FAIRFIELD MEDICAL CENTER: Form 990, tax year 2012
View the entire original 990 at ProPublica ↗
- Organization
- FAIRFIELD MEDICAL CENTER (EIN 31-0645626)
- Tax period
- 2012-01-01 to 2012-12-31
- Filed
- 2013-08-15
- IRS object ID
- 201312279349302621
- Schema version
- 2012v2.2
- 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
- Form 990
- Schedule A
- Schedule B
- Schedule D
- Schedule H
- Schedule I
- Schedule J
- Schedule K
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2013-08-15T01:44:09-00:00 | Timestamp |
| Tax Period End Date | 2012-12-31 | TaxPeriodEndDate |
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2012-01-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 310645626 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Fairfield Medical Center | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | FAIR | NameControl |
| Phone | 7406878000 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 401 North Ewing Street | AddressLine1 |
| City | Lancaster | City |
| State | OH | State |
| ZIP Code | 431303371 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | Sky L Gettys | Name |
| Title | CFO Treasurer | Title |
| Date Signed | 2013-08-14 | DateSigned |
| Authorize Third Party | false | AuthorizeThirdParty |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2012 | TaxYear |
| Build TS | 2016-02-24 21:20:13Z | BuildTS |
Form 990 IRS990
Name Of Principal Officer Business NameOfPrincipalOfficerBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Mina H Ubbing | BusinessNameLine1 |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 401 North Ewing Street | AddressLine1 |
| City | Lancaster | City |
| State | OH | State |
| ZIP Code | 43130 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 225532849 | GrossReceipts |
| Group Return For Affiliates | false | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | www.fmchealth.org | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1982 | YearFormation |
| State Legal Domicile | OH | StateLegalDomicile |
| Activity Or Mission Description | Our 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. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 15 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 15 | NbrIndependentVotingMembers |
| Total Nbr Employees | 2364 | TotalNbrEmployees |
| Total Nbr Volunteers | 209 | TotalNbrVolunteers |
| Total Gross UBI | 400728 | TotalGrossUBI |
| Contributions Grants Prior Year | 226761 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 497848 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 205693710 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 203944056 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 1811182 | InvestmentIncomePriorYear |
| Investment Income Current Year | 1855604 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 3667630 | OtherRevenuePriorYear |
| Other Revenue Current Year | 6505323 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 211399283 | TotalRevenuePriorYear |
| Total Revenue Current Year | 212802831 | TotalRevenueCurrentYear |
| Grants And Similar Amnts CY | 0 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 97776072 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 100726632 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 0 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 103335318 | OtherExpensePriorYear |
| Other Expenses Current Year | 98468771 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 201111390 | TotalExpensesPriorYear |
| Total Expenses Current Year | 199195403 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 10287893 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 13607428 | RevenuesLessExpensesCY |
| Total Assets BOY | 195128210 | TotalAssetsBOY |
| Total Assets EOY | 207783812 | TotalAssetsEOY |
| Total Liabilities BOY | 91249309 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 92223240 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 103878901 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 115560572 | NetAssetsOrFundBalancesEOY |
| Mission Description | Our 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. | MissionDescription |
| Significant New Program Services | false | SignificantNewProgramServices |
| Significant Change | false | SignificantChange |
| Expense | 72816115 | Expense |
| Revenue | 89249960 | Revenue |
| Description | Patient Care Inpatient Medical, Surgical, Emergency, Maternity, ICU, Psychiatry, and Nursing Services 75,147 admissions, procedures visits | Description |
Activity2 Activity2
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | 69197067 | Expense |
| Revenue | 116294024 | Revenue |
| Description | Patient Care Laboratory, Cardiovascular, Radiology, Therapy, Pharmacy, and Medical Supply Services 2,540,032 procedures dosages | Description |
Activity3 Activity3
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | 18659633 | Expense |
| Revenue | 951645 | Revenue |
| Description | Patient Care Nutritional Services 491,347 meals served Patient Care Laundry Services 1,581,588 pounds Patient Care Plant Engineering, Police, Housekeeping, Central Transport, Interest Depreciation 491,088 square feet | Description |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Expense | 160672815 | TotalProgramServiceExpense |
| Described In501 C3 | true | DescribedIn501C3 |
| Schedule B Required | true | ScheduleBRequired |
| Political Activities | false | PoliticalActivities |
| Lobbying Activities | false | LobbyingActivities |
| Donor Advised Funds | false | DonorAdvisedFunds |
| Conservation Easements | false | ConservationEasements |
| Collections Of Art | false | CollectionsOfArt |
| Credit Counseling | false | CreditCounseling |
| Term Or Permanent Endowments | false | TermOrPermanentEndowments |
| Report Land Bldg Equip | true | ReportLandBldgEquip |
| Report Invest Oth Securities | false | ReportInvestOthSecurities |
| Report Prog Rel Invest | false | ReportProgRelInvest |
| Report Other Assets | true | ReportOtherAssets |
| Report Other Liabilities | true | ReportOtherLiabilities |
| Report Fin48 Footnote | false | ReportFin48Footnote |
| Independent Audit Financial Stmt | false | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | true | ConsolidatedAuditFinancialStmt |
| School | false | School |
| Foreign Office | false | ForeignOffice |
| Foreign Activities | false | ForeignActivities |
| More Than5000 K To Organizations | false | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | false | MoreThan5000KToIndividuals |
| Professional Fundraising | false | ProfessionalFundraising |
