2013-05-08T15:43:14-05:00 2012-06-30 381357951 PLANTE & MORAN PLLC 65 EAST STATE STREET SUITE 600 COLUMBUS OH 43215 990 2011-07-01 310678022 SOUTHERN OHIO MEDICAL CENTER SOUT 7403567622 1248 KINNEYS LANE PORTSMOUTH OH 45662 DEAN WRAY 7403567622 2013-05-03 1 BERNIE OSTROWSKI P00366367 6148493000 2011 2016-02-25 16:41:14Z SEE SCHEDULE O MR RANDAL ARNETT 1805 27TH STREET PORTSMOUTH OH 45662 305035971 0 X WWW.SOMC.ORG X 1954 OH SOUTHERN OHIO MEDICAL CENTER IS AN ACUTE HEALTH CARE SYSTEM LOCATED IN PORTSMOUTH, OHIO. SOMC'S EXEMPT PURPOSE IS TO SERVE SOUTH CENTRAL OHIO AND NORTHEASTERN KENTUCKY WITH STATE-OF-THE-ART FACILITIES AND HEALTH CARE TECHNOLOGIES. 11 5 2425 441 0 -4273 555337 343101 269717227 290435825 4556771 6153248 5073710 4192874 279903045 301125048 19877368 23768885 0 0 115992741 121980916 0 0 20712 135798503 139513243 271668612 285263044 8234433 15862004 415553074 430168195 194361513 202051367 221191561 228116828 X WE WILL MAKE A DIFFERENCE. AT SOMC, OUR MISSION IS TO MAKE A DIFFERENCE. WE STRIVE TO LIVE OUT THAT MISSION BY PROVIDING OUR REGION WITH THE HIGHEST QUALITY OF CARE, DELIVERED BY PROFESSIONALS WHO ARE AMONG THE BEST IN THEIR FIELDS. WE EXTEND THAT CARE AND PASSION TO MAKE A DIFFERENCE IN THE COMMUNITY BY BEING A VERY GOOD NEIGHBOR, EMPLOYER, AND COMMUNITY SUPPORTER. 0 0 226894036 23768885 292830328 SEE SCHEDULE OSOUTHERN OHIO MEDICAL CENTER IS AN ACTIVE MEMBER OF THE COMMUNITIES IT SERVES AND IS INVOLVED IN VARIOUS PROGRAMS AND ACTIVITIES THROUGHOUT THE AREA. WHETHER IT'S THROUGH ANNUAL COLLABORATIVE BLOOD DRIVES, PARTICIPATION DURING COUNTY FAIRS, ATTENDANCE AT MONTHLY SCHOOL BOARD MEETINGS, OR MENTORING CHILDREN THROUGH THE MORE LITERACY LOCAL SCHOOL PROGRAM, OUR EMPLOYEES GO ABOVE AND BEYOND TO CREATE LASTING RELATIONSHIPS IN AND OUTSIDE OUR HOSPITAL WALLS, HELPING US TRULY MAKE A DIFFERENCE IN THE LIVES OF THOSE AROUND US.IT'S THROUGH THESE RELATIONSHIPS THAT SOMC HAS BEEN RECOGNIZED FOR MANY OUTSTANDING ACCOMPLISHMENTS, RECEIVING SUCH NOTABLE HONORS OVER THE YEARS AS ANCC'S MAGNET RECOGNITION, OSHA'S VPP STAR STATUS, PRESS GANEY'S DISTINCTIVE WORKPLACE AWARD, AS WELL AS BEING NAMED ONE OF FORTUNE'S 100 BEST COMPANIES TO WORK FOR AND ONE OF MODERN HEALTHCARE'S 100 BEST PLACES TO WORK.IT'S ALSO THROUGH THESE RELATIONSHIPS THAT MANY KEY DECISIONS ARE MADE AT SOMC. ONE OF OUR FIVE STRATEGIC VALUES, RELATIONSHIPS, SHAPES MANY FACETS OF CUSTOMER SERVICE AND THE CARE THAT IS PROVIDED WITHIN THE HOSPITAL. IT IS OUR GOAL TO LISTEN AND PARTNER WITH CUSTOMERS TO MAKE A DIFFERENCE TO THOSE WE SERVE. ADDITIONAL FEEDBACK IS ALSO GATHERED THROUGH FOCUS GROUPS CONDUCTED BY THE SOMC COMMUNITY RELATIONS DEPARTMENT, AS WELL AS THE SOMC EXECUTIVE TEAM'S "OPEN DOOR POLICY," WHICH BOTH PROVIDE THE OPPORTUNITY TO GATHER INFORMATION AND SUGGESTIONS TO IMPROVE HOSPITAL SERVICES AND UNDERSTAND TECHNOLOGICAL NEEDS. IN ADDITION TO PERSONAL RELATIONSHIPS, SOMC ESTABLISHES WORKING RELATIONSHIPS WITH ORGANIZATIONS THROUGHOUT THE TRI-STATE TO FOCUS ON THE HEALTH AND WELLNESS OF THE COMMUNITY. SOMC AND ITS EMPLOYEES PARTICIPATE IN A VARIETY OF COMMUNITY-BASED ORGANIZATIONS INCLUDING THE OHIO RIVER VALLEY CHAPTER RED CROSS BOARD, THE CHAMBER OF COMMERCE, ROTARY CLUB, UNITED WAY, SOUTHERN OHIO PERFORMING ARTS ASSOCIATION, MAIN STREET PORTSMOUTH, THE PORTSMOUTH AREA ARTS COUNCIL, AS WELL AS AREA SCHOOL BOARDS, COMMITTEES AND CHURCHES. OTHER PARTICIPATORY PROGRAMS INCLUDE LEADERSHIP PORTSMOUTH, OHIO PARTNERSHIP FOR EXCELLENCE, TASK FORCE ON DOMESTIC VIOLENCE, PORTSMOUTH KIWANIS SERVICE CLUB, SCIOTO RESIDENTIAL SERVICES BOARD, PARAMEDIC ADVISORY BOARD, SALVATION ARMY, RIVER SWEEP, HABITAT FOR HUMANITY, SOUTHERN OHIO CORRECTIONAL FACILITY MINISTRIES, ARTHRITIS FOUNDATION, MEDICAL RESERVE CORP, PARISH NURSE NETWORK, SOUTHERN OHIO DIABETES COALITION, PORTSMOUTH BICENTENNIAL BOARD AND THE SOUTHERN OHIO CORRECTIONAL FACILITY COMMUNITY ADVISORY BOARD. MANY BENEFITS ARE CREATED THROUGH THESE PARTNERSHIPS INCLUDING SPONSORSHIPS FOR CULTURAL AFFAIRS, COMMUNITY HEALTH AND WELLNESS PROGRAMS, HEALTH SCREENINGS, EDUCATION, CHILDREN'S PROGRAMS AND YOUTH ACTIVITIES. ONE SUCH COLLABORATIVE EFFORT ALLOWS SOMC TO PROVIDE ADULT IMMUNIZATIONS FOR INFLUENZA, PNEUMONIA AND HEPATITIS B TO HUNDREDS OF COMMUNITY MEMBERS EACH YEAR. NURSES AND PHYSICIANS VOLUNTEER THEIR TIME AND EFFORT TO TRAVEL AROUND THE SOMC REGION AND TO THIRD-WORLD COUNTRIES TO PROVIDE SERVICES FREE OF CHARGE OR AT A REDUCED RATE TO POPULATIONS WHO GREATLY BENEFIT FROM THEIR ANNUAL VISITS. ANOTHER PROGRAM, TITLED "LOVE YOUR HEART," REACHES MORE THAN 1,200 KINDERGARTEN STUDENTS EACH YEAR. DEVELOPED IN 2000 BY THE SOMC INTENSIVE CARE UNIT TO PROMOTE EARLY CHILDHOOD HEALTHY HABITS, "LOVE YOUR HEART" USES CHARACTERS FROM THE WIZARD OF OZ TO TEACH CHILDREN HOW TO TAKE CARE OF THEIR HEARTS THROUGH HEALTHY EATING, EXERCISE AND THREE OTHER HANDS-ON STATIONS. HOSPITAL EMPLOYEES, LOCAL NURSING STUDENTS, AND VOLUNTEERS FROM ALL OVER THE COMMUNITY PARTICIPATE