2013-04-11T07:56:21-05:00 2012-06-30 861065772 Deloitte Tax LLP 250 East Fifth Street Suite 1900 Cincinnati OH 45202 990 2011-07-01 314394942 OhioHealth Corporation OHIO 6145444076 180 East Broad Street 33rd Floor Columbus OH 432153707 MICHAEL W LOUGE 6145444076 2013-04-10 1 Mary E Rauschenberg P00172604 5137847100 2011 2016-02-25 16:41:14Z See Schedule O for DBA Listing David P Blom 180 East Broad Street 33rd Floor Columbus OH 432153707 8513131668 0 3858 X www.ohiohealth.com X 1891 OH To improve the health of those we serve. 20 13 14034 1942 -123003 -221267 12731793 3260692 1779937668 1884053092 59406401 49434326 276712821 63147912 2128788683 1999896022 244750 965471 0 0 932851546 860470852 0 0 0 907642142 834472830 1840738438 1695909153 288050245 303986869 2889795543 3120743143 1259831021 1296894090 1629964522 1823849053 X To improve the health of those we serve. 0 0 949411233 965471 1642889538 OhioHealth's primary purpose is to provide diversified health care services to the community and is a provider of services under contractual arrangements with the Medicare and Medicaid programs as well as other third-party reimbursement arrangements. Together, Riverside Methodist Hospital, Grant Medical Center, Doctors Hospital, and Dublin Methodist Hospital are united in our mission to provide quality, compassionate healthcare and to be responsible stewards for our community's health. For more than 100 years it has been this way. Even as the face of healthcare continues to change, the commitment of OhioHealth endures: ensuring quality care for everyone, regardless of their faith, race, age, or ability to pay. We never lose sight of our mission "to improve the health of those we serve" and our core values - compassion, excellence, stewardship, and integrity. They continue to guide us in our work today. OhioHealth touches thousands of people, saves lives, improves their health and makes their future a little brighter. Through our shared mission, vision and values, we touch more lives in central Ohio than any other health system. As a system of faith-based, not-for-profit healthcare providers - together, we are OhioHealth. 412110993 0 242585448 In fiscal year 2012 (July 1, 2011 through June 30, 2012), OhioHealth with its member hospitals and home care organizations provided charity care and community benefit programs to a greater degree than ever. In total, OhioHealth provided $230 million in charity care and community benefit programs and services, reaching hundreds of thousands of people in the communities we serve. Of this total, $170 million was provided by the hospitals of OhioHealth Corporation (Riverside Methodist Hospital, Grant Medical Center, Doctors Hospital, and Dublin Methodist Hospital). OhioHealth provides medically necessary services without charge or at amounts less than its established rates to patients who meet certain criteria under its charity care policies. In assessing a patient's ability to pay, OhioHealth not only utilizes generally recognized poverty income levels of the communities they serve, but also includes certain cases where incurred charges are significant when compared to the patient's financial resources. Charity care is determined based on established policies, using patient income and assets to determine payment ability. OhioHealth provides community services intended to benefit the underserved and enhance the health status of the communities it serves. These services include 24 hour a day emergency rooms, community health screenings, forums for various support groups, health education classes, speakers and publications, hospice and medical research. OhioHealth has been able to achieve a greater impact in the community by partnering financial and human resources with other organizations. These expenditures include a commitment to a project to reduce infant mortality, pastoral care service, various civic sponsorships, and other community partnership programs.The Corporation's total benefit to the community includes the cost of charity care (net of assistance received from the Hospital Care Assurance Program), unpaid cost of Medicaid, medical education programs as well as certain programs discussed above. 58892761 0 17449091 OhioHealth is teaching the doctors of tomorrow at its three teaching hospitals. Together, Riverside Methodist Hospital, Grant Medical Center and Doctors Hospital trained 389 residents at a cost of $58.9 million. These residents performed services to produce offsetting revenue of $17.5 million for a net community benefit of $41.4 million. 1420414987 1 1 0 1 0 0 0 0 0 1 1 1 0 0 1 1 0 1 0 0 1 0 0 0 0 0 1 1 1 0 1 1 0 1 0 0 0 0 0 0 1 1 1 0 0 0 1 1 1 1 1 0 1 X 1059 0 1 14034 1 1 1 1 CJ BD LU UK 0 0 0 0 0 0 0 0 0 X 20 13 1 0 0 0 1 1 1 1 1 0 1 1 1 1 1 1 1 1 1 1 1 1 X Craig Bjerke 6145444076 180 East Broad Street 33rd Floor Columbus OH 432153707 X Rasmussen Steven 2.00 X X 0 0 0 Wilcox Randy 2.00 X X 0 0 0 Hondros Linda 2.00 X X 0 0 0 Endres Michael J 2.00 X X 0 0 0 Abbott Lawrence C 2.00 X 0 0 0 Anderson Craig MD 2.00 X 219000 0 39370 Anderson Kerrii B 2.00 X 0 0 0 Auseon John DO 2.00 X 0 0 0 Blom David P 40.00 X X 1460465 0 1002842 Blosser T Laurence MD 2.00 X 34266 0 40 Chambers Linda MD 2.00 X 0 0 0 Crane Tanny 2.00 X 0 0 0 Dewire Rev Dr Norman E 2.00 X 0 0 0 George Peter B MD 2.00 X 115085 898513 32931 Hood Clifton R DO 2.00 X 72000 2325 40 James Donna 2.00 X 0 0 0 McCullough Steve 2.00 X 0 0 0 McConnell John P 2.00 X 0 0 0 Ough Bishop Bruce R 2.00 X 0 0 0 Scott Bradley N 2.00 X 0 0 0 Sims Gary K 2.00 X 0 0 0 Stevens Rev Dr Deborah 2.00 X 0 0 0 Louge Michael W 40.00 X 931626 0 433730 Millen Robert P 40.00 X 898141 0 298650 Pandora Frank T II Esq 40.00 X 543896 0 321199 Bernstein Michael S 40.00 X 612868 0 169055 Boggs Martha Bruce 40.00 X 482366 0 106781 Gallaher Connie L 40.00 X 304660 0 39747 Hagen Bruce P 40.00 X 669782 0 172537 Herbert-Sinden Cheryl L 40.00 X 419931 0 60225 Jablonski Susan F 40.00 X 408887 0 97854 Lawson Michael S 40.00 X 349479 0 19510 Markovich Stephen E MD 40.00 X 632936 0 178952 Reichfield Michael L 40.00 X 487136 