| Fundraising Activities | false | FundraisingActivities |
| Gaming | false | Gaming |
| Hospital | true | Hospital |
| Financial Stmt Attached | true | FinancialStmtAttached |
| Grants To Organizations | true | GrantsToOrganizations |
| Grants To Individuals | false | GrantsToIndividuals |
| Schedule J Required | true | ScheduleJRequired |
| Tax Exempt Bonds | true | TaxExemptBonds |
| Invest Tax Exempt Bonds | false | InvestTaxExemptBonds |
| Escrow Account | false | EscrowAccount |
| On Behalf Of Issuer | false | OnBehalfOfIssuer |
| Excess Benefit Transaction | false | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | false | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | false | LoanToOfficerOrDQP |
| Grant To Related Person | false | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | false | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | false | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | false | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | false | DeductibleNonCashContributions |
| Deductible Contributions Of Art | false | DeductibleContributionsOfArt |
| Terminated | false | Terminated |
| Partial Liquidation | false | PartialLiquidation |
| Disregarded Entity | true | DisregardedEntity |
| Related Entity | true | RelatedEntity |
| Related Org Controlled Entity | true | RelatedOrgControlledEntity |
| Transaction Related Entity | true | TransactionRelatedEntity |
| Transfers To Exempt Non Chrtbl Org | true | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | false | ActivitiesConductedPartnership |
| Schedule O Required | true | ScheduleORequired |
| Number Forms Transmitted With1096 | 134 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | true | ComplianceWithBackupWitholding |
| Number Of Employees | 2364 | NumberOfEmployees |
| Employment Tax Returns Filed | true | EmploymentTaxReturnsFiled |
| Unrelated Business Income | true | UnrelatedBusinessIncome |
| Form990-T Filed | true | Form990-TFiled |
| Foreign Financial Account | false | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTrans |
| Taxable Party Notification | false | TaxablePartyNotification |
| Non Deductible Contributions | false | NonDeductibleContributions |
| Quid Pro Quo Contributions | false | QuidProQuoContributions |
| Form8282 Property Disposed Of | false | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | false | FundsToPayPremiums |
| Premiums Paid | false | PremiumsPaid |
| Indoor Tanning Services | false | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 15 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 15 | NumberIndependentVotingMembers |
| Family Or Business Relationship | true | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | false | DelegationOfManagementDuties |
| Changes To Organizing Docs | false | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | false | MaterialDiversionOrMisuse |
| Members Or Stockholders | false | MembersOrStockholders |
| Election Of Board Members | false | ElectionOfBoardMembers |
| Decisions Subject To Approval | false | DecisionsSubjectToApproval |
| Minutes Of Governing Body | true | MinutesOfGoverningBody |
| Minutes Of Committees | true | MinutesOfCommittees |
| Officer Mailing Address | false | OfficerMailingAddress |
| Local Chapters | false | LocalChapters |
| Form990 Provided To Governing Body | false | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | true | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | true | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | true | RegularMonitoringEnforcement |
| Whistleblower Policy | true | WhistleblowerPolicy |
| Document Retention Policy | true | DocumentRetentionPolicy |
| Compensation Process CEO | true | CompensationProcessCEO |
| Compensation Process Other | true | CompensationProcessOther |
| Investment In Joint Venture | true | InvestmentInJointVenture |
| Written Policy Or Procedure | true | WrittenPolicyOrProcedure |
| States Where Copy Of Return Is Filed | OH | StatesWhereCopyOfReturnIsFiled |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Person | Sky L Gettys | NamePerson |
| Telephone Number | 7406878011 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 401 North Ewing Street | AddressLine1 |
| City | Lancaster | City |
| State | OH | State |
| ZIP Code | 431303371 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionA (26 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | OfficerOfficer | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | Average Hours Per Week RelatedAverageHoursPerWeekRelated | Key EmployeeKeyEmployee | Highest Compensated EmployeeHighestCompensatedEmployee |
|---|---|---|---|---|---|---|---|---|---|
| Carol Seubert Marx | |||||||||
| Chair | 003.00 | X | X | 0 | 0 | 0 | |||
| Debra Smith | |||||||||
| Vice Chair | 003.00 | X | X | 0 | 0 | 0 | |||
| Ron Burris | |||||||||
| Secretary | 003.00 | X | X | 0 | 0 | 0 | |||
| James Christian | |||||||||
| Director | 002.00 | X | 0 | 0 | 0 | ||||
| David Conley MD | |||||||||
| Director | 002.00 | X | 0 | 0 | 0 | ||||
| Adam Custer | |||||||||
| Director | 002.00 | X | 0 | 0 | 0 | ||||
| Joseph Ginty MD | |||||||||
| Director | 002.00 | X | 0 | 0 | 0 | ||||
| Mark Hedstrom | |||||||||
| Director | 002.00 | X | 0 | 0 | 0 | ||||
| Dave Oehlers | |||||||||
| Director | 002.00 | X | 0 | 0 | 0 | ||||
| Barry Ritchey | |||||||||
| Director | 002.00 | X | 0 | 0 | 0 | ||||
| Linda Sheridan | |||||||||
| Director | 002.00 | X | 0 | 0 | 0 | ||||
| Susan Nixon Stoughton | |||||||||
| Director | 002.00 | X | 0 | 0 | 0 | ||||
| Milt Taylor Jr | |||||||||
| Director | 002.00 | X | 0 | 0 | 0 | ||||
| Louis Varga | |||||||||
| Director | 002.00 | X | 0 | 0 | 0 | ||||
| Jeffrey Yenchar MD | |||||||||
| Director | 002.00 | X | 0 | 0 | 0 | ||||
| Mina H Ubbing | |||||||||
| President CEO | 055.00 | X | 545051 | 0 | 29048 | 001.00 | |||
| Sky L Gettys | |||||||||
| CFO, Treasurer | 048.00 | X | 272497 | 0 | 26624 | 002.00 | |||
| Steven D Cox MD | |||||||||
| VP - CMO | 042.00 | 308944 | 127680 | 27155 | 005.00 | X | |||
| Howard Sniderman | |||||||||
| Chief Operating Officer | 045.00 | 251888 | 0 | 21652 | X | ||||
| Cynthia Pearsall | |||||||||
| VP - CNO | 050.00 | 205065 | 0 | 13474 | X | ||||
| Jean L Robertson MD | |||||||||
| Chief Med. Info. Officer | 024.00 | 215330 | 0 | 15070 | X | ||||
| Pamela R Reed | |||||||||
| OP Services Director | 040.00 | 166573 | 0 | 15848 | X | ||||
| Randy L Brown | |||||||||
| Pharmacy Manager | 043.00 | 151271 | 0 | 20204 | X | ||||