IN PROVIDING EDUCATION DURING THIS ANNUAL BELOVED PROGRAM. THROUGH ITS CREATIVE MESSAGE AND INVENTIVE APPROACH, PARTICIPANTS FEEL THEY ARE MAKING A DIFFERENCE AND SERVING AS ROLE MODELS FOR HEALTHY LIVING. THE ICU STAFF WAS AWARDED THE AMERICAN ASSOCIATION OF CRITICAL CARE NURSES SEABURY AND SMITH NATIONAL COMMUNITY SERVICE AWARD FOR THIS EXTRAORDINARY PROGRAM.MANY WELLNESS-RELATED PROGRAMS AND SCREENINGS ARE CONDUCTED EACH YEAR BY THE SOMC COMMUNITY HEALTH AND WELLNESS DEPARTMENT IN AN EFFORT TO IMPROVE THE OVERALL WELLBEING OF THE LOCAL COMMUNITY. THE DEPARTMENT OFTEN DEDICATES EACH MONTH TO A DIFFERENT HEALTH MESSAGE AND THEN WORKS TO PROVIDE EVENTS THAT FOCUS INFORMATION ON THAT PARTICULAR AREA. FOR EXAMPLE, OCTOBER IS ANNUALLY KNOWN AS BREAST CANCER AWARENESS MONTH, AND OFTEN FEATURES MANY PROGRAMS, SCREENINGS, COMMERCIALS, FLYERS, AND ACTIVITIES THAT FOCUS SPECIFICALLY ON THAT TOPIC AND ITS EDUCATION. THE COMMUNITY HEALTH AND WELLNESS DEPARTMENT ALSO ACTIVELY SEEKS GRANTS THAT CAN BE USED TOWARD SPECIFIC COMMUNITY-WIDE PROGRAMS. THE SUSAN G. KOMEN GRANT FOR THE HANDS OF HOPE PROGRAM PROVIDES FREE OR REDUCED FEE EDUCATION, SCREENINGS AND MAMMOGRAMS TO PROMOTE EARLY DETECTION OF BREAST DISEASE. IT LINKS BREAST CANCER PATIENTS TO RESOURCES AFTER BREAST CANCER TREATMENT. SOMC IS DEDICATED TO EDUCATING ITS APPALACHIAN COMMUNITY ON SELF-BREAST EXAMS PROVIDING CLINICAL BREAST SERVICES AND DIAGNOSTIC TESTING, WITH A FOCUS ON YEARLY MAMMOGRAMS.ADDITIONAL EDUCATION EFFORTS AND COMMUNITY SUPPORT IS PROVIDED BY THE PHYSICIANS, MEDICAL STUDENTS AND EMPLOYEES OF SOMC DURING MANY VOLUNTEER OPPORTUNITIES THROUGHOUT THE YEAR, SUCH AS SPORTS PHYSICALS, DIABETES, HIGH BLOOD PRESSURE AND CANCER SCREENINGS. SOMC AND ITS EMPLOYEES ALSO GIVE BACK TO THE COMMUNITY THROUGH INTERNAL DONATION CAMPAIGNS AIMED AT RAISING FUNDS OR ITEMS FOR A SPECIFIC CAUSE. EACH YEAR, SOMC SELECTS CHAIRMEN TO LEAD THE ORGANIZATION'S UNITED WAY CAMPAIGN, WHICH DIRECTLY BENEFITS THE MORE THAN 15 LOCAL ORGANIZATIONS THAT MAKE UP THE SCIOTO COUNTY UNITED WAY PROGRAM. MORE THAN 98 PERCENT OF SOMC EMPLOYEES PARTICIPATE IN THE EVENT, CHOOSING TO MAKE DIRECT OR PAYROLL-DEDUCTED MONETARY CONTRIBUTIONS. IN ADDITION TO THIS MONETARY CONTRIBUTION, SOMC ALSO SUPPORTS THE UNITED WAY THROUGH AN ANNUAL SCHOOL SUPPLY DRIVE. THROUGH THIS PROGRAM, SOMC EMPLOYEES HELP TO PROVIDE BASIC AND NECESSARY SUPPLIES TO THE STUDENTS OF 11 COUNTY SCHOOLS. ANYWHERE FROM 1,800 TO 3,500 ITEMS HAVE ANNUALLY BEEN COLLECTED IN THE PAST, SHOWING THAT SOMC INVESTS IN THE EDUCATION OF OUR COMMUNITY'S FUTURE GENERATIONS. MANY MEMBERS OF THE COMMUNITY VOLUNTEER AT SOMC, SERVING AS COMMUNITY AMBASSADORS. THEY OFFER A FRIENDLY SMILE AND COMFORTING WORDS TO PATIENTS AND FAMILY MEMBERS, WHILE ALSO ASSISTING IN MORE THAN 40 AREAS WITHIN THE HOSPITAL. THEY GIVE BACK TO THE COMMUNITY BY RAISING FUNDS TO PURCHASE MEDICAL EQUIPMENT, ASSISTING WITH PATIENT NEEDS AND PROVIDING VARIOUS COMMUNITY SERVICES TO AID IN MAKING A DIFFERENCE. THESE 431 VOLUNTEERS PROVIDED MORE THAN 37,828 UN-PAID HOURS IN 2012. WITH THE COMMUNITIES AND SOMC WORKING SO CLOSELY TOGETHER, SOMC CAN PROUDLY SAY IT IS ABLE TO OBTAIN ITS GOAL OF "MAKING A DIFFERENCE." 226894036 1 1 0 1 0 0 0 0 0 1 1 0 0 0 1 1 0 1 0 0 0 0 0 0 1 0 1 1 1 1 1 1 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 1 1 1 1 0 1 226 0 1 2425 1 1 1 0 0 0 0 1 1 0 0 0 0 X 11 5 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 OH X RICHARD GILCHER 7403567622 1248 KINNEYS LANE PORTSMOUTH OH 45662 ROBERT E DEVER 1.00 X X 0 0 0 RANDAL ARNETT 40.00 X X 568690 0 261303 STEVEN A CONLEY 1.00 X 0 0 0 GARY DUZAN 1.00 X X 0 0 0 GEORGE LAWSON 1.00 X X 0 0 0 RITA RICE-MORRIS PHD 1.00 X 0 0 0 JOHN TURJOMAN MD 1.00 X X 6151 0 0 DAVID FOWLER 1.00 X 0 0 0 GEORGE V JOHNSON MD 1.00 X 0 0 0 JAMES W STAKER 1.00 X 0 0 0 AARON ADAMS DO 1.00 X 16288 0 0 DARREN ADAMS DO 1.00 X X 0 0 0 DEAN WRAY 40.00 X 295258 0 113833 KENDALL L STEWART 30.00 X 418989 0 50278 CLAUDIA L BURCHETT 40.00 X 227689 0 105715 VICKI A NOEL 40.00 X 200834 0 70646 LEEANN L SAMMONS 40.00 X 162070 0 59032 RORY E PHILLIPS 40.00 X 173185 0 38580 ROGER L DONINI 40.00 X 143030 0 32652 KEITH A HILES 40.00 X 142007 0 31228 BRIAN MISSLER 40.00 X 136667 0 34117 BENJAMIN L GILL 40.00 X 146221 0 31420 2637079 0 828804 42 0 1 0 REHABCARE GROUP INC 7733 FORSYTH BLVD SUITE 1200 ST LOUIS MO 63105 MANAGEMENT SERVICES 5926233 UNITED COLLECTION BUREAU INC 4100 HORIZON DR SUITE 101 COLUMBUS OH 43220 PATIENT ACCOUNT BILLING 1989028 MAYO COLLABORATIVE SERVICES 200 SW FIRST STREET ROCHESTER MN 55905 LABORATORY TESTING 1218582 DKM CONSTRUCTION INC 584 SMOKEY HOLLOW RD PIKETON OH 45661 CONSTRUCTION 1083651 HILL VIEW RETIREMENT 1610 28TH STREET PORTSMOUTH OH 45662 HOSPICE PURCHASE SERVICE 697214 33 58737 52567 131294 100503 47108 343101 PATIENT SERVICES 621300 277706688 277706688 PHARMACY INCOME 900099 11194859 11194859 RENTAL INCOME 531110 933287 933287 LAB SERVICES 900099 600991 600991 290435825 