0 139838 Vanderhoff Bruce MD 40.00 X 644486 0 169703 Yates Vinson M 40.00 X 438480 0 116826 Quinn Andrew S 40.00 X 622218 0 156364 Lozada Leonardo J MD 40.00 X 564176 0 28406 Krouse Michael T 40.00 X 459791 0 115962 Morrison Karen J 40.00 X 453670 0 121235 Kontner John G 40.00 X 450867 0 35380 Bachman Ronald J 0.00 X 465961 0 -698 Connors Karen H 0.00 X 422264 0 17292 Garlock Steven J 0.00 X 408155 0 78214 Seckinger Mark R 0.00 X 255643 0 45873 Tomaszewski James A 0.00 X 375975 0 27934 14204210 900838 4025792 700 1 1 0 Quandel Group Inc (Sch O) 8181 Worthington Road Westerville OH 43082 Construction Services 11641248 Cardinal Health - Valuelink 2320 Mcgaw Road Obetz OH 43207 Logistics Services 9514913 Mckesson Technologies Inc PO Box 98347 Chicago IL 606939430 Healthcare IT Solutions 7913564 Dawson Personnel Systems PO Box 711503 Cincinnati OH 452711503 Temporary Help Services 7525183 Daimler Group Inc (Sch O) 1533 Lake Shore Drive Columbus OH 432044891 Construction Services 7166672 504 3173710 45952 41030 3173710 3260692 Health and Medical Svc 900099 1223698048 1223698048 Medicare and Medicaid 923130 644648493 644648493 Investment Income 621990 15706551 15829554 -123003 1884053092 45293777 45293777 34472915 20302869 14170046 14170046 14170046 6497055707 6491329548 1585610 5726159 -1585610 4140549 4140549 17619 17619 0 Intercompany Admin 900099 18747982 18747982 Cafeteria/Food Service 722210 8585184 8585184 Parking Revenue 812930 1403472 1403472 20241228 20241228 48977866 1999896022 1902924077 -123003 93834256 965471 965471 14349251 4206442 10142809 925925 408550 517375 667513022 567561518 99951504 40424822 30354999 10069823 90917063 68269623 22647440 46340769 34797283 11543486 7506345 5636514 1869831 495000 495000 194325 194325 5754339 5754339 154044742 115672197 38372545 9732762 9732762 62259810 46750891 15508919 21795007 16365871 5429136 17082193 12827019 4255174 3282891 2465123 817768 218 164 54 19350644 14530399 4820245 93274249 70039634 23234615 10261205 7705139 2556066 Medical Supply Expense 283965017 283965017 0 Bad Debt 73377876 73377876 0 0 Medicaid Tax Expense 25411081 25411081 0 0 Repair & Maintenance 24859645 20822819 4036826 0 21825481 18281357 3544124 1695909153 1420414987 275494166 0 14464 134752190 99485558 0 169083852 191554851 0 0 20866886 18364908 23912324 25181844 24442378 24649722 1351872483 716838625 613756960 635033858 1351847781 1650642941 429507883 330515510 31996576 36128521 12645728 12645727 76982985 96525239 2889795543 3120743143 266316894 253842192 0 5907538 4347838 684293689 671678198 0 0 3002895 1267573 0 300310005 365758289 1259831021 1296894090 X 1629964522 1823849053 1629964522 1823849053 2889795543 3120743143 X 303986869 -110102338 X 0 1 1 X 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 0 1 587 0 1 124980 1 68758 0 0 194325 0 Explanation of Lobbying Activities: Part II-B, Line 1: Lobbying activity entails membership in American Hospital Association, Ohio Hospital Association, Association of American Medical Colleges and other healthcare related resources. 39340742 277730 745018 116994 1435648 696810 38114038 40797139 325956 5688665 63000 6681909 726109 39340742 38589258 266046 3942850 24850 1288068 688097 40797139 46414673 370999 -5396453 0 2757845 42116 38589258 0.41000 0.37000 0.22000 0 1 1 38148542 38148542 549916649 291166140 258750509 357645 57438 300207 475766436 317685152 158081284 287683211 107929895 179753316 635033858 Investments in Portfolio 330515510 F 330515510 Due to Affiliates - Loans and Notes 43970978 Pension Liability 173859617 Swap Liability 52361775 Deferred Long Term Liabilities 11396104 Other 84169815 365758289 Description of Intended Use of Endowment Funds: Part V, Line 4: To earn investment income for use in medical charity care, medical procedures, medical education and various other hospital services. Description of Uncertain Tax Positions Under FIN 48: Part X: The Corporation has analyzed the tax positions taken by the Corporation and its subsidiaries and has concluded that as of June 30, 2012, there are no uncertain positions taken or expected to be taken that would require recognition of a liability or disclosure in the financial statements. Central America & the Caribbean 0 1 Program Services Offshore Captive Management 58266 Europe (including Iceland & Greenland) 0 0 Investments 115095412 Central America & the Caribbean 0 0 Investments 209454914 0 1 0 0 0 1 324608592 0 324608592 1 0 1 1 1 0 Method Used to Acccount for Expenditures: Schedule F, Part I, Line 3: The amounts shown in column (f) for investment activities in Europe (including Iceland & Greenland) and Central America & the Caribbean represent investments in those regions. The amount shown as program service activities in Central America & the Caribbean represents total expenditures in the region. 1 1 X 1 X 1 X 1 1 1 0 1 1 100706337 19436070 81270267 0.05010 247267704 205662933 41604771 0.02560 347974041 225099003 122875038 0.07570 1842542 19279 1823263 0.00110 59014410 17449091 41565319 0.02560 1645775 1645775 0.00100 356126 356126 0.00020 1278099 18075 1260024 0.00080 64136952 17486445 46650507 0.02870 412110993 242585448 169525545 0.10440 139995 139995 0.00010 9144 9144 0.00000 6148 6148 0.00000 155287 155287 0.00010 1 19214827 0 493563589 524358759 -30795170 X 1 1 1 Grant Scope Center LLC Ambulatory Surgery Center 0.50510 0.49490 2 Knightsbridge Surgery Center Ambulatory Surgery Center 0.49820 0.41820 3 OhioHealth Sleep Services LLC Sleep Lab Services 0.79610 0.20390 4 Polaris Surgery Center LLC Ambulatory Surgery Center 0.50760 0.49240 5 The Eye Center Opthamological Surgery Center 0.03200 0.89600 6 Upper Arlington Medical Limited Partnership Property Management 0.38840 0.29710 7 Upper Arlington Surgery Center Ltd Ambulatory Surgery Center 0.40630 0.59370 8 Whitehall Surgery Center Ambulatory Surgery Center 0.39070 0.60930 9 Greater Columbus Regional Dialysis Dialysis Services 0.25000 0.75000 10 OhioHealth Group Ltd Managed Care Services 0.50000 0.50000 11 The Hand Center LLC Orthopedic Surgery 0.49000 0.51000 4 1 Riverside Methodist Hospital

