2012-11-14T13:00:39-06:00 2011-12-31 440160260 BKD LLP 312 WALNUT STREET SUITE 300 CINCINNATI OH 45202 990 2011-01-01 341105619 ST RITA'S MEDICAL CENTER STRI 4192273361 730 W Market Street Lima OH 45801 JOHN RENNER 2012-11-08 true P00961884 5136218300 2011 2016-02-24 21:20:13Z BRIAN SMITH 730 W MARKET STREET LIMA OH 45801 391186919 false 0928 X WWW.STRITAS.ORG X 1970 OH THE PRIMARY EXEMPT PURPOSE OF ST. RITA'S MEDICAL CENTER IS TO EXTEND THE HEALING MINISTRY OF JESUS BY IMPROVING THE HEALTH OF OUR COMMUNITIES WITH EMPHASIS ON PEOPLE WHO ARE POOR AND UNDERSERVED. WE COMMIT TO ACCOMPLISH THIS PURPOSE BY WORKING TOGETHER TO PROVIDE QUALITY CARE, SERVICE AND INFORMATION THAT IS VALUED BY THOSE WE SERVE. 13 9 3480 951 460566 31110 171332 90933 373428284 376097595 9771844 3228589 7677921 11419874 391049381 390836991 833666 1200025 0 0 175486534 188968213 0 0 0 185563498 178535632 361883698 368703870 29165683 22133121 581204849 583775953 216458712 242561392 364746137 341214561 X ST. RITA'S MEDICAL CENTER EXTENDS THE HEALING MINISTRY OF JESUS BY IMPROVING THE HEALTH OF OUR COMMUNITIES WITH EMPHASIS ON PEOPLE WHO ARE POOR AND UNDER-SERVED. ST. RITA'S MEDICAL CENTER DEMONSTRATES BEHAVIORS REFLECTING OUR CORE VALUES OF COMPASSION, EXCELLENCE, HUMAN DIGNITY, JUSTICE, SACREDNESS OF LIFE, AND SERVICE. TOGETHER WE COMMIT TO: COMPASSION - OUR COMMITMENT TO SERVE WITH MERCY AND TENDERNESS; EXCELLENCE - OUR COMMITMENT TO BE THE BEST IN THE QUALITY OF OUR SERVICES AND THE STEWARDSHIP OF OUR RESOURCES; HUMAN DIGNITY - OUR COMMITMENT TO BE RESPECTFUL OF ALL PERSONS; JUSTICE - OUR COMMITMENT TO ACT WITH INTEGRITY, HONESTY, AND TRUTHFULNESS; SACREDNESS OF LIFE - OUR COMMITMENT TO REVERENCE ALL LIFE; SERVICE - OUR COMMITMENT TO RESPOND TO THOSE IN NEED. false false 16357015 1195096 371734585 THE PRIMARY EXEMPT PURPOSE OF ST. RITA'S MEDICAL CENTER IS TO EXTEND THE HEALING MINISTRY OF JESUS BY IMPROVING THE HEALTH OF OUR COMMUNITIES WITH EMPHASIS ON PEOPLE WHO ARE POOR AND UNDER-SERVED. ST. RITA'S MEDICAL CENTER ACCOMPLISHES THIS PURPOSE BY DEMONSTRATING BEHAVIORS REFLECTING OUR CORE VALUES OF COMPASSION, EXCELLENCE, HUMAN DIGNITY, JUSTICE, SACREDNESS OF LIFE AND SERVICE. TOTAL COMMUNITY BENEFIT PROVIDED IN 2011 WAS $42,721,250 SERVING APPROXIMATELY 96,000 INDIVIDUALS. 4888884 0 3893264 ST. RITA'S MEDICAL CENTER IS THE ONLY PROVIDER OF ADULT, ACUTE INPATIENT BEHAVIORAL AND MENTAL HEALTH SERVICES IN THE 10-COUNTY REGION WE SERVE. COMMITTED TO HELPING PEOPLE REGAIN CONTROL OF THEIR LIVES, DEDICATED PROFESSIONALS MEET INDIVIDUALLY WITH PATIENTS TO DETERMINE THE MOST APPROPRIATE LEVEL OF CARE AND TO ENROLL THEM IN THOSE TREATMENT PROGRAMS. IN 2011, ST. RITA'S SERVED 1,200 ADULT INDIGENT PATIENTS. MENTAL HEALTH PROBLEMS OR DEPENDENCY ON DRUGS, ALCOHOL, OR BOTH ARE TREATABLE CONDITIONS. BETWEEN 2006 AND 2011, THE NEED FOR SERVICES SHOWED AN 80% INCREASE. ST. RITA'S CHOOSES TO OFFER A PROCESS OF RECOVERY BASED SIMPLY ON THE NEEDS OF OUR PATIENTS. 2442199 0 469746 ST. RITA'S HEALTH MANAGEMENT GROUP IS AN APPROACH TO PATIENT CARE THAT EMPHASIZES COORDINATED, COMPREHENSIVE CARE FOR THOSE COPING WITH CHRONIC CONDITIONS SUCH AS ASTHMA, HEART FAILURE, DIABETES, OBESITY OR ANY CONDITION REQUIRING USE BLOOD THINNERS. CAREFUL MANAGEMENT OF THESE CONDITIONS IS ESSENTIAL FOR PATIENTS TO REDUCE THEIR RISK OF COMPLICATIONS AND POTENTIAL HOSPITALIZATIONS. IT IS IMPORTANT FOR THE PATIENT TO PLAY AN ACTIVE ROLE IN THE MANAGEMENT OF THEIR HEALTH CONDITIONS. ST. RITA'S PROFESSIONALS WORK WITH PHYSICIANS AND THEIR PATIENTS TO DEVELOP AN INDIVIDUALIZED TREATMENT PLAN DESIGNED TO KEEP THEIR DISEASE UNDER CONTROL AND TO PREVENT FREQUENT READMISSIONS TO THE HOSPITAL. BY WORKING CLOSELY WITH THE PATIENT, THE HEALTH MANAGEMENT GROUP CAN HELP IMPROVE UNDERSTANDING OF THEIR HEALTH CONDITIONS, REDUCE COMPLICATIONS AND HELP KEEP PATIENTS HEALTHY IN BETWEEN THEIR PHYSICIAN APPOINTMENTS. 282141966 0 0 OTHER PROGRAM EXPENSES 282141966 0 0 305830064 true true false true false false false false false true false false false true true false true false false false false false false false false true true true false true false false false false false false true true false false false false true true true true false false true 22 0 3480 true true true false false false false false false false false false X 13 9 false false false false true true true true true false false true true true true true true false true true true X TIM RIEGER 4192269775 730 W MARKET STREET LIMA OH 45801 X STEVE WALTER 1.00 X X 0 0 0 BARRY CLARK 1.00 X 0 0 0 DANIEL CLIFFORD 1.00 X 0 0 0 DR AIMEE HAWLEY 1.00 X 0 0 0 DR JOHN SNYDER 1.00 X 0 0 0 DR KIRK GRIFFITH 1.00 X 20000 0 0 DR WILLIAM SCHERGER 1.00 X 0 0 0 GEORGE RICKS 1.00 X 0 0 0 JANE KRITES 1.00 X 0 0 0 JAYE MCCAIN 1.00 X 0 0 0 JOAN NIESE 1.00 X 0 0 0 SR DOROTHY THUM RSM 1.00 X 0 0 0 SR MARIE MOORE RSM 1.00 X 0 0 0 TRACEY REIPENHOFF 1.00 X 0 0 0 DIANA PICKARD 40.00 X 84150 0 66902 JAMES REBER 40.00 X 791071 0 176446 JOHN RENNER 40.00 X 364486 0 87125 ROBERT BAXTER 40.00 X 340114 0 58054 BRIAN SMITH 40.00 X 387971 0 147208 CHRISTINE PROVAZNIK 40.00 X 258592 0 136547 DAVID MURPHY 40.00 X 207612 0 21382 HERBERT SCHUMM MD 40.00 X 463960 0 138318 JOHN MEYER 40.00 X 273325 0 155629 KAY WELLMAN 40.00 X 282611 0 208968 MARK SKAJA 40.00 X 200664 0 40674 MICHAEL HUMPHREY MD 40.00 