2012-11-15T13:19:41-06:00 2011-12-31 351178661 BLUE & CO LLC 8800 LYRA DRIVE SUITE 450 COLUMBUS OH 43240 990 2011-01-01 344430716 FISHER-TITUS MEDICAL CENTER FISH 4196688101 272 BENEDICT AVENUE NORWALK OH 44857 DUANE WOODS JR 4196688101 2012-11-15 1 ROBERT M MORELAND P00418596 6148852583 2011 2016-02-24 21:20:13Z PATRICK MARTIN 272 BENEDICT AVENUE NORWALK OH 44857 131868568 0 X WWW.FTMC.COM X 1911 OH SEE SCHEDULE O 11 8 1081 290 1276818 245757 71950 103445 111729373 113348908 -2317815 989771 923594 1083121 110407102 115525245 137479 173780 0 0 57489634 58358974 0 0 0 53352621 52898605 110979734 111431359 -572632 4093886 181032523 186179952 61750318 67931873 119282205 118248079 X PROVIDE QUALITY HEALTHCARE IN A COST EFFECTIVE MANNER, WHILE RESPECTING THE DIGNITY AND UNIQUENESS OF EACH INDIVIDUAL WE SERVE. 0 0 87868683 173780 105318041 SEE SCHEDULE O 4937865 6745049 SEE SCHEDULE O 92806548 1 1 0 1 0 0 0 0 0 0 1 0 0 0 0 0 0 1 0 0 0 1 0 0 0 0 1 1 1 0 1 1 0 0 0 0 0 1 0 0 1 1 1 0 0 0 1 1 0 0 0 0 1 115 0 1 1081 1 1 1 0 0 0 0 0 0 0 0 0 X 11 8 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 1 1 OH X DAVID WILSON MBACMA 4196688101 272 BENEDICT AVENUE NORWALK OH 44857 JOHN D PAYNE CPA 10.00 X 0 0 0 LESLIE D STONEHAM 15.00 X X 0 0 0 MARJORIE A HARPER 4.00 X 0 0 0 CHARLES F FUREY 8.00 X X 0 0 0 GLENN TRIPPE MD 8.00 X 0 0 0 WILLIAM B CORNELL MD 8.00 X 0 0 0 VIRGINIA H POLING 6.00 X 0 0 0 THOMAS C BLEILE 8.00 X 0 0 0 REV FRED WIECHERS 8.00 X X 0 0 0 MATT GROSS 12.00 X X 0 0 0 PATRICK J MARTIN 53.00 X X 618887 0 462942 MARGARET BAIRD 50.00 X 524637 0 171895 DUANE WOODS 44.50 X 204577 0 22743 LORNA STRAYER 50.00 X 168910 0 77170 CHERIE M SPRAGG 50.00 X 182754 0 89319 JOHN BRITTON 45.00 X 176733 0 12827 PHILLIP J ANNARINO 45.00 X 165054 0 20447 JOHN K HUGHES 40.00 X 209532 0 31407 GEORGE B ELMER 40.00 X 168581 0 27835 CHRISTINA CANFIELD 40.00 X 167721 0 16074 JOSEPH E CENTA 40.00 X 258734 0 27753 KATHLEEN A MEEHAN - DE LA CRUZ 40.00 X 197826 0 30173 3043946 0 990585 28 0 1 0 THE ROBINS & MORTON GROUP 5500 MARYLAND WAY SUITE 100 BRENTWOOD TN 37027 BUILDING CONTRACTOR 3609895 CERNER CORPORATION 2800 ROCKCREEK PARKWAY KANSAS CITY MO 64117 HEALTHCARE INFORMATION TECHNOLOGY 1909613 HOSPITAL MEDICINE ASSOCIATES PO BOX 634850 CINCINNATI OH 45263 HOSPITALISTS 1455015 BOSTWICK DESIGN PARTNERSHIP 2729 PROSPECT AVE CLEVELAND OH 44115 ARCHITECTS 591266 LABORATORY CORP OF AMERICA PO BOX 12140 BURLINGTON NC 27216 LAB TESTING & BLOOD ADMIN 570906 19 409 50429 52607 43122 103445 NET PATIENT SERVICES 622110 105318041 105318041 NET NURSING HOME & ASS 623000 6754049 6754049 MEDICAL LABORATORY 621500 1265692 1265692 HEALTH AND ALLIED SERV 621990 11126 11126 113348908 420593 420593 16907546 4955 16012096 331227 895450 -326272 569178 569178 CAFETERIA SALES 722210 476717 476717 AUXILIARY SALES 453220 359982 359982 OTHER HOSPITAL REVENUE 900099 246422 246422 1083121 115525245 112072090 1276818 2072892 161792 161792 11988 11988 2898897 1988860 910037 40458639 34683252 5775387 3590596 3078046 512550 8028759 6892670 1136089 3382083 2899297 482786 233733 175300 58433 112738 56369 56369 11043008 7003480 4039528 518508 507972 10536 3975596 2792242 1183354 2893284 378079 2515205 2026624 1495444 531180 113052 101293 11759 301754 235218 66536 1371587 1264676 106911 7354126 6975332 378794 999427 804820 194607 UBI INCOME TAX 149151 0 149151 MEDICAL SUPPLIES 14244410 14242972 1438 BAD DEBT EXPENSES 5162657 5162657 OHIO HOSPITAL TAX & SNF 1302245 1302245 1096705 592544 504161 111431359 92806548 18624811 0 5475 5225 17263330 18518902 19438399 14202026 286880 245321 669314 586299 1887494 1934718 1946136 1999792 138615532 60232599 79906593 78382933 57058369 67547461 271050 245374 366431 348961 1933052 2162940 181032523 186179952 27178703 34681434 335945 314054 33945000 32760000 290670 176385 61750318 67931873 X 119263921 118229778 18284 18301 119282205 118248079 181032523 186179952 X 4093886 -5128012 X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 1 0 1 11701 11701 0 EXPLANATION OF LOBBYING ACTIVITIES: PART II-B, LINE 1: EXECUTIVE MEMBERS OF THE ORGANIZATION, ON AN OCCASIONAL BASIS, MAY WRITE OR SPEAK TO LEGISLATIVE MEMBERS CONCERNING PROPOSED LEGISLATION THAT MIGHT IMPACT THE LOCAL DELIVERY OF HEALTHCARE SERVICES. THE MEDICAL CENTER HAS MEMBERSHIPS IN VARIOUS HEALTHCARE RELATED ASSOCIATIONS, WHICH PROVIDE STATE AND NATIONAL LEADERSHIP ON LEGAL, REGULATORY, QUALITY AND ACCREDITATION ISSUES. AS A PART OF THAT LEADERSHIP ROLE THESE ORGANIZATIONS DO CONTACT LEGISLATORS TO EXPRESS THEIR ASSOCIATION'S POSITIONS ON MATTERS IMPORTANT TO THEIR MEMBERSHIP. THE FOLLOWING ORGANIZATIONS LISTED BELOW SHOW THE PERCENTAGE OF THE DUES THAT REFLECT LOBBYING AS DETERMINED BY THE IRS: OHIO HEALTH CARE ASSOCIATION - 41.4% OF DUES; OHIO HOSPITAL ASSOCIATION - 5.9% OF DUES; AMERICAN HOSPITAL ASSOCIATION - 24.6% OF DUES AND HOSPITAL COUNCIL OF NW OHIO - 24% OF DUES. 1165800 1165800 92372631 37072620 55300011 39514716 21171161 18343555 5562385 1988818 3573567 78382933 115525245 111431359 4093886 -306869 -4689523 -4996392 -902506 112425233 -306869 -2430705 -2737574 115162807 362438 362438 115525245 113327740 2126159 2126159 111201581 229778 229778 111431359 PART XI, LINE 8 - OTHER ADJUSTMENTS: FASB #158 ADJUSTMENT -4,775,201. TRANSFER OF FUNDS TO AFFILIATED ORGANIZATION, NORWALK AREA HEALTH SYSTEMS -500,000. AUDIT ADJUSTMENT EXPENSE ERROR 16,210. AUDIT CONSOLIDATING ADJUSTMENT TO DONATIONS OF NEGATIVE -9,907. PAIN MANAGEMENT LLC DIVIDEND PAYMENT TO JOINT VENTURE MEMBER NORWALK PAIN M 397,755. NET ASSETS BALANCE SHEET CHANGE FOR HEALTH PROMOTIONS 50,000. TOTAL TO SCHEDULE D, PART XI, LINE 8: -4,821,143. PART XII, LINE 2D - OTHER ADJUSTMENTS: TRANSFER TO AFFILIATED ENTITY NORWALK AREA HEALTH SYSTEMS -500,000. FASB 158 PROVISIONS -4,775,201. HEALTH PROMOTIONS OF NORWALK REVENUE 610,466. FISHER-TITUS PAIN MANAGEMENT LLC REVENUE 2,648,019. PAIN MANAGEMENT LLC DIVIDEND PAYMENT TO FTMC OF NEGATIVE -413,989. PART XII, LINE 4B - OTHER ADJUSTMENTS: HOSPITAL AUXIIARY REVENUE 360,428. HOSPITAL EXPENSE ADJUSTMENTS TO REVENUES 2,010. PART XIII, LINE 2D - OTHER ADJUSTMENTS: HEALTH PROMOTIONS OF NORWALK EXPENSES 540,213. FISHER-TITUS PAIN MANAGEMENT LLC EXPENSES 1,585,946. PART XIII, LINE 4B - OTHER ADJUSTMENTS: HOSPITAL AUXILIARY EXPENSES 221,466. HOSPITAL EXPENSE ADJUSTMENTS TO REVENUES 8,312. 