2012-05-14T15:59:43-05:00 2011-06-30 Deloitte Tax LLP 250 East Fifth Street Suite 1900 Cincinnati OH 45202 990 2010-07-01 314394942 OhioHealth Corporation OHIO 6145444052 180 East Broad Street 33rd Floor Columbus OH 432153707 MICHAEL W LOUGE 6145444052 2012-05-14 1 Mary E Rauschenberg 5137847100 2010 2016-02-24 21:20:13Z See Schedule O-Grant Medical Center Dublin Methodist Hospital Doctors Hospital & OhioHealth Neighborhood Care David P Blom 180 East Broad Street 33rd Floor Columbus OH 432153707 2133391087 0 3858 X www.ohiohealth.com X 1891 OH To improve the health of those we serve. 20 11 13516 2119 472497 355256 10881785 12731793 1676111885 1779937668 34866395 59406401 245586076 276712821 1967446141 2128788683 50000 244750 0 0 871362922 932851546 0 0 0 874521344 907642142 1745934266 1840738438 221511875 288050245 2349906280 2889795543 1169765395 1259831021 1180140885 1629964522 X To improve the health of those we serve. 0 0 1559941955 176250 1779465171 In fiscal year 2011 (July 1, 2010, through June 30, 2011), OhioHealth and its member hospitals and home care organizations provided charity care and community benefit programs to a greater degree than ever before. The hospitals of OhioHealth provided $205 million in charity care and community benefit programs and services reaching hundreds of thousands of people in the communities we serve.Together-we are united in our mission to provide quality, compassionate healthcare and to be responsible stewards of our community's health. For more than 100 years it has been that 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, saving lives, improving their health and making their futures 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. 1559941955 1 1 0 1 0 0 0 0 1 1 1 0 0 1 0 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 932 0 1 13516 1 1 1 1 CJ BD LU UK 0 0 0 0 0 0 0 0 X 20 11 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 6145444052 180 East Broad Street 33rd Floor Columbus OH 432153707 Hoaglin Thomas E 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 124456 0 36989 Auseon John DO 2.00 X 0 0 0 Blom David P 40.00 X X 1667101 0 1347424 Crane Tanny 2.00 X 0 0 0 deVillers Rebecca DO 2.00 X 72000 87172 29023 Dewire Rev Dr Norman E 2.00 X 0 0 0 George Peter B MD 2.00 X 112499 913279 40803 Hood Clifton R DO 2.00 X 40000 1225 30 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 Rasmussen Steve 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 863555 0 374134 Millen Robert P 40.00 X 836000 0 255315 Pandora Frank T II Esq 40.00 X 515976 0 309110 Bernstein Michael S 40.00 X 585242 0 161084 Boggs Martha Bruce 40.00 X 460792 0 86884 Caulin-Glaser Terri MD 40.00 X 398363 0 49664 Gallaher Connie L 40.00 X 246775 0 37239 Hagen Bruce P 40.00 X 632383 0 168821 Hanly Donna L 40.00 X 248564 0 39750 Herbert-Sinden Cheryl L 40.00 X 357291 0 58398 Jablonski Susan F 40.00 X 395518 0 94611 Lawson Michael S 40.00 X 262980 0 6986 Markovich Stephen E MD 40.00 X 469327 0 139351 Reichfield Michael L 40.00 X 456447 0 136989 Santanello Steven A DO 40.00 X 337808 74125 24853 Vanderhoff Bruce MD 40.00 X 601335 0 158652 Yates Vinson M 40.00 X 368391 0 103186 Lozada Leonardo J MD 40.00 X 540116 0 24492 Kontner John G 40.00 X 429984 0 34245 Krouse Michael T 40.00 X 427295 0 124193 Imm Amy A MD 40.00 X 405365 0 38574 Morrison Karen J 40.00 X 395651 0 118238 Innes Jeffrey T MD 2.00 X 0 0 0 Parrot Rex A 2.00 X 0 0 0 Walker Kevin 2.00 X 0 0 0 Dono Frank V 40.00 X 0 0 0 Gleeson Sean MD 40.00 X 0 0 0 Bachman Ronald J 0.00 X 265208 0 5856 Garlock Steven J 0.00 X 377789 0 78204 Connors Karen H 0.00 X 503801 0 33135 Moore Debra Plousha 0.00 X 718915 0 0 Seckinger Mark R 0.00 X 249969 0 45114 Swart Steven L 0.00 X 237079 0 29681 Tomaszewski James A 0.00 X 384660 0 24785 14988635 1075801 4215813 665 1 1 0 Cardinal Health - Valuelink 2320 Mcgaw Road Obetz OH 43207 Logistics Services 8755644 Dawson Personnel Systems PO Box 711503 Cincinnati OH 452711503 Temporary Help Services 8078371 Gilbane Building Company 2 Easton Oval Suite 110 Columbus OH 432196036 Construction Services (Sch O) 7721179 