3954386 3954386 38721 0 38721 38721 38721 5381558 605232 3743977 43951 1637581 561281 2198862 2198862 121959 58737 122995 -1036 -1036 LIFE CENTER 900099 1531821 1531821 CAFETERIA SALES 900099 1528162 1528162 GIFT SHOP SALES 900099 199466 199466 895740 663216 232524 4155189 301125048 292830328 0 7951619 23760885 23760885 8000 8000 2901111 2901111 87840482 67001809 20838673 5405277 4122970 1282307 19113388 14636612 4476776 6720658 5126300 1594358 22005 22005 312315 312315 227250 227250 20033108 15624018 4409090 2138815 2138815 50488361 38510849 11977512 1400577 602200 798377 9240575 7048404 2192171 463007 310109 152898 350743 123029 227714 8297540 7153309 1144231 17831523 15373218 2458305 931872 931872 BAD DEBT EXPENSE 23482219 23482219 OHIO FRANCHISE TAX 2968063 2968063 PHYSICIAN RECRUITMENT 569543 569543 BIO MEDICAL EXPENSE 193822 193822 561905 176053 365140 20712 285263044 226894036 58348296 20712 7240 7215 17773237 15510009 3465 0 28695733 32960807 144790 116196 3956968 3956145 1328905 2790395 325742199 158006452 171799950 167735747 171057210 188609907 5369172 3800202 1979080 2000436 13437324 12681136 415553074 430168195 18977979 24727809 152834169 150174639 1965017 1801617 20584348 25347302 194361513 202051367 X 221188096 228116828 3465 0 221191561 228116828 415553074 430168195 X 15862004 -8936737 X X 0 1 1 X 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 5781 5781 0 EXPLANATION OF LOBBYING ACTIVITIES: PART II-B, LINE 1: MEMBERSHIP DUES IN THE AMOUNT OF $43,985 AND $64,352 WERE PAID TO THE AMERICAN HOSPITAL ASSOCIATION AND THE OHIO HOSPITAL ASSOCIATION, RESPECTIVELY. OF THESE DUES, $2,199 AND $3,582 WERE RELATED TO LOBBYING ACTIVITIES. 1751554 48512 58318 38898 1819486 1618098 72131 104428 43103 1751554 1640678 75282 -62236 35626 1618098 1555536 65883 51298 32039 1640678 1.00000 0.00000 0.00000 1 0 4360622 4360622 96910155 31349998 65560157 145025 103251 41774 210544896 121568731 88976165 13781501 4984472 8797029 167735747 PENSION LIABILITY 15465330 COST REPORT SETTLEMENTS 5949776 INTERCOMPANY PAYABLES 20536 ACCRUED SELF-INSURED LIABILITY 3163268 CERP DEFERRED COMP LIABILITY 748392 25347302 DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: PART V, LINE 4: ENDOWMENT FUNDS ARE TO BE SPENT AT THE BOARD'S DISCRETION, AND ARE INTENDED TO BE RETAINED FOR FUTURE NEEDS OF THE ORGANIZATION. THE ENDOWMENT FUNDS ARE HELD AND ADMINISTERED BY THE SCIOTO FOUNDATION. DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: SOUTHERN OHIO MEDICAL CENTER AND ITS SUBSIDIARIES ARE NONPROFIT, TAX-EXEMPT ORGANIZATIONS AND, ACCORDINGLY, NO TAX PROVISION IS REFLECTED IN THE CONSOLIDATED FINANCIAL STATEMENTS. ACCOUNTING PRINCIPLES GENERALLY ACCECPTED IN THE UNITED STATES OF AMERICA REQUIRE MANAGEMENT TO EVALUATE TAX POSITIONS TAKEN BY THE ORGANIZATION AND RECOGNIZE A TAX LIABILITY IF THE ORGANIZATION 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 ORGANIZATION AND HAS CONCLUDED THAT AS OF JUNE 30, 2012, THERE ARE NO UNCERTAIN TAX POSITIONS TAKEN OR EXPECTED TO BE TAKEN THAT WOULD REQUIRE RECOGNITION OF A LIABILITY OR DISCLOSURE IN THE FINANCIAL STATEMENTS. THE ORGANIZATION 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 JUNE 30, 2009. HIKE FOR HOSPICE 51156 51083 73 1561 1407 18277 PAINT IT PINK 51982 3184 48798 25250 6 77558 4470 73088 3744 2890 69866 180696 58737 121959 5305 4297 113393 122995 -1036 1 1 X 1 X 125.000000000000 1 X 125.000000000000 1 1 1 0 1 1 4871 8051979 1024515 7027464 0.02680 42267099 29150483 13116616 0.05010 4871 50319078 30174998 20144080 0.07690 30790 127479 127479 0.00050 1335758 1335758 0.00510 221299 221299 0.00080 30790 1684536 1684536 0.00640 35661 52003614 30174998 21828616 0.08330 0 23482219 2126969 72327587 74495285 -2167698 X 1 0 1 1 SOUTHERN OHIO MEDICAL CENTER

1805 27TH STREET PORTSMOUTH OH 45662

X X X X X SOUTHERN OHIO MEDICAL CENTER 1 1 1 125.000000000000 1 125.000000000000 0 1 1 X X X X X X 1 0 1 X 0 0 5 URGENT CARE

8770 OHIO RIVER ROAD WHEELERSBURG OH 45694

URGENT CARE SOMC CANCER CENTER

1121 KINNEYS LANE PORTSMOUTH OH 45662

CANCER TREATMENT & CARE HOSPICE IN-PATIENT

2201 25TH STREET PORTSMOUTH OH 45662

HOSPICE IN-PATIENT HEALTH CARE CENTER

1212 18TH STREET PORTSMOUTH OH 45662

HEALTH CARE CENTER WOUND HEALING & SLEEP LAB

1745 27TH STREET PORTSMOUTH OH 45662