0 0 0 0 0 0 0 0 0 SOUTH AMERICA DONATION OF SUPPLIES TO HOSPITAL IN COLUMBIA 11987 DONATION OF SUPPLIES TO COLUMBIAN HOSPITAL FMV 1 0 0 0 0 0 0 1 1 X 1 X 1 X 1 1 1 0 1 1 1 1580 1732178 556418 1175760 0.01060 1 16285 11488647 6978512 4510135 0.04050 2 17865 13220825 7534930 5685895 0.05110 626 63283 925897 59804 866093 0.00780 30 166 60865 7520 53345 0.00050 4 960029 189115 770914 0.00690 6 293615 293615 0.00260 666 63449 2240406 256439 1983967 0.01780 668 81314 15461231 7791369 7669862 0.06890 1 615 5700 5700 0.00010 2 174 1031 1031 0.00000 1 24 9745 9745 0.00010 10 382 6475 6475 0.00010 14 1195 22951 22951 0.00030 1 5162657 1548797 22724813 31020478 -8295665 X 1 1 1 NORTH CENTRAL CARENET PHYSICIAN-HOSPITAL ORGANIZATION 0.50000 0.04260 0.45740 2 FISHER-TITUS PAIN MANAGEMENT LLC PAIN MANAGEMENT 0.51000 0.49000 1 1 FISHER-TITUS MEMORIAL HOSPITAL

272 BENEDICT AVENUE NORWALK OH 44857

X X X FISHER-TITUS MEMORIAL HOSPITAL 1 1 1 150.000000000000 1 200.000000000000 1 X X X X 1 1 X X X X X 1 1 X X X X 1 X 0 1 2 NORWALK MEMORIAL HOME

272 BENEDICT AVENUE NORWALK OH 44857

SKILLED NURSING FACILITY THE CARRIAGE HOUSE OF FISHER-TITUS

175 SHADY LANE DRIVE NORWALK OH 44857

ASSISTED LIVING FACILITY PART I, LINE 7: THE COSTING METHODOLOGY USED FOR THE CHARITY CARE SEGMENT OF THE LINE 7 TABLE WAS THE IRS WORKSHEET 1 "CHARITY CARE AT COSTS" IN THE INSTRUCTIONS. COST TO CHARGE RATIOS WERE CARRIED OVER FROM THE IRS WORKSHEET 2 AS A BASIS TO ESTIMATE EXPENSES AND WAS APPLIED TO THE GROSS PATIENT CHARITY CARE CHARGES RECORDED IN 2011. THE COSTING METHODOLOGY USED FOR THE UNREIMBURSED MEDICAID SEGMENT OF THE LINE 7 TABLE WERE CALCULATED USING A COST TO CHARGE RATIO EXTRACTED FROM THE MEDICAID COST REPORT DATA. THE COSTING METHODOLOGY USED FOR "OTHER BENEFITS" SEGMENT OF THE LINE 7 TABLE WERE CALCULATED USING A COMBINATION OF DIRECT COSTS AND OUR COST ACCOUNTING SYSTEM, WHICH TAKES INTO CONSIDERATION ALL PATIENT TYPES AND SEGMENTS. PART II: IN 2011, FISHER-TITUS'S COMMUNITY BUILDING ACTIVITIES AND BENEFITS PROVIDED $14.8 MILLION TO SUPPORT PROGRAMS THAT IMPACTED THE OVERALL HEALTH OF OUR COMMUNITIES AND THE QUALITY OF LIFE OF OUR RESIDENTS. WHILE HOSPITAL-BASED MEDICAL SERVICES ARE THE MOST OBVIOUS WAY WE HELP, FTMC FULFILLS THE HEALTH-CARE NEEDS OF OUR AREA WITH COMMUNITY HEALTH SCREENINGS, EDUCATION CLASSES, PATIENT ASSISTANCE PROGRAMS AND SUPPORT OF HEALTH-RELATED ACTIVITIES. FTMC EMPLOYEES SERVE ON COMMUNITY AND CIVIC BOARDS, HEALTH-ORIENTED ORGANIZATIONS AND ARE INVOLVED IN ECONOMIC DEVELOPMENT ACTIVITIES THROUGHOUT THE COUNTY. FTMC ALSO WORKS WITH SCHOOLS; WORK SITES AND SAFETY NET PROVIDERS TO PROMOTE HEALTH AND WELLNESS AND PREVENT DISEASE. FISHER-TITUS IS A LEADER IN ENVIRONMENTAL STEWARDSHIP, HAVING EARNED NUMEROUS STATE AND NATIONAL AWARDS. PART III, LINE 4: THE COSTING METHODOLOGY USED FOR COMPLETING THE SCHEDULE H PART III, LINE 2 WAS THE IRS WORKSHEET A "ESTIMATED BAD DEBT EXPENSE (AT COST)" IN THE INSTRUCTIONS. COST TO CHARGE RATIOS WERE CARRIED OVER FROM IRS WORKSHEET 2 "RATIO OF PATIENT CARE COSTS TO CHARGES" AS A BASIS TO ESTIMATE EXPENSE AND WAS APPLIED TO THE BAD DEBT EXPENSE RECORDED IN 2011. CHARITY IN BAD DEBT EXPENSE: PART III, LINE 3 AS A TAX-EXEMPT HOSPITAL, WE MUST PROVIDE NECESSARY MEDICAL CARE REGARDLESS OF THE PATIENT'S ABILITY TO PAY FOR THE SERVICES PROVIDED. AS A NOT-FOR-PROFIT, PATIENT CARE IS PROVIDED TO ALL, REGARDLESS OF THE PATIENT'S ABILITY TO PAY FOR CARE. MAKING QUALITY PATIENT CARE AVAILABLE TO ALL IN OUR COMMUNITY, REGARDLESS OF THEIR ECONOMIC MEANS, QUALIFIES BAD DEBTS AS COMMUNITY BENEFIT. THE IDENTIFICATION OF PATIENTS ELIGIBLE FOR CHARITY CARE IS SOLELY BASED ON THE COOPERATION OF THE PATIENT TO PROVIDE THE ORGANIZATION ENOUGH FAMILY AND FINANCIAL INFORMATION TO DETERMINE ELIGIBILTY TO MATCH OUR PROGRAMS. HISTORICALLY, IN ADDITION TO THE INTERNALLY IDENTIFIED CHARITY, 13-15% OF THE ACCOUNT BALANCES TURNED TO COLLECTION WERE SUBSEQUENTLY IDENTIFIED BY THE AGENCY AS CHARITY AND RETURNED. THIS CHARITY IS RECORDED ONLY WHEN IT HAS BEEN IDENTIFIED THROUGH VERIFICATION OF INABILITY TO PAY. WE DO BELIEVE THERE IS A SECOND, RELATIVELY EQUAL SEGMENT OF THE BAD DEBT THAT WOULD QUALIFY FOR CHARITY. PATIENTS WITH POOR CREDIT RATINGS AND MULTIPLE CREDITORS MAKING COLLECTION EFFORT FINDS LITTLE VALUE IN COMPLETING THE CHARITY APPLCIATION PROCESS TO ONLY ELIMINATE ONE CREDITOR AND HAVE NO IMPROVEMENT TO THEIR FINANCIAL STATUS.WE ESTIMATE THAT UNDER THE CURRENT ECONOMIC CONDITIONS UNIDENTIFIED CHARITY IN BAD DEBT EXPENSE IS ESTIMATED TO BE AN ADDITIONAL $1,548,797 OR 30% OF BAD DEBT. SINCE THIS CALCUALTION IS ON AN ACCRUAL BASIS, WE BELEIVE ESTIMATING 15% FOR CHARITY TO BE IDENTIFIED IN FUTURE YEARS AND AN ADDITIONAL 15% FOR BALANCES NEVER IDENTIFIED AS CHARITY IS A VERY CONSERVATIVE AND REASONABLE ESTIMATE OF THIS CHARITY CARE VALUE. FOOTNOTE "ALLOWANCES FOR UNCOLLECTIBLE ACCOUNTS": PART III, LINE 4 THE PROVISION FOR BAD DEBTS IS BASED UPON MANAGEMENT'S ASSESSMENT OF HISTORICAL AND EXPECTED NET COLLECTIONS CONSIDERING BUSINESS AND ECONOMIC CONDITIONS, TRENDS IN THE HEALTHCARE COVERAGE AND OTHER COLLECTION INDICATORS. PERIODICALLY THROUGHOUT THE YEAR, MANAGEMENT ASSESSES THE ADEQUACY OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS BASED UPON SPECIFIC ACCOUNTS, HISTORICAL WRITE OFF EXPERIENCE AND CURRENT MARKET CONDITIONS. THE RESULTS OF THIS REVIEW ARE THEN USED TO MAKE ANY MODIFICATIONS TO THE PROVISION FOR BAD DEBTS TO ESTABLISH THE MOST UP TO DATE APPROPRIATE ALLOWANCE FOR UNCOLLECTIBLE RECEIVABLES. PART III, LINE 8: FISHER-TITUS MEDICAL CENTER'S MEDICARE ALLOWABLE COSTS WERE CALCULATED USING A COST TO CHARGE RATIO EXTRACTED FROM THE MEDICARE COST REPORT DATA. THE MEDICAL CENTER BELIEVES THAT ALL OF THE $8.3 MILLION DOLLAR SHORTFALL SHOULD BE CONSIDERED AS COMMUNITY BENEFIT, BECAUSE OUR MISSION IS TO PROMOTE HEALTH IN THE COMMUNITY AND WE DO NOT LIMIT THE CARE AVAILABLE TO ANY PATIENTS, INCLUDING THOSE COVERED BY MEDICARE. THE IRS COMMUNITY BENEFIT STANDARD INCLUDES THE PROVISION