X 347024 0 81033 MIKE BISSEGGER 40.00 X 280659 0 70724 RONDA LEHMAN 40.00 X 244901 0 56762 WALTER KINSEY 40.00 X 201843 0 69879 WILBERT CASON 40.00 X 262118 0 121447 DR JASON BOWERSOCK 40.00 X 772904 0 20966 DR JULIUS KATO 40.00 X 957132 0 21274 DR SURIANARAYAN AMBALAVANAN 40.00 X 888089 0 14492 DR TODD HIXENBAUGH 40.00 X 842544 0 19116 DR ZOHEIR ABDELBAKI 40.00 X 1215713 0 21183 9687483 0 1734129 141 false true false 0 48307 12500 30126 90933 NET PATIENT SERVICE REVENUE 621990 364297723 364297723 RENTAL INCOME FROM AFFILIATES 531120 1761925 1761925 VENDOR/PURCHASE DISCOUNTS 900099 60994 60994 INCOME FROM JV'S AND PARTNERSHIPS 621990 9976953 9973529 3424 0 0 0 0 376097595 3505490 3505490 0 0 0 0 0 73027 349928 73027 -349928 -276901 -276901 0 0 0 CAFETERIA 722210 2014502 2014502 MEDICAL RECORDS 900099 114890 114890 CATERING 722320 129684 129684 9160798 0 457142 8703656 11419874 390836991 376094171 460566 14191321 1195096 1195096 4929 4929 0 0 6648199 5318559 1329640 0 137662992 110130393 27532599 0 34945336 27956269 6989067 9711686 7769349 1942337 0 179472 179472 352199 352199 0 0 0 73527970 58822376 14705594 471539 377231 94308 1329304 1063443 265861 32635 26108 6527 0 11115059 8892047 2223012 653216 522573 130643 0 0 7488278 5990622 1497656 0 20556396 16445117 4111279 2860724 2288579 572145 MISCELLANEOUS 2516502 2013202 503300 MEMBERSHIP DUES 2190834 1752667 438167 MEDICAL SUPPLIES 55261504 55261504 0 0 0 0 0 368703870 305830064 62873806 0 0 28249650 8721658 52542842 64902867 3878865 3965831 6368512 6813752 1801414 2109129 492038451 236810284 267231385 255228167 200883834 221535932 0 0 0 0 8311362 8282904 11936985 12215713 581204849 583775953 34844494 37264064 10724728 10825118 170889490 194472210 216458712 242561392 X 364746137 341214561 364746137 341214561 581204849 583775953 X 22133121 -45664697 X false true true X true true X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED true true false true 0 false true 14829 false false true 13922 28751 false Description of the activities reported on Lines 1a through 1i Schedule C, Part II-B, Line 1 LOBBYING ACTIVITIES PERFORMED INCLUDE BOTH THE USE OF VOLUNTEERS ENCOURAGED TO WRITE LETTERS TO PUBLIC OFFICIALS ON ISSUES THAT IMPACT THE ORGANIZATION'S ABILITY TO CONTINUE TO PROVIDE HEALTH SERVICES TO THE COMMUNITIES SERVED, AND THE USE OF PAID STAFF MEMBERS AND MANAGEMENT PERSONNEL. PAID MANAGEMENT PERSONNEL REGULARLY ISSUE MAILINGS TO LEGISLATORS ATTEMPTING TO INFLUENCE LEGISLATIVE MATTERS AND REFERENDUM, AND ORGANIZE AND HOST MEETINGS AMONG HOSPITAL EXECUTIVES AND THEIR LEGISLATORS REGARDING ISSUES THAT IMPACT THE ORGANIZATION'S ABILITY TO CONTINUE PROVIDING HEALTHCARE SERVICES TO ITS PATIENTS AND TO CONTINUE IMPROVING THE HEALTH OF THE COMMUNITIES WE SERVE. PAID STAFF MEMBERS HAVE, ON LIMITED OCCASIONS, WRITTEN TO LEGISLATORS ON SUCH ISSUES. THE PRIMARY PURPOSE FOR LOBBYING ACTIVITIES IS TO ENHANCE THE ORGANIZATION'S PUBLIC POSITION ON LEGISLATIVE AND REGULATORY ISSUES THAT IMPACT PATIENT CARE THROUGHOUT OUR SYSTEM. THE ORGANIZATION FOCUSES ON PUBLIC POLICY ISSUES THAT EXTEND OUR HEALING MINISTRY TO THOSE WHO ARE POOR AND UNDERSERVED IN THE COMMUNITIES WE SERVE. TO CARRY OUT THESE EFFORTS, THE ORGANIZATION PARTNERS WITH EXPERT CONSULTANTS AND PROFESSIONAL TRADE ASSOCIATIONS TO BUILD AWARENESS AND EXECUTE SPECIFIC STRATEGIES THAT WILL YIELD A FAVORABLE OUTCOME FOR PATIENT CARE IN THE ORGANIZATION'S FACILITIES WHERE THEY ARE TREATED. 18475811 18475811 319029231 116532461 202496770 242173 242173 0 148571354 117702140 30869214 5719882 2333510 3386372 255228167 0 NOTES PAYABLE TO AFFILIATES 122672800 PROPERTY & SALES TAXES PAYABLE 93288 SELF & MEDICAL SELF INSURANCE PAYABLE 3759873 CURRENT FAS 106 OBLIGATION 78597 DEBT GUARANTEES 6330682 LONG-TERM SERP LIABILITY 2117483 OTHER LONG-TERM LIABILITIES 37426 PENSION & POSTRETIREMENT HEALTH BENEFITS 59382061 194472210 390836991 368435874 22401117 0 0 22401117 0 0 0 0 0 0 0 0 0 0 0 0 FIN 48 (ASC 740) footnote Schedule D, Part X, Line 2 THE COMPANY [CATHOLIC HEALTH PARTNERS AND AFFILIATED ENTITIES] COMPLETED AN ANALYSIS OF ITS TAX POSITIONS IN ACCORDANCE WITH APPLICABLE ACCOUNTING GUIDANCE AT DECEMBER 31, 2011 AND 2010, AND DETERMINED THAT NO AMOUNTS WERE REQUIRED TO BE RECOGNIZED IN THE CONSOLIDATED FINANCIAL STATEMENTS AT DECEMBER 31, 2011 OR 2010. true true X true X true X true true true false true true 9129 16357015 3741814 12615201 0.03420 18422 50972334 34150880 16821454 0.04560 0 0.00000 0 27551 67329349 37892694 29436655 0.07980 25 53980 3032745 81243 2951502 0.00800 1 112 112000 0 112000 0.00030 10 14447 19587184 11535805 8051379 0.02180 1 190 149187 0 149187 0.00040 12 100 1103458 39483 1063975 0.00290 49 68829 23984574 11656531 12328043 0.03340 49 96380 91313923 49549225 41764698 0.11320 0 0.00000 0 0.00000 1 130385 130385 0.00040 0 0.00000 0 0.00000 1 14903 14903 0.00000 0 0.00000 3 231 811264 811264 0.00220 0 0.00000 5 231 956552 0 956552 0.00260 false 13533931 0 87540855 101261907 -13721052 X true true WEST CENTRAL OHIO SURGERY & ENDOSCOPY CENTER AMBULATORY SURGERY CENTER 0.6 0 0.4 WEST CENTRAL OHIO GROUP LTD (DBA INSTITUTE FOR ORTHOPEDIC SURGERY) ORTHOPEDIC HOSPITAL 0.51 0 0.49 KIDNEY SERVICES OF WEST CENTRAL OHIO DIALYSIS CENTER 0.51 0 0.49 CORNERSTONE ALLIANCE MEDICAL MANAGEMENT 0.5 0 0.5 2 1 ST RITA'S MEDICAL CENTER