SLEEP LAB PART I, LINE 3C: THE HOSPITAL USES FEDERAL POVERTY GUIDELINES PART I, LINE 6A: NOT APPLICABLE PART I, LINE 7: COSTS FOR LINES 7A AND 7B WERE CALCULATED USING THE COST-TO-CHARGE RATIO DERIVED FROM WORKSHEET 2, AND THE COSTS ON LINES 7E, 7F, AND 7I WERE BASED ON ACTUAL COSTS. PART I, LINE 7G: NOT APPLICABLE PART I, LINE 7, COLUMN (F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $ 23482219. PART II: NOT APPLICABLE PART III, LINE 4: TOTAL BAD DEBT EXPENSE REPORTED ON THE FINANCIAL STATEMENTS EXCLUDES AMOUNTS KNOWN TO QUALIFY FOR CHARITY DISCOUNTS. ANY PARTIAL PAYMENTS THAT ARE SUBSEQUENTLY RECEIVED ARE APPLIED AS AN OFFSET TO BAD DEBT EXPENSE. NONE OF THE BAD DEBT EXPENSE REPORTED ON THE FINANCIAL STATEMENTS IS TREATED AS A COMMUNITY BENEFIT. THE ESTIMATED AMOUNT OF BAD DEBT EXPENSE REPORTED ON THE FINANCIAL STATEMENTS ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S CHARITY CARE POLICY REPRESENTS ACCOUNTS THAT WERE DEEMED TO BE BAD DEBT WHICH SUBSEQUENTLY APPLIED FOR FINANCIAL ASSISTANCE. THE ACCOUNTS BELIEVED TO QUALIFY FOR CHARITY CARE HOWEVER WERE NOT MOVED FROM BAD DEBTS.FOOTNOTE TO FINANCIAL STATEMENTS: AN ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS IS ESTABLISHED ON AN AGGREGATE BASIS BY USING HISTORICAL WRITE-OFF FACTORS APPLIED TO UNPAID ACCOUNTS BASED ON AGING. LOSS RATE FACTORS ARE BASED ON HISTORICAL LOSS EXPERIENCE AND ADJUSTED FOR ECONOMIC CONDITIONS AND OTHER TRENDS AFFECTING THE ORGANIZATION'S ABILITY TO COLLECT OUTSTANDING AMOUNTS. UNCOLLECTIBLE AMOUNTS ARE WRITTEN OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS IN THE PERIOD THEY ARE DETERMINED TO BE UNCOLLECTIBLE. PART III, LINE 8: MEDICARE COSTS WERE TAKEN FROM THE MEDICARE COST REPORT, WHICH USES A COST TO CHARGE RATIO ALLOWED UNDER MEDICARE COST REPORT METHODOLOGY. NONE OF THE SHORTFALL IS TREATED AS COMMUNITY BENEFIT. PART III, LINE 9B: WE TREAT ALL PATIENTS THE SAME. IF THERE IS INSURANCE COVERAGE, WE BILL THE CLAIMS FOR PAYMENT. IF THERE IS NO INSURANCE - OR IF THERE IS A BALANCE REMAINING AFTER INSURANCE PAYS - THE PATIENT IS SENT THE SAME AMOUNT OF STATEMENTS OVER A PERIOD OF TIME, PHONE ATTEMPTS ARE MADE AND, IF THERE IS NO RESPONSE TO OUR EFFORTS, THE ACCOUNTS ARE PLACED WITH OUTSIDE AGENCIES FOR COLLECTION. SOUTHERN OHIO MEDICAL CENTER PART V, SECTION B, LINE 19D: SOMC'S PATIENT PRICING IS BUILT ON CHARGE SPECIFIC COSTS FROM OUR INTERNAL COSTING SYSTEM WHICH THEN IS EVALUATED AGAINST MEDICARE, MEDICAID AND/OR OTHER FEE SCHEDULE IN EFFECT THEN ALSO WITH OTHER HOSPITALS PRICES BOTH LOCALLY AND REGIONALLY WHERE OBTAINABLE. SOMC CHARGES FAP ELIGIBLE INDIVIDUALS THE SAME INITIALLY AS OTHER INDIVIDUALS WITH INSURANCE COVERING MEDICAL CARE. IT IS ONLY AFTER THE FAP ELIGIBLE PATIENTS APPLY FOR FINANCIAL ASSISTANCE THAT THE CHARGED AMOUNT MAY BE ADJUSTED. IF THE FAP ELIGIBLE PATIENTS' APPLICATION QUALIFIES FOR FINANCIAL ASSISTANCE THEN THEY ARE ABLE TO RECIEVE UP TO A 100% REDUCTION TO THE CHARGED AMOUNT. PART VI, LINE 2: THE COMMUNITY RELATIONS AND THE WORKFORCE DEVELOPMENT DEPARTMENTS CONDUCT ANNUAL FOCUS GROUPS WITH OUR KEY CUSTOMERS AS WELL AS EVALUATE THE DISEASE PROCESSES EFFECTING OUR COMMUNITY. DATA FOR THESE DISEASE PROCESSES IS COLLECTED THROUGH INTERNAL DATABASES AS WELL AS THROUGH THE CDC AND PORTSMOUTH HEALTH DEPARTMENT. COMMUNITY FOCUS GROUPS ARE CONTRACTED THROUGH A THIRD PARTY VENDOR AND ARE HELD EACH YEAR AFTER SOUTHERN OHIO MEDICAL CENTER'S STRATEGIC PLANNING PROCESS. PART VI, LINE 3: SOMC CONTRACTS WITH ELIGIBILITY ASSISTANCE PROGRAM (EAP) WHOSE STAFF IS LOCATED ON-SITE TO SEE PATIENTS INHOUSE, OFFER ASSISTANCE WITH APPLICATIONS FOR OHIO MEDICAID, HCAP AND/OR CHARITY FUNDING. THEY ALSO CONTACT OUTPATIENTS WITH LARGE BALANCES TO OFFER THE SAME ASSISTANCE. EACH BILLING STATEMENT MAILED TO PATIENTS ALSO OFFERS THE FINANCIAL ASSISTANCE APPLICATION (FOR HCAP AND CHARITY FUNDING) FOR THE PATIENT TO COMPLETE AND RETURN TO THE BUSINESS OFFICE. PART VI, LINE 4: SOMC IS LOCATED IN PORTSMOUTH, OHIO, A RURAL COMMUNITY AT THE CONFLUENCE OF THE OHIO AND SCIOTO RIVERS IN THE SOUTHERNMOST TIP OF THE STATE. SOMC'S TOTAL MARKET AREA INCLUDES SCIOTO, PIKE, LAWRENCE AND ADAMS COUNTIES IN OHIO, AND LEWIS AND GREENUP COUNTIES IN KENTUCKY WITH A TOTAL MARKET POPULATION OF 246,537 (WWW.CENSUS.GOV/POPEST/COUNTIES). SOMC PROVIDES A FULL CONTINUUM OF HEALTH CARE SERVICES TO OUR COMMUNITIES THROUGH A STATE-OF-THE-ART 233-BED ACUTE CARE FACILITY AT OUR MAIN CAMPUS AS WELL AS MULTIPLE PHYSICIAN SATELLITE FACILITIES THROUGHOUT THE COMMUNITIES OF LUCASVILLE, MINFORD, PORTSMOUTH, SCIOTOVILLE, WAVERLY, WHEELERSBURG, WEST UNION AND VANCEBURG IN KENTUCKY.SOMC'S LARGEST PAYER GROUPS ARE MEDICARE AND MEDICAID. THE UNITED STATES CENSUS BUREAU DATA (2010) SHOWS THAT SCIOTO COUNTY RESIDENTS HAVE A MEAN HOUSEHOLD INCOME NEARLY 15,000 LESS THAN MEDIAN HOUSEHOLD INCOME FOR THE STATE OF OHIO, AS WELL AS 16.9% OF FAMILIES BELOW POVERTY LEVEL, COMPARED TO OHIO'S RATE OF 10.8%. THE SAME DATA ALSO SHOWS THAT SCIOTO COUNTY HAS A 12.0% UNEMPLOYMENT RATE COMPARED TO THE STATE OF OHIO'S RATE OF 6.0%. SOUTHERN OHIO MEDICAL CENTER PROVIDED MORE THAN $20 MILLION IN CHARITY CARE OVER THE LAST YEAR. PART VI, LINE 5: SOUTHERN OHIO MEDICAL CENTER IS AN ACTIVE MEMBER OF THE COMMUNITIES IT SERVES AND IS INVOLVED IN VARIOUS PROGRAMS AND ACTIVITIES THROUGHOUT THE AREA. WHETHER IT'S THROUGH ANNUAL COLLABORATIVE BLOOD DRIVES, PARTICIPATION DURING COUNTY FAIRS, ATTENDANCE AT MONTHLY SCHOOL BOARD MEETINGS, OR MENTORING CHILDREN THROUGH THE MORE LITERACY LOCAL SCHOOL PROGRAM, OUR EMPLOYEES GO ABOVE AND BEYOND TO CREATE LASTING RELATIONSHIPS IN AND OUTSIDE OUR HOSPITAL WALLS, HELPING