OF CARE TO THE ELDERLY. THIS YEAR, MEDICARE ACCOUNTED FOR 44% OF HOSPITAL REVENUES AND THESE MEDICARE BENEFICIARIES WERE PROVIDED CARE IN SPITE OF THIS SHORTFALL. CARING FOR THE MEDICARE BENEFICIARIES RELIEVES THE FEDERAL GOVERNMENT OF THE BURDEN OF PAYING THE TRUE COST FOR THEIR CARE AS THESE PATIENTS TYPICALLY HAVE LOW AND/OR FIXED INCOMES. TAX EXEMPT HOSPITALS ARE ALSO EXPECTED TO PARTICIPATE IN THE MEDICARE PROGRAM. MEDICARE SHORTFALLS MUST BE ABSORBED BY THE MEDICAL CENTER IN ORDER TO CONTINUE TREATING THE ELDERLY IN OUR COMMUNITY. PART III, LINE 9B THE CHARITY POLICY IS A SUBSET OF THE OVERALL COLLLECTION POLICY. WHEN PATIENTS ARE IDENTIFIED AS QUALIFYING FOR ANY OF THE CHARITY CATEGORIES WE SEARCH ACCOUNTS RECEIVABLE AND ACCOUNTS PLACED WITH COLLECTION AGENCIES AND PACKAGE THEM WITH THE APPLICATION. IN ADDITION, CHARITY INFORMATION IS SHARED WITH OUR RELATED ORGANIZATIONS AND FORMS THE BASIS FOR THEIR CHARITY ADJUSTMENTS. IN ADDITION, WITH PATIENT APPROVAL, WE MAY CONTACT LOCAL PHYSICIAN PRACTICES WITH THE INFORMATION AS MANY WILL ADJUST THEIR BALANCES BASED UPON THE INFORMATION PROVIDED. FISHER-TITUS MEMORIAL HOSPITAL PART V, SECTION B, LINE 16E: AS PART OF ITS FINANCIAL ASSISTANCE POLICY, FISHER TITUS MEDICAL CENTER (THE HOSPITAL) MAKES A CONCERTED EFFORT TO DETERMINE IF AN INDIVIDUAL IS ELIGIBLE FOR FINANCIAL ASSISTANCE PRIOR TO PROCEEDING WITH COLLECTION ACTIVITIES BY THE HOSPITAL OR BY ENGAGING A THIRD PARTY. THESE EFFORTS INCLUDE NOTIFYING THE INDIVIDUAL OF THE FINANCIAL ASSISTANCE POLICY (FAP) ON ADMISSION, INCLUDING INFORMATION ABOUT THE FAP IN COMMUNICATIONS ABOUT THE INDIVIDUALS BILLS AND DOCUMENTING THE HOSPITALS DETERMINATION OF AN INDIVIDUALS ELIGIBILITY TO RECEIVE ASSISTANCE UNDER THE FAP. IF THE RESULT OF THESE EFFORTS IS UNSUCCESSFUL, THE HOSPITAL WILL PROCEED WITH COLLECTIONS ACTIVITY. THESE ACTIVITIES INCLUDE REPORTING THE INDIVIDUAL TO THE APPROPRIATE CREDIT AGENCY, LEGAL ACTIONS OR LIENS AS DEEMED NECESSARY. IF IT IS DETERMINED THAT AN INDIVIDUAL IS ELIGIBLE UNDER THE FAP SUBSEQUENT TO COLLECTION ACTIVITY BEGINNING, ALL COLLECTION ACTIVITY WILL CEASE. PART V, SECTION B 19(D) THE DISCOUNT RATE FOR SELF-PAY PATIENTS WAS SET TO MATCH THE RATE OF OUR TWO PREDOMINANT COMMERCIAL INSURANCE CONTRACTS WHICH MAKE UP 2/3RDS OF OUR POPULATION COVERED BY THIRD PARTY INSURANCE. PART V, SECTION B 20 & 21 FISHER TITUS MEDICAL CENTER INITIALLY CHARGES ALL CLASSES OF PATIENTS THE SAME GROSS CHARGE FOR ANY PARTICULAR SERVICE AND IS REFLECTED AS SUCH ON ALL INITIAL BILLS. AT THE TIME OF ADMISSION, FTMC ATTEMPTS TO COLLECT INFORMATION ON THE INTENDED MEANS OF PAYING FOR SERVICES INCLUDING DISTRIBUTING INFORMATION ON APPLYING FOR FINANCIAL ASSISTANCE, BUT DON'T RESTRICT ACCESS BASED ON WHETHER IT IS PROVIDED. PATIENTS WHO APPLY FOR FINANCIAL ASSISTANCE, EITHER AT THE TIME OF SERVICE OR AT SOME TIME AFTER SERVICES ARE PROVIDED, HAVE THEIR BILLS PUT ON A "HOLD" STATUS AS SOON AS PATIENTS MAKE ANY CONTACT WITH OUR FINANCIAL COUNSELING STAFF. UPON REVIEW AND APPROVAL OF APPLICATIONS AND ANY DISCUSSION WITH OUR FINANCIAL COUNSELORS GROSS CHARGES ARE THEN ADJUSTED ACCORDING TO FTMC CHARITY POLICY BEFORE ANY FURTHER BILLING PROCESSES ARE RESUMED. PART VI, LINE 3: PATIENTS ARE INTERVIEWED AFTER REGISTRATION TO ASSIST THEM IN DETERMINING EACH PATIENT'S ELIGIBILITY FOR FINANCIAL ASSISTANCE PROGRAMS AVAILABLE INTERNALLY AND EXTERNALLY. FTMC HAS BILINGUAL SIGNAGE POSTED IN THE ADMITTING/REGISTRATION AREAS, BILLING OFFICE AND FINANCIAL COUNSELING OFFICES, AND IN THE INPATIENT GUIDES IN ALL PATIENT ROOMS. THE FTMC WEBSITE HAS A SECTION ABOUT THE FINANCIAL ASSISTANCE PROGRAM AND CONTRACT INFORMATION. A MESSAGE ABOUT FINANCIAL ASSISTANCE AND CHARITY CARE ALSO IS INCLUDED ON THE BILLS THAT ARE SENT TO THE PATIENTS. MANY MATERIALS ARE BILINGUAL AND INTERPRETATION SERVICES ARE AVAILABLE. THE MEDICAL CENTER SUPPORTS AN OUTSIDE COUNSELOR DEDICATED TO HELPING PATIENTS BECOME QUALIFIED FOR MEDICAID OR OTHER GOVERNMENT PROGRAMS. THEY ALSO REFER PATIENTS WHO DON'T QUALIFY FOR THOSE PROGRAMS TO OUR FTMC FINANCIAL COUNSELORS FOR ASSISTANCE WITH H.C.A.P., FISHER-TITUS CHARITY AND FISHER-TITUS COMMUNITY ASSISTANCE PROGRAMS. OUR SOCIAL SERVICES DEPARTMENT REGULARLY REFERS PATIENTS IN NEED TO OUR FINANCIAL COUNSELORS FOR ASSISTANCE. WE ALSO TAKE REFERRALS FROM THE LOCAL COUNTY HUMAN SERVICES AGENCIES, VICTIMS OF VIOLENT CRIMES, LOCAL HEALTH DEPARTMENTS, LOCAL LAW ENFORCEMENT AGENCIES, CHURCHES, ETC. FTMC IS VERY PROACTIVE IN TAKING THE MESSAGE TO OUR COMMUNITY. BROCHURES ARE AVAILABLE AT COMMUNITY OUTREACH EVENTS HELD IN THE HOSPITAL AND AT OUTSIDE COMMUNITY EVENTS. FTMC COMMUNICATES THE INFORMATION ABOUT CHARITY CARE PROGRAMS THROUGH ITS COMMUNITY NEWSLETTER AND LOCAL NEWS MEDIA. PART VI, LINE 4: THE FISHER-TITUS MEDICAL CENTER PROVIDED SERVICES TO THE RESIDENTS OF HURON, ERIE, AND THE ADJACENT COUNTIES OF SANDUSKY, CRAWFORD, LORAIN, RICHLAND AND ASHLAND. THE PRIMARY AREA IS THE GREATER HURON COUNTY AREA IN NORTH CENTRAL OHIO, WHICH IS HOME TO OVER 62,000 RESIDENTS. FTMC'S 50 ACRE CAMPUS IS IN THE COUNTY SEAT OF NORWALK, WHICH IS THE LARGEST CITY IN THE COUNTY WITH OVER 17,000 RESIDENTS. FTMC HAS NUMEROUS MEDICAL OFFICES THROUGHOUT THE COUNTY IN SMALLER CITIES TO PROVIDE EASIER ACCESS TO PHYSICIANS FOR COMMUNITY MEMBERS. THE COUNTY IS HOME TO SEVERAL LARGE MANUFACTURERS WHO HAVE EXPERIENCED MAJOR JOB LOSSES OVER THE PAST 10 YEARS. HURON COUNTY HAD THE TENTH HIGHEST UNEMPLOYMENT RATE IN OHIO IN 2011 WITH AN ANNUAL AVERAGE OF 11.7%. THE LARGEST PERCENTAGE OF RESIDENTS IS 65 AND OLDER. 