCE APPLICATIONS ARE ON THE BACK OF THE STATEMENT. PHONE NUMBERS ARE PROVIDED FOR ASSISTANCE. 2 LODI COMMUNITY CARE CENTER 402 HIGHLAND LODI OH 44254 PHYSICIANS OFFICE LODI COMMUNITY CARE CENTER 221 ELYRIA ST LODI OH 44254 PHYSICIANS OFFICE PART I, LINE 7: COSTING METHODOLOGY. THE ORGANIZATION USED A COST TO CHARGE RATIO. THE COST TO CHARGE RATIO USED WAS DERIVED USING WORKSHEET 2 OF THE SCHEDULE H INSTRUCTIONS.COLUMN (F): IN CALCULATING THE PERCENTAGE OF TOTAL EXPENSE REPORTED IN COLUMN (F), TOTAL EXPENSES AS REPORTED ON FORM 990, PART IX, LINE 25, COLUMN (A) WERE REDUCED BY $2,206,377 - THE AMOUNT OF BAD DEBT EXPENSE INCLUDED ON THAT LINE. PART III, LINE 2: COSTING METHODOLOGY. BAD DEBTS AS REPORTED ON LINE 2 ARE DERIVED FROM THE GROSS CHARGES WRITTEN OFF AS UNCOLLECTIBLE FOR FINANCIAL REPORTING PURPOSES. THE COST-CHARGE RATIO DERIVED FROM SCHEDULE H, WORKSHEET 2 - RATIO OF PATIENT CARE COST TO CHARGES, WAS APPLIED IN CALCULATING LINE 2. PART III, LINE 4: THE PROVISION FOR BAD DEBTS IS BASED UPON MANAGEMENT'S ASSESSMENT OF HISTORICAL AND EXPECTED NET COLLECTIONS CONSIDERING HISTORICAL BUSINESS AND ECONOMIC CONDITIONS, TRENDS IN HEALTH CARE COVERAGE AND OTHER COLLECTION INDICATORS. PERIODICALLY THROUGHOUT THE YEAR, MANAGEMENT ASSESSES THE ADEQUACY OF THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS BASED UPON HISTORICAL WRITE-OFF EXPERIENCE BY PAYOR CATEGORY. THE RESULTS OF THIS REVIEW ARE THEN USED TO MAKE ANY MODIFICATIONS TO THE PROVISION FOR BAD DEBTS TO ESTABLISH AN APPROPRIATE ALLOWANCE FOR UNCOLLECTIBLE RECEIVABLES.AFTER SATISFACTION OF AMOUNTS DUE FROM INSURANCE, LODI COMMUNITY HOSPITAL FOLLOWS ESTABLISHED GUIDELINES FOR PLACING CERTAIN PAST-DUE PATIENT BALANCES WITH COLLECTION AGENCIES, SUBJECT TO VARIOUS RESTRICTIONS INCLUDING A PROHIBITION AGAINST ENGAGING IN EXTRAORDINARY COLLECTION PROCEDURES AGAINST AN INDIVIDUAL WITHOUT HAVING FIRST MADE REASONABLE EFFORTS TO DETERMINE THAT INDIVIDUALS ELIGIBILITY UNDER THE FINANCIAL ASSISTANCE POLICY. PART III, LINE 9B: LODI COMMUNITY HOSPITAL'S BAD DEBT COLLECTION POLICY ADDRESSES HOW TO IDENTIFY AND PROCESS PATIENTS' ACCOUNTS FOR QUALIFICATION AS CHARITY CARE OR OTHER FINANCIAL ASSISTANCE. AT REGISTRATION/ADMISSION A SCREENING PROCESS IDENTIFIES THOSE PATIENTS WITHOUT INSURANCE. THOSE PATIENT ACCOUNTS ARE AUTOMATICALLY CHECKED FOR POSSIBLE MEDICAID OR OTHER FINANCIAL ASSISTANCE ELIGIBILITY. WHERE ELEGIBILITY IS ESTABLISHED, THE PATIENT RECEIVES ASSISTANCE AFTER COMPLETING ANY REQUIRED