US TRULY MAKE A DIFFERENCE IN THE LIVES OF THOSE AROUND US.IT'S THROUGH THESE RELATIONSHIPS THAT SOMC HAS BEEN RECOGNIZED FOR MANY OUTSTANDING ACCOMPLISHMENTS, RECEIVING SUCH NOTABLE HONORS OVER THE YEARS AS ANCC'S MAGNET RECOGNITION, OSHA'S VPP STAR STATUS, PRESS GANEY'S DISTINCTIVE WORKPLACE AWARD, AS WELL AS BEING NAMED ONE OF FORTUNE'S 100 BEST COMPANIES TO WORK FOR AND ONE OF MODERN HEALTHCARE'S 100 BEST PLACES TO WORK.IT'S ALSO THROUGH THESE RELATIONSHIPS THAT MANY KEY DECISIONS ARE MADE AT SOMC. ONE OF OUR FIVE STRATEGIC VALUES, RELATIONSHIPS, SHAPES MANY FACETS OF CUSTOMER SERVICE AND THE CARE THAT IS PROVIDED WITHIN THE HOSPITAL. IT IS OUR GOAL TO LISTEN AND PARTNER WITH CUSTOMERS TO MAKE A DIFFERENCE TO THOSE WE SERVE. ADDITIONAL FEEDBACK IS ALSO GATHERED THROUGH FOCUS GROUPS CONDUCTED BY THE SOMC COMMUNITY RELATIONS DEPARTMENT, AS WELL AS THE SOMC EXECUTIVE TEAM'S "OPEN DOOR POLICY," WHICH BOTH PROVIDE THE OPPORTUNITY TO GATHER INFORMATION AND SUGGESTIONS TO IMPROVE HOSPITAL SERVICES AND UNDERSTAND TECHNOLOGICAL NEEDS. IN ADDITION TO PERSONAL RELATIONSHIPS, SOMC ESTABLISHES WORKING RELATIONSHIPS WITH ORGANIZATIONS THROUGHOUT THE TRI-STATE TO FOCUS ON THE HEALTH AND WELLNESS OF THE COMMUNITY. SOMC AND ITS EMPLOYEES PARTICIPATE IN A VARIETY OF COMMUNITY-BASED ORGANIZATIONS INCLUDING THE OHIO RIVER VALLEY CHAPTER RED CROSS BOARD, THE CHAMBER OF COMMERCE, ROTARY CLUB, UNITED WAY, SOUTHERN OHIO PERFORMING ARTS ASSOCIATION, MAIN STREET PORTSMOUTH, THE PORTSMOUTH AREA ARTS COUNCIL, AS WELL AS AREA SCHOOL BOARDS, COMMITTEES AND CHURCHES. OTHER PARTICIPATORY PROGRAMS INCLUDE LEADERSHIP PORTSMOUTH, OHIO PARTNERSHIP FOR EXCELLENCE, TASK FORCE ON DOMESTIC VIOLENCE, PORTSMOUTH KIWANIS SERVICE CLUB, SCIOTO RESIDENTIAL SERVICES BOARD, PARAMEDIC ADVISORY BOARD, SALVATION ARMY, RIVER SWEEP, HABITAT FOR HUMANITY, SOUTHERN OHIO CORRECTIONAL FACILITY MINISTRIES, ARTHRITIS FOUNDATION, MEDICAL RESERVE CORP, PARISH NURSE NETWORK, SOUTHERN OHIO DIABETES COALITION, PORTSMOUTH BICENTENNIAL BOARD AND THE SOUTHERN OHIO CORRECTIONAL FACILITY COMMUNITY ADVISORY BOARD. MANY BENEFITS ARE CREATED THROUGH THESE PARTNERSHIPS INCLUDING SPONSORSHIPS FOR CULTURAL AFFAIRS, COMMUNITY HEALTH AND WELLNESS PROGRAMS, HEALTH SCREENINGS, EDUCATION, CHILDREN'S PROGRAMS AND YOUTH ACTIVITIES. ONE SUCH COLLABORATIVE EFFORT ALLOWS SOMC TO PROVIDE ADULT IMMUNIZATIONS FOR INFLUENZA, PNEUMONIA AND HEPATITIS B TO HUNDREDS OF COMMUNITY MEMBERS EACH YEAR. NURSES AND PHYSICIANS VOLUNTEER THEIR TIME AND EFFORT TO TRAVEL AROUND THE SOMC REGION AND TO THIRD-WORLD COUNTRIES TO PROVIDE SERVICES FREE OF CHARGE OR AT A REDUCED RATE TO POPULATIONS WHO GREATLY BENEFIT FROM THEIR ANNUAL VISITS. ANOTHER PROGRAM, TITLED "LOVE YOUR HEART," REACHES MORE THAN 1,200 KINDERGARTEN STUDENTS EACH YEAR. DEVELOPED IN 2000 BY THE SOMC INTENSIVE CARE UNIT TO PROMOTE EARLY CHILDHOOD HEALTHY HABITS, "LOVE YOUR HEART" USES CHARACTERS FROM THE WIZARD OF OZ TO TEACH CHILDREN HOW TO TAKE CARE OF THEIR HEARTS THROUGH HEALTHY EATING, EXERCISE AND THREE OTHER HANDS-ON STATIONS. HOSPITAL EMPLOYEES, LOCAL NURSING STUDENTS, AND VOLUNTEERS FROM ALL OVER THE COMMUNITY PARTICIPATE IN PROVIDING EDUCATION DURING THIS ANNUAL BELOVED PROGRAM. THROUGH ITS CREATIVE MESSAGE AND INVENTIVE APPROACH, PARTICIPANTS FEEL THEY ARE MAKING A DIFFERENCE AND SERVING AS ROLE MODELS FOR HEALTHY LIVING. THE ICU STAFF WAS AWARDED THE AMERICAN ASSOCIATION OF CRITICAL CARE NURSES SEABURY AND SMITH NATIONAL COMMUNITY SERVICE AWARD FOR THIS EXTRAORDINARY PROGRAM.MANY WELLNESS-RELATED PROGRAMS AND SCREENINGS ARE CONDUCTED EACH YEAR BY THE SOMC COMMUNITY HEALTH AND WELLNESS DEPARTMENT IN AN EFFORT TO IMPROVE THE OVERALL WELLBEING OF THE LOCAL COMMUNITY. THE DEPARTMENT OFTEN DEDICATES EACH MONTH TO A DIFFERENT HEALTH MESSAGE AND THEN WORKS TO PROVIDE EVENTS THAT FOCUS INFORMATION ON THAT PARTICULAR AREA. FOR EXAMPLE, OCTOBER IS ANNUALLY KNOWN AS BREAST CANCER AWARENESS MONTH, AND OFTEN FEATURES MANY PROGRAMS, SCREENINGS, COMMERCIALS, FLYERS, AND ACTIVITIES THAT FOCUS SPECIFICALLY ON THAT TOPIC AND ITS EDUCATION. THE COMMUNITY HEALTH AND WELLNESS DEPARTMENT ALSO ACTIVELY SEEKS GRANTS THAT CAN BE USED TOWARD SPECIFIC COMMUNITY-WIDE PROGRAMS. THE SUSAN G. KOMEN GRANT FOR THE HANDS OF HOPE PROGRAM PROVIDES FREE OR REDUCED FEE EDUCATION, SCREENINGS AND MAMMOGRAMS TO PROMOTE EARLY DETECTION OF BREAST DISEASE. IT LINKS BREAST CANCER PATIENTS TO RESOURCES AFTER BREAST CANCER TREATMENT. SOMC IS DEDICATED TO EDUCATING ITS APPALACHIAN COMMUNITY ON SELF-BREAST EXAMS PROVIDING CLINICAL BREAST SERVICES AND DIAGNOSTIC TESTING, WITH A FOCUS ON YEARLY MAMMOGRAMS.ADDITIONAL EDUCATION EFFORTS AND COMMUNITY SUPPORT IS PROVIDED BY THE PHYSICIANS, MEDICAL STUDENTS AND EMPLOYEES OF SOMC DURING MANY VOLUNTEER OPPORTUNITIES THROUGHOUT THE YEAR, SUCH AS SPORTS PHYSICALS, DIABETES, HIGH BLOOD PRESSURE AND CANCER SCREENINGS. SOMC AND ITS EMPLOYEES ALSO GIVE BACK TO THE COMMUNITY THROUGH INTERNAL DONATION CAMPAIGNS