| Betsy L Winsley | |||||||||
| Pharmacy Supervisor | 044.00 | 151556 | 0 | 10935 | X | ||||
| Jeffrey M Ayers MD | |||||||||
| Residency Prog. Dir. | 040.00 | 148347 | 7243 | 18942 | 002.00 | X | |||
| Grant R Brame | |||||||||
| Physicians Assistant | 040.00 | 142373 | 0 | 19079 | X | ||||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 2558895 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 134923 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 218031 | TotalOtherCompensation |
| Number Individuals GT100 K | 35 | NumberIndividualsGT100K |
| Formers Listed | false | FormersListed |
| Total Comp GT150 K | true | TotalCompGT150K |
| Compensation From Other Sources | false | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (5 entries)
| Address Line1AddressOfContractor/AddressUS/AddressLine1 | CityAddressOfContractor/AddressUS/City | StateAddressOfContractor/AddressUS/State | ZIP CodeAddressOfContractor/AddressUS/ZIPCode | Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|---|---|---|---|
| McKesson | |||||
| PO Box 98347 | Chicago | IL | 606930001 | Information Technology Services | 3238716 |
| Aramark Healthcare | |||||
| 12483 Collections Center Drive | Chicago | IL | 60693 | Biomedical Services | 2995010 |
| Central Ohio Orthopedic Consultants | |||||
| 2405 N Columbus Street Suite 120 | Lancaster | OH | 43130 | Physician Services | 476740 |
| Bricker & Eckler | |||||
| 100 South Third Street | Columbus | OH | 43215 | Legal Services | 442700 |
| East Main Shopping | |||||
| 123 Broad Street Suite 211 | Lancaster | OH | 43130 | Rent | 369407 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 14 | NumberOfContractorsGT100K |
| All Other Contributions | 497848 | AllOtherContributions |
| Total Contributions | 497848 | TotalContributions |
Program Service Revenue ProgramServiceRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | Patient Service Revenue Net | Description |
| Total Revenue Column | 203944056 | TotalRevenueColumn |
| Related Or Exempt Function Income | 203944056 | RelatedOrExemptFunctionIncome |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 203944056 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 1451443 | TotalRevenueColumn |
| Exclusion | $1,451,443 | ExclusionAmount |
Gross Rents GrossRents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 634278 | Real |
Less Rental Expenses LessRentalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 422785 | Real |
Rental Income Or Loss RentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 211493 | Real |
Net Rental Income Or Loss NetRentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 211493 | TotalRevenueColumn |
Gross Amount Sales Assets GrossAmountSalesAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 12666914 | Securities |
| Other | 44480 | Other |
Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 12202964 | Securities |
| Other | 104269 | Other |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 463950 | Securities |
| Other | -59789 | Other |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 404161 | TotalRevenueColumn |
Other Revenue Misc OtherRevenueMisc (3 entries)
| DescriptionDescription | Total Revenue ColumnTotalRevenueColumn | ExclusionExclusionAmount | Business CodeBusinessCode | Unrelated Business RevenueUnrelatedBusinessRevenue |
|---|---|---|---|---|
| Cafeteria Sales | 815900 | $815,900 | ||
| Patronage Dividends | 393622 | $393,622 | 900099 | |
| Outside Reference Lab | 356351 | 621500 | 356351 |
Miscellaneous Revenue MiscellaneousRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 4727957 | TotalRevenueColumn |
| Related Or Exempt Function Income | 4683580 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 44377 | UnrelatedBusinessRevenue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 6293830 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 212802831 | TotalRevenueColumn |
| Related Or Exempt Function Income | 208627636 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 400728 | UnrelatedBusinessRevenue |
| Exclusion | $2,660,965 | ExclusionAmount |
Grants To Domestic Orgs GrantsToDomesticOrgs
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Grants To Domestic Individuals GrantsToDomesticIndividuals
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Foreign Grants ForeignGrants
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Benefits To Members BenefitsToMembers
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1943042 | Total |
| Program Services | 1063628 | ProgramServices |
| Management And General | 879414 | ManagementAndGeneral |
Comp Disqual Persons CompDisqualPersons
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 78477962 | Total |
| Program Services | 69442014 | ProgramServices |
| Management And General | 9035948 | ManagementAndGeneral |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 4389746 | Total |
| Program Services | 4202912 | ProgramServices |
| Management And General | 186834 | ManagementAndGeneral |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 10136102 | Total |
| Program Services | 6198890 | ProgramServices |
| Management And General | 3937212 | ManagementAndGeneral |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 5779780 | Total |
| Program Services | 5065519 | ProgramServices |
| Management And General | 714261 | ManagementAndGeneral |
Fees For Services Management FeesForServicesManagement
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 544249 | Total |
| Management And General | 544249 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 71800 | Total |
| Management And General | 71800 | ManagementAndGeneral |
Fees For Services Lobbying FeesForServicesLobbying
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Fees For Services Prof Fundraising | FeesForServicesProfFundraising |
Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 18390298 | Total |
| Program Services | 7885725 | ProgramServices |
| Management And General | 10504573 | ManagementAndGeneral |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Royalties Royalties
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3483255 | Total |
| Program Services | 3224188 | ProgramServices |
| Management And General | 259067 | ManagementAndGeneral |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Travel Entrtnmnt Public Officials TravelEntrtnmntPublicOfficials
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Conferences Meetings ConferencesMeetings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2820327 | Total |
| Program Services | 2566498 | ProgramServices |