APPLICATIONS. PATIENTS WHO QUALIFY FOR 100% CHARITY CARE WILL HAVE THEIR CHARGES WRITTEN OFF AS SUCH AND NO COLLECTION EFFORTS WILL FOLLOW. PATIENTS THAT QUALIFY FOR A SLIDING SCALE DISCOUNT THROUGH CHARITY CARE WILL HAVE THEIR STATEMENT ADJUSTED ACCORDINGLY. IF THE ADJUSTED BALANCE IS UNPAID, THE ADJUSTED BALANCE GOES TO COLLECTIONS IN ACCORDANCE WITH POLICY FOR ALL BAD DEBT ACCOUNTS. PART VI, LINE 2: THERE ARE A VARIETY OF NEEDS ASSESSMENT METHODS EMPLOYED BY LODI COMMUNITY HOSPITAL IN DETERMINING THE HEALTH NEEDS OF THE COMMUNITY IT SERVES. FOR MEDICAL STAFFING AND SERVICES, A COMBINATION OF FACTORS INCLUDING THE COMMUNITY'S DEMOGRAPHICS AND HEALTH NEEDS, THE DEMOGRAPHICS OF MEDICAL STAFF (PHYSICIAN AGE, SPECIALTY, ETC...) ARE WEIGHED TO DETERMINE WHERE RESOURCES SHOULD BE CONCENTRATED IN ORDER TO MEET CURRENT AND FUTURE HEALTHCARE NEEDS OF THE COMMUNITY. LODI COMMUNITY HOSPITAL PARTICIPATES IN HEALTHCARE INITIATIVES OF STATE AND LOCAL HEALTH DEPARTMENTS, EITHER SOLELY OR IN CONCERT WITH OTHER HEALTHCARE PROVIDERS, DEPENDING ON THE INITIATIVE. LODI COMMUNITY HOSPITAL HAS WORKED WITH LOCAL CHURCHES AND SOCIAL WELFARE ORGANIZATIONS TO IDENTIFY AND SERVICE HEALTHCARE NEEDS OF PERSONS WHO ARE UNDERSERVED BY GOVERNMENT PROGRAMS OR WHO HAVE FALLEN COMPLETELY THROUGH GOVERNMENT SAFETY NETS. PART VI, LINE 3: FINANCIAL ASSISTANCE APPLICATIONS ARE ON THE BACK OF EVERY PATIENT STATEMENT AS WELL AS MESSAGES INFORMING PATIENTS THAT ASSISTANCE IS AVAILABLE - VIA WEBSITE, AUTOMATED ATTENDANT OR CUSTOMER SERVICE LINE, SUCH MESSAGES ALSO ARE CONSPICUOUSLY POSTED IN PATIENT AREAS AND THROUGHOUT OUR FACILITIES. PART VI, LINE 4: LODI COMMUNITY HOSPITAL IS LOCATED IN SOUTHERN MEDINA COUNTY AND SERVES THE POPULATION OF 174,035 PEOPLE IN MEDINA. THE MEDIAN AGE OF RESIDENTS IN MEDINA IS 36.6 AND THE MEDIAN HOUSEHOLD INCOME IS AROUND $55,000. THE DOMINANT INDUSTRIES IN THE AREA ARE AGRICULTURE, MANUFACTURING, RETAIL AND GOVERNMENT. LODI COMMUNITY HOSPITAL ALSO SERVES A LARGE AMISH POPULATION. WHILE MEDINA COUNTY'S CURRENT UNEMPLOYMENT RATE IS AT 5.4% THE SURROUNDING COUNTIES' RATES ARE HIGHER; LORAIN IS 6.9% AND CUYAHOGA IS 7.0% WITH THE STATE OF OHIO AT 5.7%. PART VI, LINE 5: IN ORDER TO ENSURE THE FURTHERANCE OF LODI COMMUNITY HOSPITAL'S EXEMPT PURPOSE, ITS BOARD OF DIRECTORS CONSISTS OF COMMUNITY MEMBERS - THE MAJORITY OF WHOM ARE INDEPENDENT. THE SIZE OF THE BOARD - 13 IN 2013 - IS DESIGNED TO BE LARGE ENOUGH TO PROVIDE SUFFICIENT EXPERTISE AND DIVERSITY FOR AN