3535 Olentangy River Road Columbus OH 432143908

X X X 2 Grant Medical Center

111 South Grant Avenue Columbus OH 432154701

X X X 3 Doctors Hospital

5100 West Broad Street Columbus OH 432281607

X X X 4 Dublin Methodist Hospital

7500 Hospital Drive Dublin OH 430168518

X X Riverside Methodist Hospital 1 1 1 200.000000000000 1 400.000000000000 1 X X X X X 1 1 X 1 0 1 X X 0 0 Grant Medical Center 2 1 1 200.000000000000 1 400.000000000000 1 X X X X X 1 1 X 1 0 1 X X 0 0 Doctors Hospital 3 1 1 200.000000000000 1 400.000000000000 1 X X X X X 1 1 X 1 0 1 X X 0 0 Dublin Methodist Hospital 4 1 1 200.000000000000 1 400.000000000000 1 X X X X X 1 1 X 1 0 1 X X 0 0 24 Polaris Surgery Center

300 Polaris Parkway Westerville OH 430827989

Surgery Center Riverside Outpatient Surgery Center

2240 North Bank Drive Columbus OH 432205420

Surgery Center Knightsbridge Surgery Center

4845 Knightsbridge Blvd Suite 110 Columbus OH 432142463

Surgery Center OhioHealth Urgent Care

2030 Stringtown Road Grove City OH 43123

Urgent Care Facility OhioHealth Urgent Care

5610 North Hamilton Road Columbus OH 43230

Urgent Care Facility OhioHealth Urgent Care

6955 Hospital Drive Dublin OH 43016

Urgent Care Facility East Side Surgery Center

4850 East Main Street Columbus OH 432133162

Surgery Center Grant Scope Center LLC

700 E Broad St First Floor Columbus OH 43215

Endoscopy Surgery Center OhioHealth Urgent Care

24 Hidden Ravines Drive Powell OH 43068

Urgent Care Facility OhioHealth Sleep Services

300 Polaris Parkway Suite 2450 Westerville OH 43082

Sleep Diagnostic Center OhioHealth Sleep Services

974 Bethel Road Suite C Columbus OH 43214

Sleep Diagnostic Center OhioHealth Sleep Services

7811 Flint Road Suite B Columbus OH 43235

Sleep Diagnostic Center OhioHealth Sleep Services

2041 Stringtown Road Grove City OH 43123

Sleep Diagnostic Center OhioHealth Sleep Services

151 Clint Drive Pickerington OH 43147

Sleep Diagnostic Center OhioHealth Urgent Care

1132 Hunter Avenue Columbus OH 43201

Urgent Care Facility OhioHealth Sleep Services

6770 Avery-Muirfield Drive Dublin OH 43017

Sleep Diagnostic Center OhioHealth Sleep Services

801 OhioHealth Blvd Suite 250 Delaware OH 43015

Sleep Diagnostic Center OhioHealth Sleep Services

285 East State Street Suite 425 Columbus OH 43215

Sleep Diagnostic Center OhioHealth Sleep Services

1810 Mackenzie Drive Columbus OH 43220

Sleep Diagnostic Center Eye Center of Columbus

262 Neil Avenue Columbus OH 43215

Eye Care Services OhioHealth Sleep Services

7600 Olentangy River Road Suite 200B Columbus OH 43235

Sleep Diagnostic Center OhioHealth Sleep Services

3545 Olentangy River Road Suite 200 Columbus OH 43214

Sleep Diagnostic Center Hand and Microsurgery Associates

1210 Gemini Place Suite 200 Columbus OH 43240

Surgery Center Greater Columbus Regional Dialysis

285 East State Street Suite 170 Columbus OH 43215

Dialysis Part I, Line 7: For the cost of charity care, a cost-to-charge ratio was used that was derived from Worksheet 2. For unreimbursed Medicaid, a cost accounting system was used for all amounts reported in the table. This cost accounting system includes all patient segments. All other amounts reported on the table are based on actual costs tracked through cost centers. Costs related to the volunteer time of employees were determined using standard wage rates for hours contributed during work hours. Part I, L7 Col(f): The amount of bad debt expense reported on Form 990, Part IX, Line 25, column (A), but subtracted for purposes of calculating the percentage in Schedule H, Part I, Line 7, column (f) is $73,377,876. A system wide community benefit of $230 million reflects all entities within the system that provide community benefit and this amount is reported in the Statement of Program Service Accomplishments. The $170 million portion of total community benefit reported in Schedule H reflects all community benefit provided by OhioHealth Corporation doing business as Riverside Methodist Hospital, Grant Medical Center, Doctors Hospital, and Dublin Methodist Hospital. Part II: Together with our associates and physicians who live in the communities we serve, we share aspirations for the community in which we live, work and raise our families. Our Team OhioHealth is comprised of associates who volunteer their time at various community events such as American Heart Association's Heart Walk, Komen Race for the Cure, Arthritis Foundation's Jingle Bell Run, and March of Dimes March for Babies. Community involvement is an important part of our mission "to improve the health of those we serve". We collaborate with various non-profit organizations to ensure that our communities are provided with the appropriate services that will enable them to live a healthy life. OhioHealth associates serve meals at the YWCA Family Center, an emergency shelter supporting families experiencing housing crises. We believe that healthy people live in healthy communities. OhioHealth associates and physicians have participated in various community initiatives of the United Way of Central Ohio such as Community Care Day. During Community Care Day, United Way assigns projects to complete such as repair, painting, gardening, and construction at various non-profit agencies. OhioHealth also participates in Project Mentor; a collaboration between Columbus City Schools and Big Brothers Big Sisters of Central Ohio. Project Mentor's goal is to empower individual students to focus on their assets to improve academic performance and eventually increase high school graduation rates. Each student mentee is coached on developing skills to build self-confidence, academic competence, and become caring individuals. These skills will eventually serve as strong foundations for productive lives and help students avoid high-risk behaviors. Project Mentor enables high school students to do their best academically, and adopt positive lifestyle behaviors in the communities in which they live. It has been shown that children who have a mentor are more likely to develop the skills and knowledge they need to succeed. Mentees can also positively influence other children in the school. OhioHealth partners with Learning for Life Exploring, a division of Simon Kenton Council Boy Scouts of America, to carry out the Medical Explorer's Program. The Medical Explorer's Program aims to (a) identify students who are interested in health care careers, (b) provide opportunities for health care professionals to discuss the nature of their work to young people, and (c) educate young people about OhioHealth's state-of-the-art medical facilities, services provided, and performance and dedication of the health care team. Part III, Line 4: Accounts receivable are stated net of contractual allowances and the allowance for doubtful accounts. The allowance for doubtful accounts is determined utilizing a number of factors including account aging and financial class information, as well as recent and historical collection activity. OhioHealth applies a discount to self pay patient accounts not qualified for charity at the time of billing. If the account is deemed uncollectible, the balance is written off to bad debt. OhioHealth makes all reasonable efforts to qualify eligible patients for charity, including periodic retrospective account reviews to determine if patients that were written off to bad debt should have qualified for charity. In accordance with the Catholic Health Association guidelines per "A Guide for Planning and Reporting Community Benefits" OhioHealth does not report bad debt as community benefit. Part III, Line 8: In accordance with the Catholic Health Association guidelines per "A Guide for Planning and Reporting Community Benefits" OhioHealth does not report Medicare shortfall as community benefit. Part III, Line 9b: The organization has a written debt collection policy. The policy provides the following guidelines as it relates to patients who qualify for Charity Care: the patient may apply for financial assistance via Medicaid, Victims of Crime, HCAP/Charity, or with an OhioHealth contracted company to help the applicant complete the process when needed. The operational practice, consistent with the intent of the policy, is that once the charity determination is made, collection efforts are suspended. If a patient qualified for a discount, collection efforts on the remaining balance are consistent with all other self pay collections. Riverside Methodist Hospital Part V, Section B, Line 13g: Signs are posted at multiple entry points and patient registration locations stating our intent to comply with the State of Ohio's Hospital Care Assurance Program (HCAP). Additionally, the signage contains reference to the organization's Charity Care program. Information materials are available at registration locations and interpretive services can be arranged if the patient/guarantor does not speak English. OhioHealth facility billing statements also include information regarding HCAP and can be used to apply for financial assistance. Hospital Patient Billing Brochures explain that OhioHealth provides care to everyone who comes for services, regardless of their ability to pay. The brochure provides information about HCAP and the hospitals' charity care programs, how to apply, and the numbers to call with questions.Hospital