| Management And General | 253829 | ManagementAndGeneral |
Payments To Affiliates PaymentsToAffiliates
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 11742790 | Total |
| Program Services | 7931861 | ProgramServices |
| Management And General | 3810929 | ManagementAndGeneral |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 953679 | Total |
| Management And General | 953679 | ManagementAndGeneral |
Other Expenses OtherExpenses (3 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral |
|---|---|---|---|
| Supplies | 42612058 | 42409448 | 202610 |
| Physician Fees | 7120767 | 7013800 | 106967 |
| Other Expenses | 10729548 | 3668332 | 7061216 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 199195403 | Total |
| Program Services | 160672815 | ProgramServices |
| Management And General | 38522588 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 13064912 | BOY |
| EOY | 14096893 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 9555987 | BOY |
| EOY | 9971448 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 19507703 | BOY |
| EOY | 22080093 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3488639 | BOY |
| EOY | 3640422 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2762580 | BOY |
| EOY | 3556960 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 223513998 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 139005761 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 83752968 | BOY |
| EOY | 84508237 | EOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 41230021 | BOY |
| EOY | 44534619 | EOY |
Intangible Assets IntangibleAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4185642 | BOY |
| EOY | 4515499 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 17579758 | BOY |
| EOY | 20879641 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 195128210 | BOY |
| EOY | 207783812 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 11162242 | BOY |
| EOY | 15510410 | EOY |
Tax Exempt Bond Liabilities TaxExemptBondLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 65036346 | BOY |
| EOY | 61700147 | EOY |
Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1320504 | BOY |
| EOY | 1137601 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 13730217 | BOY |
| EOY | 13875082 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 91249309 | BOY |
| EOY | 92223240 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 103878901 | BOY |
| EOY | 115560572 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 103878901 | BOY |
| EOY | 115560572 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 195128210 | BOY |
| EOY | 207783812 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | 13607428 | ReconcilationRevenueExpenses |
| Reconciliation Unrealized Invest | 2656456 | ReconciliationUnrealizedInvest |
| Reconcilation Other Changes | -4582213 | ReconcilationOtherChanges |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | false | AccountantCompileOrReview |
| FS Audited | true | FSAudited |
FS Audited Basis FSAuditedBasis
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Statement Consolidated | X | FinancialStatementConsolidated |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | true | AuditCommittee |
| Federal Grant Audit Required | false | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital170b1 Aiii | X | Hospital170b1Aiii |
| Public Support Pertcentage170 | 0.00000 | PublicSupportPertcentage170 |
| Public Support Percentage509 | 0.00000 | PublicSupportPercentage509 |
| Investment Income Percentage | 0.00000 | InvestmentIncomePercentage |
Schedule B IRS990ScheduleB
Contributor Info ContributorInfo
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor Number | RESTRICTED | ContributorNumber |
Contributor Name Business ContributorNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor Address US ContributorAddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Aggregate Contributions | RESTRICTED | AggregateContributions |
Schedule D IRS990ScheduleD
| Field | Value | IRS element (for citing) |
|---|---|---|
| Included On FS | false | IncludedOnFS |
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 4575244 | OtherCostOrOtherBasis |
| Book Value | 4575233 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | 87455 | InvestmentCostOrOtherBasis |
| Other Cost Or Other Basis | 94038240 | OtherCostOrOtherBasis |
| Depreciation | 49602285 | Depreciation |
| Book Value | 44544211 | BookValue |
Leasehold Improvements LeaseholdImprovements
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 3191549 | OtherCostOrOtherBasis |
| Depreciation | 3026742 | Depreciation |
| Book Value | 164807 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 117989805 | OtherCostOrOtherBasis |
| Depreciation | 87558413 | Depreciation |
| Book Value | 34627559 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 3631705 | OtherCostOrOtherBasis |
| Depreciation | 3084881 | Depreciation |
| Book Value | 596427 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 84508237 | TotalOfBookValueLandBuildings |
Other Securities OtherSecurities (2 entries)
| DescriptionDescription |
|---|
| Financial derivatives and other financial products |
| Closely-held equity interests |
Other Assets OtherAssets (6 entries)
| DescriptionDescription | Book ValueBookValue |
|---|---|
| Unamortized bond financing expense | 2113073 |
| Due from related organizations | 6696229 |
| Notes receivable/income guarantee | 2462171 |
| Investment in subsidiary | 7632586 |
| Other receivables | 1260423 |
| Third party settlements | 715159 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | 20879641 | TotalBookValueOtherAssets |
Other Liabilities OtherLiabilities (3 entries)
| DescriptionDescription | AmountAmount |
|---|---|
| Federal income taxes | |
| Accrued payroll and benefits | $13,875,082 |
| Third Party settlements |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 13875082 | TotalOfAmounts |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Charity Care Policy | true | CharityCarePolicy |
| Written Policy | true | WrittenPolicy |
| FPG Reference Free Care | true | FPGReferenceFreeCare |
| Pcent100 | X | Pcent100 |
| FPG Reference Discounted Care | true | FPGReferenceDiscountedCare |
| Pcent200 D | X | Pcent200D |
| Free Disc Care Medically Indigent | true | FreeDiscCareMedicallyIndigent |
| Amounts Budgeted For Charity Care | true | AmountsBudgetedForCharityCare |
| Expenses Exceeded Budget | false | ExpensesExceededBudget |
| Annual Community Benefit Report | true | AnnualCommunityBenefitReport |