ORGANIZATION OF THIS SIZE WITHOUT BEING TOO LARGE TO MANAGE ITSELF. THE BOARD, AS WELL AS SENIOR MANAGEMENT AND MEDICAL STAFF LEADERS, ARE CHARGED BY POLICY WITH THE EXPECTATION THAT PERSONS IN SUCH POSITIONS WILL ADVOCATE STRONG TIES BETWEEN THE ORGANIZATION AND THE COMMUNITY IT SERVES. AMONG OTHER THINGS THE POLICY CITES THE ASSUMPTION OF BOARD POSITIONS WITH SERVICE ORGANIZATIONS AND COMMUNITY AGENCIES AS WAYS TO PROMOTE SUCH TIES. THROUGH THE HEALTH SYSTEM'S COMMUNITY HEALTH COMMITTEE, LODI COMMUNITY HOSPITAL RECEIVES CONSIDERABLE SUPPORT IN MAINTAINING CONTACTS WITH A DIVERSE CROSS SECTION OF ITS COMMUNITY. THE COMMUNITY HEALTH COMMITTEE SUPPORTS INITIATIVES DESIGNED TO MEET THE NEEDS OF VULNERABLE, DISADVANTAGED POPULATIONS AND THOSE WHO LACK ACCESS TO QUALITY HEALTH CARE. THE MAJORITY OF THE COMMUNITY MEMBERS ARE INDEPENDENT MEMBERS WHOSE FOCUSED MISSION PROVIDES AN IMPORTANT ACCESS POINT FOR GROUPS WITHIN THE COMMUNITY.LODI COMMUNITY HOSPITAL ALSO MAINTAINS AN OPEN MEDICAL STAFF.LODI COMMUNITY HOSPITAL IS BOUND BY LAW TO REINVEST ANY SURPLUS FROM OPERATIONS INTO ITS FACILITIES AND PROGRAMS IN FURTHERANCE OF ITS EXEMPT PURPOSE, PROMOTING THE HEALTH OF THE COMMUNITY IT SERVES. PART VI, LINE 6: AKRON GENERAL HEALTH SYSTEM IS A NOT-FOR-PROFIT HEALTHCARE ORGANIZATION WITH THE MISSION OF IMPROVING THE HEALTH AND LIVES OF PATIENTS AND THE COMMUNITY, AKRON GENERAL HEALTH SYSTEM INCLUDES: AKRON GENERAL MEDICAL CENTER, A 537-BED TEACHING AND RESEARCH MEDICAL CENTER, AND EDWIN SHAW REHAB, THE AREA'S LARGEST PROVIDER OF REHABILITATION SERVICES: AKRON GENERAL PARTNERS, WHICH INCLUDES PARTNERS PHYSICIAN GROUP, THE AKRON GENERAL HEALTH & WELLNESS CENTERS, LODI COMMUNITY HOSPITAL, COMMUNITY HEALTH CENTERS AND OTHER COMPANIES; AKRON GENERAL COMMUNITY HEALTH VENTURES, WHICH INCLUDES VISITING NURSE SERVICE AND AFFILIATES, THE LARGEST AND MOST COMPREHENSIVE PROVIDER OF HOME HEALTHCARE SERVICES IN OHIO, AND THE AKRON GENERAL FOUNDATION.AKRON GENERAL HEALTH SYSTEM BRINGS TOGETHER A NETWORK OF HEALTH CARE FACILITIES AND STAFF WITH A RICH HERITAGE OF EXCEPTIONAL CARE. IT IS AN INTEGRATED HEALTH SYSTEM THAT PROVIDES HIGH-QUALITY HEALTHCARE FOR PATIENTS AND COMMUNITY THROUGHOUT THEIR ENTIRE LIFE - BIRTHS, INPATIENT AND OUTPATIENT SERVICES FOR ADULTS, EMERGENCY CARE, HOME CARE, WELLNESS, DURABLE MEDICAL EQUIPMENT AND HOSPICE SERVICES. X X 1 1 X X X X X 0 1 0 0 0 0 0 0 0 ALAN PAPA PRESIDENT, COO, DIRECTOR 0 369686 0 0 0 39336 0 103343 0 26235 0 538600 0 0 THOMAS STOVER