Patient Billing Brochures are handed to every self pay patient with the financial assistance application and available upon request for insured patients. Financial Counselors are located at each of the main hospital campuses to provide information about the financial assistance programs to the patients as well as assist with completing the financial assistance application.All self pay registrations are referred to the financial counselors or on-site vendors and an attempt is made for direct contact to discuss and complete the financial assistance application. There may be times, such as very late in the evening or very early morning, when all self pay patients are not seen face-to-face before they are discharged. However, there are phone attempts and letters mailed to these patients to explain financial assistance and attempt completion of the financial assistance application.The front of every patient billing statement references assistance for amounts not covered by insurance to those individuals whose income is below the established poverty level. There are telephone numbers for customer service, with service hours, and an email address provided on the front of every patient billing statement. On the back of every patient billing statement is the financial assistance application with the federal poverty guidelines. Included are directions to complete the application, sign, and where to send the application. During the Pre-Registration/Preadmissions process, the Registration representative will inform scheduled self pay patients via telephone that financial assistance may be available and that he/she may be referred to the Customer Call Center for assistance in applying. The registrar will transfer the patient to the verbal financial assistance queue and/or will provide the telephone number to the verbal financial assistance queue in the Customer Call Center.The Customer Call Center will discuss financial assistance with any patient that expresses need or concern in paying the balance on their account. The representative will forward the caller to the verbal financial assistance queue or have a financial assistance application mailed to the patient.The financial assistance application is available in 5 different languages based on the needs of the communities. Grant Medical Center Part V, Section B, Line 13g: Signs are posted at multiple entry points and patient registration locations stating our intent to comply with the State of Ohio's Hospital Care Assurance Program (HCAP). Additionally, the signage contains reference to the organization's Charity Care program. Information materials are available at registration locations and interpretive services can be arranged if the patient/guarantor does not speak English. OhioHealth facility billing statements also include information regarding HCAP and can be used to apply for financial assistance. Hospital Patient Billing Brochures explain that OhioHealth provides care to everyone who comes for services, regardless of their ability to pay. The brochure provides information about HCAP and the hospitals' charity care programs, how to apply, and the numbers to call with questions.Hospital Patient Billing Brochures are handed to every self pay patient with the financial assistance application and available upon request for insured patients. Financial Counselors are located at each of the main hospital campuses to provide information about the financial assistance programs to the patients as well as assist with completing the financial assistance application.All self pay registrations are referred to the financial counselors or on-site vendors and an attempt is made for direct contact to discuss and complete the financial assistance application. There may be times, such as very late in the evening or very early morning, when all self pay patients are not seen face-to-face before they are discharged. However, there are phone attempts and letters mailed to these patients to explain financial assistance and attempt completion of the financial assistance application.The front of every patient billing statement references assistance for amounts not covered by insurance to those individuals whose income is below the established poverty level. There are telephone numbers for customer service, with service hours, and an email address provided on the front of every patient billing statement. On the back of every patient billing statement is the financial assistance application with the federal poverty guidelines. Included are directions to complete the application, sign, and where to send the application. During the Pre-Registration/Preadmissions process, the Registration representative will inform scheduled self pay patients via telephone that financial assistance may be available and that he/she may be referred to the Customer Call Center for assistance in applying. The registrar will transfer the patient to the verbal financial assistance queue and/or will provide the telephone number to the verbal financial assistance queue in the Customer Call Center.The Customer Call Center will discuss financial assistance with any patient that expresses need or concern in paying the balance on their account. The representative will forward the caller to the verbal financial assistance queue or have a financial assistance application mailed to the patient.The financial assistance application is available in 5 different languages based on the needs of the communities. Doctors Hospital Part V, Section B, Line 13g: Signs are posted at multiple entry points and patient registration locations stating our intent to comply with the State of Ohio's Hospital Care Assurance Program (HCAP). Additionally, the signage contains reference to the organization's Charity Care program. Information materials are available at registration locations and interpretive services can be arranged if the patient/guarantor does not speak English. OhioHealth facility billing statements also include information regarding HCAP and can be used to apply for financial assistance. Hospital Patient Billing Brochures explain that OhioHealth provides care to everyone who comes for services, regardless of their ability to pay. The brochure provides information about HCAP and the hospitals' charity care programs, how to apply, and the numbers to call with questions.Hospital Patient Billing Brochures are handed to every self pay patient with the financial assistance application and available upon request for insured patients. Financial Counselors are located at each of the main hospital campuses to provide information about the financial assistance programs to the patients as well as assist with completing the financial assistance application.All self pay registrations are referred to the financial counselors or on-site vendors and an attempt is made for direct contact to discuss and complete the financial assistance application. There may be times, such as very late in the evening or very early morning, when all self pay patients are not seen face-to-face before they are discharged. However, there are phone attempts and letters mailed to these patients to explain financial assistance and attempt completion of the financial assistance application.The front of every patient billing statement references assistance for amounts not covered by insurance to those individuals whose income is below the established poverty level. There are telephone numbers for customer service, with service hours, and an email address provided on the front of every patient billing statement. On the back of every patient billing statement is the financial assistance application with the federal poverty guidelines. Included are directions to complete the application, sign, and where to send the application. During the Pre-Registration/Preadmissions process, the Registration representative will inform scheduled self pay patients via telephone that financial assistance may be available and that he/she may be referred to the Customer Call Center for assistance in applying. The registrar will transfer the patient to the verbal financial assistance queue and/or will provide the telephone number to the verbal financial assistance queue in the Customer Call Center.The Customer Call Center will discuss financial assistance with any patient that expresses need or concern in paying the balance on their account. The representative will forward the caller to the verbal financial assistance queue or have a financial assistance application mailed to the patient.The financial assistance application is available in 5 different languages based on the needs of the communities. Dublin Methodist Hospital Part V, Section B, Line 13g: Signs are posted at multiple entry points and patient registration locations stating our intent to comply with the State of Ohio's Hospital Care Assurance Program (HCAP). Additionally, the signage contains reference to the organization's Charity Care program. Information materials are available at registration locations and interpretive services can be arranged if the patient/guarantor does not speak English. OhioHealth facility billing statements also include information regarding HCAP and can be used to apply for financial assistance. Hospital Patient Billing Brochures explain that OhioHealth provides care to everyone who comes