92% OF THE RESIDENTS ARE CAUCASIAN WITH A GROWING HISPANIC POPULATION OF 5.6%. THE MEDIAN HOUSEHOLD INCOME IN 2010 WAS $45,542 WITH 12.9% OF THE FAMILIES LIVING BELOW THE POVERTY LEVEL AND 26.3% LIVING BELOW 200% OF THE POVERTY RATE. THE OVERALL TRENDS INDICATE A DECLINE IN EMPLOYMENT-BASED MEDICAL INSURANCE AND INCREASING UNINSURED AND RELIANCE ON GOVERNMENT PROGRAMS. PART VI, LINE 5: THE BOARD OF DIRECTORS IS COMPOSED OF AREA RESIDENTS INCLUDING BUSINESS AND COMMUNITY LEADERS, PHYSICIANS AND OTHER INTERESTED PERSONS. THESE VOLUNTEERS GIVE COUNTLESS HOURS OF SERVICE TO THE MEDICAL CENTER IN THEIR OVERSIGHT ROLE. THEY ARE INVOLVED IN THE COMMUNITY NEEDS ASSESSMENT PROCESS, IN FUNDRAISING, AND IN GENERAL STEWARDHSIP. FTMC'S MEDICAL STAFF IS OPEN AND PRIVILEGES ARE GRANTED TO ALL QUALIFIED PHYSICIANS WHO APPLY AND MEET THE STANDARDS OF THE MEDICAL CENTER PRIVILEGING PROCESS. THE MEDICAL CENTER UTILIZES SURPLUS FUNDS TO MAINTAIN ACCESS TO PATIENT SERVICES AND TO EXPAND ACCESS POINTS OF CARE TO PATIENTS THROUGHOUT THE COMMUNITY INCLUDING, BUT NOT LIMITED TO THE FOLLOWING:1. EDUCATIONAL PROGRAMS THAT PROVIDE CLASSES AND INFORMATION ON TOBACCO CESSATION, HEALTHY AGINING, CHILDBIRTH, INFANT CARE, EARLY PREGNANCY AND MORE2. FREE BLOOD PRESSURE AND DIABETES SCREENINGS, AND MAMMOGRAMS TO QUALIFYING INDIVIDUALS, FREE OR LOW-COST SCREENINGS FOR BREAST, PROSTATE, SKIN AND COLORECTAL CANCERS ANS WELL AS OSTEOPOROSIS ASSESSMENTS. PART VI LINE 2 FISHER-TITUS SPONSORED AND COLLABORATED WITH THE HURON COUNTY HEALTH DEPARTMENT AND OTHER HEALTH-RELATED ORGANIZATIONS (CALLED HURON COUNTY HEALTH PARTNERS) TO DEVELOP AND FUND THE HURON COUNTY NEEDS ASSESSMENT IN 2011. THE HURON COUNTY HEALTH PARTNERS AND FISHER-TITUS USED THE RESULTS TO ADDRESS AND MONITOR HEALTH PRIORITIES IN THE COUNTY. FTMC ALSO USES THIS INFORMATION TO ADD AND EXPAND SERVICES AND TO RECRUIT PHYSICIANS TO MEET THE THEN IDENTIFIED MEDICAL NEEDS OF OUR COMMUNITY. FROM THESE PRIORITIES, FTMC HAS DEVELOPED NUMEROUS PROGRAMS TARGETING THE HURON COUNTY'S HIGH RATE OF OBESITY, DIABETES AND CARDIOVASCULAR ISSUES. PROGRAMS INCLUDE DIABETES SCREENINGS AT HISPANIC HEALTH FAIRS AND AT SALVATION ARMY SOUP KITCHENS, NUTRITION AND FITNESS FOR SCHOOL CHILDREN AND A COUNTY-WIDE WALKING PROGRAM IN PARTNERSHIP WITH THE AMERICAN HEART ASSOCIATION AND LOCAL BUSINESS. 1 SERVICES FOR AGING INC 130 SHADY LANE DR NORWALK OH 44857 341108780 501(C)(3) 12500 HELP ASSIST SENIORS IN THE LOCAL COMMUNITY IN GETTING LOW-COST HEALTHCARE SERVICES. HURON COUNTY HEALTH DEPARTMENT 180 MILAN AVE NORWALK OH 44857 10000 DONATION FOR THE HURON COUNTY HEALTH DEPARTMENT CLINIC AND SERVICES NORWALK AREA UNITED FUND 10 WEST MAIN ST NORWALK OH 44857 340906312 501(C)(3) 20000 CONTRIBUTE TO THE UNITED WAY PACESETTER CAMPAIGN TO HELP THE LOCAL COMMUNITY NORWALK ECONOMIC DEVELOPMENT CORP 10 1/2 WEST MAIN STREET NORWALK OH 44857 341787391 501(C)(3) 10000 CONTRIBUTION TO THE NORWALK ECONOMIC DEVELOPMENT CORP TO HELP THE LOCAL COMMUNITY SHELBY CHRISTIAN & MISSIONARY ALLIANCE CHURCH 105 E SMILEY AVENUE SHELBY OH 44875 341354574 501(C)(3) 29982 FMV MISCELLANEOUS OPERATING ROOM MEDICAL SUPPLIES DONATED MISCELLANEOUS SUPPLIES TO CHURCH MISSION PROGRAM SHELBY CHRISTIAN & MISSIONARY ALLIANCE CHURCH 105 E SMILEY AVENUE SHELBY OH 44875 341354574 501(C)(3) 34158 FMV MISCELLANEOUS CATH LAB MEDICAL SUPPLIES DONATED MISCELLANEOUS SUPPLIES TO CHURCH MISSION PROGRAM HURON COUNTY HEALTH DEPARTMENT 180 MILAN AVE NORWALK OH 44857 10500 HELP WITH COUNTY WIDE 2011 HEALTH ASSESMENT CITY OF NORWALK 100 REPUBLIC STREET NORWALK OH 44857 9000 DONATION TO NORWALK PARKS AND RECREATION DEPARTMENT FOR "GET ACTIVE" PROGRAM MERCY HEALTH FOUNDATION JOPLIN 3016 MCCLELLAN BLVD JOPLIN MO 64804 501(C)(3) 25652 CONTRIBUTE TO ST JOHNS REGIONAL MEDICAL CENTER FOR RELIEF EFFORTS DUE TO TORNADO IN JOPLIN, MO 5 2 PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, PART I, LINE 2: THE MEDICAL CENTER REVIEWS EACH GRANT OR DONATION REQUEST BEFORE IT IS MADE. X X X X X X 0 1 0 0 0 0 0 0 0 PATRICK J MARTIN 474001 0 139571 0 5315 0 444538 0 18404 0 1081829 0 0 0 MARGARET BAIRD 210835 0 49692 0 264110 0 159060 0 12835 0 696532 0 260064 0 DUANE WOODS 176422 0 27758 0 397 0 8250 0 14493 0 227320 0 0 0 LORNA STRAYER 152448 0 15931 0 531 0 51565 0 25605 0 246080 0 0 0 CHERIE M SPRAGG 165000 0 6712 0 11042 0 80448 0 8871 0 272073 0 0 0 JOHN BRITTON 152101 0 24440 0 192 0 12827 0 0 0 189560 0 0 0 PHILLIP J ANNARINO 143704 0 20452 0 898 0 4263 0 16184 0 185501 0 0 0 JOHN K HUGHES 200994 0 7136 0 1402 0 8250 0 23157 0 240939 0 0 0 GEORGE B ELMER 146513 0 21572 0 496 0 5230 0 22605 0 196416 0 0 0 CHRISTINA CANFIELD 144570 0 22111 0 1040 0 2894 0 13180 0 183795 0 0 0 JOSEPH E CENTA 224432 0 2500 0 31802 0 7596 0 20157 0 286487 0 0 0 KATHLEEN A MEEHAN - DE LA CRUZ 191701 0 2500 0 3625 0 8250 0 21923 0 227999 0 0 0 SUPPLEMENTAL INFORMATION PART III PART 1 LINE 4B - INCLUDED IN MR. MARTIN'S TOTAL CONTRIBUTIONS TO DEFERRED COMPENSATION OF $444,538 IS $144,236 OF VESTED DEFERRED WAGES AND QUALIFIED RETIREMENT PLAN CONTRIBUTIONS AND $300,302 FOR THE CURRENT YEAR ACCRUAL OF A NON-VESTED, NON-QUALIFIED RETIREMENT PLAN. THIS PLAN PROVIDES AN ADDITIONAL RETIREMENT BENEFIT BASED ON YEARS OF ELIGIBLE SERVICE AND VESTED STATUS AND REMAINS SUBJECT TO A SUBSTANTIAL RISK OF FORFEITURE. SUPPLEMENTAL INFORMATION PART III PART II LINE 1 - INCLUDED IN PATRICK MARTIN'S TOTAL W-2 COMPENSATION OF $618,887 IS $192,259 WHICH REPRESENTS THE PORTION OF MR. MARTIN'S SALARY ALLOCABLE TO THE NORWALK MEMORIAL HOME, A DIVISION OF FISHER-TITUS MEDICAL CENTER. SUPPLEMENTAL INFORMATION PART III PART 1 LINE 4B & PART II, LINE 2 - INCLUDED IN MARGARET BAIRD'S TOTAL W-2 COMPENSATION OF $264,110 IS $260,064 WHICH REPRESENTS THE CURRENT YEAR PAYMENT OF DEFERRED COMPENSATION FROM A NON-QUALIFIED RETIREMENT PLAN WHICH WAS DEFERRED ON PRIOR FORM 990'S. MARGARET BAIRD RETIRED AS OUR EXCEUTIVE VICE PRESIDENT ON SEPTEMBER 30, 2011. INCLUDED IN HER TOTAL W-2 COMPENSATION OF $524,637 IS $68,084 WHICH REPRESENTS THE PORTION OF MS. BAIRD'S SALARY ALLOCABLE TO THE NORWALK MEMORIAL HOME, A DIVISION OF FISHER-TITUS MEDICAL CENTER. INCLUDED IN THE TOTAL CONTRIBUTION TO DEFERRED COMPENSATION OF $159,060 IN COLUMN C IS $159,060 OF VESTED DEFERRED WAGES AND NON QUALIFIED RETIREMENT PLAN CONTRIBUTIONS. SUPPLEMENTAL INFORMATION PART III PART II LINE 3 - INCLUDED IN DUANE WOOD'S TOTAL W-2 COMPENSATION OF $204,577 IS $31,934 WHICH REPRESENTS THE PORTION OF MR. WOOD'S SALARY ALLOCABLE TO THE NORWALK MEMORIAL HOME, A DIVISION OF FISHER-TITUS MEDICAL CENTER. SUPPLEMENTAL INFORMATION PART III PART I LINE 4B - ON DECEMBER 21, 2011 THE BOARD APPROVED A NEW SERP, NON-VEST, NON-QUALIFIED RETIREMENT PLAN FOR DUANE WOODS AND PHILLIP ANNARINO AND THAT THE RETIREMENT PLAN WOULD