AIMED AT RAISING FUNDS OR ITEMS FOR A SPECIFIC CAUSE. EACH YEAR, SOMC SELECTS CHAIRMEN TO LEAD THE ORGANIZATION'S UNITED WAY CAMPAIGN, WHICH DIRECTLY BENEFITS THE MORE THAN 15 LOCAL ORGANIZATIONS THAT MAKE UP THE SCIOTO COUNTY UNITED WAY PROGRAM. MORE THAN 98 PERCENT OF SOMC EMPLOYEES PARTICIPATE IN THE EVENT, CHOOSING TO MAKE DIRECT OR PAYROLL-DEDUCTED MONETARY CONTRIBUTIONS. IN ADDITION TO THIS MONETARY CONTRIBUTION, SOMC ALSO SUPPORTS THE UNITED WAY THROUGH AN ANNUAL SCHOOL SUPPLY DRIVE. THROUGH THIS PROGRAM, SOMC EMPLOYEES HELP TO PROVIDE BASIC AND NECESSARY SUPPLIES TO THE STUDENTS OF 11 COUNTY SCHOOLS. ANYWHERE FROM 1,800 TO 3,500 ITEMS HAVE ANNUALLY BEEN COLLECTED IN THE PAST, SHOWING THAT SOMC INVESTS IN THE EDUCATION OF OUR COMMUNITY'S FUTURE GENERATIONS. MANY MEMBERS OF THE COMMUNITY VOLUNTEER AT SOMC, SERVING AS COMMUNITY AMBASSADORS. THEY OFFER A FRIENDLY SMILE AND COMFORTING WORDS TO PATIENTS AND FAMILY MEMBERS, WHILE ALSO ASSISTING IN MORE THAN 40 AREAS WITHIN THE HOSPITAL. THEY GIVE BACK TO THE COMMUNITY BY RAISING FUNDS TO PURCHASE MEDICAL EQUIPMENT, ASSISTING WITH PATIENT NEEDS AND PROVIDING VARIOUS COMMUNITY SERVICES TO AID IN MAKING A DIFFERENCE. THESE 431 VOLUNTEERS PROVIDED MORE THAN 37,828 UN-PAID HOURS IN 2012. WITH THE COMMUNITIES AND SOMC WORKING SO CLOSELY TOGETHER, SOMC CAN PROUDLY SAY IT IS ABLE TO OBTAIN ITS GOAL OF "MAKING A DIFFERENCE." PART VI, LINE 6: SOUTHERN OHIO MEDICAL CENTER IS A SINGLE ACUTE CARE PROVIDER OF HEALTH SERVICES AT TWO FACILITIES IN THE PORTSMOUTH, OHIO AREA. SOMC IS THE PARENT ORGANIZATION OF FRIENDS OF SOMC, SOMC MEDICAL CARE FOUNDATION, INC., SOMC TITLE HOLDING COMPANY, AND THE SOLE BENEFICIARY OF SOMC FOUNDATION.THE FRIENDS OF SOMC RENDER SERVICE TO SOUTHERN OHIO MEDICAL CENTER OF PORTSMOUTH, OHIO AND ITS PATIENTS AND ASSIST THE HOSPITAL IN PROMOTING HEALTH AND WELFARE OF THE COMMUNITY IN ACCORDANCE WITH THE OBJECTIVES ESTABLISHED BY THE GOVERNING BOARD OF TRUSTEES OF SOUTHERN OHIO MEDICAL CENTER. IN ADDITION, THE FRIENDS OF SOMC CREATE, RECEIVE AND MAINTAIN A FUND OR FUNDS OF REAL OR PERSONAL PROPERTY OR BOTH, TO USE AND APPLY THE WHOLE OR ANY PART OF THE INCOME THEREFROM AND THE PRINCIPAL THEREOF EXCLUSIVELY FOR THE USE AND BENEFIT OF SOUTHERN OHIO MEDICAL CENTER.SOMC MEDICAL CARE FOUNDATION IS ORGANIZED AND OPERATES EXCLUSIVELY FOR CHARITABLE, EDUCATIONAL AND SCIENTIFIC PURPOSES FOR THE BENEFIT OF SOMC, AN OHIO NON-PROFIT CORPORATION INCLUDING (A) PROVIDING MEDICAL, SURGICAL AND OTHER HEALTH CARE AND TREATMENT OF THE SICK, DISABLED, AND INJURED, REGARDLESS OF RACE, COLOR, RELIGION, NATIONAL ORIGIN, AGE, HANDICAP, SEX, OR THE ABILITY TO PAY FOR SERVICES; (B) CONDUCTING EDUCATIONAL ACTIVITIES RELATED TO HEALTHCARE AND TREATMENT OF THE SICK, DISABLED, INJURED AND TO PROMOTE AND CARRY ON MEDICAL, SCIENTIFIC AND CLINICAL RESEARCH RELATED TO HEALTH CARE AND TREATMENT OF THE SICK, DISABLED, AND INJURED; AND (C) ENGAGING IN ANY LAWFUL ACTIVITIES FOR WHICH CORPORATIONS MAY BE FORMED UNDER CHAPTER 1785 OF THE OHIO REVISED CODE THAT ARE NOT CONSISTNET WITH THE FOREGOING.SOMC TITLE HOLDING COMPANY OWNS AND MANAGES REAL ESTATE ON BEHALF OF SOUTHERN OHIO MEDICAL CENTER.SOMC FOUNDATION SUPPORTS SOUTHERN OHIO MEDICAL CENTER WITH FINANCIAL TRANSFERS. 1 AMERICAN RED CROSS 614 GLOVER ST PORTSMOUTH OH 45662 314414096 501(C)(3) 22225 YEARLY PLEDGE AND SPONSORSHIP DINNER. NOTRE DAME SCHOOLS 2220 SUNRISE AVE PORTSMOUTH OH 45662 311652882 501(C)(3) 6090 DEVELOPMENT FUND, GOLD TEAM SPONSOR, BID YOUR HEART OUT DONATION. PORTSMOUTH RIVER DAYS INC PO BOX 132 PORTSMOUTH OH 45662 314395524 501(C)(3) 10000 SPONSORSHIP OF RIVER DAYS COMMUNITY FESTIVAL. SHAWNEE STATE UNIVERSITY 940 2ND STREET PORTSMOUTH OH 45662 237073017 501(C)(3) 52850 VARIOUS SPONSORSHIPS AND DONATIONS. SOUTHERN OHIO GROWTH PARTNERSHIP PO BOX 509 PORTSMOUTH OH 45662 311068766 501(C)(3) 5000 PROGRAM DONATION. PORTSMOUTH AREA ARTS COUNCIL PO BOX 1258 PORTSMOUTH OH 45662 310916197 501(C)(3) 7277 SPONSORSHIP OF "DICKENS OF A CHRISTMAS" AND "RESPECT IS A MAGIC WORD." SCIOTO COUNTY JUNIOR FAIR 602 7TH STREET COURTHOUSE ROOM 7 PORTSMOUTH OH 45662 311115810 501(C)(3) 6500 SPONSORSHIP OF CIRCUS. SOMC MEDICAL CARE FOUNDATION INC 1248 KINNEYS LANE PORTSMOUTH OH 45662 311374523 501(C)(3) 23476090 INTERCOMPANY SUPPORT. SOUTHERN OHIO PERFORMING ARTS PO BOX 1122 PORTSMOUTH OH 45662 311346687 501(C)(3) 15000 SPONSORSHIP OF "BROADWAY SERIES." CIVIC FORUM 5466 STATE RT 139 PORTSMOUTH OH 45662 312339573 501(C)(3) 5000 SPELLING BEE AND FIREWORKS ON JULY 4TH. SOUTHERN OHIO MUSEUM PO BOX 990 PORTSMOUTH OH 45662 310914613 501(C)(3) 15000 SPONSORSHIP OF "CREAM OF THE CROP" AND DONATIONS. CIRQUE D'ART THEATRE 412-414 CHILLICOTHE ST PORTSMOUTH OH 45662 262867950 501(C)(3) 7277 SPONSORSHIP OF "THE NUTCRACKER." WAVERLY CITY SCHOOLS 1 TIGER DRIVE WAVERLY OH 45690 316401098 501(C)(3) 5000 RELATIONSHIPS AND DONATIONS 13 0 EMPLOYEE RELIEF FUND 8 8000 PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, PART