730 W MARKET STREET LIMA OH 45801

X X X 2 INSTITUTE OF ORTHOPEDIC SURGERY

801 MEDICAL DRIVE LIMA OH 45804

X 27 KIDNEY SERVICES OF WEST CENTRAL OH

750 W HIGH STREET SUITE 100 LIMA OH 45801

OUTPATIENT DIALYSIS CENTER WEST CENTRAL OHIO SURGERY & ENDOSCOPY CENTER

770 W HIGH STREET SUITE 100 LIMA OH 45801

OUTPATIENT SURGERY & DIAGNOSTIC CENTER NEW VISION MEDICAL LABORATORY

750 W HIGH STREET SUITE 400 LIMA OH 45801

LABORATORY SERVICES PUTNAM COUNTY AMBULATORY CARE CENTER

601 STATE ROUTE 224 GLANDORF OH 45848

EMERGENCY ROOM - 24 HOURS ALLISON RADIATION ONCOLOGY CENTER

803 WEST MARKET STREET LIMA OH 45805

OUTPATIENT ONCOLOGY CENTER ST RITA'S HOME MEDICAL EQUIPMENT

770 W NORTH STREET LIMA OH 45801

HOME MEDICAL EQUIPMENT SERVICES ST RITA'S HYPERBARIC OXYGEN THERAPY SERVICE

830 W HIGH STREET SUITE 250 LIMA OH 45801

OUTPATIENT OXYGEN THERAPY SERVICES ST RITA'S WOMEN'S WELLNESS CENTER

770 W HIGH ST SUITE 250 LIMA OH 45801

OUTPATIENT WOMEN'S DIAGNOSTIC CENTER DELPHOS AMBULATORY CARE CENTER

1800 E FIFTH STREET DELPHOS OH 45833

ER-OTHER ST RITA'S SLEEP DISORDERS CENTER

830 W HIGH STREET SUITE 350 LIMA OH 45801

OUTPATIENT SLEEP DISORDERS CENTER ST RITA'S OP REHABILITATION SERVICES

830 W HIGH STREET SUITE 150 LIMA OH 45805

REHABILITATION CLINIC ST RITA'S HOME CARE

959 WEST NORTH STREET LIMA OH 45801

HOME CARE SERVICES ST RITA'S WESTSIDE URGENT CARE

2195 ALLENTOWN ROAD LIMA OH 45805

URGENT CARE FACILITY ST RITA'S HOSPICE

959 WEST NORTH STREET LIMA OH 45801

HOSPICE SERVICES ST RITA'S EASTSIDE URGENT CARE

967 BELLEFONTAINE AVENUE LIMA OH 45804

URGENT CARE FACILITY ST RITA'S OCCUPATIONAL HEALTH CENTER

1875 SOUTH DIXIE HIGHWAY LIMA OH 45804

OCCUPATIONAL HEALTH FACILITY NORTH CENTRAL OHIO PHYSICIAN'S SERVICES

770 W HIGH STREET SUITE 220 LIMA OH 45801

PHYSICIAN SERVICES ST RITA'S WAPAK IMAGING

1015 S BLACKHOOF STREET SUITE D WAPAKONETA OH 45895

DIAGNOSTIC CENTER ST RITA'S HEALTH MANAGEMENT GROUP

770 W HIGH STREET SUITE 450 LIMA OH 45801

OUTPATIENT CLINICS ST RITA'S AUDIOLOGY

770 W HIGH STREET SUITE 230 LIMA OH 45801

OUTPATIENT AUDIOLOGY CENTER ST RITA'S HOME INFUSION

959 WEST NORTH STREET LIMA OH 45801

HOME INFUSION SERVICES ST RITA'S OUTPATIENT ONCOLOGY

830 W HIGH STREET SUITE 150 LIMA OH 45801

OUTPATIENT ONCOLOGY CENTER MED-CARE CLINIC

939 W MARKET ST LIMA OH 45805

OUTPATIENT PHYSICIAN CLINIC ST RITA'S OP REHABILITATION SERVICES

1100 DEFIANCE STREET WAPAKONETA OH 45895

DIAGNOSTIC CENTER ST RITA'S OP REHABILITATION SERVICES

101 PUTNAM PARKWAY - SR 109 OTTAWA OH 45875

REHABILITATION CLINIC ST RITA'S SPECIALTY CLINICS

830 W HIGH STREET SUITE 307 LIMA OH 45801

SPECIALTY CLINICS ST RITA'S WOUND CARE CLINIC

830 W HIGH STREET SUITE 250 LIMA OH 45801

OUTPATIENT WOUND CARE CLINIC Community benefit report prepared by related organization Schedule H, Part I, Line 6a THE ORGANIZATION'S COMMUNITY BENEFIT REPORT IS CONTAINED IN A REPORT PREPARED BY CATHOLIC HEALTH PARTNERS (CHP), A RELATED TAX-EXEMPT ORGANIZATION. A COPY OF THE COMMUNITY BENEFIT REPORT CAN BE FOUND ON CHP'S WEBSITE AT WWW.HEALTH-PARTNERS.ORG. Bad Debt Expense excluded from financial assistance calculation Schedule H, Part I, Line 7, column(f) 0 Subsidized Health Services Schedule H, Part I, Line 7g ST. RITA'S MEDICAL CENTER INCLUDED AS SUBSIDIZED HEALTH SERVICES COSTS ASSOCIATED WITH OUR PEDIATRIC SPECIALITY CLINIC. THE AMOUNT OF COMMUNITY BENEFIT EXPENSE REPORTED FOR THE PEDIATRIC SPECIALTY CLINICS AS SUBSIDIZED HEALTH SERVICES IS $236,448. Bad debt expense - financial statement footnote Schedule H, Part III, Line 4 THE HOSPITAL'S AUDITED FINANCIAL STATEMENTS DO NOT CONTAIN A FOOTNOTE THAT DESCRIBES BAD DEBT EXPENSE. THE HOSPITAL ELECTED TO EARLY ADOPT ASU 2011-07. ACCORDINGLY, BAD DEBT EXPENSE IS REFLECTED AS A DEDUCTION FROM REVENUE RATHER THAN AN OPERATING EXPENSE. THE PROVISION FOR BAD DEBTS IS BASED UPON MANAGEMENT'S ASSESSMENT OF HISTORICAL AND EXPECTED NET COLLECTIONS CONSIDERING HISTORICAL BUSINESS AND ECONOMIC CONDITIONS, TRENDS IN HEALTH CARE COVERAGE, AND OTHER COLLECTION INDICATORS. THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY DOES NOT PERMIT THE COST OF PATIENTS WHO ARE UNCOOPERATIVE OR UNABLE TO BE LOCATED TO BE RECLASSIFIED FROM BAD DEBT TO FINANCIAL ASSISTANCE. THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY REQUIRES AN APPLICATION AND SUPPORTING DOCUMENTATION. THEREFORE, ZERO DOLLARS ARE BEING REPORTED ON PART III, LINE 3 AS AMOUNTS INCLUDED IN BAD DEBT THAT COULD BE ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY. NET PATIENT ACCOUNTS ARE REDUCED BY AN ALLOWANCE FOR DOUBTFUL RECEIVABLES BASED UPON THE HOSPITAL'S HISTORICAL COLLECTION EXPERIENCE ADJUSTED FOR CURRENT ENVIRONMENTAL RISKS AND TRENDS FOR EACH MAJOR PAYOR SOURCE. SIGNIFICANT PROVISION IS MADE FOR SELF-PAY PATIENT ACCOUNTS IN THE PERIOD OF SERVICE BASED ON PAST COLLECTION EXPERIENCE. THE HOSPITAL'S CONCENTRATION OF CREDIT RISK RELATED TO NET PATIENT ACCOUNTS IS LIMITED DUE TO THE DIVERSITY OF PATIENTS AND PAYORS. NET PATIENT ACCOUNTS CONSIST OF AMOUNTS DUE FROM GOVERNMENTAL PROGRAMS (PRIMARILY MEDICARE AND MEDICAID), PRIVATE INSURANCE COMPANIES, MANAGED CARE PROGRAMS AND PATIENTS THEMSELVES. NET PATIENT SERVICE REVENUE FOR SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY PAYOR COVERAGE IS RECOGNIZED BASED ON CONTRACTUAL RATES FOR SERVICES RENDERED. THE HOSPITAL RECOGNIZES A SIGNIFICANT AMOUNT OF PATIENT SERVICE REVENUE AT THE TIME SERVICES ARE RENDERED EVEN THOUGH IT DOES NOT ASSESS THE PATIENT'S ABILITY TO PAY. AS A RESULT, THE PROVISION FOR BAD DEBTS