2013-08-15T01:44:09-00:00 2012-12-31 990 2012-01-01 310645626 Fairfield Medical Center FAIR 7406878000 401 North Ewing Street Lancaster OH 431303371 Sky L Gettys 2013-08-14 false 2012 2016-02-24 21:20:13Z Mina H Ubbing 401 North Ewing Street Lancaster OH 43130 225532849 false X www.fmchealth.org X 1982 OH 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. 15 15 2364 209 400728 226761 497848 205693710 203944056 1811182 1855604 3667630 6505323 211399283 212802831 0 0 97776072 100726632 0 0 103335318 98468771 201111390 199195403 10287893 13607428 195128210 207783812 91249309 92223240 103878901 115560572 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. false false 72816115 89249960 Patient Care Inpatient Medical, Surgical, Emergency, Maternity, ICU, Psychiatry, and Nursing Services 75,147 admissions, procedures visits 69197067 116294024 Patient Care Laboratory, Cardiovascular, Radiology, Therapy, Pharmacy, and Medical Supply Services 2,540,032 procedures dosages 18659633 951645 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 160672815 true true false false false false false false false true false false true true false false true false false false false false false false false true true true false true true false false false false false false false false false false false false false false true true true true true false true 134 0 true 2364 true true true false false false false false false false false false X 15 15 true false false false false false false true true false false false true true true true true true true true true OH X Sky L Gettys 7406878011 401 North Ewing Street Lancaster OH 431303371 Carol Seubert Marx 003.00 X X 0 0 0 Debra Smith 003.00 X X 0 0 0 Ron Burris 003.00 X X 0 0 0 James Christian 002.00 X 0 0 0 David Conley MD 002.00 X 0 0 0 Adam Custer 002.00 X 0 0 0 Joseph Ginty MD 002.00 X 0 0 0 Mark Hedstrom 002.00 X 0 0 0 Dave Oehlers 002.00 X 0 0 0 Barry Ritchey 002.00 X 0 0 0 Linda Sheridan 002.00 X 0 0 0 Susan Nixon Stoughton 002.00 X 0 0 0 Milt Taylor Jr 002.00 X 0 0 0 Louis Varga 002.00 X 0 0 0 Jeffrey Yenchar MD 002.00 X 0 0 0 Mina H Ubbing 055.00 001.00 X 545051 0 29048 Sky L Gettys 048.00 002.00 X 272497 0 26624 Steven D Cox MD 042.00 005.00 X 308944 127680 27155 Howard Sniderman 045.00 X 251888 0 21652 Cynthia Pearsall 050.00 X 205065 0 13474 Jean L Robertson MD 024.00 X 215330 0 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401 North Ewing Street Lancaster OH 43130

www.fmchealth.org X X X 1 1 1 true X X X X X X X X X 10 true true true X X X X X X X true false true true 0000000001.000000000000 true 0000000002.000000000000 true X X X X true true X X X X X X X true true X X X X true X false true 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 true Fairfield Medical Center Foundation 401 North Ewing Street Lancaster OH 43130 208952945 501c3 194098 1 X X X X false true false false false false false true false Mina H Ubbing 411568 63764 69719 17150 11898 574099 Sky L Gettys 236914 34383 1200 17150 9474 299121 Steven D Cox MD 273550 34194 1200 17150 10005 336099 Howard Sniderman 224038 26650 1200 17150 4502 273540 Cynthia Pearsall 181206 22659 1200 12936 538 218539 Jean L Robertson MD 206980 7950 400 15070 230400 Pamela R Reed 141995 5766 18812 11864 3984 182421 Randy L Brown 146213 4458 600 10795 9409 171475 Betsy L Winsley 151556 10539 396 162491 Jeffrey M Ayers MD 148347 10476 8466 167289 Grant R Brame 100493 41880 10251 8828 161452 A County of Fairfield Ohio 316400066 304286AK3 2003-12-23 34490356 To construct a parking garage and add additional space to hospital. false false B County of Fairfield Ohio 316400066 2010-06-30 20000000 To refund prior issue to fund capital purchases. false false C County of Fairfield Ohio 316400066 2010-12-22 10000000 To fund capital purchases. false false A 30161142 1815250 2507003 1123902 29037240 2005 false false true true B 12605608 20000000 91148 7303244 2010 true false true C 10000000 57471 9942529 2011 false false false A false false false false true B false false false false true C false false false false true 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 A false B false C false IV 2c 06/15/2008 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. Home Health Resources 401 North Ewing Street Lancaster OH 43130 311159707 Durable Med. Equip. OH Zane Properties Corporation 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 N/A false 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 Zane Properties Corporation 401 North Ewing Street Lancaster OH 43130 311202009 Holding Company OH Fairfield Medical Center C Corp 1.00000 false true false false false false false true false false false true false true false true false true true false 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