BE RETROACTIVE BACK TO JAN-01-2011. HOWEVER NO AMOUNT WAS ACCRUED FOR 2011 FOR THIS RETIREMENT BENEFIT. SUPPLEMENTAL INFORMATION PART III PART 1, LINE 3 - RESPONSIBILITY FOR DETERMINING AND RECOMMENDING EXECUTIVE COMPENSATION RESTS WITH THE JOINT PERSONNEL COMMITTEE OF THE FISHER-TITUS MEDICAL CENTER AND NORWALK AREA HEALTH SYSTEMS, INC. BOARDS. THE COMMITTEE RETAINS AN INDEPENDENT EXECUTIVE COMPENSATION CONSULTANT TO HELP ESTABLISH CASH COMPENSATION TARGET RANGES AND IDENTIFY REASONABLE AND CUSTOMARY BENEFIT PROGRAMS FOR EXECUTIVES. THE INDEPENDANT CONSULTANT REPORTS TO THE JOINT PERSONNEL COMMITTEE ON RELEVANT PEER GROUPS, CASH COMPENSATION REPORTED IN AVAILABLE SALARY SURVEYS FOR THE PEER GROUP, AND TRENDS IN BENEFITS AND PERQUISITE PROGRAMS CUSTOMARILY AVAILABLE AMONG THE PEER GROUP FOR EXECUTIVES. RECOMMENDATIONS BY THE CONSULTANT ARE PRESENTED TO THE JOINT PERSONNEL COMMITTEE WHICH PREPARES MINUTES OF ITS DELIBERATIONS REGARDING EXECUTIVE COMPENSATION INCLUDING RECOMMENDATIONS THAT ARE PROVIDED TO EACH OF THE DIRECTORS OF FTMC AND NAHS. THE RECOMMENDATIONS TO BE ACTED ON MUST BE APPROVED FIRST BY THE JOINT PERSONNEL COMMITTEE AND THEN BY THE MEDICAL CENTER'S BOARD OF DIRECTORS BEFORE FINALLY BEING CONSIDERED BY THE SYSTEM'S BOARD OF DIRECTORS. THE MINUTES OF EACH BOARD MEETING WHERE ACTION IS TAKEN REFLECT SUCH ACTION. THE PROCESS IS PERFORMED ANNUALLY IN THE SPRING AND WAS LAST DONE IN MAY 2011. COUNTY OF HURON OHIO 346400672 447540CC7 2007-06-28 28622597 SEE PART V BELOW 0 0 0 COUNTY OF HURON OHIO 346400672 447540BN4 2003-01-08 30000000 SEE PART V BELOW 0 0 0 28838308 564200 7215711 21058397 2008 1 0 1 1 30714144 524983 263425 27308799 2616937 2005 1 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 PART I, LINE A SERIES 2007A BONDS - PURPOSE WAS TO ACQUIRE, CONSTRUCT AND INSTALL A VASCULAR HEART ADDITION TO THE HOSPITAL'S MAIN CAMPUS AS WELL AS SUPPORT SERVICES AND THE RENOVATION OF THE EXISTING EMERGENCY ROOM. PART I, LINE B SERIES 2003A BONDS - PURPOSE WAS TO ACQUIRE, CONSTRUCT AND INSTALL MULTI-STORY ADDITION TO THE HOSPITAL'S MAIN CAMPUS DEVOTED TO INPATIENT SERVICES AS WELL AS SUPPORT SERVICES AND THE RENOVATION OF SEVERAL AREAS OF THE EXISTING FACILITY. PART II, COLUMN A, LINE 3 INCLUDED IN THE TOTAL PROCEEDS OF $28,838,308 IS INVESTMENT EARNINGS OF $215,711. PART II, COLUMN A, LINE 11 $21,058,397 OF THE PROCEEDS WERE USED TO REFUND THE HOSPITAL'S COUNTY OF HURON REVENUE BONDS, SERIES 1996B AND A PORTION OF THE SERIES 2003A BONDS PART II, COLUMN B, LINE 3 INCLUDED IN THE TOTAL PROCEEDS OF $30,714,144 IS INVESTMENT EARNINGS OF $714,144. PART II, COLUMN B, LINE 11 $2,616,937 OF THE PROCEEDS WERE USED TO REFUND THE HOSPITAL'S COUNTY OF HURON REVENUE BONDS, SERIES 1995A BONDS. CHRISTINA CANFIELD PRIVATE PRACTICE OPERATING LOANS X 373304 245321 0 1 1 245321 MRS JOHN BRITTON SPOUSE OF KEY EMPLOYEE 52075 EMPLOYEMENT 0 BAYLESS PATHMARK SEE PART V 130000 INDEPENDENT CONTRACTOR 0 BLEILE ENTERPRISE SEE PART V 134066 VENDOR TRANSACTION 0 PART II LINE 1 PURPOSE OF LOAN: PRIVATE PRACTICE OPERATING LOANS BEFORE PRACTICEACQUISTION. BEGINNING IN 1998 AND CONTINUING THROUGH 2005, FISHER-TITUS MEDICAL CENTER ADVANCED FUNDS TO DR. CHRISTINA CANFIELD AND IN THREE INSTANCES, TO DR. CANFIELD AND HER PROFESSIONAL CORPORATION, "WAKEMAN AREA FAMILY CARE CENTER, INC." (THE CORPORATION). THE CORPORATION IS AN OHIO PROFESSIONAL CORPORATION THAT WAS FORMED IN 1998. DR. CANFIELD IS THE SOLE SHAREHOLDER. THE FUNDS WERE PRIMARILY ADVANCED UNDER INTEREST BEARING LINES OF CREDIT TO FACILITATE DR. CANFIELD'S INITIAL ESTABLISHMENT AND CONTINUATION OF A FAMILY MEDICAL PRACTICE IN WAKEMAN, OH. WAKEMAN, OHIO IS WITHIN THE SERVICE AREA OF FISHER-TITUS MEDICAL CENTER AND IS AN UNDERSERVED AREA, WITH NO OTHER PROVIDERS AND A HIGHER PROPORTION OF UNINSURED. THE ADVANCES ALSO WERE INTENDED TO ASSIST DR. CANFIELD'S PRACTICE WITH OPERATIONAL EXPENSES INCLUDING TRANSITION FROM A THIRD-PARTY BILLING SERVICE TO AN IN-HOUSE BILLING AND COLLECTION OPERATION AND EXPENSES ASSOCIATED WITH ATTEMPTS TO ADD ADDITIONAL PHYSICIANS TO THE MEDICAL PRACTICE. THE MEDICAL CENTER PROVIDED THE ADVANCES UNDER THE LINES OF CREDIT TO ENHANCE THE ABILITY OF DR. CANFIELD AND HER CORPORATION TO PROVIDE QUALITY MEDICAL SERVICES TO RESIDENTS OF WAKEMAN, OHIO. PRIOR TO THE OPENING, DR. CANFIELD'S PRACTICE, RESIDENTS OF WAKEMAN NEEDING MEDICAL CARE WERE REQUIRED TO TRAVEL 10-15 MILES TO OTHER COMMUNITIES TO RECEIVE CARE AS THERE WERE NO PHYSICIANS IN THE WAKEMAN COMMUNITY. THE ADVANCES WERE NECESSARY TO IMPROVE THE QUALITY OF HEALTH CARE IN THE WAKEMAN AREA AND PROVIDE ACCESS TO NEEDED HEALTH SERVICES, BOTH BEING CONSISTENT WITH THE MEDICAL CENTER'S EXEMPT PURPOSE OF PROVIDING MEDICAL CARE AND PROMOTING HEALTH IN ITS SERVICE AREA. SUBSEQUENT TO THE LINE OF CREDIT ADVANCES, DR. CANFIELD AND HER CORPORATION SOLD THE CORPORATION'S ASSETS AND ACCOUNTS RECEIVABLE TO FTMC MEDICAL CARE, LLC. FTMC MEDICAL CARE, LLC IS AN OHIO LIMITED LIABILITY COMPANY. FISHER-TITUS MEDICAL CENTER IS THE SOLE MEMBER OF THE LLC. THE PURCHASE PRICE OF THE ASSETS WAS BASED ON AN INDEPENDENT APPRAISAL. THE ASSET PURCHASE AGREEMENT PROVIDED THAT AFTER PAYMENT OF TRADE PAYABLES OF THE PRACTICE, THE PURCHASE PRICE WOULD BE USED TO PAY OFF THE CORPORATION'S OBLIGATIONS ON THE LINES OF CREDIT, AND TO THE EXTENT PURCHASE PRICE PROCEEDS WERE STILL AVAILABLE, WOULD BE DISTRIBUTED TO DR. CANFIELD WHO WAS REQUIRED TO USE THEM TO PAY BALANCES STILL OUTSTANDING ON LINES OF CREDIT ON WHICH SHE WAS PERSONALLY OBLIGATED. DR. CANFIELD SIMULTANEOULY BECAME AN EMPLOYEE OF THE LLC. PART IV, LINE 2 RELATIONSHIP BETWEEN INTERESTED PERSON AND ORGANIZATION: DIRECTOR WILLAIM CORNELL, MD IS A PARTNER OF BAYLESS PATHMARK. PART IV, LINE 3 RELATIONSHIP BETWEEN INTERESTED PERSON AND ORGANIZATION: DIRECTOR THOMAS BLEILE IS A FAMILY MEMBER OF THE INDIVIDUAL WHO OWNS BLEILE ENTERPRISE. X 1 4940 FAIR MARKET VALUE X 1 38182 FAIR MARKET VALUE 0 1 0 MISSION STATEMENT PART I, LINE 1 PROVIDE QUALITY HEALTHCARE IN A COST EFFECTIVE MANNER WHILE RESPECTING THE DIGNITY AND UNIQUENESS OF EACH INDIVIDUAL WE SERVE. STATEMENT OF PROGRAM SERVICE ACCOMPLISHMENTS PART III, LINE 4A/4B