IS PRESENTED AS A DEDUCTION FROM PATIENT SERVICE REVENUE (NET OF CONTRACTUAL PROVISIONS AND DISCOUNTS). AMOUNTS RECOGNIZED ARE SUBJECT TO ADJUSTMENT UPON REVIEW BY THIRD-PARTY PAYORS. FOR UNINSURED PATIENTS THAT DO NOT QUALIFY FOR CHARITY CARE, THE HOSPITAL RECOGNIZES REVENUE WHEN SERVICES ARE PROVIDED. BASED ON HISTORICAL EXPERIENCE, A SIGNIFICANT PORTION OF THE HOSPITAL'S UNINSURED PATIENTS WILL BE UNABLE OR UNWILLING TO PAY FOR SERVICES PROVIDED. THUS, THE HOSPITAL RECORDS A SIGNIFICANT PROVISION FOR BAD DEBTS RELATED TO UNINSURED PATIENTS IN THE PERIOD THE SERVICES ARE PROVIDED. Community benefit & methodology for determining medicare costs Schedule H, Part III, Line 8 THE HOSPITAL FOLLOWS THE CATHOLIC HEALTH ASSOCIATION OF THE UNITED STATES POLICY DOCUMENT, COMMUNITY BENEFIT PROGRAM, A REVISED RESOURCE FOR SOCIAL ACCOUNTABILITY ("CHA GUIDELINES") FOR DETERMINING COMMUNITY BENEFIT. THE CHA GUIDELINES RECOMMEND THAT HOSPITALS NOT INCLUDE MEDICARE LOSSES AS COMMUNITY BENEFIT. THE HOSPITAL'S COST ACCOUNTING SYSTEM WAS USED TO DETERMINE THE MEDICARE AMOUNTS IN PART III. Collection practices for patients eligible for financial assistance Schedule H, Part III, Line 9b PATIENTS KNOWN TO QUALIFY FOR CHARITY CARE OR FINANICAL ASSISTANCE ARE NOT SENT TO A COLLECTION AGENCY. THE ORGANIZATION REPEATEDLY OFFERS PATIENTS ACCESS TO FINANCIAL HELP DURING THEIR HOSPITAL STAY AND AFTER, AS WELL AS WITH EACH BILLING NOTICE. BILLS ARE SENT TO A COLLECTION AGENCY AS A LAST RESORT AND ONLY: WHEN PATIENTS HAVE THE ABILITY TO PAY SOME PORTION OF THEIR HEALTHCARE EXPENSES BUT REFUSE TO DO SO; WHEN PATIENTS REFUSE TO WORK WITH THE ORGANIZATION TO DETERMINE IF THEY QUALIFY FOR FREE OR DISCOUNTED CARE VIA FEDERAL, STATE, LOCAL OR HOSPITAL ASSISTANCE PROGRAMS; WHEN THE ORGANIZATION IS UNABLE TO LOCATE THE PATIENT OR PERSON RESPONSIBLE FOR THE BILL. Means used to determine amounts billed Schedule H, Part V Section B, Line 19d (1) ST. RITA'S MEDICAL CENTER - THE MAXIMUM AMOUNT THAT CAN BE CHARGED TO FAP-ELIGIBLE INDIVIDUALS FOR EMERGENCY CARE OR OTHER MEDICALLY NECESSARY CARE IS BASED UPON FEDERAL POVERTY LEVELS STATED IN THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY.;(2) INSTITUTE OF ORTHOPEDIC SURGERY - THE MAXIMUM AMOUNT THAT CAN BE CHARGED TO FAP-ELIGIBLE INDIVIDUALS FOR EMERGENCY CARE OR OTHER MEDICALLY NECESSARY CARE IS BASED UPON FEDERAL POVERTY LEVELS STATED IN THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY.; Needs assessment. Schedule H, Part VI, Line 2 THE HOSPITAL AND OTHER ORGANIZATIONS IN THE COMMUNITY COME TOGETHER TO CONDUCT A NEEDS ASSESSMENT WITH THE ASSISTANCE OF OUTSIDE EXPERTS SUCH AS FACULTY FROM SCHOOLS OF PUBLIC HEALTH. THE ALLEN COUNTY ASSESSMENT IS COORDINATED BY: ALLEN COUNTY HEALTH PEOPLE 2011, THE ALLEN COUNTY HEALTH DEPARTMENT, LIMA MEMORIAL HEALTH SYSTEM, MENTAL HEALTH AND RECOVERY SERVICES BOARD, THE OHIO STATE UNIVERSITY AT LIMA, ST. RITA'S MEDICAL CENTER, AND UNITED WAY OF GREATER LIMA. A COMMUNITY BENEFIT SERVICE MAY BE OFFERED WHEN A PUBLIC AGENCY OR COMMUNITY GROUP REQUESTS THE HOSPITAL TO PROVIDE CERTAIN COMMUNITY BENEFIT ACTIVITIES OR PROGRAMS, OTHER TAX-EXEMPT OR COMMUNITY ORGANIZATIONS HAVE ASKED TO PARTNER WITH THE HOSPITAL TO PROVIDE A PROGRAM, OR HOSPITAL PERSONNEL HAVE IDENTIFIED NEEDS BASED ON HOSPITAL DATA. ST. RITA'S MEDICAL CENTER ASSESSES AND CONTINUALLY RESPONDS TO CHANGING COMMUNITY NEEDS THROUGH THE SERVICES OFFERED. ST. RITA'S MEDICAL CENTER CONDUCTS A COMMUNITY NEEDS ASSESSMENT EVERY 3 YEARS AND UPDATES ARE PROVIDED BETWEEN ASSESSMENTS. ST. RITA'S MEDICAL CENTER INCORPORATES PLANNING FOR COMMUNITY BENEFITS AS PART OF ITS ANNUAL BUSINESS AND STRATEGIC PLANNING PROCESSES. ST. RITA'S MEDICAL CENTER RECOGNIZES THE HEALTH OF THE COMMUNITY IS INFLUENCED BY SOCIAL, ECONOMIC, AND ENVIRONMENTAL FACTORS, NOT JUST BY DISEASE AND ILLNESS. OUR COMMUNITY BENEFIT INCLUDES BOTH QUALITATIVE AND QUANTITATIVE DATA; DEMOGRAPHICS INCLUDING RACE, AGE, AND ETHNICITY; SOCIOECONOMIC DATA INCLUDING INCOME, EDUCATION, AND HEALTH INSURANCE RATES; PRIMARY CARE AND CHRONIC DISEASE NEEDS TO UNINSURED PERSONS; AND DATA ON HEALTH DISPARITIES IN HEALTH OUTCOMES AMONG MINORITY GROUPS. ST. RITA'S MEDICAL CENTER HAS A DEDICATED STAFF TO ASSIST IN THE COMMUNITY BENEFIT EFFORT. ST. RITA'S MEDICAL CENTER'S COMMUNITY BENEFITS COMMITTEE MEETS BI-MONTHLY TO PROVIDE OVERSIGHT TO THE ORGANIZATION'S COMMUNITY BENEFITS PROGRAM. ST. RITA'S MEDICAL CENTER WORKS CLOSELY WITH HEALTH AND HUMAN SERVICE ORGANIZATIONS IN THE AREA, PARTNERING WITH SOME TO PROVIDE SERVICES AND TO AVOID DUPLICATION. Patient education of eligibility for assistance. Schedule H, Part VI, Line 3 ST. RITA'S MEDICAL CENTER POSTS ITS CHARITY CARE POLICY, OR A SUMMARY THEREOF, AND FINANCIAL ASSISTANCE CONTACT INFORMATION IN ADMISSIONS AREAS, EMERGENCY DEPARTMENTS AND OTHER AREAS OF THE ORGANIZATION'S ON-CAMPUS FACILITIES IN WHICH ELIGIBLE PATIENTS ARE LIKELY TO BE PRESENT, AS WELL AS IN SOME OF OUR OFF-CAMPUS FACILITIES WHICH WOULD INCLUDE THE URGENT CARE LOCATIONS AND THE MED-CARE CLINIC. ST. RITA'S ALSO PROVIDES A COPY OF THE POLICY, OR A SUMMARY THEREOF, AND FINANCIAL ASSISTANCE CONTACT INFORMATION TO PATIENTS AS PART OF THE INTAKE PROCESS AND WITH DISCHARGE MATERIALS. ADDITIONALLY, A FINANCIAL ASSISTANCE APPLICATION IS ON THE BACK OF EVERY PATIENT BILL. THE ST. RITA'S FINANCIAL ASSISTANCE PROGRAM DISCUSSES WITH THE PATIENTS THE AVAILABILITY OF VARIOUS GOVERNMENT BENEFITS, SUCH AS MEDICAID OR STATE PROGRAMS, AND ASSISTS THE PATIENTS WITH QUALIFICATIONS FOR SUCH PROGRAMS, WHERE