I, LINE 2: SOUTHERN OHIO MEDICAL CENTER MAY MAKE CONTRIBUTIONS IN SUPPORT OF ORGANIZATIONS IN THE COMMUNITY. FOR GRANTS TO INDIVIDUALS LISTED IN PART III, FUNDS ARE DONATED BY EMPLOYEES AND MATCHED BY SOUTHERN OHIO MEDICAL CENTER. IN THE EVENT THAT AN EMPLOYEE EXPERIENCES AN EMERGENCY WHERE THEY ARE IN SERIOUS FINANCIAL NEED, A COMMITTEE MAY APPROVE GRANTS FROM THE EMPLOYEE RELIEF FUND. X 0 0 X X X X X 0 1 0 0 0 1 0 0 0 RANDAL ARNETT 519376 0 29553 0 19761 0 243228 0 18075 0 829993 0 0 0 DEAN WRAY 264595 0 12451 0 18212 0 94389 0 19444 0 409091 0 0 0 KENDALL L STEWART 314812 0 14048 0 90129 0 32203 0 18075 0 469267 0 0 0 CLAUDIA L BURCHETT 217993 0 8736 0 960 0 83088 0 22627 0 333404 0 0 0 VICKI A NOEL 191910 0 8517 0 407 0 46323 0 24323 0 271480 0 0 0 LEEANN L SAMMONS 154908 0 6848 0 314 0 35817 0 23215 0 221102 0 0 0 RORY E PHILLIPS 167920 0 5127 0 138 0 14105 0 24475 0 211765 0 0 0 ROGER L DONINI 142765 0 265 0 0 0 7176 0 25476 0 175682 0 0 0 KEITH A HILES 141537 0 470 0 0 0 6552 0 24676 0 173235 0 0 0 BRIAN MISSLER 135915 0 470 0 282 0 9741 0 24376 0 170784 0 0 0 BENJAMIN L GILL 140266 0 5716 0 239 0 15846 0 15574 0 177641 0 0 0 PART I, LINE 1A THE ORGANIZATION PAYS A COUNTRY CLUB MEMBERSHIP ON THE CEO'S BEHALF AS A MEANS FOR THE CEO TO NETWORK WITH PHYSICIANS. NONE OF THE COUNTRY CLUB MEMBERSHIP DUES WERE TREATED AS TAXABLE COMPENSATION TO THE CEO. PART I, LINE 1B SOUTHERN OHIO MEDICAL CENTER DOES NOT FOLLOW A WRITTEN POLICY FOR REIMBURSEMENT OR A PROVISION OF THE BENEFIT. THE ORGANIZATION PAYS THE COUNTRY CLUB MEMBERSHIP DIRECTLY ON BEHALF OF THE CEO, SO NO REIMBURSEMENT POLICY IS IN PLACE. THE CEO'S EMPLOYMENT CONTRACT SETS FORTH THE DECISION FOR THE ORGANIZATION TO FOLLOW TO PROVIDE THE PAYMENT OF THE COUNTRY CLUB DUES AS A BENEFIT TO THE CEO. PART I, LINE 4B THE ORGANIZATION MADE CONTRIBUTIONS TO A SERP FOR THE FOLLOWING INDIVIDUALS: RANDAL ARNETT: 226,078 KENDALL STEWART: 17,503 DEAN WRAY: 79,689 CLAUDIA BURCHETT: 63,222 VICKI NOEL: 34,158 LEEANN SAMMONS: 27,666 BENJAMIN GILL: 9,178 THE SERP PLAN IS AVAILABLE ONLY TO INDIVIDUALS WHO HAVE HELD AN EXECUTIVE POSITION FOR ONE YEAR. THE SERP WILL VEST UPON THE EXECUTIVE REACHING A SPECIFIED AGE. IF AN EXECUTIVE SEVERS EMPLOYMENT OR IS TERMINATED, A NONCOMPETE AGREEMENT IS IN PLACE FOR 2 YEARS. THE EXECUTIVE FORFEITS ANY SERP PAYMENTS IF HE/SHE DOES NOT CONFORM TO THE NONCOMPETE AGREEMENT. THE AMOUNTS LISTED ABOVE ARE INCLUDED IN COMPENSATION REPORTED IN SCHEDULE J, PART II, COLUMN C. KENDALL STEWART'S SERP WAS PAID OUT DURING THE CALENDAR YEAR IN THE AMOUNT OF $69,273. THE PAY OUT IS INCLUDED IN COMPENSATION REPORTED IN SCHEDULE J, PART II, COLUMN B(III). PART I, LINE 6 SOMC COMPENSATES INDIVIDUALS LISTED IN PART VII, SECTION A, LINE 1A, AS WELL AS OTHER ELIGIBLE EMPLOYEES, INCENTIVE COMPENSATION BASED ON TARGET GOALS THAT ARE, IN PART, CONTINGENT ON THE NET EARNINGS OF THE ORGANIZATION. RECIPIENTS MUST MEET CERTAIN SPECIFIC OBJECTIVES/GOALS, ONE OF WHICH IS NET EARNINGS OF THE ORGANIZATION, IN ORDER TO RECEIVE ANY BONUS. THE NET EARNINGS OF THE ORGANIZATION TARGET REPRESENTS ONLY ONE COMPONENT THAT MAKES UP THE INDIVIDUAL'S BONUS CALCULATION. IN ADDITION, WHEN CONSIDERING ALL FACTORS OF THE BONUS CALCULATION, THERE IS A MAXIMUM BONUS AMOUNT THAT EACH INDIVIDUAL IS ENTITLED TO RECEIVE THAT IS BASED ON A SPECIFIED PERCENTAGE OF THE EMPLOYEE'S COMPENSATION. COUNTY OF SCIOTO OHIO 316400086 808878FP2 2008-07-23 150783464 HOSPITAL ADDITION & RENOVATIONS AND CURRENT REFUNDING OF 2006 BONDS 0 0 0 7505000 178832345 10956614 2835022 127600000 1619626 7850000 27628899 2009 1 0 1 1 0 0 1 1 0 0.00000 0.00000 0.00000 1 0 0 0 0 0 0 PART II, LINE 1: RETIRED CUSIP 808878FL1 ($2,380,000) AND CUSIP 808878FM9 ($2,500,000) AND CUSIP 808878FN7. PART II, LINE 3: INCLUDES ISSUE PRICE PLUS UNSPENT PROCEEDS FROM 2006 BONDS. INTEREST EARNINGS ON CONSTRUCTION FUND AFTER 7/23/08, INTEREST EARNINGS ON EXPENSE FUND, INTEREST EARNINGS ON CAPITALIZED INTEREST FUND AND INTEREST EARNINGS ON DSFR. PART II, LINE 5: INCLUDES INTEREST EARNINGS ON THE CAPITALIZED INTEREST FUND, WHICH WERE USED TO PAY CAPITALIZED INTEREST ON THE 2008 BONDS. PART II, LINE 6: $127,600,000 OF PROCEEDS WERE USED TO CURRENTLY REFUND THE 2006 BONDS. THE ESCROW FUND WAS EXPENDED ON THE DATE OF ISSUANCE OF THE SERIES 2008 BONDS (7/23/08). PART II, LINE 7: INCLUDES UNDERWRITER'S DISCOUNT PLUS SERIES 2008 PROCEEDS DEPOSITED IN 2008 EXPENSE FUND. PART II, LINE 9: INCLUDES QUALIFIED HEDGE TERMINATION PAYMENT PLUS NON-QUALIFIED HEDGE TERMINATION PAYMENT RELATED TO THE 2006 SERIES BONDS. PART II, LINE 10: INCLUDES UNSPENT PROCEEDS FOR 2006 BONDS PLUS INTEREST EARNINGS ON THE CONSTRUCTION FUND. PART III, LINE 3: ALL MANAGEMENT CONTRACTS COMPLY WITH SAFE HARBOR REVENUE PROCEDURE 97-13. PART V: SOMC PLANS TO WORK WITH BOND COUNSEL TO DEVELOP WRITTEN PROCEDURES. BANNON HOWLAND & DEVER BOARD CHAIR ROBERT DEVER IS SENIOR PARTNER OF BANNON, HOWLAND, & DEVER 240593 $20,000 PER MONTH RETAINER AS GENERAL COUNSEL TO SOUTHERN OHIO MEDICAL CENTER AND ITS RELATED ENTITIES. 