MD DIRECTOR 0 675545 0 0 0 44875 0 58291 0 21059 0 799770 0 0 ROBERT KAMIENSKI MD DIRECTOR 0 359452 0 27024 0 14825 0 35030 0 14996 0 451327 0 0 CRAIG M BABBITT SECRETARY 0 312405 0 0 0 32566 0 86957 0 22862 0 454790 0 0 DEBORAH L GORBACH ASST TREASURER 0 184653 0 0 0 12702 0 99052 0 15923 0 312330 0 0 SUE MCCARTHY TREASURER 0 395144 0 0 0 27526 0 5105 0 14996 0 442771 0 0 THOMAS WHELAN PRESIDENT COMMUNITY/SPECIALTY HOSP 125078 67350 0 0 11188 6024 24650 13273 13770 7581 174686 94228 0 0 PART I, LINE 1A THE EXPENSES INDICATED IN PART I, LINE 1 ARE TAXABLE BENEFITS. AS SUCH THEY ARE PART OF TOTAL COMPENSATION. TOTAL COMPENSATION IS TESTED FOR REASONABLENESS AS DESCRIBED IN SCHEDULE O FOR FORM 990, PART VI, SECTION B, LINES 15A AND B. DISCRETIONARY SPENDING ACCOUNT A PORTION OF THE EMPLOYEES' TAXABLE INCOME IS DESIGNATED AS A DISCRETIONARY SPENDING ACCOUNT BENEFIT. THE RECIPIENTS ARE TAXED ON THE ENTIRE VALUE OF THE BENEFIT. THE NET AMOUNT MAY THEN BE APPLIED TO ONE OR MORE OF A LIMITED NUMBER OF CHOICES AVAILABLE UNDER THIS BENEFIT. IF ANY OF THE NET AMOUNT REMAINS AFTER CHOOSING FROM SUCH OPTIONS, IT IS APPLIED TOWARD THE RECIPIENT'S NON-QUALIFIED RETIREMENT BENEFIT. THIS BENEFIT WAS OFFERED TO EMPLOYEES AT THE VICE PRESIDENT LEVEL AND ABOVE. IN 2013, 1 EMPLOYEE RECEIVED THIS BENEFIT FROM THE REPORTING ORGANIZATION. TAX INDEMNIFICATION AND GROSS-UP PAYMENTS SUPPLEMENTAL RETIREMENT IS GROSSED-UP FOR TAX PURPOSES. THE GROSS-UP AND THE BENEFIT BOTH ARE TAXED AND ARE INCLUDED IN TOTAL COMPENSATION. TOTAL COMPENSATION IS TESTED FOR REASONABLENESS AS DESCRIBED IN SCHEDULE O FOR FORM 990, PART VI, SECTION B, LINES 15A AND B. THIS BENEFIT WAS OFFERED TO EMPLOYEES AT THE VICE PRESIDENT LEVEL AND ABOVE. IN 2013, 1 EMPLOYEE RECEIVED THIS BENEFIT FROM THE REPORTING ORGANIZATION. NOTE THAT, TAX INDEMNIFICATION IS NOT OFFERED AS A BENEFIT. PART I, LINE 4B LINE 4B: THE FOLLOWING EMPLOYEES PARTICIPATED IN A NONQUALIFIED TAXABLE PLAN. BEGINNING AFTER DECEMBER 31, 2012, THE PLAN IS NO LONGER FUNDED WITH EMPLOYER CONTRIBUTIONS. THOMAS WHELAN CRAIG BABBITT DEBBIE GORBACH SUE J. MCCARTHY TIM STOVER, M.D. ALAN PAPA DAVID PETER, M.D. RELATED ORGANIZATION COMPENSATION AKRON GENERAL HEALTH SYSTEM (FEIN 34-1546466) IS THE SOLE MEMBER OF AKRON GENERAL MEDICAL CENTER (FEIN 34-0714478). AKRON GENERAL MEDICAL CENTER IS THE SOLE MEMBER OF LODI COMMUNITY HOSPITAL. THE INDIVIDUALS LISTED BELOW ARE FULL TIME EMPLOYEES OF AKRON GENERAL HEALTH SYSTEM. THE AMOUNTS SHOWN IN SCHEDULE