APPLICABLE. THE PURPOSE OF THE ST. RITA'S FINANCIAL ASSISTANCE PROGRAM IS TO ASSIST PATIENTS IN OBTAINING MEDICAL BENEFITS THROUGH FEDERAL, STATE, AND HOSPITAL PROGRAMS. REPRESENTATIVES WILL PROVIDE THE FOLLOWING SERVICES AT NO COST TO THE PATIENT: * EXPLORE ELIGIBILITY UNDER PUBLIC ASSISTANCE PROGRAMS * FILE APPLICATIONS ON PATIENT'S BEHALF * SCHEDULE AND ATTEND APPOINTMENTS * PROVIDE TRANSPORTATION WHEN NECESSARY * PROVIDE MEDICAL DOCUMENTATION TO SOCIAL SECURITY ADMINISTRATION FOR DISABILITY CLAIMS. THROUGH THE ST. RITA'S FINANCIAL ASSISTANCE PROGRAM, PATIENTS AND THEIR COUNSELORS LOOK AT WHAT OPTIONS ARE AVAILABLE. ST. RITA'S UNDERSTANDS THAT NOT EVERYONE CAN PAY FOR HEALTHCARE SERVICES. OUR PROGRAM IS HERE TO OFFER OPTIONS AND ASSISTANCE FOR THOSE WHO ARE UNINSURED OR UNDERINSURED. OUR FINANCIAL ASSISTANCE PROGRAM IS AN EXTENSION OF THE ST. RITA'S MEDICAL CENTER MISSION TO IMPROVE THE HEALTH OF OUR COMMUNITY WITH EMPHASIS ON THE POOR AND UNDERSERVED. MEETING THE NEEDS OF THOSE WITH LIMITED RESOURCES HAS ALWAYS BEEN THE HEART OF OUR MISSION. IN ADDITION TO THE RESOURCES AND SERVICES LISTED ABOVE, ST. RITA'S ALSO HAS AN OHIO BENEFIT BANK AVAILABLE ON-SITE IN THE MEDICAL LIBRARY TO PROVIDE ADDITIONAL RESOURCES FOR PATIENTS. THE OHIO BENEFIT BANK IS A PROGRAM AVAILABLE TO HELP ASSIST IN A RANGE OF BENEFITS, SUCH AS FOOD STAMPS, MEDICAL BENEFITS AND HELP FOR FILING FEDERAL AND STATE TAXES ALL AT ONCE. ALL OF THE CLIENT SERVICES ARE FREE AND ARE DESIGNED TO HELP PATIENTS GET THE BENEFITS AND TAX CREDITS THEY MAY BE ELIGIBLE FOR. Community information. Schedule H, Part VI, Line 4 ST. RITA'S MEDICAL CENTER SERVES A 10 COUNTY GEOGRAPHIC AREA FEATURING THE FOLLOWING COUNTIES: ALLEN, AUGLAIZE, HARDIN, HANCOCK, LOGAN, MERCER, PUTNAM, PAULDING, SHELBY, AND VAN WERT. THE POPULATION OF ST. RITA'S MEDICAL CENTER'S PRIMARY SERVICE AREA IS APPROXIMATELY 108,473 AND IS OLDER, POORER, AND HAS WORSE HEALTH STATISTICS THAN STATE AND NATIONAL AVERAGES. OUR COMMUNITY IS CHANGING AND WE ALSO SERVE A GROWING UNINSURED AND UNDERINSURED POPULATION. THERE ARE 2 HOSPITALS IN THE COMMUNITY AND BOTH ARE NON-PROFIT HOSPITALS. SOUTHSIDE LIMA AND NORTH LIMA HAVE BEEN FEDERALLY DESIGNATED AS A MEDICALLY UNDERSERVED AREAS OR POPULATIONS. THE DEMOGRAPHIC AREA SERVED BY ST. RITA'S MEDICAL CENTER INCLUDES THE FOLLOWING ETHNIC AND CULTURAL GROUPS: WHITE, AFRICAN AMERICAN, HISPANIC OR LATINO, ASIAN, AND AMERICAN INDIAN AND ALASKA NATIVE. 12.1% OF RESIDENTS ARE IN HOUSEHOLDS BELOW THE FEDERAL POVERTY GUIDELINES. 5% OF FAMILIES ARE ON MEDICAID OR OTHER ASSISTANCE. IN THE COMMUNITY SERVED BY ST. RITA'S MEDICAL CENTER, HEART DISEASE, CANCER, AND STROKE ARE THE MAJOR HEALTH PROBLEMS AND/OR LEADING CAUSES OF DEATH. EACH OF THESE ARE PREVENTABLE THROUGH PROPER CARE AND MAINTAINING CONTROL OF ILLNESS/DISEASE AS WELL AS BY LEADING HEALTHIER LIVES. THE SMOKING RATE IS 22% OF THE POPULATION. ST. RITA'S MEDICAL CENTER WORKS CLOSELY WITH LOCAL COMMUNITY AGENICES AND HEALTH DEPARTMENTS TO ADDRESS THESE PROBLEMS AND MINIMIZE THE EFFECTS ON THOSE WHO SUFFER. IN 2011, ST. RITA'S MEDICAL CENTER HAD 20,160 ADMISSIONS, 421,072 OUTPATIENT VISITS, AND 68,667 EMERGENCY ROOM VISITS. Promotion of community health Schedule H, Part VI, Line 5 ST. RITA'S MEDICAL CENTER OPERATES AN EMERGENCY ROOM OPEN TO ALL PERSONS REGARDLESS OF ABILITY TO PAY. IN ADDITION TO PROVIDING EMERGENCY SERVICES, ST. RITA'S MEDICAL CENTER ALSO PROVIDES MINOR EMERGENCY AND URGENT CARE SERVICES TO ALL REGARDLESS OF ABILITY TO PAY. ST. RITA'S MEDICAL CENTER OPERATES TRAUMA SERVICES, AIR AMBULANCE SERVICES, DISEASE MANAGEMENT, WOUND CARE, SPECIALTY CLINICS, DEVELOPMENTAL THERAPY, NEIGHBORHOOD NURSE PROGRAM, MED-CARE CLINIC, HOSPICE, HOME CARE, CRISIS INTERVENTION, BEHAVIORAL SERVICES AND REHABILITATION SERVICES. ST. RITA'S MEDICAL CENTER HAS AN OPEN MEDICAL STAFF WITH PRIVILEGES AVAILABLE TO ALL QUALIFIED PHYSICIANS IN THE AREA. THE MAJORITY OF THE GOVERNING BODY CONSISTS OF INDEPENDENT PERSONS REPRESENTATIVE OF THE COMMUNITY SERVED BY ST. RITA'S MEDICAL CENTER. ST. RITA'S MEDICAL CENTER ENGAGES IN THE TRAINING AND EDUCATION OF HEALTH CARE PROFESSIONALS. ST. RITA'S MEDICAL CENTER PROVIDES BOTH PHARMACY AND PODIATRIC MEDICINE RESIDENCY PROGRAMS. ST. RITA'S MEDICAL CENTER SERVES AS A CLINICAL EXPERIENCE SITE FOR OTHER HEALTH PROFESSIONALS. JOB SHADOWING AND CLINICAL EXPERIENCE PROGRAMS PROVIDE EXPOSURE FOR STUDENTS OF PHYSICAL THERAPY, RADIOLOGY, SURGERY, RESPIRATORY THERAPY, AND NURSING. ST. RITA'S MEDICAL CENTER PARTICIPATES IN MEDICAID, MEDICARE, CHAMPUS, AND/OR OTHER GOVERNMENT-SPONSORED HEALTH CARE PROGRAMS. IN ADDITION TO OUR PARTICIPATION IN THESE PROGRAMS, ST. RITA'S ABSORBED MORE THAN $13,721,052 IN UNREIMBURSED MEDICARE COSTS DURING 2011. ST. RITA'S MEDICAL CENTER FURTHERS ITS EXEMPT PURPOSE BY PROVIDING THE FOLLOWING COMMUNITY BENEFIT PROGRAMS IN THE COMMUNITIES IN WHICH IT SERVES: ST. RITA'S MEDICAL CENTER'S EMERGENCY DEPARTMENT TREATS AN INCREASING NUMBER OF PATIENTS WHO USE THE FACILITY FOR PRIMARY CARE NEEDS. PATIENT DEMOGRAPHICS REFLECT THE CHANGING COMMUNITY. AS IN OTHER COMMUNITIES, SOME AREA PHYSICIANS PLACE LIMITS ON THEIR ACCEPTANCE OF MEDICAID PATIENTS. IN ADDITION, SOME PRIMARY CARE PHYSICIANS REFER PATIENTS REFER PATIENTS WITH AFTER-HOURS NEEDS DIRECTLY TO AREA EMERGENCY ROOMS. COMMUNITY GROUPS AND INDIVIDUALS ARE VERY SUPPORTIVE OF ST. RITA'S MEDICAL CENTER. THERE WERE 951 ADULT, COLLEGE, TEEN, AND JOB SHADOWING VOLUNTEERS IN 2011. ST. RITA'S HAD FORGED COLLABORATIVE RELATIONSHIPS WITH THE FEDERALLY QUALIFIED HEALTH CENTERS IN ITS COMMUNITY SUCH AS ALLEN COUNTY HEALTH PARTNERS. Affiliated health care system Schedule H, Part VI, Line 6 ST. RITA'S MEDICAL CENTER IS A MEMBER OF ST. RITA'S HEALTH PARTNERS. ST. RITA'S HAS BEEN AN INTEGRAL PART OF THE COMMUNITY SINCE 1918. ST. RITA'S MEDICAL CENTER IS AN ACUTE CARE HOSPITAL WITH APPROXIMATELY 425 LICENSED BEDS. ST. RITA'S HEALTH PARTNERS COMMUNITY BENEFIT FOR 2011 PER THE AUDIT FOOTNOTE IS AS FOLLOWS: TOTAL 2011 COMMUNITY BENEFIT: $42.7 MILLION BENEFITS TO THE BROADER COMMUNITY: $11.2 MILLION UNREIMBURSED CARE FOR THOSE WHO ARE POOR AND QUALIFY FOR MEDICAID: $16.8 MILLION COST OF CARE FOR THOSE WHO COULD NOT AFFORD TO PAY: $12.6 MILLION SUPPORT FOR OTHER PROGRAMS FOR THOSE WHO ARE POOR: $2.1 MILLION COMMUNITY BENEFIT AS A PERCENT OF TOTAL EXPENSE: 10.8% ST. RITA'S MEDICAL CENTER IS A MEMBER OF CATHOLIC HEALTH PARTNERS (CHP). CHP IS THE CONTINUATION OF THE HEALTH MINISTRY STARTED MORE THAN 150 YEARS AGO BY OUR CO-SPONSORING CONGREGATIONS: THE SISTERS OF MERCY, REGIONAL COMMUNITY OF CINCINNATI (OH) (NOW THE SISTERS OF MERCY, SOUTH CENTRAL COMMUNITY); THE MID-ATLANTIC COMMUNITY; THE SISTERS OF HUMILITY OF MARY; THE FRANCISCAN SISTERS OF THE POOR, AND COVENANT HEALTH SYSTEMS. OUR SYSTEM OF REGIONAL HEALTH CARE PROVIDERS SERVES LOCAL HEALTH NEEDS IN COMMUNITIES IN OHIO AND KENTUCKY. CHP IS FOCUSED ON IMPROVING THE HEALTH OF COMMUNITIES WE SERVE BY PROVIDING INTEGRATED HEALTH SERVICES THROUGH FACILITIES THAT INCLUDE ACUTE CARE HOSPITALS, SENIOR HEALTH AND HOUSING FACILITIES, HOME HEALTH AGENCIES, HOSPICE PROGRAMS, OUTREACH SERVICES AND WELLNESS CENTERS. OUR HOSPITALS INCLUDE CRITICAL ACCESS FACILITIES OFFERING ESSENTIAL HEALTH SERVICES THAT WOULD OTHERWISE NOT EXIST IN THOSE COMMUNITIES. WE CARE FOR EVERYONE WHO COMES TO USE, REGARDLESS OF THEIR ABILITY TO PAY. AS WE HAVE DONE FOR DECADES, WE PROVIDE EXTENSIVE SERVICES TO THE BROADER COMMUNITY, WITH EMPHASIS ON SERVICES FOR PERSONS WHO ARE POOR AND UNDERSERVED. CHP'S HOME OFFICE PROVIDES SERVICES AND SUPPORT TO THE ENTIRE SYSTEM, INCLUDING BUT NOT LIMITED TO: PROVIDING GOVERNANCE, MANAGEMENT OVERSIGHT, STRATEGIC LEADERSHIP, FOCUSING RESOURCES TO ASSURE THE HEALING MISSION, PROVIDING ACCESS TO LOWER COST DEBT FINANCING TO SUPPORT OPERATIONS, IMPROVING CLINICAL OUTCOMES AND REDUCING OPERATING COSTS. SYSTEM-WIDE COMMUNITY BENEFIT FOR 2011 PER THE AUDIT FOOTNOTE IS AS FOLLOWS: TOTAL 2011 COMMUNITY BENEFIT: $345.7 MILLION BENEFITS TO THE BROADER COMMUNITY: $76.0 MILLION UNREIMBURSED CARE FOR THOSE WHO ARE POOR AND QUALIFY FOR MEDICAID: $124.3 MILLION COST OF CARE FOR THOSE WHO COULD NOT AFFORD TO PAY: $116.7 MILLION SUPPORT FOR OTHER PROGRAMS FOR THOSE WHO ARE POOR: $28.7 MILLION COMMUNITY BENEFIT AS A PERCENT OF TOTAL EXPENSE: 10.0% true ALLEN COUNTY HEALTH DEPARTMENT 219 E MARKET STREET LIMA OH 45802 346400019 501(C)(3) 33571 HEALTH MINISTRIES PROGRAM ALLEN COUNTY HEALTH PARTNERS 441 E 8TH STREET LIMA OH 458042482 562330309 501(C)(3) 283171 DENTAL CLINIC ALLEN LIMA LEADERSHIP 144 SOUTH MAIN STREET LIMA OH 45801 341536300 501(C)(3) 6720 MISSION SUPPORT AMERICAN CANCER SOCIETY NW REGION 740 COMMERCE DRIVE PERRYSBUERG OH 43551 251798733 501(C)(3) 12500 MISSION SUPPORT AMERICAN RED CROSS 610 SOUTH COLLETT LIMA OH 45805 344428650 501(C)(3) 10000 MISSION SUPPORT AMERICAN TOWNSHIP FIRE DEPARTMENT 105 W MAIN STREET ELIDA OH 45807 346400022 501(C)(3) 43963 MEDICAL EQUIPMENT DONATION BLUFFTON UNIVERSITY 1 UNIVERSITY DRIVE BLUFFTON OH 45817 344428207 501(C)(3) 15000 MISSION SUPPORT CHAMBER FOUNDATION 144 SOUTH MAIN STREET LIMA OH 45801 341536300 501(C)(3) 5600 ADVERTISING SPONSORSHIP CHRISTIAN CORNER COMMUNITY CENTER 1601 MCCLAIN ROAD LIMA OH 45804 346407479 501(C)(3) 5000 MISSION SUPPORT CLOSING THE ACHIEVEMENT GAP 1 SPARTAN WAY LIMA OH 45801 346400788 501(C)(3) 10000 MISSION SUPPORT FAMILY PROMISE OF LIMA ALLEN COUNTY 1295 PIERCE STREET LIMA OH 45801 208987019 501(C)(3) 7500 MISSION SUPPORT LIMA NOON OPTIMIST FOUNDATION PO BOX 428 LIMA OH 45802 341783126 501(C)(3) 7000 MISSION SUPPORT LIMA SYMPHONY ORCHESTRA 133 NORTH ELIZABETH STREET LIMA OH 45801 344465022 501(C)(3) 6000 MISSION SUPPORT MARCH OF DIMES 3450 W CENTRAL AVENUE SUITE 352 TOLEDO OH 43606 131846366 501(C)(3) 5000 MISSION SUPPORT NEWSPAPER IN EDUCATION THE LIMA NEWS 3515 ELIDA ROAD LIMA OH 45807 371690521 5500 MISSION SUPPORT OUR DAILY BREAD KITCHEN 1275 S CENTRAL LIMA OH 45802 341134252 501(C)(3) 5000 MISSION SUPPORT SAMARITAN HOUSE 328 W MCKIBBEN STREET LIMA OH 45801 341595265 501(C)(3) 5500 MISSION SUPPORT ST LOUIS UNIVERSITY 221 NORTH GRAND BOULEVARD DUBOURG HALL ROOM 121 ST LOUIS MO 63103 430654872 501(C)(3) 11485 MISSION SUPPORT STAR SPANGLED SPECTACULAR PO BOX 1602 LIMA OH 45802 264000194 501(C)(3) 15000 MISSION SUPPORT UNITED WAY OF GREATER LIMA 616 S COLLETT STREEET LIMA OH 45805 344466356 501(C)(3) 10200 MISSION SUPPORT UNIVERSITY OF NORTHWESTERN OHIO 1441 N CABLE ROAD LIMA OH 45805 341695897 501(C)(3) 125000 MISSION SUPPORT WALGREEN'S PO BOX 90480 CHICAGO IL 606960480 361924025 283221 INDIGENT MEDICAL PROGRAM HERITAGE ELEMENTARY SCHOOL 816 COLLEGE AVE LIMA OH 45805 346400788 501(C)(3) 10000 MISSION SUPPORT LIMA CATHOLIC CENTRAL HIGH SCHOOL 720 S CABLE ROAD LIMA OH 45805 344465253 501(C)(3) 5165 MISSION SUPPORT SRHC FOUNDATION 730 W MARKET STREET LIMA OH 45801 341368429 501(C)(3) 268000 MISSION SUPPORT 23 2 Procedures for monitoring use of grant funds Schedule I, Part I, Line 2 EACH ORGANIZATION MUST PROVIDE A COMPLETED FORM DEMONSTRATING TO ST. RITA'S THEIR NEEDS AND HOW THE MONEY IS TO BE USED, AS WELL AS A COPY OF THEIR 