COMTEX Laundry Inc 575 Harmon Avenue Columbus OH 43223 Laundry Services 5937658 Elford Inc Construction Services 1220 Dublin Road Columbus OH 43215 Construction Services (Sch O) 5891682 516 12615968 115825 12615968 12731793 Health and Medical Svc 900099 1764599524 1764599524 Investment Income 621990 15338144 14865647 472497 1779937668 36521176 36521176 14396970 243357 14153613 14153613 14153613 25778646 1450887 4344308 25778646 -2893421 22885225 22885225 14739 14739 0 Intercompany Admin 900099 236147047 236147047 Cafeteria/Food Service 722210 8574414 8574414 Parking Revenue 812930 1405399 1405399 16432348 16432348 262559208 2128788683 1779465171 472497 336119222 244750 244750 16473598 5916164 10557434 1483847 191517 1292330 731747550 623644515 108103035 41406361 34829720 6576641 97724933 82203120 15521813 44015257 37024241 6991016 5583305 4696499 886806 508300 427566 80734 176117 148144 27973 5121018 4307638 813380 190731943 160437671 30294272 8527793 7173310 1354483 348269552 292953320 55316232 19556712 16450487 3106225 50997759 42897700 8100059 2700428 2271514 428914 13562700 11408514 2154186 90054398 75750908 14303490 15209952 12794130 2415822 Bad Debt 78189549 78189549 Repair & Maintenance 43116938 36268603 6848335 Medicaid Tax Expense 13249644 11145181 2104463 Intercompany Expense 6270467 5274518 995949 UBI Taxes 33108 27849 5259 15782459 13264827 2517632 1840738438 1559941955 280796483 0 93783846 134752190 160625982 169083852 0 12662949 20866886 25230365 23912324 25225920 24442378 1315658818 701901858 606206066 613756960 988134164 1351847781 308178994 429507883 28991198 31996576 12645728 100866796 76982985 2349906280 2889795543 243438646 266316894 3907913 5907538 584084003 684293689 4196815 3002895 13336000 320802018 300310005 1169765395 1259831021 X 1180140885 1629964522 1180140885 1629964522 2349906280 2889795543 X 288050245 161773392 X X 0 1 1 X 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 0 1 219 0 1 176117 1 58842 0 0 235178 0 40797139 325956 5688665 63000 6681909 726109 39340742 38589258 266046 3942850 24850 1288068 688097 40797139 46414673 370999 -5396453 0 2757845 42116 38589258 0.39670 0.35590 0.24740 0 1 1 29183692 29183692 598462873 334055701 264407172 197407 159290 38117 426015807 271531257 154484550 261799039 96155610 165643429 613756960 Investments in Portfolio 429507883 F 429507883 Due to Affiliates - Loans and Notes 102078206 Pension Liability 105884378 Swap Liability 23286973 Deferred Long Term Liabilities 10011718 Other 59048730 300310005 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. Central America & the Caribbean 0 1 Program Services Offshore Captive Management 56375 Europe (including Iceland & Greenland) 0 0 Investments 105219148 Central America & the Caribbean 0 0 Investments 192273391 0 1 0 0 0 1 297548914 0 297548914 1 0 1 1 1 0 1 1 X 1 X 1 X 1 1 0 1 1 89128623 24532629 64595994 0.03660 222852691 178135417 44717274 0.02540 311981314 202668046 109313268 0.06200 1651450 9555 1641895 0.00090 48556764 10734246 37822518 0.02150 2192244 2192244 0.00120 967513 57585 909928 0.00050 53367971 10801386 42566585 0.02410 365349285 213469432 151879853 0.08610 194028 16 194012 0.00010 8870 8870 0.00000 7196 7196 0.00000 210094 16 210078 0.00010 1 22760855 0 465045584 505139555 -40093971 X 1 1 1 Grant Scope Center LLC Ambulator Surgery Center 0.50000 0.50000 2 Knightsbridge Surgery Center Ambulatory Surgery Center 0.49100 0.42670 3 OhioHealth Sleep Services LLC Sleep Lab Services 0.76850 0.23150 4 Polaris Surgery Center LLC Ambulatory Surgery Center 0.50500 0.49500 5 The Eye Center Opthamological Surgery Center 0.03200 0.89600 6 Upper Arlington Medical Limited Parternship Property Management 0.38840 0.29710 7 Upper Arlington Surgery Center Ltd Ambulatory Surgery Center 0.36000 0.64000 8 Whitehall Surgery Center Ambulatory Surgery Center 0.38500 0.61500 9 Greater Columbus Regional Dialysis Dialysis Services 0.25000 0.75000 10 OhioHealth Ambulatory Care Corp LTD Urgent Care Services 0.50000 0.50000 11 OhioHealth Group LTD Managed Care Services 0.50000 0.50000 4 1 Riverside Methodist Hospital