for services, regardless of their ability to pay. The brochure provides information about HCAP and the hospitals' charity care programs, how to apply, and the numbers to call with questions.Hospital Patient Billing Brochures are handed to every self pay patient with the financial assistance application and available upon request for insured patients. Financial Counselors are located at each of the main hospital campuses to provide information about the financial assistance programs to the patients as well as assist with completing the financial assistance application.All self pay registrations are referred to the financial counselors or on-site vendors and an attempt is made for direct contact to discuss and complete the financial assistance application. There may be times, such as very late in the evening or very early morning, when all self pay patients are not seen face-to-face before they are discharged. However, there are phone attempts and letters mailed to these patients to explain financial assistance and attempt completion of the financial assistance application.The front of every patient billing statement references assistance for amounts not covered by insurance to those individuals whose income is below the established poverty level. There are telephone numbers for customer service, with service hours, and an email address provided on the front of every patient billing statement. On the back of every patient billing statement is the financial assistance application with the federal poverty guidelines. Included are directions to complete the application, sign, and where to send the application. During the Pre-Registration/Preadmissions process, the Registration representative will inform scheduled self pay patients via telephone that financial assistance may be available and that he/she may be referred to the Customer Call Center for assistance in applying. The registrar will transfer the patient to the verbal financial assistance queue and/or will provide the telephone number to the verbal financial assistance queue in the Customer Call Center.The Customer Call Center will discuss financial assistance with any patient that expresses need or concern in paying the balance on their account. The representative will forward the caller to the verbal financial assistance queue or have a financial assistance application mailed to the patient.The financial assistance application is available in 5 different languages based on the needs of the communities. Riverside Methodist Hospital Part V, Section B, Line 19d: The four hospitals utilize the same charity care policy. They offer different levels of financial assistance based on the patient's income compared to the federal poverty level (FPL). Any patient with income at 200% or below of the FPL gets a 100% discount. A patient between 201-267% receives a 75% discount (average Medicaid discount). A patient between 268-334% receives a 70% discount (average Medicare discount). A patient between 335-400% receives a 45% discount (average managed care discount). All patients without insurance receive a 35% uninsured discount, regardless of their income level. Grant Medical Center Part V, Section B, Line 19d: The four hospitals utilize the same charity care policy. They offer different levels of financial assistance based on the patient's income compared to the federal poverty level (FPL). Any patient with income at 200% or below of the FPL gets a 100% discount. A patient between 201-267% receives a 75% discount (average Medicaid discount). A patient between 268-334% receives a 70% discount (average Medicare discount). A patient between 335-400% receives a 45% discount (average managed care discount). All patients without insurance receive a 35% uninsured discount, regardless of their income level. Doctors Hospital Part V, Section B, Line 19d: The four hospitals utilize the same charity care policy. They offer different levels of financial assistance based on the patient's income compared to the federal poverty level (FPL). Any patient with income at 200% or below of the FPL gets a 100% discount. A patient between 201-267% receives a 75% discount (average Medicaid discount). A patient between 268-334% receives a 70% discount (average Medicare discount). A patient between 335-400% receives a 45% discount (average managed care discount). All patients without insurance receive a 35% uninsured discount, regardless of their income level. Dublin Methodist Hospital Part V, Section B, Line 19d: The four hospitals utilize the same charity care policy. They offer different levels of financial assistance based on the patient's income compared to the federal poverty level (FPL). Any patient with income at 200% or below of the FPL gets a 100% discount. A patient between 201-267% receives a 75% discount (average Medicaid discount). A patient between 268-334% receives a 70% discount (average Medicare discount). A patient between 335-400% receives a 45% discount (average managed care discount). All patients without insurance receive a 35% uninsured discount, regardless of their income level. Part VI, Line 2: The Mission and Ministry Department and the Mission/Ministry and Community Needs Committee of the OhioHealth Board of Trustees are responsible for corporate oversight and strategic direction for community benefit services. These two entities are responsible for monitoring community health needs and providing oversight of metrics on community benefit and mission effectiveness. OhioHealth has ongoing partnerships with Columbus Public Health, Ohio Department of Health, and Access Health Columbus in identifying health priorities locally and statewide. OhioHealth is active in direct discussions regarding epidemiologic data and what OhioHealth can do to impact public health issues. Access Health Columbus' goal is to improve access to healthcare for all individuals in central Ohio, specifically the most vulnerable. A representative of OhioHealth's leadership is a part of these mentioned organizations and agencies to ensure that our planning and practice are meeting the identified needs of central Ohio.OhioHealth utilizes primary and secondary data sources to compile the community health needs assessment. OhioHealth combines the primary data source and secondary data sources to conduct a statistical analysis regarding community health needs and consequently provides the information to OhioHealth leadership to create the OhioHealth community benefit strategic priorities. Part VI, Line 3: Signs are posted at multiple entry points and patient registration locations stating our intent to comply with the State of Ohio's Hospital Care Assurance Program (HCAP). Additionally, the signage contains reference to the organization's Charity Care program. Information materials are available at registration locations and interpretive services can be arranged if the patient/guarantor does not speak English. OhioHealth facility billing statements also include information regarding HCAP and can be used to apply for financial assistance. Part VI, Line 4: The following demographic information was obtained from Claritas 2012. Columbus is the capital and largest city in the state of Ohio. The city has a diverse economy based on education, insurance, banking, fashion, defense, aviation, food, logistics, steel, energy, medical research, health care, hospitality, retail, and technology.OhioHealth's primary service area covers Franklin and Delaware Counties as well as a few rural communities in neighboring counties. Over the next five years, the population in this area is estimated to change from 1,509,028 to 1,578,088, resulting in a growth of 4.6% Of this area's current year estimated population: 70.6% are White alone, 18.1% are Black or African American alone, 4.5% are Hispanic, 3.9% are Asian alone, and 2.9% are other races.In 2012, the average household income in the primary service area is estimated to be $68,697.The primary service area demographics are impacted by the number of colleges and universities. Currently, it is estimated that 36.8% of the population age 25 and over in this area have earned a Bachelor's Degree or greater. As a result of the student population, the primary service area is relatively young. For this area, 25% of the population is estimated to be 0-17 years old, 27% are between ages 18-34, 28% are between ages 35-54, and 20% are older than 54. OhioHealth is a health care system covering Franklin, Delaware, Athens, Hardin and Marion counties that in total includes eight hospitals, ambulatory health care services, physician clinics, hospice care, and other entities in support of the hospital and healthcare services. Of those eight hospitals, OhioHealth Corporation operates four hospitals, Riverside, Grant, Doctors and Dublin, in its primary service area of Franklin County. -Riverside Methodist Hospital is a 1,059-bed facility recognized locally, regionally and nationally for quality care, service and reputation. Riverside Methodist offers world-class medical care and advanced medical innovations in multiple specialties including heart and vascular, neuroscience, cancer care, and maternity care.-Grant Medical Center is a 645-bed comprehensive healthcare facility in downtown Columbus with a national reputation for specialized trauma capabilities, orthopedic and surgical excellence, and nursing expertise. Grant has one of the busiest Level I Trauma Centers in Ohio.