FISHER-TITUS MEDICAL CENTER (FTMC) IS AN INDEPENDENT NON-PROFIT COMMUNITY HEALTHCARE ORGANIZATION GOVERNED BY A BOARD OF DIRECTORS COMPOSED OF AREA RESIDENTS INCLUDING BUSINESS AND COMMUNITY LEADERS, PHYSICIANS AND OTHER INTERESTED INDIVIDUALS. FTMC IS COMPOSED OF THE FOLLOWING FOUR OPERATING DIVISIONS: FISHER-TITUS MEMORIAL HOSPITAL THE HOSPITAL PROVIDES INPATIENT AND OUTPATIENT HEALTHCARE SERVICES TO THE RESIDENTS OF HURON, ERIE AND THE ADJACENT COUNTIES OF SANDUSKY, CRAWFORD, LORAIN, ASHLAND AND RICHLAND. IN 2011, THE HOSPITAL PROVIDED 15,671 DAYS OF INPATIENT CARE TO 4,169 PATIENTS. THE HOSPITAL ALSO PROVIDED 90,925 PATIENTS WITH 132,277 OUTPATIENT VISITS, AND THERE WERE 26,779 EMERGENCY ROOM VISITS DURING THE YEAR. THE NORWALK MEMORIAL HOME THE NORWALK MEMORIAL HOME PROVIDES SKILLED AND LONG-TERM CARE IN ITS TRANSITIONAL AND EXTENDED CARE UNITS. DURING 2011, THE HOME SERVED 377 RESIDENTS AND PROVIDED 24,000 DAYS OF CARE. THE HOME HEALTH CENTER HOME HEALTH AGENCY THE HOME HEALTH CENTER PROVIDED 13,352 HOME VISITS TO 487 DIFFERENT PATIENTS IN 2011. THE CARRIAGE HOUSE OF FISHER-TITUS OPENED IN 1998, THE CARRIAGE HOUSE IS A 48-UNIT ASSISTED LIVING FACILITY, WHICH PROVIDED 17,018 DAYS OF ASSISTED LIVING CARE TO 63 RESIDENTS IN 2011. PROGRAM EXPANSIONS, IMPROVEMENTS, AND ACCREDITATIONS AMERICAS FIRST ALL-DIGITAL SMART HOSPITAL: IN APRIL 2011, FISHER-TITUS CELEBRATED ITS ONE-YEAR ANNIVERSARY AS THE NATIONS FIRST ALL-DIGITAL SMART COMMUNITY HOSPITAL RECOGNIZING THE AMAZING ACCOMPLISHMENT OF MEDICAL CENTER PHYSICIANS, CAREGIVERS AND EMPLOYEES IN PARTNERSHIP WITH LEADING INTERNATIONAL HEALTH-CARE TECHNOLOGY COMPANY CERNER CORPORATION FOR DESIGNING AND IMPLEMENTING THE SYSTEM. OVER THE PAST YEAR, OUR PATIENTS HAVE BEEN AMONG THE FIRST TO EXPERIENCE THIS PATIENT-FOCUSED TECHNOLOGY AIMED AT PROVIDING THE HIGHEST QUALITY AND SAFEST CARE POSSIBLE THROUGH A FULLY INTEGRATED ELECTRONIC HEALTH RECORD SYSTEM AND INTERACTIVE TECHNOLOGY IN SMART HOSPITAL ROOMS. FISHER-TITUS IS NOW AMONG JUST 5% OF HOSPITALS IN THE NATION FOR THIS LEVEL OF MEDICAL TECHNOLOGY BRINGING US TO AN EVEN GREATER LEVEL OF CLINICAL QUALITY, PATIENT SAFETY, AND COORDINATION OF CARE. AS A CERNER SHOWCASE SITE, FISHER-TITUS HAS HOSTED HOSPITALS FROM ALL OVER THE WORLD INCLUDING THE CLEVELAND CLINIC, THE VETERANS ADMINISTRATION, AND BRAZILS HOSPITAL ALBERT EINSTEIN TO SEE THIS STATE-OF-THE-ART TECHNOLOGY IN ACTION. ELECTRONIC MEDICAL RECORDS FISHER TITUS MEDICAL CENTER ACHIEVED THE HEALTH INFORMATION AND MANAGEMENT SYSTEMS SOCIETY, HIMSS LEVEL 6 (THE HIGHEST LEVEL BEING LEVEL 7) FOR ELECTRONIC MEDICAL RECORD (EMR) ADOPTION. FTMC IS AMONG 5% OF HOSPITALS THAT HAVE ACHIEVED THIS LEVEL OF TECHNOLOGY TOWARD A PAPERLESS PATIENT RECORD ENVIRONMENT BRINGING US TO AN EVEN GREATER LEVEL OF SAFE AND HIGH-QUALITY PATIENT-FOCUSED CARE. FACILITY AND PROGRAM EXPANSIONS NEW EMERGENCY DEPARTMENT / REGISTRATION-ADMITTING / AND OUTPATIENT LABORATORY SERVICES RESIDENTS IN MAY 2011, FISHER-TITUS BROKE GROUND ON A $12.5 MILLION FACILITY THAT NOW HOUSES THE MEDICAL CENTERS EMERGENCY DEPARTMENT, REGISTRATION/ADMITTING AREAS, AND OUTPATIENT LABORATORY SERVICES. THIS EXPANSION, WHICH OPENED IN MAY 2012, ALLOWED FISHER-TITUS MEDICAL CENTER TO RE-ENGINEER THE ER PATIENT PROCESSFROM ADMISSION AND REGISTRATION TO THE DELIVERY OF CARETO ENSURE THE BEST OUTCOMES AND THE BEST OVERALL EXPERIENCE FOR PATIENTS AND THEIR FAMILIES. IN 2011, THE PAIN MANAGEMENT CENTER EXPANDED SERVICES WITH NEW PHYSICIAN OFFICE LOCATIONS AT NORTHERN OHIO MEDICAL SPECIALISTS IN SANDUSKY AND IN ASHLAND IN COOPERATION WITH SAMARITAN REGIONS HEALTH SYSTEM. THE PAIN MANAGEMENT TEAM OF INTERVENTIONAL PAIN SPECIALISTS DR. ADAM HEDAYA AND DR. ZACH ZUMBAR SEE PATIENTS AT THOSE LOCATIONS AND PERFORM INTERVENTIONAL PROCEDURES AT THE STATE-OF-THE-ART PAIN MANAGEMENT CENTER AT FISHER-TITUS. PHYSICIAN ASSISTANT PAM SNYDER ALSO JOINED THE PAIN MANAGEMENT CENTER TEAM OF PROVIDERS. EDUCATION AND RESEARCH - TO ENSURE THAT WE HAVE THE QUALITY WORKFORCE WE NEED TO CARE FOR OUR COMMUNITY IN THE FUTURE, WE ARE COMMITTED TO THE EDUCATION OF CURRENT AND FUTURE CAREGIVERS, AND WE WORK WITH EHOVE CAREER CENTER, FIRELANDS BOWLING GREEN STATE UNIVERSITY CAMPUS, LORAIN COUNTY COMMUNITY COLLEGE, NORTH CENTRAL STATE COLLEGE, TERRA COMMUNITY COLLEGE, THE OHIO STATE UNIVERSITY, AND OHIO UNIVERSITY TO PROVIDE INTERNSHIPS, INSTRUCTORS, CLASSROOM SPACE, AND CLINICAL TRAINING. WE ARE PLEASED TO BE ABLE TO OFFER A COMPREHENSIVE LEARNING EXPERIENCE UTILIZING OUR STATE-OF-THE-ART FACILITIES AND ADVANCED TECHNOLOGY. FTMC OFFERS FINANCIAL ASSISTANCE TO COMMUNITY MEMBERS AND MEDICAL CENTER EMPLOYEES TO PURSUE TRAINING IN MEDICAL SHORTAGE AREAS, SUCH AS REGISTERED NURSING, RESPIRATORY THERAPY, RADIOLOGY TECHNOLOGISTS, REHABILITATION SPECIALISTS AND LABORATORY TECHNICIANS. AWARDS AND ACCREDITATIONS - THROUGHOUT THE YEARS, FTMC HAS BEEN HIGHLY SUCCESSFUL IN MEETING THE CHALLENGES OF AN INCREASINGLY COMPLEX HEALTH-CARE INDUSTRY AND HAS PROVIDED EXCEPTIONAL SERVICE QUALITY TO MEMBERS OF THE SURROUNDING COMMUNITIES. FTMC IS ONE OF LESS THAN 2% OF HOSPITALS IN THE NATION DUALLY ACCREDITED BY THE JOINT COMMISSION (TJC) AND THE HEALTHCARE FACILITIES ACCREDITATION PROGRAM (HFAP). IN 2011 WE BECAME THE COUNTYS FIRST FULLY-ACCREDITED CHEST PAIN CENTER AND CERTIFIED AS A HFAP PRIMARY STROKE CENTER. THESE ACCREDITATIONS, ALONG WITH OUR STATUS AS A LEVEL 3 TRAUMA CENTER PROVIDE OUR COMMUNITY MEMBERS THE ASSURANCE THAT THEY WILL RECEIVE THE HIGHEST QUALITY OF CARE AT FISHER-TITUS IN AN EMERGENCY AS WELL AS FOLLOW-UP CARE. OUR CANCER CARE CENTER EARNED A THREE-YEAR ACCREDITATION WITH COMMENDATION BY THE COMMISSION ON CANCER OF THE AMERICAN COLLEGE OF SURGEONS. OUR CANCER PROGRAM HAS BEEN ACCREDITED SINCE 1989. THE MEDICAL CENTERS FOCUS ON QUALITY CARE AND EXCEPTIONAL SERVICE IS EVIDENCED BY THE MANY DEPARTMENTAL ACCREDITATIONS AND AWARDS AND RECOGNITIONS RECEIVED BY THE MEDICAL CENTER IN 2011: -MAMMOGRAPHY ANNUAL QUALITY INSPECTION -AMERICAN COLLEGE OF RADIOLOGY ACCREDITATION IN DIGITAL MAMMOGRAPHY -AMERICAN ASSOCIATION OF RESPIRATORY CARE, QUALITY RESPIRATORY CARE AWARD -AMERICAN COLLEGE OF SURGEONS COMMISSION ON CANCER