990. THE APPLICATIONS ARE SCREENED AND EVAULATED BASED ON COMMUNITY NEED, CARE FOR THE POOR, AND ALIGNMENT WITH OUR MISSION. DONATIONS OVER $10,000 MUST BE APPROVED BY THE BOARD OF DIRECTORS, WHILE ANY DONATION OVER $5,000 IS APPROVED BY AN ADMINISTRATION LEVEL COUNCIL. FOR ONGOING DONATIONS, WE RECEIVE FEEDBACK FROM THE ORGANIZATION ON HOW THE MONEY HAS BEEN USED. false true false false false false false true false BRIAN SMITH 307143 0 68688 0 12140 0 118730 0 28478 0 535179 0 0 0 CHRISTINE PROVAZNIK 188632 0 42374 0 27586 0 119176 0 17371 0 395139 0 0 0 DAVID MURPHY 175707 0 31371 0 534 0 1742 0 19640 0 228994 0 0 0 DIANA PICKARD 77374 0 6159 0 617 0 46389 0 20513 0 151052 0 0 0 DR JASON BOWERSOCK 367513 0 388619 0 16772 0 2410 0 18556 0 793870 0 0 0 DR JULIUS KATO 503139 0 452751 0 1242 0 2450 0 18824 0 978406 0 0 0 DR SURIANARAYAN AMBALAVANAN 570474 0 314916 0 2699 0 2450 0 12042 0 902581 0 0 0 DR TODD HIXENBAUGH 470878 0 369602 0 2064 0 0 0 19116 0 861660 0 0 0 DR ZOHEIR ABDELBAKI 703351 0 511651 0 711 0 2178 0 19005 0 1236896 0 0 0 HERBERT SCHUMM MD 329663 0 87134 0 47163 0 110096 0 28222 0 602278 0 0 0 JAMES REBER 465740 0 190694 0 134637 0 154068 0 22378 0 967517 0 0 0 JOHN MEYER 211476 0 55241 0 6608 0 121676 0 33953 0 428954 0 0 0 JOHN RENNER 274954 0 69499 0 20033 0 73666 0 13459 0 451611 0 0 0 KAY WELLMAN 208403 0 53614 0 20594 0 200575 0 8393 0 491579 0 0 0 MARK SKAJA 147556 0 36251 0 16857 0 7506 0 33168 0 241338 0 0 0 MICHAEL HUMPHREY MD 261964 0 66862 0 18198 0 60727 0 20306 0 428057 0 0 0 MIKE BISSEGGER 186063 0 47338 0 47258 0 51939 0 18785 0 351383 0 0 0 ROBERT BAXTER 322712 0 0 0 17402 0 35521 0 22533 0 398168 0 0 0 RONDA LEHMAN 185694 0 42252 0 16955 0 37525 0 19237 0 301663 0 0 0 WALTER KINSEY 156726 0 39838 0 5279 0 58384 0 11495 0 271722 0 0 0 WILBERT CASON 179285 0 47020 0 35813 0 108165 0 13282 0 383565 0 0 0 Arrangement used to establish the top management official's compensation Schedule J, Part I, Line 3 THE COMPENSATION OF JAMES REBER, CEO, IS DETERMINED BY CATHOLIC HEALTH PARTNERS (CHP), A RELATED TAX-EXEMPT ORGANIZATION. CHP UTILIZES A COMPENSATION COMMITTEE, AN INDEPENDENT COMPENSATION CONSULTANT, A COMPENSATION SURVEY AND APPROVAL BY BOARD OR COMPENSATION COMMITTEE WHEN DETERMINING MR. REBER'S COMPENSATION. Supplemental nonqualified retirement plan Schedule J, Part I, Line 4b THE ST. RITA'S MEDICAL CENTER 457(F) PLAN PROVIDES A FLEXIBLE BENEFIT ALLOWANCE TO PERSONS SELECTED BY THE BOARD OF TRUSTEES OR ITS DELEGATE. THIS ALLOWANCE, WHICH IS BASED ON A SPECIFIED PERCENTAGE OF COMPENSATION, MAY BE ALLOCATED AMONG VARIOUS INSURANCE AND DEFERRED COMPENSATION BENEFIT OPTIONS. AMOUNTS INCLUDIBLE IN TAXABLE COMPENSATION FOR LISTED PARTICIPATING INDIVIDUALS IN THS REPORTING YEAR WERE AS FOLLOWS: HERBERT SCHUMM, MD $28,382; CHRISTINE PROVAZNIK $10,834; WILBERT CASON $17,006; MARK SKAJA $3,582; JOHN RENNER $0; BRIAN SMITH $0; MICHAEL HUMPHREY, MD $0; KAY WELLMAN $0; JOHN MEYER $0; MIKE BISSEGGER $0; WALTER KINSEY $0, RONDA LEHMAN $0; ROBERT BAXTER $0. THE CHP SERP PLAN PART I, LINE 4B THE CHP SERP PLAN IS A DEFERRED COMPENSATION PLAN WHICH PROVIDES SUPPLEMENTAL RETIREMENT BENEFITS TO PERSONS SELECTED BY THE BOARD OF TRUSTEES OR ITS DELEGATE. IT PROVIDES ANNUAL CREDITS OF A SPECIFIED PERCENTAGE OF COMPENSATION AND ANNUAL INTEREST CREDITS. PARTICIPANTS VEST 50%, 75%, AND 100% IN THEIR ACCOUNTS AFTER 5, 6, AND 7 YEARS OF SERVICE, RESPECTIVELY, VESTING OCCURS EARLIER FOR DEATH OR TOTAL DISABILITY OR REACHING AGE 60 WHILE EMPLOYED, OR INVOLUNTARY TERMINATION OF EMPLOYMENT WITHIN 24 MONTHS AFTER A CHANGE IN CONTROL OF THE ORGANIZATION OR DUE TO POSITION ELIMINATION, PAYMENTS DURING EMPLOYMENT ARE MADE FOR REQUIRED TAX WITHHOLDINGS. PAYMENT OF THE VESTED ACCOUNT BALANCE IN A LUMP SUM OCCURS AFTER TERMINATION OF EMPLOYMENT. AMOUNTS INCLUDIBLE AS TAXABLE COMPENSATION FOR LISTED INDIVIDUALS DUE TO SERP PARTICIPATION IN THE REPORTING YEAR WERE AS FOLLOWS: JAMES REBER $101,411. SRMC EXECUTIVE RETENTION PLAN PART I, LINE 4B THE ST. RITA'S MEDICAL CENTER EXECUTIVE RETENTION PLAN IS A DEFERRED COMPENSATION PLAN WHICH PROVIDES EMPLOYMENT CONTINUATION INCENTIVES TO PERSONS SELECTED BY THE BOARD OF TRUSTEES OR ITS DELEGATE. IT PROVIDES ANNUAL CREDITS OF A SPECIFIED PERCENTAGE OF COMPENSATION AND ANNUAL INTEREST CREDITS. PARTICIPANTS VEST AND CEASE TO RECEIVE CREDITS AFTER 5 YEARS OF PLAN PARTICIPATION PROVIDED THEY REMAIN EMPLOYED. VESTING AND CESSATION OF CREDITS OCCUR EARLIER FOR DEATH OR TOTAL DISABILITY WHILE EMPLOYED, INVOLUNTARY TERMINATION OF EMPLOYMENT WITHIN 24 MONTHS AFTER A CHANGE IN CONTROL OF THE ORGANIZATION, OR FOR CERTAIN PARTICIPANTS, UPON BEING OFFERED A SPECIFIED PROMOTION. PAYMENT OF THE VESTED ACCOUNT BALANCE IN A LUMP SUM OCCURS UPON VESTING. AMOUNTS INCLUDIBLE AS TAXABLE COMPENSATION FOR LISTED INDIVIDUALS DUE TO RETENTION PLAN PARTICIPATION IN THE REPORTING YEAR WERE AS FOLLOWS: BRIAN SMITH $0. Non-fixed payments Schedule J, Part I, Line 7 THE ORGANIZATION PROVIDES ANNUAL INCENTIVE COMPENSATION FOR LISTED INDIVIDUALS. THE ORGANIZATION'S BOARD OF TRUSTEES ESTABLISHES OBJECTIVE THRESHOLDS FOR QUALITY, COMMUNITY BENEFIT, AND FINANCIAL PERFORMANCE WHICH MUST BE ACHIEVED FOR INCENTIVES TO BE AWARDED. THE BOARD ALSO ESTABLISHES THRESHOLD, TARGET AND MAXIMUM LEVELS FOR INCENTIVE AWARDS. WITHIN THESE ESTABLISHED PARAMETERS, THE BOARD DETERMINES THE CEO'S INCENTIVE AWARD AND INCENTIVE AWARDS FOR OTHER LISTED INDIVIDUALS ARE DETERMINED BY THE CEO AND DISCLOSED TO THE BOARD. THE BOARD MAY AUTHORIZE MODIFIED INCENTIVE AWARDS WHEN