0 PORTSMOUTH INSURANCE AGENCY BOARD MEMBER GARY DUZAN IS A PARTNER OF PORTSMOUTH INSURANCE AGENCY 372495 INSURANCE PROVIDER 0 US BANK BOARD MEMBER DAVID FOWLER IS AN OFFICER AT US BANK'S PORTSMOUTH BRANCH 203150 SERVICE CHARGES, INTEREST, AND FEES ASSOCIATED WITH SEVERAL DIFFERENT BANK ACCOUNTS. 0 X CLOTHING, FURNISHINGS, AND FOOD 1 47108 COST OF DONATED ITEM 0 0 0 FORM 990, PART VI, SECTION B, LINE 11 FORM 990 INFORMATION IS COMPILED IN THE ACCOUNTING DEPARTMENT THEN SENT TO THE INDEPENDENT TAX ACCOUNTANTS TO ANALYZE THE INFORMATION AND COMPLETE THE TAX RETURN. THE FORM IS THEN REVIEWED BY FINANCIAL STAFF, TIED OUT TO THE TRIAL BALANCE, AND E-MAILED TO THE BOARD. IN ADDITION, THE CFO PRESENTS FORM 990 TO THE BOARD EXECUTIVE COMPENSATION COMMITTEE BEFORE FILING WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C CONFLICT OF INTEREST STATEMENTS ARE FILLED OUT ANNUALLY IN JANUARY FOR OFFICERS AND FOR NEW AND RETURNING BOARD MEMBERS. COMPLETED CONFLICT OF INTEREST STATEMENTS ARE REVIEWED BY THE AUDIT & COMPLIANCE COMMITTEE. ANY CONFLICTS ARE DOCUMENTED IN THE MINUTES AND ADDRESSED. CONFLICTS OF INTEREST ARE RAISED BY OFFICERS OR BOARD MEMBERS ONCE THEY ARE KNOWN BY THE INDIVIDUAL. BOARD MEMBERS ABSTAIN FROM VOTING IF A CONFLICT IS IDENTIFIED THAT THE BOARD MEMBER IS INVOLVED WITH. FORM 990, PART VI, SECTION B, LINE 15 ON AN ANNUAL BASIS, AN INDEPENDENT CONSULTANT PROVIDES THE BOARD COMPENSATION COMMITTEE WITH COMPARABLE DATA AND OTHER FACTS WHICH ARE USED BY THE COMMITTEE TO DETERMINE EXECUTIVE PAY PHILOSOPHY. THE INDEPENDENT CONSULTANT USED COMPENSATION SURVEYS OF THE SURROUNDING AREA TO DETERMINE EXECUTIVE COMPENSATION RECOMMENDATIONS. THE DECISIONS FOR CEO AND OFFICER COMPENSATION ARE DOCUMENTED IN THE BOARD COMPENSATION COMMITTEE MINUTES, WHICH WAS LAST PERFORMED DURING 2011. THIS COMMITTEE DETERMINES THE CEO'S PAY AND SETS PAY RANGES FOR THE OTHER EXECUTIVES. FORM 990, PART VI, SECTION C, LINE 19 SOUTHERN OHIO MEDICAL CENTER PROVIDES ITS FINANCIAL STATEMENTS TO THE PUBLIC THROUGH THE FILING OF ITS FORM 990 AS WELL AS ITS BOND DISCLOSURE. GOVERNING DOCUMENTS AND THE CONFLICT OF INTEREST POLICY ARE MADE AVAILABLE TO THE PUBLIC ON SOUTHERN OHIO MEDICAL CENTER'S WEBSITE. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED LOSSES ON INVESTMENTS: -2,410,361. CHANGE IN ACTUARIAL VALUE OF PENSION -6,615,000. INCREASE IN CASH SURRENDER VALUE OF CERP 88,624. TOTAL TO FORM 990, PART XI, LINE 5: -8,936,737. FORM 990, PART XII, LINE 2C: THE ORGANIZATION HAS A COMMITTEE RESPONSIBLE FOR OVERSIGHT OF THE AUDIT AND SELECTION OF AN INDEPENDENT ACCOUNTANT. THE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. FORM 990, PAGE 1, LINE C: DOING BUSINESS AS: SOMC CANCER CENTER, SOMC HOME HEALTH SERVICES, SOMC L.I.F.E. CENTER, RIVERVIEW RETIREMENT CENTER, SOMC URGENT CARE CENTER, SOMC HOSPICE CENTER, SOMC WOUND HEALING CENTER. FORM 990, PART VII: THE FOLLOWING BOARD MEMBERS DEVOTED TIME TO THE FOLLOWING RELATED PARTIES: SOMC MEDICAL CARE FOUNDATION: RANDAL ARNETT 1 HOUR KENDALL STEWART 10 HOURS DEAN WRAY 1 HOUR CLAUDIA BURCHETT 1 HOUR VICKI NOEL 1 HOUR LEEANN SAMMONS 1 HOUR BENJAMIN GILL 1 HOUR THE FRIENDS OF SOUTHERN OHIO MEDICAL CENTER: RANDAL ARNETT 1 HOUR DEAN WRAY 1 HOUR CLAUDIA BURCHETT 1 HOUR VICKI NOEL 2 HOURS LEEANN SAMMONS 1 HOUR BENJAMIN GILL 1 HOUR SOUTHERN OHIO MEDICAL CENTER TITLE HOLDING COMPANY: RANDAL ARNETT 1 HOUR DEAN WRAY 1 HOUR CLAUDIA BURCHETT 1 HOUR VICKI NOEL 1 HOUR LEEANN SAMMONS 1 HOUR BENJAMIN GILL 2 HOURS SOMC FOUNDATION, INC. RANDAL ARNETT 1 HOUR DEAN WRAY 1 HOUR CLAUDIA BURCHETT 1 HOUR VICKI NOEL 2 HOURS LEEANN SAMMONS 1 HOUR BENJAMIN GILL 1 HOUR SOMC FOUNDATION INC 1805 27TH STREET PORTSMOUTH OH 45662 311564440 HOLD INVESTMENTS FOR BENEFIT OF SOUTHERN OHIO MEDICAL CENTER OH 501(C)(3) LINE 11A, I N/A 1 THE FRIENDS OF SOUTHERN OHIO MEDICAL CENTER 1805 27TH STREET PORTSMOUTH OH 45662 310677520 FUNDRAISING OH 501(C)(3) LINE 11A, I N/A 1 SOMC MEDICAL CARE FOUNDATION INC 1248 KINNEYS LANE PORTSMOUTH OH 45662 311374523 MEDICINE AND SURGERY OH 501(C)(3) LINE 11A, I N/A 1 SOUTHERN OHIO MEDICAL CENTER TITLE HOLDING COMPANY 1805 27TH STREET PORTSMOUTH OH 45662 311417566 MANAGE REAL ESTATE OH 501(C)(2) N/A N/A 1 0 1 1 0 0 0 0 0 0 1 1 1 0 1 1 1 1 1 SOMC MEDICAL CARE FOUNDATION B 23476090 ACCRUAL TRANSACTIONS SOMC MEDICAL CARE FOUNDATION J 148148 RENTAL CHARGES PER CONTRACT SOMC MEDICAL CARE FOUNDATION K 151961 COST PER CONTRACT SOMC MEDICAL CARE FOUNDATION L 154276 COST PER CONTRACT SOMC MEDICAL CARE FOUNDATION N 30508017 ALLOCATION OF COSTS SOMC MEDICAL CARE FOUNDATION O 12351874 ALLOCATION OF COSTS SOMC MEDICAL CARE FOUNDATION P 6185815 ALLOCATION OF COSTS SOMC TITLE HOLDING COMPANY J 1556930 RENTAL CHARGES PER CONTRACT SOMC TITLE HOLDING COMPANY O 1165782 ALLOCATION OF COSTS THE FRIENDS OF SOUTHERN OHIO MEDICAL CENTER P 137414 ALLOCATION OF COSTS SOMC TITLE HOLDING COMPANY N 320022 ALLOCATION OF COSTS