ACCREDITATION WITH COMMENDATIONS -LABORATORY SERVICES CAP ACCREDITATION -BLOOD GAS LABORATORY CAP ACCREDITATION -NUCLEAR MEDICINE AMERICAN COLLEGE OF RADIOLOGY ACCREDITATION -INTERSOCIETAL COMMISSION FOR ACCREDITATION OF VASCULAR LABORATORIES -OHIO HOSPITAL ASSOCIATION SAFETY AWARD -MELVIN CREELEY ENVIRONMENTAL LEADERSHIP AWARD FTMC EMPLOYS 950 AREA RESIDENTS AND IS THE SECOND LARGEST EMPLOYER IN HURON COUNTY AND IS PROUD TO HAVE BEEN NAMED AMONG THE TOP 100 BEST PLACES TO WORK IN HEALTHCARE BY MODERN HEALTHCARE MAGAZINE THREE OF THE FOUR PAST YEARS. FISHER-TITUS ALSO IS A AMERICAN HEART ASSOCIATION FIT-FRIENDLY FACILITY WITH PLATINUM-LEVEL STATUS RECOGNITION FOR ITS COMMITMENT TO PROVIDE VALUE-ADDED BENEFITS TO IMPACT THE OVERALL HEALTH AND FITNESS OF ITS EMPLOYEES INCLUDING WEIGHT WATCHERS, A FULLY OUTFITTED EMPLOYEE FITNESS CENTER, SMOKING CESSATION PROGRAMMING AND WALKING PROGRAMS. EXCELLENT PHYSICIANS: FISHER-TITUS IS COMMITTED TO RECRUITING PHYSICIANS TO SERVE THE UNIQUE HEALTH-CARE NEEDS OF OUR COMMUNITY MEMBERS. IN 2011, WE WELCOMED THESE NEW PHYSICIANS TO OUR MEDICAL STAFF: RICHARD COLE, DO, FAMILY PRACTICE; TARA KERSEY-BARRETT, DO, FAMILY PRACTICE; JAMES MARCH JR., DO, ANESTHESIOLOGY; GARY MOORMAN, DO, EMERGENCY MEDICINE AND ADMINISTRATION; JAMES PRESTON, DO, FAMILY PRACTICE & PALLIATIVE CARE; AMY WILBER, DO, OBSTETRICS/GYNECOLOGY; JONATHAN ZAHLER, DO, OPHTHALMOLOGY; AND ZACHARY ZUMBAR, MD, PAIN MANAGEMENT. NEW MEMBERS TO THE FISHER-TITUS HOSPITALISTS TEAM, INTERNAL MEDICINE PHYSICIANS WHO SERVE PATIENTS IN THE HOSPITALS, INCLUDED ALAA ALAHMAD, MD; MICHAEL JOURDEN, MD; RONOBIR MALLICK, DO, MS; MBANEFO OJUKWU, MD; AND BASHAR SALEM, MD. PART III, LINE 4A/4B CONTINUED COMMUNITY HEALTH AND OUTREACH PROGRAMS FTMC COMMUNITY BENEFITS EXTEND OUTSIDE OUR WALLS TO FAMILIES, BUSINESS, SCHOOLS, CHURCHES AND NEIGHBORHOODS THROUGH OUTREACH PROGRAMS AND OTHER COORDINATED CARE ACTIVITIES THAT MAKE OUR COMMUNITIES HEALTHIER PLACES TO LIVE, WORK AND WORSHIP. FISHER-TITUS HAS PROVIDED LEADERSHIP AND FUNDING FOR THE HURON COUNTY HEALTH ASSESSMENT AND IN 2011 A NEW HEALTH ASSESSMENT WAS PUBLISHED AND DISTRIBUTED. THE ASSESSMENT'S FINDINGS PROVIDE FISHER-TITUS THE FOUNDATION TO DEVELOP PROGRAMS AND WORK IN PARTNERSHIP WITH OUR PHYSICIANS, RESIDENTS AND COMMUNITY LEADERS, AS WELL AS CIVIC, SOCIAL AND MEDICAL ORGANIZATIONS TO ADDRESS THESE HEALTH NEEDS AND PROVIDE HIGH-QUALITY CARE FOR OUR RESIDENTS. THE 2011 FINDINGS SOLIDIFIED THE TREND OF HEART DISEASE, DIABETES, OBESITY AND TOBACCO-USE AS LEADING HEALTH ISSUES IN HURON COUNTY. THE INCREASING RATES OF DIABETES AND OBESITY, AND THE HEALTH CHALLENGES THESE TWO CONDITIONS PRESENT CONTINUE TO BE THE FOCUS OF OUR COMMUNITY PROGRAMS. WE REACH OUT TO THESE HIGH RISK CONSTITUENTS THROUGH CHURCHES, LOCAL COMMUNITY ORGANIZATIONS AND OTHER GRASSROOTS EFFORTS. OUR GOAL IS TO HELP ALL RESIDENTS EQUALLY ACCESS THE CARE THEY NEED, AND HELP THEM LEARN TO MANAGE THEIR CONDITIONS AND LIVE HEALTHIER SAFER LIVES. FISHER-TITUS MEDICAL CENTER COLLABORATED WITH THE NORWALK LIONS CLUB, CITY OF NORWALK PARKS N RECREATION, AND CURVES, WITH SUPPORT FROM LOCAL MEDIA, TO PUT A FOCUS ON DIABETES IN A FUN AND ENGAGING PROGRAM CALLED THE HEALTHIEST LOSER CHALLENGE. THE COMMUNITY WATCHED AND LEARNED WHILE 146 AREA RESIDENTS AT RISK FOR DIABETES OR DIAGNOSED WITH DIABETES OR PRE-DIABETES UNDERTOOK A THREE-MONTH CHALLENGE TOWARD A HEALTHIER LIFESTYLE. THE PROGRAMS GOAL WAS TO HELP PARTICIPANTS MANAGE THEIR DIABETES RISK AND WEIGHT BY PROVIDING THEM TOOLS TO DEVELOP NEW HEALTHY HABITS INCLUDING EXERCISE, HEALTHY EATING, AND GAINING KNOWLEDGE ABOUT DIABETES AND RELATED HEALTH ISSUES. PARTICIPANTS RECEIVED HEALTH ASSESSMENTS INCLUDING A1C GLUCOSE TESTS, A RESOURCE BOOK, AND VOUCHERS FOR LOCAL FITNESS CENTER FEES AND EQUIPMENT. OF THE 70 WHO FINISHED THE CHALLENGE 62 LOST AN AVERAGE OF 14 POUNDS AND 46 DECREASED THEIR A1C SCORES. THE WINNER LOST 53.2 POUNDS. FTMC SUPPORTS OTHER AREA NON-PROFIT COMMUNITY ORGANIZATIONS THAT ARE COMMITTED TO COMMUNITY HEALTH IMPROVEMENT THROUGH FINANCIAL INVESTMENTS, IN-KIND SERVICE AND EMPLOYEE VOLUNTEERISM. MANY OF OUR COMMUNITY BENEFIT PROGRAMS ARE ORGANIZED TO WORK COLLABORATIVELY WITH COMMUNITY GROUPS, SCHOOLS AND GOVERNMENT ORGANIZATIONS TO EFFECTIVELY LEVERAGE RESOURCES AND ADDRESS IDENTIFIED COMMUNITY NEEDS. IN 2011, WE OFFERED COMMUNITY HEALTH EDUCATION PROGRAMS, INCLUDING SCHOOL-BASED PROGRAMS, SUPPORT GROUPS, COMMUNITY-BASED HEALTH FAIRS AND SCREENINGS THAT IMPACTED OUR RESIDENTS THROUGH 66,017 ENCOUNTERS. AUXILIARY AND VOLUNTEER SERVICE: DURING 2011,OUR 280 CARING VOLUNTEERS DONATED 53,878 HOURS OF AUXILIARY AND VOLUNTEER SERVICES TO THE MEDICAL CENTER. VOLUNTEERS PROVIDE A VARIETY OF SERVICES INCLUDING HELPING FAMILY MEMBERS, PROVIDING TRANSPORTATION, ASSISTING AT COMMUNITY HEALTH PROGRAMS, DELIVERING REFRESHMENTS, MAIL AND FLOWERS TO HOSPITAL PATIENTS AND RESIDENTS OF THE NORWALK MEMORIAL HOME PLUS ESCORTING PATIENTS THROUGHOUT THE BUILDING. THEY ALSO PERFORM CLERICAL DUTIES, STAFF THE MEDICAL CENTERS GIFT SHOP AND ORGANIZE SEVERAL FUND-RAISING EVENTS THROUGHOUT THE YEAR. VOLUNTEER AMBASSADORS HAVE INSTRUCTED PATIENTS SINCE APRIL, 2010 ON THE USE OF THE TELEVISION/COMPUTER SCREENS LOCATED IN EACH PATIENT ROOM. VOLUNTEERS WORKING IN THIS CAPACITY ARE AT FISHER-TITUS MEDICAL CENTER SEVEN DAYS PER WEEK EACH MORNING FOR 2 HOURS. AMONG THE ITEMS PATIENTS ARE INSTRUCTED ON ARE HOW TO ACCESS THE DAYS MENU, MEDICAL INFORMATION PERTAINING TO THE PERSONS HEALTH PROBLEMS, ACCESSING THE INTERNET, PLAYING GAMES, OBTAINING THE NAMES OF CAREGIVERS AS THEY ENTER THE PATIENTS ROOM, CHOOSING MOVIES, ETC. THE PATIENT THEN MAY USE A REMOTE CONTROL OR A WIRELESS KEYBOARD TO ACCESS THIS INFORMATION. INFORMATION SERVICES PROVIDES ALL COMPUTER TRAINING FOR VOLUNTEERS THAT WORK IN THIS CAPACITY. IN APPRECIATION FOR THEIR WORK IN 2011, THE MEDICAL CENTER PROVIDED 12,618 FREE MEALS TO THE VOLUNTEER STAFF AT A COST OF $77,222. COMMUNITY HEALTH IMPROVEMENT SERVICES: NUMEROUS HEALTH SCREENINGS ARE OFFERED THROUGHOUT THE YEAR AT THE MEDICAL CENTER AND AT VARIOUS COMMUNITY LOCATIONS AND EVENTS THROUGHOUT OUR SERVICE AREA. THESE PROGRAMS