J PART II LINE 2 REFLECT COMPENSATION FOR SERVICES TO THAT ORGANIZATION. CRAIG M. BABBITT TIM STOVER, M.D. SUE J. MCCARTHY ALAN PAPA DEBBIE GORBACH AKRON GENERAL HEALTH SYSTEM (FEIN 34-1546466) IS THE SOLE MEMBER OF AKRON GENERAL MEDICAL CENTER (FEIN 34-0714478). AKRON GENERAL MEDICAL CENTER IS THE SOLE MEMBER OF LODI COMMUNITY HOSPITAL. THOMAS WHELAN DIVIDES HIS DUTIES BETWEEN AKRON GENERAL MEDICAL CENTER AND LODI COMMUNITY HOSPITAL. THE AMOUNTS SHOWN IN SCHEDULE J PART II LINE 2 REFLECT COMPENSATION FOR SERVICES TO THAT ORGANIZATION. AKRON GENERAL HEALTH SYSTEM (FEIN 34-1546466) IS THE SOLE MEMBER OF AKRON GENERAL MEDICAL CENTER. IT IS ALSO THE SOLE MEMBER OF AKRON GENERAL PARTNERS (FEIN 20-1801493) WHICH IN TURN IS THE SOLE MEMBER OF PARTNERS PHYSICIAN GROUP (FEIN 34-1843403) WHICH IN TURN IS THE SOLE MEMBER OF NHV PHYSICIANS PROFESSIONAL CORPORATION (FEIN 34-1818688). THE INDIVIDUAL LISTED BELOW IS PAID AS AN EMPLOYEE OF NHV PHYSICIANS PROFESSIONAL CORPORATION. THE AMOUNTS SHOWN IN SCHEDULE J PART II LINE 2 REFLECT COMPENSATION FOR SERVICES TO THAT ORGANIZATION. ROBERT KAMIENSKI, M.D. FORM 990, PART VI, SECTION A, LINE 6 LODI COMMUNITY HOSPITAL HAS ONE MEMBER, AKRON GENERAL MEDICAL CENTER. AKRON GENERAL MEDICAL CENTER IS ORGANIZED IN OHIO AS A NON-PROFIT ORGANIZATION AND IS RECOGNIZED AS EXEMPT FROM FEDERAL INCOME TAX UNDER IRC 501(C)(3). AKRON GENERAL MEDICAL CENTER IS NOT A PRIVATE FOUNDATION. FORM 990, PART VI, SECTION A, LINE 7A AKRON GENERAL MEDICAL CENTER IS THE SOLE MEMBER OF LODI COMMUNITY HOSPITAL. AKRON GENERAL HEALTH SYSTEM IS THE SOLE MEMBER OF AKRON GENERAL MEDICAL CENTER. THE ORGANIZATION FOLLOWS THE PRACTICE UNDER WHICH LODI COMMUNITY HOSPITAL CURRENT BOARD SUGGESTS CANDIDATES FOR OPENINGS ON ITS BOARD, THAT ARE THEN REVIEWED FOR APPROVAL BY AKRON GENERAL HEALTH SYSTEM'S BOARD. FORM 990, PART VI, SECTION A, LINE 7B AKRON GENERAL MEDICAL CENTER IS THE SOLE MEMBER OF LODI COMMUNITY HOSPITAL. AKRON GENERAL HEALTH SYSTEM IS THE SOLE MEMBER OF AKRON GENERAL MEDICAL CENTER. AKRON GENERAL HEALTH SYSTEM'S RESPONSIBILITIES INCLUDE PROVIDING LONG TERM PLANNING, ESTABLISHING SYSTEM POLICIES AND PROCEDURES, FINANCIAL MANAGEMENT, AND ASSISTING ORGANIZATIONS WITHIN THE SYSTEM IN CARRYING OUT THIER EXEMPT PROGRAMS. GENERALLY, AKRON GENERAL HEALTH SYSTEM LIMITS ITS POWER OF APPROVAL OVER DECISIONS MADE BY THE BOARD OF LODI COMMUNITY HOSPITAL TO THOSE CONCERNING MEMBERSHIP OF THAT BOARD AND THAT ORGANIZATION'S ANNUAL BUDGET. FORM 990, PART