-Doctors Hospital is a 262-bed community facility with a full complement of healthcare services and technology. It stands out among other Ohio hospitals as a premier osteopathic teaching institution.-Dublin Methodist Hospital is a 107-bed facility with a full-service Emergency Department as well as inpatient and outpatient medical and surgical services. Using evidence-based design concepts, the hospital's environment is designed to achieve health benefits including increased patient satisfaction, improved safety, and fewer patient transfers.In conjunction with other community stakeholders, OhioHealth Corporation collaborated for its Community Health Needs Assessment and so gathered significant, additional demographic and community profile information. This information is published in the Community Health Needs Assessment and is available to the public. Part VI, Line 5: A majority of the organization's governing body is comprised of persons who reside in the organization's primary service area who are neither employees nor contractors of the organization, nor family members thereof. OhioHealth extends medical staff privileges and/or membership to all qualified physicians in the communities it serves to ensure that each community has access to the necessary medical services.OhioHealth reinvests in our community to improve quality of care, increase access to care and enhance service to our patients and their families. Instead of paying dividends to shareholders or owners, OhioHealth uses its earnings to provide a broad array of community benefits. For example:-We provide charity care to those without adequate resources to pay for their care, in conjunction with our charity care policies.-We invest in research, innovation and technology, and medical education and training, to advance medical knowledge and provide the highest quality of care and service to our patients.-We subsidize essential community health services - trauma centers, poison control, psychiatric services, and kidney dialysis, as examples that might not otherwise pay for themselves.-We support a wide range of vital community outreach services, targeting in particular, the most vulnerable and historically underserved residents of our community.In total, OhioHealth Corporation and affiliates provided $230,387,000 of community benefit. The total community benefit represents an appropriate balance of charity care, community health services, subsidized health services, research and net medical education costs, and cash or in-kind community building. Part VI, Line 6: OhioHealth Corporation operates general acute care hospitals as well as outpatient facilities. In addition, OhioHealth Corporation is the parent organization and sole voting member of several rural community hospitals, organizations providing multidisciplinary home care and rehabilitation, medical research, fundraising in support of the system hospitals, medical facility property management, and physician foundations. All serving in OhioHealth "systemness" to improve the health of those we serve. Reports Filed With States Part VI, Line 7 OH 1 Ronald McDonald House Charities of Central Ohio 711 E Livingston Ave Columbus OH 43205 310890152 501(c)(3) 250000 Expansion project to a current facility to meet the future needs of the community. YWCA 65 S 4th Street Columbus OH 43215 311418939 501(c)(3) 163892 Provide funding for the YWCA Family Center. COSI 333 West Broad Street Columbus OH 43215 311351334 501(c)(3) 107333 Committed to $300K, total expensed all in FY12, paid $100,000. Remainder paid in next 2 years. West Ohio Conference United Methodist Church 32 Wesley Boulevard Worthington OH 43085 314420544 501(c)(3) 12000 OH Partnership with West Ohio Medical Mission in Mexico. American Heart Association 5455 N High Street Columbus OH 43214 135613797 501(c)(3) 41000 Heart Walk 2011, 2012 Cols Go Red, Heart Ball New Albany Walking Classic 4000 Baughman Grant NewAlbany OH 43054 203840246 501(c)(3) 25000 Sponsorship for walking classic event, an event to benefit "Healthy New Albany" a 501c3 org. Columbus Bicentennial Celebration 2012 1269 Grandview Avenue Columbus OH 43212 451730585 501(c)(3) 25000 Sponsorship for bicentennial celebration taking place in Sept 2012. Komen Race for the Cure 929 Eastwind Drive Suite 211 Westerville OH 43081 751835298 501(c)(3) 20000 Sponsorship for Race for the Cure 2012. Nationwide Children's Hospital 700 Childrens Hospital Drive Columbus OH 43205 314379441 501(c)(3) 13300 The Opening Gala Bronze Sponsorship. American Cancer Society 5555 Frantz Road Dublin OH 43017 251798733 501(c)(3) 14750 Relay for Life Sponsorship; Sponsorship Drive for Life; Cattle Baron's Ball. Who's Who Publishing 920 Leona Avenue Columbus OH 43201 264163198 10000 Sponsorship for Who's Who in Latino & Black Cols. The Links Foundation 1200 Massachusetts Ave NW Washington DC 20005 521170830 501(c)(3) 7250 Gala Sponsorship. American Red Cross 995 East Broad Street Columbus OH 43205 310642918 501(c)(3) 7500 Sponsorship for 2012 Humanitarian of the Year Award Luncheon; Golf Classic. Alzheimers Association 3380 Tremont Road Columbus OH 43221 310996236 501(c)(3) 6250 Sponsorship Delaware County Walk & Sponsorship for Gala. Lifecare Alliance of Ohio 1699 West Mound Street Columbus OH 43223 314379494 501(c)(3) 7000 Big Wheels Event Sponsorship; Sponsorship for Cancer Screening. Arthritis Foundation 3740 Ridge Mill Drive Hilliard OH 43026 274014550 501(c)(3) 5860 Sponsorships for Crystal Ball; Golf Sponsorship; Jingle Bell Run Sponsorship. March of Dimes 975 Eastwind Drive Suite 150 Westerville OH 43081 314414879 501(c)(3) 5600 Sponsorship for March for Babies $5,000; Signature Chefs Auction $1,500. Tech Columbus 1275 Kinnear Road Columbus OH 43212 311658220 501(c)(3) 6000 Sponsorship for Tech Columbus Innovation Awards. Columbus Urban League 788 Mt Vernon Avenue Columbus OH 43203 314379453 501(c)(3) 5803 Sponsorship for Equal Opportunity Luncheon. The Ohio State University Foundation - HSMP Alumni 174 W 18th Avenue Columbus OH 43210 311145986 501(c)(3) 6000 Sponsorship for OSU HSMP Alumni Society - HSMP Management Institute. Big Brothers Big Sisters of Central Ohio 1855 E Dublin-Granville Road Columbus OH 43229 314379429 501(c)(3) 5500 Sponsorship for Taste of Class for Kids. UHCAN (Universal Health Care Action of Ohio) 370 S 5th Street Suite G 3 Columbus OH 43215 311542417 501(c)(3) 5500 Donation for Universal Healthcare Action of Ohio. 21 1 Procedure for Monitoring Grants in the U.S.: Part I, Line 2: Schedule I, Part I, Line 2: OhioHealth Corporation primarily makes general contributions and pays for sponsorships to other tax exempts organizations that benefit the community. In accordance with OhioHealth Corporation's Authority Matrix for issuance of payments, all payments contributed were authorized by the approved level of management. X 0 1 X X X X X X 1 1 0 0 0 0 0 1 0 Anderson Craig MD 198064 0 4358 0 16578 0 17736 0 21634 0 258370 0 0 0 Blom David P 909472 0 520616 0 30377 0 986026 0 16816 0 2463307 0 0 0 George Peter B MD 115007 645997 0 181655 78 70861 0 16825 0 16106 115085 931444 0 0 Louge Michael W 616389 0 300000 0 15237 0 411488 0 22242 0 1365356 0 0 0 Millen Robert P 597747 0 280000 0 20394 0 274408 0 24242 0 1196791 0 0 0 Pandora Frank T II Esq 354965 0 160000 0 28931 0 305484 0 15715 0 865095 0 0 0 Bernstein Michael S 418890 0 175000 0 18978 0 147265 0 21790 0 781923 0 0 0 Boggs Martha Bruce 320878 0 138000 0 23488 0 92926 0 13855 0 589147 0 0 0 Gallaher Connie L 216070 0 81500 0 7090 0 21518 0 18229 0 344407 0 0 0 Hagen Bruce P 447925 0 188000 0 33857 0 156083 0 16454 0 842319 0 0 0 Herbert-Sinden Cheryl L 273446 0 121000 0 25485 0 43449 0 16776 0 480156 0 0 0 Jablonski Susan F 276094 0 128000 0 4793 0 88734 0 9120 0 506741 0 0 0 Lawson Michael S 258465 0 74407 0 16607 0 12250 0 7260 0 368989 0 0 0 Markovich Stephen E MD 428856 0 182050 0 22030 0 157321 0 21631 0 811888 0 0 0 Reichfield Michael L 318901 0 142000 0 26235 0 115810 0 24028 0 626974 0 0 0 Vanderhoff Bruce MD 447166 0 187400 0 9920 0 150591 0 19112 0 814189 0 0 0 Yates Vinson M 287212 0 130000 0 21268 0 93921 0 22905 0 555306 0 0 0 Quinn Andrew S 464361 0 152986 0 4871 0 138892 0 17472 0 778582 0 0 0 Lozada Leonardo J MD 411016 0 131973 0 21187 0 17849 0 10557 0 592582 0 0 0 Krouse Michael T 329283 0 109149 0 21359 0 98710 0 17252 0 575753 0 0 0 Morrison Karen J 296961 0 135000 0 21709 0 100993 0 20242 0 574905 0 0 0 Kontner John G 311228 0 134458 0 5181 0 17828 0 17552 0 486247 0 0 0 Bachman Ronald J 0 0 0 0 465961 0 -698 0 0 0 465263 0 155617 0 Connors Karen H 0 0 50000 0 372264 0 1464 0 15828 0 439556 0 0 0 Garlock Steven J 266465 0 116268 0 25422 0 59638 0 18576 0 486369 0 0 0 Seckinger Mark R 182590 0 52000 0 21053 0 30975 0 14898 0 301516 0 0 0 Tomaszewski James A 268384 0 82843 0 24748 0 21247 0 6687 0 403909 0 0 0 Supplemental Information Part III Part I, Line 1a, First-class or charter travel: Disclosure primarily due to a charter flight taken by executives and physicians in August 2011 to Swedish Health Services in Seattle as part of the OhioHealth Neurosciences Institute project due diligence. Supplemental Information Part III Part I, Line 4a: The following individuals listed in Form 990, Part VII