3535 Olentangy River Road Columbus OH 432143908

X 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 NA 1 25 The Bone and Joint Center

323 East Town Street Columbus OH 432154753

Bone and Joint Center Riverside Outpatient Surgery Center

2240 North Bank Drive Columbus OH 432205420

Surgery Center Polaris Surgery Center

300 Polaris Parkway Westerville OH 430827989

Surgery Center Knightsbridge Surgery Center

4845 Knightsbridge Blvd Suite 110 Columbus OH 432142463

Surgery Center Eye Center of Columbus

262 Neil Avenue Columbus OH 43215

Eye Care Services 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 Sleep Services

974 Bethel Road Suite C Columbus OH 43214

Sleep Diagnostic Center OhioHealth Sleep Services

300 Polaris Parkway Suite 2450 Westerville OH 43082

Sleep Diagnostic Center OhioHealth Sleep Services

6770 Avery-Muirfield Drive Dublin OH 43017

Sleep Diagnostic Center OhioHealth Sleep Services

2041 Stringtown Road Grove City OH 43123

Sleep Diagnostic Center OhioHealth Sleep Services

7811 Flint Road Suite B Columbus OH 43235

Sleep Diagnostic Center OhioHealth Sleep Services

151 Clint Drive Pickerington OH 43147

Sleep Diagnostic Center OhioHealth Sleep Services

7600 Olentangy River Road Suite 200B Columbus OH 43235

Sleep Diagnostic 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 OhioHealth Sleep Services