VI, SECTION B, LINE 11 LODI COMMUNITY HOSPITAL IS A MEMBER OF THE AKRON GENERAL HEALTH SYSTEM. LODI COMMUNITY HOSPITAL PREPARES ITS FORM 990 INTERNALLY. THE RETURN IS SUBJECT TO FINANCIAL REVIEW BY THE CHIEF FINANCIAL OFFICER OF AKRON GENERAL HEALTH SYSTEM, THE VICE PRESIDENT OF ACCOUNTING AND FINANCE OF AKRON GENERAL HEALTH SYSTEM, AND REVIEWED FOR COMPLIANCE WITH THE REPORTING REQUIREMENTS OF FORM 990 BY THE DIRECTOR OF CORPORATE TAX FOR AKRON GENERAL HEALTH SYSTEM. FORM 990, PART VI, SECTION B, LINE 12C LODI COMMUNITY HOSPITAL IS A MEMBER OF THE AKRON GENERAL HEALTH SYSTEM (SYSTEM). AKRON GENERAL HEALTH SYSTEM IS THE PARENT ORGANIZATION OF THE SYSTEM AND AS SUCH IT DETERMINES CERTAIN POLICIES AND PROCEDURES APPLICABLE TO ALL MEMBER ORGANIZATIONS. IN THE CASE OF CONFLICT OF INTEREST REPORTING, AKRON GENERAL HEALTH SYSTEM NOT ONLY DETERMINES THE POLICY AND THE PROCEDURE, IT CARRIES OUT THE PROCEDURE FOR ALL SYSTEM ORGANIZATIONS. A CONFLICT OF INTEREST QUESTIONNAIRE IS DISTRIBUTED TO ALL BOARD MEMBERS, MANAGEMENT PERSONNEL, EMPLOYED PHYSICIANS AND ANY OTHER PERSONNEL THAT HAVE BEEN DESIGNATED BY MANAGEMENT. THE DISTRIBUTION COVERS ALL SYSTEM ORGANIZATIONS. ALL RESPONSES THAT INDICATE A PERCEIVED CONFLICT OF INTEREST ARE TURNED OVER TO THE GOVERNANCE COMMITTEE (THE COMMITTEE) OF AKRON GENERAL HEALTH SYSTEM FOR REVIEW. THE COMMITTEE MAKES A DETERMINATION AS TO WHETHER THE PERCEIVED CONFLICT IS LIKELY TO BE AN ACTUAL CONFLICT, THE MATERIALITY OF ANY ACTUAL CONFLICTS AND THE EXTENT OF SAFEGUARDS REQUIRED FOR ANY ACTUAL CONFLICTS. SAFEGUARDS INCLUDE, BUT ARE NOT LIMITED TO, REQUIRING, IN THE CASE OF A BOARD MEMBER, THAT THE PERSON RECUSE HIMSELF OR HERSELF FROM ANY DISCUSSIONS OR VOTING THAT MAY BE AFFECTED BY THE CONFLICT, REQUIRING THE PERSON TO DISENGAGE FROM THE CONDUCT CREATING THE CONFLICT OR REQUIRING THE PERSON TO RESIGN FROM THE POSITION AFFECTED BY THE CONFLICT. THIS PROCESS IS CONDUCTED BY AKRON GENERAL HEALTH SYSTEM'S LEGAL SERVICES DEPARTMENT ANNUALLY. THE CONFLICT OF INTEREST LETTER PUTS THE RECIPIENT ON NOTICE THAT HE OR SHE IS UNDER AN ONGOING DUTY TO REPORT ANY POTENTIAL CONFLICTS THAT MAY ARISE SUBSEQUENT TO THIS FORMAL PROCESS. SUBSEQUENT EVENT REPORTING IS MONITORED BY AKRON GENERAL HEALTH SYSTEM'S LEGAL SERVICES DEPARTMENT. ANY SUBSEQUENT REPORTED ITEMS ARE SUBJECT TO THE AFOREMENTIONED REVIEW PROCESS BY AKRON GENERAL HEALTH SYSTEM'S GOVERNANCE COMMITTEE. FORM 990, PART VI, SECTION B, LINE 15 THE REPORTING ORGANIZATION IS A MEMBER OF