| Report Publically Available | true | ReportPublicallyAvailable |
Charity Care At Cost CharityCareAtCost
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 4909492 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 2453874 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 2455618 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.01230 | PercentOfTotalExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 26416126 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 19356228 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 7059898 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.03540 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 31325618 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 21810102 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 9515516 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.04770 | PercentOfTotalExpense |
Community Health Services CommunityHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 2225334 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 36855 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 2188479 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.01100 | PercentOfTotalExpense |
Health Professions Education HealthProfessionsEducation
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 3329243 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 2054979 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 1274264 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00640 | PercentOfTotalExpense |
Subsidized Health Services SubsidizedHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 12836114 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 8770348 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 4065766 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.02040 | PercentOfTotalExpense |
Cash And In Kind Contributions CashAndInKindContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 155537 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 155537 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00080 | PercentOfTotalExpense |
Total Other Benefits TotalOtherBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 18546228 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 10862182 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 7684046 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.03860 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 49871846 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 32672284 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 17199562 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.08630 | PercentOfTotalExpense |
Economic Development EconomicDevelopment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 46097 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 46097 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00020 | PercentOfTotalExpense |
Environmental Improvements EnvironmentalImprovements
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 11466 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 11466 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00010 | PercentOfTotalExpense |
Leadership Development LeadershipDevelopment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 128262 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 128262 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00060 | PercentOfTotalExpense |
Coalition Building CoalitionBuilding
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 15740 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 15740 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00010 | PercentOfTotalExpense |
Total Total
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 201565 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 201565 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00100 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | true | BadDebtExpenseReported |
| Bad Debt Expense | $11,639,250 | BadDebtExpenseAmount |
| Amount Attributable To | 1338514 | AmountAttributableTo |
| Amount Reimbursed By Medicare | 50584388 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 50912904 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | -328516 | MedicareSurplusOrShortfall |
Costing Methodology Used CostingMethodologyUsed
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | X | CostToChargeRatio |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | true | WrittenDebtCollectionPolicy |
| Provision For Charity Care | true | ProvisionForCharityCare |
Form990 Schedule H Part IV Form990ScheduleHPartIV (2 entries)
| Description Ent Primary ActivityDescriptionEntPrimaryActivity | Organization Profit Or OwnershipOrganizationProfitOrOwnership | Physicans Profit Or OwnershipPhysicansProfitOrOwnership |
|---|---|---|
| Southeast Ohio Sleep Disorders | ||
| Sleep Lab | 0.51000 | 0.49000 |
| Fairfield Diagnostic Imaging | ||
| Imaging Center | 0.65000 | 0.35000 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Hospital Facilities | 1 | NumberOfHospitalFacilities |
Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility Number | 1 | FacilityNumber |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Fairfield Medical Center | BusinessNameLine1 |
Address Address
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 401 North Ewing Street | AddressLine1 |
| City | Lancaster | City |
| State | OH | State |
| ZIP Code | 43130 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | www.fmchealth.org | WebsiteAddress |
| Licensed Hospital | X | LicensedHospital |
| General Medical And Surgical | X | GeneralMedicalAndSurgical |
| Er24 Hours | X | Er24Hours |
| Facility Reporting Group | 1 | FacilityReportingGroup |
Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | 1 | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital Facility Number | 1 | HospitalFacilityNumber |
| CHNA Conducted | true | CHNAConducted |
| Community Definition | X | CommunityDefinition |
| Community Demographics | X | CommunityDemographics |
| Existing Resources | X | ExistingResources |
| How Data Obtained | X | HowDataObtained |
| Community Health Needs | X | CommunityHealthNeeds |
| Other Health Issues | X | OtherHealthIssues |
| Identifying Process | X | IdentifyingProcess |
| Consulting Process | X | ConsultingProcess |
| Information Gaps | X | InformationGaps |
| Needs Assessment Conducted | 10 | NeedsAssessmentConducted |
| Take Into Account | true | TakeIntoAccount |
| Other Facilities | true | OtherFacilities |
| CHNA Widely Available | true | CHNAWidelyAvailable |