received severance payments: Ronald J. Bachman - $263,820 Karen H. Connors - $375,430 Part I, Line 4b: The following individuals listed in Form 990, Part VII participated in a supplemental non-qualified retirement plan: David P. Blom - $952,745 Michael S. Bernstein - $126,987 Martha Bruce Boggs - $73,312 Bruce P. Hagen - $133,936 Cheryl L. Herbert-Sinden - $17,137 Susan F. Jablonski - $71,250 Michael W. Louge - $388,599 Stephen E. Markovich, M.D. - $133,066 Robert P. Millen - $252,573 Frank T. Pandora II Esq. - $266,448 Michael Reichfield - $99,123 Bruce Vanderhoff, M.D. - $127,372 Vinson M. Yates - $64,041 Michael T. Krouse - $85,511 Karen J. Morrison - $81,384 Steven J. Garlock - $20,532 Mark R. Seckinger - $1,038 Andrew S. Quinn - $126,642 Karen H. Connors - $0 Ronald J. Bachman - $202,141 These arrangements are an industry standard and are unfunded. Due to the substantial risk of forfeiture provision, there is no guarantee that these officers will ever receive these benefits. Amounts for these arrangements are included in the deferred compensation amount. Supplemental Information Part III Part I, Line 7: Incentive bonuses are calculated using an objective formula that includes clinical quality, patient, physician and employee satisfaction, and financial items. Minor modifications to increase or decrease incentive payments, within the maximum amount established for each position, may be made based on individual performance and accountabilities. In addition, one time bonuses may be awarded to recognize exemplary performance. All payments are examined for reasonableness and are reviewed and approved by either the Executive Compensation Committee (for disqualified persons) or through management and the company's human resources function (for non-disqualified persons). County of Franklin Ohio 316400067 3531866P9 2009-02-25 165800000 To Refund Series 2006, issued on 5/10/06 0 0 0 County of Franklin Ohio 316400067 3531868AO 2011-06-23 320668797 To Refund Series 2008A, issued on 8/1/08 and Series 2001, issued 9/1/01 0 0 0 County of Franklin Ohio 316400067 3531863Q0 2003-11-05 27755000 To Refund Series 2000A, issued on 1/27/00 0 0 0 County of Franklin Ohio 316400067 3531863P2 2003-11-05 123578533 To Refund Series 1993A, issued on 4/27/93 0 0 0 165800000 1195000 164605000 2009 1 0 1 1 320668797 2122360 116879007 202446437 2011 1 0 0 1 27755000 211270 6710 27537020 2003 1 0 1 1 3125000 123578533 1139905 2681000 119757628 2003 1 0 1 1 0 1 1 0 0 0.01400 0.00000 0.01400 1 0 1 1 0 0 0.02400 0.00000 0.02400 1 0 1 0 0 0 1 0 1 0 0 0 1 0 1 0 0 0 1 0 0 0 0 0 1 Part I, Line B, column (e): Issue price of $313,765,000 is the par issue price of the bonds. Part II, Line 3, Column B total proceeds of issue of $320,668,797 includes a premium of $6,903,797 received over par from the sale of the bonds. Part I, Line C, Column E: Form 8038 for the bonds erroneously presented the issue price for the bonds as $27,755,533, but the correct value is $27,755,000. Part I, Line D, Column F: Form 8038 for the bonds erroneously described the refunded bonds as having been issued 4/5/2011, but the correct date is 4/27/1993. Part II, Line 4: The amounts shown here consist solely of debt service fund deposits. Part II, Column B, Line 11: $13,336,000 of the proceeds was used to pay off a draw on a taxable line of credit which had been used to pay the termination amount on the 2006 Swap. While this is a refunding debt issuance, the proceeds flowed through the project fund. Part III: Part III has not been completed with respect to the 2003C and 2003D bonds shown in columns C and D, since such bonds refunded pre-2003 bond issues. Had completion of Part III been required, line 7 would have been answered "yes" for these bonds. Part IV, Line 2, Column B: Portions of this bond issue bear fixed interest rates, but some bear variable rates. Hence, it is a variable yield issue for tax purposes. Live Technologies Inc Director of Org - Entity more than 35% owned by Director (Lawrence Abbott) 328749 Payments - Goods or services provided to OhioHealth Corporation. 0 Central Ohio Newborn Medicine Director of Org - Entity more than 5% owned by Director (Craig Anderson MD) 177467 Payments - Goods or services provided to OhioHealth Corporation. 0 Time Warner Cable Director of Org - A Director of OhioHealth (Donna James) is a Director 398335 Payments - Goods or services provided to OhioHealth Corporation. 0 Jacob Millen Officer of Org - Son of Officer (Robert P. Millen) 47674 Comp/Ben - Son is employed at Riverside Methodist Hospital and receives compensation. 0 Mark Vanderhoff Key Employee - Brother of a Key Employee (Bruce Vanderhoff) 105013 Comp/Ben - Brother is employed at Grant Medical Center and receives compensation. 0 Sarcom Director of Org - A Director of OhioHealth (Randy Wilcox) is a Director 367762 Payments - Goods or services provided to OhioHealth Corporation. 0 Heart Property LLC Director of Org - Entity more than 35% owned by Director (Peter George, MD) 134091 Payments - Goods or services provided to OhioHealth Corporation. 0 Columbus Radiology Group Fmr Key Employee - Son-in-law of Fmr Key Employee (Steven Garlock) is a Dir 115075 Payments - Goods or services provided to OhioHealth Corporation. 0 Abigail Hagen Key Employee - Daughter of Key Employee (Bruce P. Hagen) 10551 Comp/Ben - Daughter is employed at McConnell Heart and Health Center and receives compensation. 0 Ohio Hospital Association Insurance Solutions Officer of Org - An Officer of OhioHealth (Frank T. Pandora) is a Director 199519 Payments - Goods or services provided to OhioHealth Corporation. 0 The Hand Center LLC Key Employee of Org - Key Employee (Michael S. Bernstein) is a Director 882000 Payments - Goods or services provided to OhioHealth Corporation. 0 OhioHealth Group Ltd Officer/Key Employee of Org - An Officer and a Key Employee are Directors 2782392 Payments - Goods or services provided to OhioHealth Corporation.Continued from relationship between interested person and organization - CFO and CMO of OhioHealth Corporation are Directors. 0 X Hospital PP&E 1 3173710 Cost/selling price 0 1 0 Method for Determining Number of Contributors: Part I, Column (b): OhioHealth Foundation contributes PP&E necessary to the operations of OhioHealth Corporation hospitals. Form 990, Part I, Doing Business As: Grant Medical Center, Riverside Methodist Hospital, Dublin Methodist Hospital, Doctors Hospital, and OhioHealth Neighborhood Care. Form 990, Part I, Summary: Revenue and expense reporting for the current year reflects a change in reporting intercompany eliminations compared to prior years. Current year amounts have been reduced to reflect intercompany eliminations. Form 990, Part VI, Section A, line 2 Many of the persons listed in Part VII have a "business relationship" with each other by virtue of sitting on related OhioHealth entity boards. OhioHealth Corporation has an ownership interest in limited liability companies (LLCs) that provide healthcare or related services. As a member of such LLCs, OhioHealth Corporation has the right to appoint two individuals to the managing board of such LLCs. As a result, these individuals may be deemed to have a "business relationship" with each other for purposes of Part VI, Section A, Line 2. Michael J. Endres, Treasurer of OhioHealth Corporation, Kerrii B. Anderson, Director of OhioHealth Corporation, and John P. McConnell, Director of OhioHealth Corporation, have a business relationship. Form 990, Part VI, Section A, line 6 The West Ohio Conference of The United Methodist Church is the sole member of OhioHealth Corporation, and this membership is permissible under Ohio Revised Code Section 1702.13. Form 990, Part VI, Section A, line 7a The West Ohio Conference of the United Methodist Church is the sole voting member of OhioHealth Corporation which in turn is the sole voting member of all subsidiary organizations. This membership is permissible under Ohio Revised Code Section 1702.13. Form 990, Part VI, Section A, line 7b Revisions of the Code of Regulations that affect the rights of the Member must be approved by the Member. Form 990, Part VI, Section B, line 11 Corporate Finance, using a public accounting tax firm, prepares the Form 990. Multiple levels of internal review occur, as well as a presentation to the OhioHealth Board Finance and Audit Committee, prior to copies being provided to the OhioHealth Corporation Board before filing. Form 990, Part VI, Section B, line 12c The conflict of interest policy has been reviewed by independent tax counsel to assure its compliance with the requirements of the Internal Revenue Service. The policy requires all officers, directors and key employees to complete an annual questionnaire pertaining to conflicts of interest. The questionnaire is administered by the General Counsel of OhioHealth, the parent company of the organization. The responses are recorded and reported to the Board in the format approved by the Chair of the Board (a community member). In the interim between questionnaires, conflicts are to be reported to the General Counsel, who will advise the conflicted officer, director or key employee on the steps required to manage or clear the conflict. Failure to report a conflict, or failure to follow the steps advised to clear the conflict, constitutes grounds for disciplinary