THE AKRON GENERAL HEALTH SYSTEM. THE EXEMPT PURPOSE OF THE SYSTEM PARENT, AKRON GENERAL HEALTH SYSTEM (AGHS), IS TO SUPPORT THE MEMBERS OF THAT SYSTEM. ONE OF THE SUPPORT SERVICES THAT AGHS PROVIDES IS DETERMINING THE COMPENSATION OF THE TOP MANAGEMENT PERSONNEL OF THE REPORTING ORGANIZATION. AGHS FOLLOWS A PROCESS FOR DETERMINING COMPENSATION OF THE ORGANIZATION'S CEO AND OTHER TOP MANAGEMENT PERSONNEL THAT IS MODELED AFTER THE REQUIREMENTS FOUND IN INTERNAL REVENUE CODE SECTION 4958 FOR ESTABLISHING THE PRESUMPTION OF REASONABLE COMPENSATION. THEREFORE, THE PROCESS CALLS FOR RECOMMENDATIONS - DEVELOPED BY AN INDEPENDENT COMPENSATION CONSULTANT, BASED ON COMPARABLE MARKET DATA FROM PUBLISHED SURVEYS AND THE FORMS 990 OF COMPARABLE ORGANIZATIONS - THAT ARE WITHIN THE RANGE OF THE COMPENSATION OF SIMILARLY SITUATED PERSONS AT SIMILARLY SITUATED ORGANIZATIONS. THESE RECOMMENDATIONS ARE REVIEWED BY A COMMITTEE OF THE REPORTING ORGANIZATION'S BOARD OF DIRECTORS. THE COMMITTEE IS COMPRISED OF INDEPENDENT PERSONS AND THE DELIBERATIONS ARE DOCUMENTED, CONTEMPORANEOUSLY, IN THE COMMITTEE'S MINUTES. THE COMPENSATION FOR ALL TOP MANAGEMENT WAS REVIEWED FOR REASONABLENESS USING THIS PROCESS IN 2012. FORM 990, PART VI, SECTION C, LINE 19 CURRENTLY, LODI COMMUNITY HOSPITAL DOES NOT MAKE ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, OR ITS FINANCIAL STATEMENTS GENERALLY AVAILABLE TO THE PUBLIC. LODI COMMUNITY HSOPITAL DOES MAKE THESE DOCUMENTS AVAILABLE ON A CASE BY CASE BASIS. FORM 990, PART IX, LINE 11G PHYSICIAN PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 678,062. MANAGEMENT AND GENERAL EXPENSES 2,500. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 680,562. OTHER PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 911,271. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 911,271. BILLING & COLLECTION FEES: PROGRAM SERVICE EXPENSES 53,231. MANAGEMENT AND GENERAL EXPENSES 50,889. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 104,120. LICENSES & REGISTRATION: PROGRAM SERVICE EXPENSES 53,850. MANAGEMENT AND GENERAL EXPENSES 54,299. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 108,149. SECURITY SERVICES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 11,315. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 11,315. COURIER: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 54,122. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 54,122. TRANSCRIPTION: PROGRAM SERVICE EXPENSES 46,506. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 46,506. MISCELLANEOUS: PROGRAM SERVICE EXPENSES 220,502. MANAGEMENT AND GENERAL EXPENSES 189,029. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 409,531. FORM 990, PART XI, LINE 9: CHANGE IN INTEREST IN FOUNDATION NET ASSETS -73,980. GRANT FUNDING FOR CAPITAL 8,384. TRANSFER TO/FROM AFFILIATES -409,374. AKRON GENERAL HEALTH SYSTEM 1 AKRON GENERAL AVENUE AKRON OH 44307 341546466 SUPPORTING ORGANIZATION OH IRC 501(C)(3) 11C, FI NONE 0 AKRON GENERAL PARTNERS INC 1 AKRON GENERAL AVENUE AKRON OH 44307 201801493 SUPPORTING ORGANIZATION OH IRC 501(C)(3) 11A AKRON GENERAL HEALTH SYSTEM 1 AKRON GENERAL FOUNDATION 1 AKRON GENERAL AVENUE AKRON OH 44307 341127047 FUNDRAISING OH IRC 501(C)(3) 7 AKRON GENERAL HEALTH SYSTEM 1 COMMUNITY HEALTH VENTURES INC 1 HOME CARE PLACE AKRON OH 44320 341478435 SUPPORTING ORGANIZATION OH IRC 501(C)(3) 11C, FI AKRON GENERAL HEALTH SYSTEM 1 AKRON GENERAL MEDICAL CENTER 1 AKRON GENERAL AVENUE AKRON OH 44307 340714478 HOSPITAL OH IRC 501(C)(3) 3 AKRON GENERAL HEALTH SYSTEM 1 PARTNERS PHYSICIAN GROUP 1 AKRON GENERAL AVENUE AKRON OH 44307 341843403 COMMUNITY HEALTH SERVICES OH IRC 501(C)(3) 9 AKRON GENERAL PARTNERS INC 1 NHV PHYSICIANS PROFESSIONAL CORPORATION 1 AKRON GENERAL AVENUE AKRON OH 44307 341818688 PRIMARY & SPECIALTY OUTPATIENT HEALTHCARE OH IRC 501(C)(3) 11A PARTNERS PHYSICIAN GROUP 1 AKRON GENERAL MEDICAL CENTER SELF INSURANCE TRUST FUND 1 AKRON GENERAL AVENUE AKRON OH 44307 341243687 SUPPORTING ORGANIZATION OH IRC 501(C)(3) 11A AKRON GENERAL MEDICAL CENTER 1 VISITING NURSE SERVICE INC 1 HOME CARE PLACE AKRON OH 44320 340714779 HOME HEALTH CARE OH IRC 501(C)(3) 9 COMMUNITY HEALTH VENTURES INC 1 HOSPICE CARE OHIO INC 1 HOME CARE PLACE AKRON OH 44320 341771508 HOSPICE SERVICES OH IRC 501(C)(3) 9 COMMUNITY HEALTH VENTURES INC 1 VISITING HOURS INC 1 HOME CARE PLACE AKRON OH 44320 341347010 HOME HEALTH CARE OH IRC 501(C)(3) 9 COMMUNITY HEALTH VENTURES INC 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 1 AKRON GENERAL HEALTH SYSTEM O 733591 FAIR MARKET VALUE AKRON GENERAL HEALTH SYSTEM P 56803 FAIR MARKET VALUE AKRON GENERAL MEDICAL CENTER S 769980 COST AKRON GENERAL MEDICAL CENTER R 2411542 COST AKRON GENERAL MEDICAL CENTER Q 1899547 COST AKRON GENERAL MEDICAL CENTER P 384629 COST PARTNERS PHYSICIAN GROUP R 232554 COST PARTNERS PHYSICIAN GROUP Q 649927 COST PARTNERS PHYSICIAN GROUP P 415438 COST AKRON GENERAL PARTNERS INC R 68762 COST AKRON GENERAL PARTNERS INC Q 83511 COST