APPROPRIATE IN ITS JUDGEMENT. PERRY CORPORATION BARRY CLARK (BOARD MEMBER) IS AN OFFICER 680242 INDEPENDENT CONTRACTOR false STACEY WALTER SPOUSE OF STEVE WALTER (BOARD MEMBER) 20236 EMPLOYMENT false LIMA PATHOLOGY INC KIRK GRIFFITH, MD (BOARD MEMBER) HAS AN OWNERSHIP INTEREST 682110 INDEPENDENT CONTRACTOR false SMS PROTECH BARRY CLARK (BOARD MEMBER) IS AN OFFICER 4143126 INDEPENDENT CONTRACTOR false TERESA CLIFFORD SPOUSE OF DAN CLIFFORD, BOARD MEMBER 17524 EMPLOYMENT false Description of other program services Form 990, Part III, Line 4d OTHER PROGRAM EXPENSES CONSOLIDATED AUDITED FINANCIAL STATEMENTS FORM 990, PART IV, LINE 20B THE FILING ORGANIZATION DOES NOT HAVE SEPARATE, INDEPENDENT AUDITED FINANCIAL STATEMENTS. THE ORGANIZATION IS INCLUDED IN CATHOLIC HEALTH PARTNERS' CONSOLIDATED AUDITED FINANCIAL STATEMENTS, WHICH ARE PREPARED IN ACCORDANCE WITH GENERALLY ACCEPTED ACCOUNTING PRINCIPLES. CATHOLIC HEALTH PARTNERS' AUDIT AND CORPORATE RESPONSIBILITY COMMITTEE HAS RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT AND THE SELECTION OF AN INDEPENDENT ACCOUNTANT. Classes of members or stockholders Form 990, Part VI, Section A, Line 6 CATHOLIC HEALTH PARTNERS IS THE SOLE MEMBER OF ST. RITA'S MEDICAL CENTER. Members or stockholders electing members of governing body Form 990, Part VI, Section A, Line 7a CATHOLIC HEALTH PARTNERS APPROVES MEMBERS THAT ARE APPOINTED TO THE BOARD OF TRUSTEES. ALL MEMBERS OF THE BOARD OF TRUSTEES HAVE FULL VOTING RIGHTS. Decisions requiring approval by members or stockholders Form 990, Part VI, Section A, Line 7b CERTAIN MATTERS REQUIRE APPROVAL OF THE CHP CORPORATE MEMBER, CHP GOVERNING BODY, OR CHP CEO. THE REGULATIONS OF THE ORGANIZATION DESCRIBE THE LEVEL OF APPROVAL REQUIRED FOR VARIOUS DECISIONS. Review of form 990 by governing body Form 990, Part VI, Section B, Line 11b THE FORM 990 IS PREPARED BY CHP'S TAX DEPARTMENT AND REVIEWED BY AN INDEPENDENT ACCOUNTING FIRM. UPON REVIEW, THE FORM 990 IS THEN FORWARDED TO THE AUDIT & CORPORATE RESPONSIBILITY COMMITTEE FOR APPROVAL. ADDITIONALLY, THE COMPENSATION COMMITTEE REVIEWS ALL COMPENSATION-RELATED SCHEDULES AND DISCLOSURES. BOTH THE AUDIT & CORPORATE RESPONSIBILITY COMMITTEE AND THE COMPENSATION COMMITTEE ARE INDEPENDENT OF THE FILING ORGANIZATION. ONCE THE FORM 990 IS REVIEWED BY ALL APPLICABLE PARTIES, A COPY OF THE FINAL VERSION IS PROVIDED TO ALL MEMBERS OF THE GOVERNING BODY PRIOR TO FILING. Conflict of interest policy Form 990, Part VI, Section B, Line 12c ALL BOARD MEMBERS ARE COVERED BY THE CATHOLIC HEALTH PARTNERS (CHP) CONFLICT OF INTEREST POLICY WHICH REQUIRES DISCLOSURE ON AN ANNUAL BASIS. ALL POTENTIAL CONFLICTS OF INTEREST ARE REVIEWED BY CHP CORPORATE COMPLIANCE OFFICER. AT THE BEGINNING OF EACH BOARD MEETING ALL BOARD MEMBERS ARE REQUIRED TO DISCLOSE ANY CONFLICTS OF INTEREST. BOARD MEMBERS DETERMINED TO HAVE A CONFLICT OF INTEREST ARE PROHIBITED FROM PARTICIPATING IN DELIBERATIONS AND DECISION-MAKING FOR THE TRANSACTION IN WHICH THE CONFLICT EXISTS. Process used to establish compensation of other officers/key employees Form 990, Part VI, Section B, Line 15b THE REGIONAL CEO RECOMMENDS COMPENSATION FOR OFFICERS AND KEY EMPLOYEES. THE COMMITTEE REVIEWS AND APPROVES OR ADJUSTS THE RECOMMENDED ADJUSTMENTS TO THE OFFICERS AND KEY EMPLOYEES' BASE COMPENSATION AND INCENTIVE AWARD, WITHIN SUCH ESTABLISHED PARAMETERS. A FORMAL PERFORMANCE APPRAISAL PROCESS IS INCORPORATED IN THE COMPENSATION ADJUSTMENT AND AWARD PROCESS. IT UTILIZES A MULTI-PERSPECTIVE APPROACH AND PERFORMANCE MEASURES WHICH ARE LINKED TO THE ORGANIZATION'S ACHIEVEMENT OF TEAM AND INDIVIDUAL OBJECTIVES AND PERFORMANCE. COMPENSATION-RELATED DETERMINATIONS ARE CONDUCTED IN ACCORDANCE WITH APPLICABLE REQUIREMENTS OF THE INTERNAL REVENUE CODE AND REGULATIONS TO QUALIFY FOR THE PRESUMPTION THAT THE COMPENSATION IS REASONABLE, INCLUDING BUT NOT LIMITED TO APPROVAL BY AN AUTHORIZED BODY COMPOSED OF INDIVIDUALS WHO DO NOT HAVE A CONFLICT OF INTEREST, OBTAINING AND RELYING ON APPROPRIATE DATA AS TO COMPARABILITY, AND CONCURRENT DOCUMENTATION OF THE BASIS FOR THE COMPENSATION DETERMINATIONS. Governing documents, conflict of interest policy and financial statements available to the public Form 990, Part VI, Section C, Line 19 THE SYSTEM-WIDE CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE POSTED ON THE CATHOLIC HEALTH PARTNERS WEBSITE. Average number of hours devoted per week to related organization Form 990, Part VII, Section A, Column B STEVE WALTER - 1 SR. DOROTHY THUM, RSM - 5 JAMES REBER - 3 BRIAN SMITH - 1 JOHN MEYER - 1 Other changes in net assets or fund balances Form 990, Part XI, Line 5 NET UNREALIZED GAINS (LOSSES) ON INVESTMENTS - -7897293; RECORD UPDATED PENSION VALUES - -37767404; LACP - ST RITA'S MEDICAL CENTER LLC 303 W SPRING STREET LIMA OH 45801 262878453 AMBULANCE SVC OH 2974795 3496681 ST RITA'S MEDICAL CENTER ST RITA'S PROFESSIONAL SERVICES LLC 730 W MARKET STREET LIMA OH 45801 262788491 PHYSICIAN PRACTICES OH 24149563 1405670 ST RITA'S MEDICAL CENTER CATHOLIC HEALTH PARTNERS 615 ELSINORE PLACE CINCINNATI OH 45202 311161086 HEALTHCARE SYSTEM PARENT OH 501(C)(3) 11 - Type III - FI NA false CATHOLIC HEALTH PARTNERS FOUNDATION 615 ELSINORE PLACE CINCINNATI OH 45202 201072726 FUNDRAISING OH 501(C)(3) 7 CATHOLIC HEALTH PARTNERS false CATHOLIC HEALTHCARE PARTNERS HOUSING DEVELOPMENT 615 ELSINORE PLACE CINCINNATI OH 45202 208943658 HUD PARENT OH 501(C)(3) 9 CATHOLIC HEALTH PARTNERS false CATHOLIC HEALTHCARE PARTNERS RETIREMENT 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