| Own Website | X | OwnWebsite |
| On Request | X | OnRequest |
| Adopt Implement Strategy | X | AdoptImplementStrategy |
| Execute Implement Strategy | X | ExecuteImplementStrategy |
| Develop Community Plan | X | DevelopCommunityPlan |
| Participate Community Plan | X | ParticipateCommunityPlan |
| Prioritize Health Needs | X | PrioritizeHealthNeeds |
| All Needs Addressed | true | AllNeedsAddressed |
| Organization Incur Excise Tax | false | OrganizationIncurExciseTax |
| Eligibility Criteria Explained | true | EligibilityCriteriaExplained |
| Uses FPG Free | true | UsesFPGFree |
| FPG Free Percent | 0000000001.000000000000 | FPGFreePercent |
| Uses FPG Discounted | true | UsesFPGDiscounted |
| FPG Discount Percent | 0000000002.000000000000 | FPGDiscountPercent |
| Explains Basis | true | ExplainsBasis |
| Income Level | X | IncomeLevel |
| Medical Indigency | X | MedicalIndigency |
| Insurance Status | X | InsuranceStatus |
| Uninsured Discount | X | UninsuredDiscount |
| Explains Application Method | true | ExplainsApplicationMethod |
| Includes Publicity Measures | true | IncludesPublicityMeasures |
| Posted On Website | X | PostedOnWebsite |
| Attached To Invoices | X | AttachedToInvoices |
| Posted In Emergency Room | X | PostedInEmergencyRoom |
| Posted In Admission Office | X | PostedInAdmissionOffice |
| Provided On Admission | X | ProvidedOnAdmission |
| Available On Request | X | AvailableOnRequest |
| Other Publicity | X | OtherPublicity |
| Actions On Nonpayment | true | ActionsOnNonpayment |
| Collection Activities | true | CollectionActivities |
| Notify Upon Admission | X | NotifyUponAdmission |
| Notify Before Discharge | X | NotifyBeforeDischarge |
| Notified All Patients | X | NotifiedAllPatients |
| Documented Determination | X | DocumentedDetermination |
| Nondiscrim Emergency Care Policy | true | NondiscrimEmergencyCarePolicy |
| Average Negotiated Rates | X | AverageNegotiatedRates |
| Amounts Generally Billed | false | AmountsGenerallyBilled |
| Gross Charges | true | GrossCharges |
Form990 Schedule H Part VI Form990ScheduleHPartVI (14 entries)
| IdentifierIdentifier | ExplanationExplanation |
|---|---|
| Part I Line 3c | Fairfield Medical Center uses Federal Poverty Guidelines to assess Charity Care eligibility. |
| Part I Line 6a | A Community Benefit report is prepared yearly and included with the Monitor, our informational magazine that is mailed to over 2,500 households in the area. It is also, of course, available upon request. |
| Part III Line 4 | 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 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. |
| Part III Line 4 | Bad 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 8 | We believe the entire amount on line 7 should be considered Community Benefit. As a smaller regional hospital, we are limited in the quantities of scale that we have access to, which could decrease our expenses. In spite of all the cost-cutting measures we have implemented, we still lose money in our Medicare program. Because we treat patients for the good of the community, we believe the total Medicare shortfall should be considered Community Benefit. We use a modified Ohio Hospital Association model to compute Medicare shortfall using the Medicare Cost Report as submitted to Medicare. |
| Part III Line 8 | The total for Medicare Cost is taken directly from the Medicare Cost Report. |
| Part III Line 9b | In 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 9b | We 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 V | FMC worked in conjunction with the Fairfield Community Department of Health for the Community Needs Health Assessment. |
| Part VI Line 2 | A Community Health Needs Assessment CHNA was conducted in 2010. From that CHNA we determined that there were several health issues that could be addressed and were. One of the issues was obesity, so Fairfield Medical Center FMC in cooperation with other local health organizations, formed fitTogether to try to encourage people in the community to eat right and to exercise. In addition to the CHNA, FMC keeps in touch with local governmental agencies. From this connection with the Sheriffs office, we learned that Opiate and other drug addictions were rampant in our community. We could also see in our nursery that many babies were being born addicted to opiates, so we addressed that concern by joining with other local agencies to form the Opiate Task Force to educate the community about the drug problem and to educate health professionals regarding the medical aspects of drug addiction. We were in contact with local doctors and educated them regarding written prescriptions for drugs and the alarmingly growing drug addiction problem in our community. We also keep in contact with the doctors in the community regarding health care needs, which then are assessed by FMC for feasability of meeting those needs either now or in the future. |
| Part VI Line 3 | A representative from the Contracts and Collections Dept. meets with patients before discharge and explains the financial assistance available. Every bill sent to every patient addresses the options available to those who are financially unable to pay their bills. We also have large signs in the registration offices telling people that they can talk to someone privately and in confidence regarding their bill if they feel that they are unable to pay. Our website also addresses eligibility for financial assistance. No one who has a medical need is turned away. We also offer counselors who are glad to assist with the application process. Patients are asked to fill out a Determination of Eligibility for Uncompensated Services in order for staff to identify those who are eligible, while at the same time preserving his or her dignity. If a patient is determined to be eligible for HCAP, he or she is asked to complete an application and verification of Ohio residency. Those persons stating they have no income are required to submit a verification by way of a notarized statement. |
| Part VI Line 4 | The geographic area if Fairfield County is 505.11 square miles. The overall poulations is approximately 147,066. About 16,913 11.5 of the population lives at or below the poverty level. There is a wide demographic range in ages, which is addressed by Fairfield Medical Center in its various programs and services available. |