action. Members of the governing board with a transactional conflict are required to recuse themselves from any discussion and/or vote pertaining to the conflicted transaction, and this is reflected in the minutes of the organization. Legal counsel attends Board meetings and Board committee meetings with the instruction to assure the conflict of interest policy is followed. Form 990, Part VI, Section B, line 15 The CEO's compensation is set by the Compensation Committee, which is composed of independent and disinterested members of the Board of Directors. The CEO's 2011 base salary and his 2011 total compensation (which includes annual incentive and all benefits) were estimated to approximate the 55th percentile. The organization's performance for FY6/30/2012 was at the 87th percentile as measured by the Balanced Scorecard using Quality, Customer Service, Worklife and Finance indicators. The Compensation Committee annually receives a report from its independent executive compensation consultant, which includes third-party comparability data for functionally-similar positions in comparable not-for-profit health systems across the United States. The annual report to the Compensation Committee, completed each fall, includes market analyses for base salaries, total cash compensation, benefits and perquisites, and aggregate total compensation values for the Chief Executive Officer, Executive Vice Presidents, Senior Vice Presidents and Entity Presidents, to support OhioHealth's qualification for the rebuttable presumption of reasonableness. The Compensation Committee reviews and approves each executive's compensation, based on performance and the compensation philosophy, and rationale for the Committee's decisions is documented in meeting minutes. With respect to non-disqualified positions, compensation is determined in the same manner as set forth above, however it is not reviewed by the Executive Compensation Committee and is instead determined by management. Form 990, Part VI, Section C, line 19 Information is made available as required. Form 990, Part VII, Section A: Peter George, M.D. worked 40 hours a week for a related organization. Form 990, Part VII, Section B: Amounts paid to Quandel Group and Daimler Group represent amounts paid for materials and services. These amounts cannot be separated. Changes in Net Assets or Fund Balances: Form 990, Part XI, line 5: Net unrealized losses on investments: -21,487,690. Pension Related Changes Other Than Net Periodic Pension Costs -77,914,046. Intercompany Transactions 21,651,371. Change in Fair Value of Interest Rate Swaps -32,351,973. Total to Form 990, Part XI, Line 5: -110,102,338. Form 990, Part XII, Line 3: OhioHealth Corporation was required to undergo an A-133 audit due to federal rewards received by OhioHealth Corporation and several of its wholly owned subsidiaries. DH Ventures Ltd 180 East Broad Street 33rd Floor Columbus OH 432153707 311686358 Holding Company OH 0 0 OhioHealth Corporation CG Broad Norton LLC 180 East Broad Street 33rd Floor Columbus OH 432153707 261564783 Real Estate Holding Company OH -1167 243155 OhioHealth Corporation OhioHealth Medical Specialty Foundation LLC 180 East Broad Street 33rd Floor Columbus OH 432153707 261210223 Physician Practices OH 0 0 OhioHealth Corporation OhioHealth Hospital Management Services 180 East Broad Street 33rd Floor Columbus OH 432153707 300632745 Hospital Management Services OH 73180 0 OhioHealth Corporation Pickerington Fairfield Land Company LLC 180 East Broad Street 33rd Floor Columbus OH 432153707 452035147 Real Estate Holding Company OH 0 6760330 OhioHealth Corporation Grove City Land Company LLC 180 East Broad Street 33rd Floor Columbus OH 432153707 452651557 Real Estate Holding Company OH 0 3585940 OhioHealth Corporation OhioHealth Urgent Care LLC 180 East Broad Street 33rd Floor Columbus OH 432153707 273371022 Urgent Care Services OH -128852 2778768 OhioHealth Corporation Marion Practices LLC 180 East Broad Street 33rd Floor Columbus OH 432153707 455500349 Holding Company OH 0 0 OhioHealth Corporation Marion Area Physicians LLC 180 East Broad Street 33rd Floor Columbus OH 432153707 800835324 Physician Practices OH 0 0 OhioHealth Corporation Marion General Hospital 1000 McKinley Park Drive Marion OH 43302 311070877 Health Care OH Section 501(c)(3) Schedule A, Line 3 OhioHealth Corporation 1 Grady Memorial Hospital 561 West Central Avenue Delaware OH 43015 314379436 Health Care OH Section 501(c)(3) Schedule A, Line 3 OhioHealth Corporation 1 Hardin Memorial Hospital 921 East Franklin Street Kenton OH 43326 344440479 Health Care OH Section 501(c)(3) Schedule A, Line 3 OhioHealth Corporation 1 Hardin Physician Foundation Inc 921 East Franklin Street Kenton OH 43326 311414276 Foundation OH Section 501(c)(3) Schedule A, Line 3 Hardin Memorial Hospital 1 Hardin Memorial Hospital Foundation 921 East Franklin Street Kenton OH 43326 341521537 Foundation OH Section 501(c)(3) Schedule A, Line 3 Hardin Memorial Hospital 1 Doctors Health Corporation of Nelsonville 1950 Mount St Mary Drive Nelsonville OH 45764 311620551 Health Care OH Section 501(c)(3) Schedule A, Line 3 OhioHealth Corporation 1 GrantRiverside Medical Care Foundation 180 East Broad Street 33rd Floor Columbus OH 432153707 311351965 Health Care OH Section 501(c)(3) Schedule A, Line 3 OhioHealth Corporation 1 OhioHealth Foundation 180 East Broad Street 33rd Floor Columbus OH 432153707 237446919 Foundation OH Section 501(c)(3) Schedule A, Line 3 OhioHealth Corporation 1 Grady Memorial Hospital Foundation 561 West Central Avenue Delaware OH 43015 311763100 Foundation OH Section 501(c)(3) Schedule A, Line 3 OhioHealth Foundation 1 HomeReach 180 East Broad Street 33rd Floor Columbus OH 432153707 311372702 Health Care OH Section 501(c)(3) Schedule A, Line 3 OhioHealth Corporation 1 HomeReach HomeCare 180 East Broad Street 33rd Floor Columbus OH 432153707 311417595 Health Care OH Section 501(c)(3) Schedule A, Line 3 HomeReach 1 OhioHealth Research Institute 180 East Broad Street 33rd Floor Columbus OH 432153707 316059784 Research OH Section 501(c)(3) Schedule A, Line 3 OhioHealth Corporation 1 Hospital Properties Inc 180 East Broad Street 33rd Floor Columbus OH 432153707 311206071 Property Management OH Section 501(c)(2) N/A OhioHealth Corporation 1 OhioHealth Sleep Services LLC 6186 Huntley Road STE B Columbus OH 43229 201547399 Physician Practice OH OhioHealth Corporation Related 3185152 3583211 0 0 0.79610 Polaris Surgery Center LLC 6200 Cleveland Avenue Columbus OH 43231 208074623 Medical Services OH OhioHealth Corporation Related 3592045 5425132 0 1 0.51320 Marion Ancillary Services 1040 Delaware Avenue Marion OH 43302 311704991 Outpatient Services OH N/A Upper Arlington Medical LP 180 East Broad Street 33rd Floor Columbus OH 43215 311472667 Medical Services OH OhioHealth Star Corporation Related 78813 1100801 0 0 0.47820 ESWL Real Estate & Equipment LP 100 West Third Avenue Suite 350 Columbus OH 43201 311138732 Equipment Rental OH N/A Marion Area Health Center 1050 Delaware Avenue Marion OH 43302 311639538 Outpatient Surgery Center OH N/A Grant Scope Center LLC 180 East Broad Street 33rd Floor Columbus OH 43215 260765486 Endoscopy Services OH OhioHealth Corporation Related 1543808 1003079 0 0 0.50500 OhioHealth Star Corporation 180 East Broad Street 33rd Floor Columbus OH 432153707 311119936 Administrative Services OH N/A C OhioHealth Star Properties 180 East Broad Street 33rd Floor Columbus OH 432153707 311347216 Administrative Services OH N/A C MedStart Inc 180 East Broad Street 33rd Floor Columbus OH 432153707 311482649 Administrative Services OH N/A C GM Health Services 561 West Central Avenue Delaware OH 43015 311094787 Industrial Health, DME Home, Collection Agency OH N/A C HealthWorks 561 West Central Avenue Delaware OH 43015 311435822 Medical Service Phys Practices OH N/A C Grady Anesthesia Services 561 West Central Avenue Delaware OH 43015 203750671 Anesthesia Services OH N/A C HardinCare Inc 921 East Franklin Street Kenton OH 43326 341492617 Property Management OH N/A C Intel Health Services PO Box 1051 Governors Square Bu Grand Cayman CJ KY1-1102 314394942 Insurance/Reinsurance CJ OhioHealth Corporation C 3607559 13098890 1.00000 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 1 1 1 OhioHealth Star Corporation R 587530 Actual Dollars Transferred Hospital Properties Inc J 1835565 Market Rent Hospital Properties Inc P 1478287 Actual Expense Paid Hospital Properties Inc Q 19192549 EOY Fund Bal Transfer Hospital Properties Inc O 467167 Actual Expense Paid Hospital Properties Inc R 7238273 Actual Dollars Transferred Hospital Properties Inc Q 4174569 Actual Dollars Transferred Hospital Properties Inc Q 23720447 Market Value of FA HealthWorks Q 2016177 Actual Expense Paid HealthWorks O 193638 Actual Expense Paid Grady Anesthesia Services Q 115537 Actual Expense paid OhioHealth Foundation R 7760170 Actual Dollars Transferred Grady Hospital Foundation R 607262 Actual Dollars Transferred Grady Memorial Hospital Q 60672479 Actual Dollars Transferred HomeReach HomeCare Q 3004590 Actual Dollars Transferred HomeReach Q 27206138 Actual Dollars Transferred Marion General Hospital R 507153 Actual Dollars Transferred OhioHealth Research Institute R 1071292 Actual Dollars Transferred Intel Health Services O 3053970 Actual Dollars Transferred