3545 Olentangy River Road Suite 200 Columbus OH 43214

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 Urgent Care

24 Hidden Ravines Drive Powell OH 43068

Urgent Care Facility OhioHealth Sleep Services

1810 Mackenzie Drive Columbus OH 43220

Sleep Diagnostic Center Whetstone Gardens & Care Center

3710 Olentangy River Road Columbus OH 43214

Nursing Home OhioHealth Sleep Services

7634 Rivers Edge Drive Columbus OH 43235

Sleep Diagnostic 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 percentages in Schedule H, Part I, Line 7, column (f) is $78,189,549.System wide community benefit of $205 million reflects all entities within the system that provide community benefit and this amount is reported in the Statement of Program Service Accomplishments. The portion of total community benefit of $152 million reported in Schedule H reflects all community benefit as 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, Arthritis Foundation Run, and March of Dimes Walk. Community involvement is an important part of our mission of "to improve the health of those we serve". We collaborate with various sectors to ensure that our communities are provided with the best services that will enable them to live a healthy life. OhioHealth associates serve meals at 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, and construction at various United Way agencies. CARE Columbus involves mentoring and training in order to bridge cultural gap between diverse patient populations and health care providers to potentially reduce health disparities.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, helping students avoid high-risk behaviors. Project Mentor enables high school students to do their best academically, and adopt positive lifestyle behaviors in the communities they live in. 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, 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 this balance are consistent with all other self pay collections. 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 2011. Columbus is the capital and the 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.The current year median age for this population is 34.9.Of this area's current year estimated population: 73.2% are White Alone, 16.4% are Black or African American Alone, 3.7% are Asian Alone, 4.1% are Hispanic, and 2.5% are other races.The number of households in this area is estimated to be 595,482. The number of households in the United States is estimated to be 116,862,305.The average household income in the Columbus area is estimated to be $68,995 for the current year, while the average household income for the United States is estimated to be $67,529 for the same time frame. For this area, 65.1% of the population is estimated to be employed and age 16 and over for the current year. For the United States, 59.4% of the population is estimated to be employed and age 16 and over for the current year.Currently, it is estimated that 36.3% of the population age 25 and over in this area had earned a Bachelor's Degree or greater. In comparison, for the United States, it is estimated that for the population over age 25, 27.7% had earned a Bachelor's Degree or greater. Part VI, Line 6: 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 provided $204,866,000 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 7: 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, 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 West Ohio Conference United Methodist Church 32 Wesley Blvd Worthington OH 430853585 314420544 501(c)(3) 62000 To Assist with Disaster Relief Roman Catholic Diocese of Columbus 198 East Broad Street Columbus OH 43215 314379603 501(c)(3) 10000 To Increase Priest Availability in Central Ohio Hospitals The Ohio University Foundation Inc PO Box 869 Athens OH 457010869 316402269 501(c)(3) 100000 To Support Medical Research American Cancer Society Inc Ohio Division 5555 Frantz Road Dublin OH 43017 340726080 501(c)(3) 10500 General Support American Heart Association 5455 N High Street Columbus OH 43214 135613797 501(c)(3) 26500 General Support Arthritis Foundation Inc 3740 Ridge Mill Drive Hilliard OH 430269231 314419290 501(c)(3) 6500 General Support Columbus Affiliate of the Susan G Komen Breast Cancer Foundation Inc 5005 LBJ Freeway Dallas TX 75244 752844651 501(c)(3) 15000 General Support LifeCare Alliance 1699 West Mound Street Columbus OH 43223 314379494 501(c)(3) 10000 General Support 8 Procedure for Monitoring Grants in the U.S.: Part I, Line 2: Schedule I, Part I, Line 2: OhioHealth Corporation does not regularly issue grants; therefore there is no formal process in place for monitoring of grants. However, in accordance with OhioHealth Corporation's Authority Matrix for issuance of payment, the grants 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 104124 0 3754 0 16578 0 19065 0 17924 0 161445 0 0 0 Blom David P 866676 0 770740 0 29685 0 1330400 0 17024 0 3014525 0 0 0 deVillers Rebecca DO 72000 71589 0 8685 0 6898 0 10698 0 18325 72000 116195 0 0 George Peter B MD 112499 644157 0 220760 0 48362 578 21400 0 18825 113077 953504 0 0 Louge Michael W 578770 0 270000 0 14785 0 354152 0 19982 0 1237689 0 0 0 Millen Robert P 559150 0 257000 0 19850 0 231630 0 23685 0 1091315 0 0 0 Pandora Frank T II Esq 341283 0 147000 0 27693 0 294014 0 15096 0 825086 0 0 0 Bernstein Michael S 403596 0 166000 0 15646 0 139851 0 21233 0 746326 0 0 0 Boggs Martha Bruce 308840 0 127000 0 24952 0 68065 0 18819 0 547676 0 0 0 Caulin-Glaser Terri MD 293712 0 81576 0 23075 0 36352 0 13312 0 448027 0 0 0 Gallaher Connie L 183848 0 59624 0 3303 0 21076 0 16163 0 284014 0 0 0 Hagen Bruce P 431778 0 169000 0 31605 0 153273 0 15548 0 801204 0 0 0 Hanly Donna L 188087 0 56272 0 4205 0 25737 0 14013 0 288314 0 0 0 Herbert-Sinden Cheryl L 235403 0 100000 0 21888 0 41850 0 16548 0 415689 0 0 0 Jablonski Susan F 265848 0 123000 0 6670 0 85765 0 8846 0 490129 0 0 0 Lawson Michael S 214711 0 44903 0 3366 0 0 0 6986 0 269966 0 0 0 Markovich Stephen E MD 337378 0 110000 0 21949 0 118829 0 20522 0 608678 0 0 0 Reichfield Michael L 301412 0 132000 0 23035 0 113507 0 23482 0 593436 0 0 0 Santanello Steven A DO 326517 74125 0 0 11291 0 22925 0 1928 0 362661 74125 0 0 Vanderhoff Bruce MD 402343 0 159000 0 39992 0 140097 0 18555 0 759987 0 0 0 Yates Vinson M 255095 0 89525 0 23771 0 81501 0 21685 0 471577 0 0 0 Lozada Leonardo J MD 397480 0 121129 0 21507 0 17506 0 6986 0 564608 0 0 0 Kontner John G 295568 0 129390 0 5026 0 17484 0 16761 0 464229 0 0 0 Krouse Michael T 301651 0 104520 0 21124 0 107498 0 16695 0 551488 0 0 0 Imm Amy A MD 300245 0 83955 0 21165 0 21879 0 16695 0 443939 0 0 0 Morrison Karen J 262366 0 112000 0 21285 0 98053 0 20185 0 513889 0 0 0 Bachman Ronald J 0 0 0 0 265208 0 5856 0 0 0 271064 0 0 0 Garlock Steven J 258903 0 95000 0 23886 0 59902 0 18302 0 455993 0 0 0 Connors Karen H 225221 0 100000 0 178580 0 15268 0 17867 0 536936 0 0 0 Moore Debra Plousha 0 0 0 0 718915 0 0 0 0 0 718915 0 632391 0 Seckinger Mark R 175445 0 55000 0 19524 0 31412 0 13702 0 295083 0 0 0 Swart Steven L 147268 0 0 0 89811 0 12106 0 17575 0 266760 0 0 0 Tomaszewski James A 266688 0 93430 0 24542 0 20820 0 3965 0 409445 0 0 0 Part I, Line 1a Housing allowance or residence for personal use: For key executives, OhioHealth provides a temporary housing allowance, administered by Human Resources, if relocation is required in order to accept employment with OhioHealth. As part of a relocation package, the following individual received a cash payment to offset the cost of temporary housing. The full amount was treated as taxable compensation reported on the individual's W-2. Martha Bruce Boggs - $1,771.47 Part I, Lines 4a-b The following individuals listed in Form 990, Part VII received severance payments: Ronald J. Bachman - $263,820.18 Karen H. Connors - $158,835.82 Steven L. Swart - $76,615.47 The following individuals listed in Form 990, Part VII participated in a supplemental non-qualified retirement plan: David P. Blom - $1,297,808 Michael S. Bernstein - $122,367 Martha Bruce Boggs - $68,055 Bruce P. Hagen - $131,577 Cheryl L. Herbert-Sinden - $8,193 Susan F. Jablonski - $66,615 Michael W. Louge - $331,741 Stephen E. Markovich, M.D. - $91,471 Robert P. Millen - $210,245 Karen J. Morrison - $73,543 Frank T. Pandora II, Esq. - $251,659 Michael L. Reichfield - $93,825 Bruce Vanderhoff, M.D. - $117,366 Vinson M. Yates - $54,615 Michael T. Krouse - $80,382 Steven J. Garlock - $ 21,307 Mark R. Seckinger - $555 Karen H. Connors - $0 Ronald J. Bachman - $0 Debra Plousha Moore - $0 Steven L. Swart - $0 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. 