| Part VI Line 5 | FMCs greatest asset has always been its compassionate, caring and dynamic employees who are passionate about sharing what they know with the community around them. Our Contracts and Collections Dept. is very active in the Ohio Senior Health Insurance Information OSHIIP program through the Ohio Insurance Association. Our caring employees help guide senior citizens through the choices available to them with Medicare. We are only one of six hospitals in Ohio that participate in this program and have won numerous awards. We have a Community Educator who is happy to go throughout the area teaching various skills to various groups. We also have numerous support groups available and freely share our expertise. We are active in many local organizations including the Opiate Task Force and participate in the Tour de Cause bike ride that benefits our local Recovery Center. We also participate in many cancer education venues. We saw the need to increase medical availability to our lower income population, so we provided grant funds to the Fairfield Community Health Center to help improve the impact that organization can make in our community. |
| Part VI, Line 7 | OH |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Records Maintained | true | RecordsMaintained |
Recipient Table RecipientTable
Recipient Name Business RecipientNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Fairfield Medical Center Foundation | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 401 North Ewing Street | AddressLine1 |
| City | Lancaster | City |
| State | OH | State |
| ZIP Code | 43130 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN Of Recipient | 208952945 | EINOfRecipient |
| IRC Section | 501c3 | IRCSection |
| Amount Of Cash Grant | 194098 | AmountOfCashGrant |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Nbr Of501 C3 And Govt Grants | 1 | TotalNbrOf501C3AndGovtGrants |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Committee | X | CompensationCommittee |
| Independent Consultant | X | IndependentConsultant |
| Written Employment Contract | X | WrittenEmploymentContract |
| Board Or Committee Approval | X | BoardOrCommitteeApproval |
| Severance Payment | false | SeverancePayment |
| Supplemental Nonqual Retire Plan | true | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | false | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | false | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | false | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | false | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | false | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | true | AnyNonFixedPayments |
| Initial Contract Exception | false | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (11 entries)
| TitleTitle | Base Compensation Filing OrgBaseCompensationFilingOrg | Bonus Filing OrgBonusFilingOrg | Other Compensation Filing OrgOtherCompensationFilingOrg | Deferred Comp Filing OrgDeferredCompFilingOrg | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg | Total Compensation Filing OrgTotalCompensationFilingOrg |
|---|---|---|---|---|---|---|
| Mina H Ubbing | ||||||
| President CEO | 411568 | 63764 | 69719 | 17150 | 11898 | 574099 |
| Sky L Gettys | ||||||
| CFO, Treasurer | 236914 | 34383 | 1200 | 17150 | 9474 | 299121 |
| Steven D Cox MD | ||||||
| VP - CMO | 273550 | 34194 | 1200 | 17150 | 10005 | 336099 |
| Howard Sniderman | ||||||
| Chief Operating Officer | 224038 | 26650 | 1200 | 17150 | 4502 | 273540 |
| Cynthia Pearsall | ||||||
| VP - CNO | 181206 | 22659 | 1200 | 12936 | 538 | 218539 |
| Jean L Robertson MD | ||||||
| Chief Med. Info. Officer | 206980 | 7950 | 400 | 15070 | 230400 | |
| Pamela R Reed | ||||||
| OP Services Director | 141995 | 5766 | 18812 | 11864 | 3984 | 182421 |
| Randy L Brown | ||||||
| Pharmacy Manager | 146213 | 4458 | 600 | 10795 | 9409 | 171475 |
| Betsy L Winsley | ||||||
| Pharmacy Supervisor | 151556 | 10539 | 396 | 162491 | ||
| Jeffrey M Ayers MD | ||||||
| Residency Prog. Dir. | 148347 | 10476 | 8466 | 167289 | ||
| Grant R Brame | ||||||
| Physicians Assistant | 100493 | 41880 | 10251 | 8828 | 161452 | |
Schedule K IRS990ScheduleK
Form990 Schedule K Part I Form990ScheduleKPartI (3 entries)
| Bond ReferenceBondReferenceCd | Issuer EINIssuerEIN | CUSIP NumberCUSIPNumber | Date IssuedDateIssued | Issue PriceIssuePrice | Description Of PurposeDescriptionOfPurpose | DefeasedDefeased | On Behalf Of IssuerOnBehalfOfIssuer |
|---|---|---|---|---|---|---|---|
| County of Fairfield Ohio | |||||||
| A | 316400066 | 304286AK3 | 2003-12-23 | 34490356 | To construct a parking garage and add additional space to hospital. | false | false |
| County of Fairfield Ohio | |||||||
| B | 316400066 | 2010-06-30 | 20000000 | To refund prior issue to fund capital purchases. | false | false | |
| County of Fairfield Ohio | |||||||
| C | 316400066 | 2010-12-22 | 10000000 | To fund capital purchases. | false | false | |
Form990 Schedule K Part II Form990ScheduleKPartII (3 entries)
| Bond ReferenceBondReferenceCd | Total ProceedsTotalProceeds | Amount In Reserve FundAmountInReserveFund | Issuance Costs From ProceedsIssuanceCostsFromProceeds | Working Capital ExpendituresWorkingCapitalExpenditures | Capital ExpendituresCapitalExpenditures | Year Of Subst CompletionYearOfSubstCompletion | Current RefundingCurrentRefunding | Advance RefundingAdvanceRefunding | Final Allocation MadeFinalAllocationMade | Adequate Books And Recds MaintaindAdequateBooksAndRecdsMaintaind | Amount RetiredAmountRetired |
|---|---|---|---|---|---|---|---|---|---|---|---|
| A | 30161142 | 1815250 | 2507003 | 1123902 | 29037240 | 2005 | false | false | true | true | |
| B | 20000000 | 91148 | 7303244 | 2010 | true | false | true | 12605608 | |||
| C | 10000000 | 57471 | 9942529 | 2011 | false | false | false |
Form990 Schedule K Part III Form990ScheduleKPartIII (3 entries)
| Bond ReferenceBondReferenceCd | Owning Bond Financed PropertyOwningBondFinancedProperty | Any Lease ArrangementsAnyLeaseArrangements | Mngment Cntrct Bond Financd PrprtyMngmentCntrctBondFinancdPrprty | Any Research AgreementsAnyResearchAgreements | Engage Bond Counsel ResearchEngageBondCounselResearch |
|---|---|---|---|---|---|
| A | false | false | false | false | true |
| B | false | false | false | false | true |
| C | false | false | false | false | true |
Form990 Schedule K Part IV Form990ScheduleKPartIV (3 entries)
| Bond ReferenceBondReferenceCd | Form8038 T FiledForm8038TFiled | Rebate Not Due YetRebateNotDueYet | Exception To RebateExceptionToRebate | No Rebate DueNoRebateDue | Variable Rate IssueVariableRateIssue | Hedge Identified In Books And RecdsHedgeIdentifiedInBooksAndRecds | Gross Proceeds Invested In GICGrossProceedsInvestedInGIC | Gross Proceeds InvestedGrossProceedsInvested | Written Proc To Monitor ReqsWrittenProcToMonitorReqs |
|---|---|---|---|---|---|---|---|---|---|
| A | false | true | false | false | false | false | false | false | false |
| B | false | false | false | false | false | false | false | false | false |
| C | false | false | false | false | false | false | false | false | false |
Form990 Schedule K Part V Form990ScheduleKPartV (3 entries)
| Bond ReferenceBondReferenceCd | Proc To Undertk Corrective ActionProcToUndertkCorrectiveAction |
|---|---|
| A | false |
| B | false |
| C | false |
Form990 Schedule K Part VI Form990ScheduleKPartVI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | IV | Identifier |
| Return Reference | 2c | ReturnReference |
| Explanation | 06/15/2008 | Explanation |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (6 entries)
| ExplanationExplanation |
|---|
| Form 990 Part VI Section A Line 2 Various 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 11b The 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 12c Directors, 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 15a b Annually, 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 19 The governing documents, conflict of interest, and financials are made available to the public by requests made to FMC management. |
| Form 990 Part XI Line 5 The 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. |
Schedule R IRS990ScheduleR
Form990 Schedule R Part I Form990ScheduleRPartI
Name Of Disregarded Entity NameOfDisregardedEntity
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Home Health Resources | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 401 North Ewing Street | AddressLine1 |
| City | Lancaster | City |
| State | OH | State |
| ZIP Code | 43130 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 311159707 | EIN |
| Primary Activities | Durable Med. Equip. | PrimaryActivities |
| Legal Domicile State | OH | LegalDomicileState |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Zane Properties Corporation | BusinessNameLine1 |
Form990 Schedule R Part II Form990ScheduleRPartII (2 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivities | Legal Domicile StateLegalDomicileState | Exempt Code SectionExemptCodeSection | Public Charity StatusPublicCharityStatus | Business Name Line1DirectControllingEntityName/BusinessNameLine1 | Controlled OrgControlledOrg | Direct Controlling Entity NADirectControllingEntityNA |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Fairfield Healthcare Professionals Inc | |||||||||||
| 401 North Ewing Street | Lancaster | OH | 43130 | 311425884 | Physician Practices | OH | 501c3 | 11a | Fairfield Medical Center | false | |
| Fairfield Medical Center Foundation | |||||||||||
| 401 North Ewing Street | Lancaster | OH | 43130 | 208952945 | Fundraising | OH | 501c3 | 7 | false | N/A | |
Form990 Schedule R Part III Form990ScheduleRPartIII (2 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivityPrimaryActivity | Legal Domicile StateLegalDomicileState | Business Name Line1DirectControllingEntityName/BusinessNameLine1 | Predominant Income TypePredominantIncomeType | Disproportionate AllocationsDisproportionateAllocations | General Or Managing PartnerGeneralOrManagingPartner | Percentage OwnershipPercentageOwnership |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Southeast Ohio Sleep Disorders Center LLC | |||||||||||
| 135 North Ewing Street FL 3 | Lancaster | OH | 43130 | 311639116 | Sleep disorder trmt | OH | Fairfield Medical Center | Related | false | true | 0.51000 |
| Simplified Healthcare Solutions LLC | |||||||||||
| 5980 Wilcox Place Suite F | Dublin | OH | 43016 | 201720030 | Claims review/processing | OH | Fairfield Medical Center | Related | false | true | 1.00000 |
Form990 Schedule R Part IV Form990ScheduleRPartIV
Name Of Related Org NameOfRelatedOrg
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Zane Properties Corporation | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 401 North Ewing Street | AddressLine1 |
| City | Lancaster | City |
| State | OH | State |
| ZIP Code | 43130 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 311202009 | EIN |
| Primary Activity | Holding Company | PrimaryActivity |
| Legal Domicile State | OH | LegalDomicileState |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Fairfield Medical Center | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Type Of Entity | C Corp | TypeOfEntity |
| Percentage Ownership | 1.00000 | PercentageOwnership |
| Controlled Org | false | ControlledOrg |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | true | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | false | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | false | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | false | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | false | LoansOrGuaranteesFromOtherOrg |
| Dividends Related Organization | false | DividendsRelatedOrganization |
| Sale Of Assets To Other Org | true | SaleOfAssetsToOtherOrg |
| Purchase Of Assets From Other Org | false | PurchaseOfAssetsFromOtherOrg |
| Exchange Of Assets | false | ExchangeOfAssets |
| Rental Of Facilities To Other Orgs | false | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | true | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | false | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | true | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | false | SharingOfFacilities |
| Sharing Of Paid Employees | true | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | false | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | true | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | true | OtherTransferToOtherOrg |
| Other Transfer From Other Org | false | OtherTransferFromOtherOrg |
Transactions Related Orgs Table TransactionsRelatedOrgsTable (10 entries)
| Transaction TypeTransactionType | Amount InvolvedAmountInvolved |
|---|---|
| Southeast Ohio Sleep Disorders Center LLC | |
| a | 47220 |
| Fairfield Healthcare Professionals Inc | |
| a | 12000 |
| Fairfield Healthcare Professionals Inc | |
| g | 237177 |
| Zane Properties Corporation | |
| k | 192540 |
| Simplified Healthcare Solutions LLC | |
| m | 245924 |
| Fairfield Healthcare Professionals Inc | |
| o | 3791198 |
| Zane Properties Corporation | |
| p | 52655 |
| Fairfield Healthcare Professionals Inc | |
| q | 2075000 |
| Fairfield Healthcare Professionals Inc | |
| r | 1466821 |
| Zane Properties Corporation | |
| r | 529248 |