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 3531867N3 2011-06-23 313765000 Refund Series 2008A, 2001 Synthetic Lease, Swap Termination and New Money 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 164605000 165800000 1195000 2009 1 0 1 1 186700000 320668797 188546437 2122360 102764000 13336000 14115007 2011 1 0 0 1 27537020 27755000 211270 6710 2003 1 0 1 1 119757628 123578533 1139905 2681000 2003 1 0 1 1 0 1 1 0 0 0.01400 0.01400 1 0 1 1 0 0 0.02400 0.02400 1 0 0 1 0 0 0.02100 0.02100 1 0 1 1 0 0 0.03700 0.03700 1 0 1 0 NA 0 NA 0 1 0 1 0 NA 0 NA 0 1 0 1 0 NA 0 NA 0 1 0 0 0 NA 0 NA 0 1 Schedule K, Part II, Column B: Since the Series 2011 A-D are treated as one issue for tax purposes and have one 8038, we only used one column for reporting. 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 III, Line 4: OhioHealth revised the calculations of Private Use to no longer carry forward instances of private use where the associated assets have exceeded their useful life. (e.g. Typewriters financed by 1974 bonds are no longer subject to private use) Part IV, Line 2: Series A is Fixed Rate, Series B, C, and D are various modes of Variable Rate Bonds. Schedule K, Part II, Column B, Line 11: $13,336,000 of the proceeds was used to pay off a taxable line which had been used to pay the termination amount on the 2006 Swap. While this is a refunding, the proceeds flowed through the project fund. Live Technologies Inc Director of Org - Entity more than 35% owned by Director (Lawrence Abbott) 399368 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) 205533 Payments - Goods or services provided to OhioHealth Corporation. 0 Beatrice Mills RN Director of Org - Daughter of Director (Rebecca deVillers, DO) 56594 Comp/Ben - Daughter is employed at Grant Medical Center and receives compensation. 0 Huntington National Bank Director of Org - A Director of OhioHealth (Michael Endres) is a Director 862918 Banking Fees 0 Linda Kress Key Employee - Sister of Key Employee (Donna L. Hanly) 39374 Comp/Ben - Sister is employed at OhioHealth Corporation and receives compensation. 0 American Electric Power Director of Org - A Director of OhioHealth (Thomas Hoaglin) is a Director 10404753 Payments - Electricity provided to OhioHealth Corporation. 0 Lifeline of Ohio Key Employee - Key Employee of OhioHealth (Sue Jablonski) is a Director 363639 Payments - Goods or services provided to OhioHealth Corporation. 0 Time Warner Cable Director of Org - A Director of OhioHealth (Donna James) is a Director 297742 Payments - Goods or services provided to OhioHealth Corporation. 0 Jacob Millen Officer of Org - Son of Officer (Robert P. Millen) 20394 Comp/Ben - Son is employed at Riverside Methodist Hospital and receives compensation. 0 Ohio Hospital Association Insurance Solutions Officer of Org - An Officer of OhioHealth (Frank T. Pandora) is a Director. 194273 Payments - Goods or services provided to OhioHealth Corporation. 0 Mark Vanderhoff Key Employee - Brother of Key Employee (Bruce Vanderhoff, M.D.) 84587 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 776476 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) 134740 Payments - Goods or services provided to OhioHealth Corporation. 0 X Hospital PP&E 1 12615968 Cost or Selling Price 0 1 0 Method for Determining Number of Contributors: Part I, Column (b): OhioHealth Foundation contributes PP&E necessary to the operation of OhioHealth Corporation hospitals. 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. David P. Blom, President/CEO of OhioHealth Corporation, and Randy Wilcox, Vice Chairman of OhioHealth Corporation, have a business relationship. Michael J. Endres, Treasurer of OhioHealth Corporation, and John P. McConnell, Director of OhioHealth Corporation, have a business relationship. Form 990, Part VI, Section A, line 6 Pursuant to Ohio Revised Code Section 1702.13, OhioHealth Corporation has a sole member, The West Ohio Conference of The United Methodist Church. Form 990, Part VI, Section A, line 7a Pursuant to Ohio Revised Code Section 1702.13, The West Ohio Conference of the United Methodist Church is the sole voting member of OhioHealth Corporation. OhioHealth Corporation is the sole voting member of all subsidiary organizations. 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 2010 base salary fell below the middle of the market and his 2010 total compensation (which includes annual incentive and all benefits) was estimated to approximate the 87th percentile. The organization's performance for FY6/30/2011 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. Changes in Net Assets or Fund Balances: Form 990, Part XI, line 5: Net unrealized gains on investments: 146,934,431. Pension Related Changes 62,622,627. Intercompany Transactions -61,267,862. Change in Fair Value of Interest Rate Swaps 7,263,979. Other Unrestricted Net Asset Changes 6,220,217. Total to Form 990, Part XI, Line 5: 161,773,392. 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. Form 990, Part VII, Section A: Rebecca deVillers, D.O. and Peter George, M.D. each work 40 hours a week for a related organization. Steven A. Santanello, D.O. provided services "on call" and the hours per week varied due to the nature of an "on call" position. Form 990, Part VII, Section B: Amounts reported for Gilbane Building Company and Elford Inc. Construction Services represent amounts paid for both services and materials. These amounts cannot be separated. DH Ventures Ltd 180 East Broad Street 33rd Floor Columbus OH 432153707 311686358 Holding Company OH -13505 0 OhioHealth Corporation CG Broad Norton LLC 180 East Broad Street 33rd Floor Columbus OH 432153707 261564783 Real Estate Holding Company OH -3462 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 137500 0 OhioHealth Corporation Pickerington Fairfield Land Company LLC 180 East Broad Street 33rd Floor Columbus OH 432153707 452035147 Real Estate Holding Company OH 0 100000 OhioHealth Corporation Grove City Land Company LLC 180 East Broad Street 33rd Floor Columbus OH 432153707 452651557 Real Estate Holding Company OH 0 0 OhioHealth Corporation OhioHealth Urgent Care LLC 180 East Broad Street 33rd Floor Columbus OH 432153707 273371022 Urgent Care Services OH 90632 2074422 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 (dba OHPMS & dba OHMSF) 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 OhioHealth Corporation 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 2873174 8170592 0 0 0.91960 Polaris Surgery Center LLC 6200 Cleveland Avenue Columbus OH 43231 208074623 Medical Services OH OhioHealth Corporation Related 3281109 3319188 0 0 0.51320 Marion Ancillary Services 1040 Delaware Avenue Marion OH 43302 311704991 Outpatient Services OH N/A Upper Arlington Medical Limited Partnership 180 East Broad Street 33rd Floor Columbus OH 43215 311472667 Medical Services OH OhioHealth Star Corporation Related 74992 1132483 0 0 0.47820 ESWL Real Estate & Equipment Limited Partnership 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 N/A 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 Buil Grand Cayman CJ KY1-1102 314394942 Insurance/Reinsurance CJ OhioHealth Corporation C -3727368 14441689 1.00000 0 0 0 1 0 0 0 0 0 1 1 0 0 0 1 1 1 1 Hospital Properties Inc J 2523829 Market Rent Hospital Properties Inc P 1403811 Actual Expense Paid Hospital Properties Inc R 3636162 Actual Dollars Transferred Hospital Properties Inc R 4535041 Master Custody Investments Trans Hospital Properties Inc Q 2964522 Actual Dollars Transferred OhioHealth Star Corporation Q 734476 Actual Dollars Transferred Healthworks O 189437 Actual Expense Paid Healthworks Q 1885764 Actual Expense Paid Grady Anesthesia Services Q 620417 Actual Expense Paid Doctors Hospital of Nelsonville Q 176160 Actual Dollars Transferred OhioHealth Foundation Q 4575709 Actual Dollars Transferred Grant Riverside Medical Care Foundtion Q 300000 Actual Dollars Transferred Grady Hospital Foundation Q 146218 Actual Dollars Transferred Grady Memorial Hospital R 20401211 Actual Dollars Transferred Hardin Memorial Hospital Q 102007 Actual Dollars Transferred HomeReach HomeCare Q 1070995 Actual Dollars Transferred HomeReach R 6657695 Actual Dollars Transferred Marion General Hospital R 84214 Actual Dollars Transferred OhioHealth Research Institute R 3749804 Actual Dollars Transferred Intel Health Servicess O 3054148 Actual Dollars Transferred OhioHealth Sleep Services Q 5500000 Business Valuation Upper Arlington Medical Limited Partnership D 2800000 Outstanding Loan Balance