INCLUDE SCREENING FOR BLOOD PRESSURE, BLOOD GLUCOSE, CHOLESTEROL LEVELS, SKIN CANCER, PROSTATE CANCER, OSTEOPOROSIS AND SCREENING MAMMOGRAMS. IN ADDITION, THE MEDICAL CENTER SPONSORS NUMEROUS SUPPORT GROUPS TO PROVIDE EDUCATION, CARE AND EMOTIONAL SUPPORT TO INDIVIDUALS AND FAMILIES AFFECTED BY DISABILITIES AND CHRONIC MEDICAL CONDITIONS. FTMCS HEALTH MINISTRY PROGRAM, FORMED IN 2000, HAS BEEN A VERY EFFECTIVE GRASSROOTS INITIATIVE TO GATHER INFORMATION AND PROVIDE HEALTH PROGRAMS THROUGHOUT HURON COUNTY. CURRENTLY 50 AREA CONGREGATIONS ARE MEMBERS OF THE FTMC HEALTH MINISTRY PROGRAM WHICH PROVIDES HEALTH AND WELLNESS INFORMATION AND PROGRAMS IN AREA CHURCHES. THE MEDICAL CENTER IN PARTNERSHIP WITH ITS PHYSICIANS AND OTHER COMMUNITY ORGANIZATIONS PROVIDES PUBLIC FORUMS AND EDUCATIONAL SESSIONS ON A VARIETY OF TOPICS, WHICH ARE SOMETIMES HELD IN TANDEM WITH THE HEALTH SCREENINGS PROVIDED. WE ALSO PROVIDE NUMEROUS HEALTH FAIRS DURING THE YEAR IN SEVERAL LOCATIONS THROUGHOUT THE COUNTY AND SURROUNDING COMMUNITIES IN OUR SERVICE AREA. THESE COMMUNITY HEALTH IMPROVEMENT SERVICES BENEFITED 64,478 PEOPLE IN 2011 AT A COST OF $888,611. PROFESSIONAL MEDICAL EDUCATION: THE MEDICAL CENTER SUPPORTS THE FAMILY PRACTICE RESIDENCY PROGRAM AT FIRELANDS REGIONAL MEDICAL CENTER TO ENHANCE THE AVAILABILITY OF FAMILY PRACTICE PHYSICIANS WITHIN THE LOCAL COMMUNITY. FTMC FUNDS THE COST OF A FAMILY PRACTICE RESIDENT THAT SHARES TIME BETWEEN THE HOSPITALS EMERGENCY ROOM AND THE COUNTY HEALTH DEPARTMENT CARING FOR THE UNDERSERVED. IN ADDITION, FTMC SUPPORTS AND STAFFS SEVERAL CLASSES FOR HEALTH PROFESSIONALS INCLUDING HEALTHCARE PROVIDER CPR, ADVANCED CARDIAC LIFE SUPPORT, BASIC LIFE SUPPORT INSTRUCTOR COURSE AND PEDIATRIC ADVANCE LIFE SUPPORT. THE TOTAL COST OF PROFESSIONAL MEDICAL EDUCATION PROVIDED TO 166 PARTICIPANTS WAS $53,345. SUBSIDIZED HEALTH SERVICES: THE MEDICAL CENTER ALSO SUBSIDIZES CERTAIN HEALTH SERVICES AND PROCESSES IN ORDER TO ADDRESS SPECIFIC HEALTH ISSUES IN THE COMMUNITY, PROVIDE CARE TO THE UNDERSERVED, OR ENHANCE THE OVERALL QUALITY OF HEALTHCARE WITHIN THE COMMUNITY. ALSO, THE MEDICAL CENTER SUBSIDIZED THE COST OF ELECTRONIC MEDICAL RECORD SOFTWARE USED BY PHYSICIANS IN OUR SERVICE AREA. THE SOFTWARE ENHANCES THE ACCURACY AND SPEED OF MEDICAL INFORMATION AVAILABLE TO HEALTHCARE PROVIDERS WITHIN THE AREA AND TO ASSIST THE COMMUNITY IN MOVING TOWARD A REGIONAL HEALTH INFORMATION DATABASE. THE COST ASSOCIATED WITH THE HEALTH SERVICES AND ELECTRONIC MEDICAL RECORDS SYSTEM IN 2011 WAS $770,914. DONATIONS AND COMMUNITY SUPPORT: THE MEDICAL CENTER MAKES CASH AND NON-CASH CONTRIBUTIONS ANNUALLY TO LOCAL NON-PROFIT ORGANIZATIONS THAT BENEFIT THE HEALTH AND DEVELOPMENT OF OUR LOCAL COMMUNITY AND ITS RESIDENTS. IN ADDITION, THE MEDICAL CENTER SUPPORTS AREA SCHOOLS BY AWARDING SPECIAL HEALTH EDUCATION GRANTS TO SCHOOL DISTRICTS IN OUR SERVICE TERRITORY TO FUND INNOVATIVE PROGRAMS IN THE AREAS OF SCIENCE, MATH, HEALTH AND HEALTH RELATED EDUCATION. THE TOTAL COST OF THESE DONATIONS AND SUPPORT IN 2011 WAS $293,615. FORM 990, PART VI, SECTION A, LINE 6 THE SOLE MEMBER OF FISHER-TITUS MEDICAL CENTER IS THE PARENT COMPANY NORWALK AREA HEALTH SYSTEMS, INC., AN OHIO NONPROFIT CORPORATION. FORM 990, PART VI, SECTION A, LINE 7A THE FOLLOWING POWERS ARE RESERVED EXCLUSIVELY TO THE MEMBER (NORWALK AREA HEALTH SYSTEM, INC): A) TO ELECT THE DIRECTORS OF THE CORPORATION, AND TO REMOVE THEM AT WILL OR WITHOUT CAUSE. FORM 990, PART VI, SECTION A, LINE 7B THE FOLLOWING POWERS ARE RESERVED EXCLUSIVELY TO THE MEMBER (NORWALK AREA HEALTH SYSTEM, INC): A) TO AMEND OR REPEAL THE ARTICLES OF INCORPORATION AND THE CODE OF REGULATIONS; B) TO APPROVE THE ANNUAL OPERATING AND CAPITAL BUDGETS OF THE CORPORATION; C) TO APPROVE ANY CAPITAL OR OTHER EXTRAORDINARY EXPENDITURES IN EXCESS OF THE AMOUNT PRESCRIBED FROM TIME TO TIME BY THE MEMBER, WHICH AMOUNT SHALL BE REVIEWED BY THE MEMBER ANNUALLY; D) TO APPROVE ANY BORROWING OF ANY SUM OF MONEY FOR ANY PURPOSE IN EXCESS OF THE AMOUNT PRESCRIBED FROM TIME TO TIME BY THE MEMBER, WHICH AMOUNT SHALL BE REVIEWED BY THE MEMBER ANNUALLY; E) TO APPROVE ANY MERGER OF THE CORPORATION OR ANY SALE OF SUBSTANTIALLY ALL ITS ASSETS; TO DISSOLVE OR TERMINATE THE EXSISTENCE OF THE CORPORATION AND TO DETERMINE THE DISTRIBUTION OF ASSETS UPON SUCH DISSOLUTION OR TERMINATION. FORM 990, PART VI, SECTION B, LINE 11 THE BOARD OF DIRECTORS OF THE FISHER-TITUS MEDICAL CENTER DELEGATED THE RESPONSIBILITY FOR THE REVIEW OF THE MEDICAL CENTER'S FORM 990, PLUS ALL REQUIRED SCHEDULES AND ATTACHMENTS, TO THE MEDICAL CENTER'S AUDIT COMMITTEE. THE MEMBERS OF THIS COMMITTEE HAVE A STRONG BACKGROUND IN ACCOUNTING, LEGAL, FINANCE, AND BUSINESS AND HAVE THE TECHNICAL EXPERTISE TO PERFORM A SUBSTANTIVE REVIEW. THE AUDIT COMMITTEE REVIEWED THE MEDICAL CENTER'S FORM 990 PRIOR TO FILING AND REPORTED TO THE MEDICAL CENTER'S BOARD OF DIRECTORS REGARDING THE RESULTS OF THEIR REVIEW. IN ADDITION, EACH MEMBER OF THE MEDICAL CENTER'S BOARD OF DIRECTORS HAD ACCESS TO A COPY OF THE FORM 990 FOR VIEWING PRIOR TO FILING VIA A SECURE INTERNET WEBSITE AND A PAPER COPY WAS AVAILABLE FOR REVIEW AT THE BOARD MEETINGS. FORM 990, PART VI, SECTION B, LINE 12C ALL OF OUR AFFILIATED CORPORATE BOARD MEMBERS ARE REQUIRED TO COMPLETE A CONFLICT OF INTEREST STATEMENT UPON JOINING THE BOARD AND ANNUALLY THROUGHOUT THEIR TENURE. THESE ARE RETAINED BY ADMINISTRATION. AREAS OF CONFLICT ARE REVIEWED AND ADDRESSED AS NECESSARY TO THE TRANSACTIONS OF THE BOARD. IF AN AREA OF CONFLICT ARISES, BOARD MEMBERS ARE EXCUSED AND PROHIBITED FROM PARTICIPATING IN THE BOARD'S DELIBERATIONS AND DISCUSSIONS REGARDING THE AREA OF CONFLICT. FORM 990, PART VI, SECTION B, LINE 15 RESPONSIBILITY FOR DETERMINING AND RECOMMENDING EXECUTIVE COMPENSATION RESTS WITH THE JOINT PERSONNEL COMMITTEE OF THE FISHER-TITUS MEDICAL CENTER AND NORWALK AREA HEALTH SYSTEMS, INC. BOARDS. THE COMMITTEE RETAINS AN INDEPENDENT EXECUTIVE COMPENSATION CONSULTANT TO HELP ESTABLISH CASH COMPENSATION TARGET RANGES AND IDENTIFY REASONABLE AND CUSTOMARY BENEFIT PROGRAMS FOR EXECUTIVES. THE INDEPENDANT CONSULTANT REPORTS TO THE JOINT PERSONNEL COMMITTEE ON RELEVANT PEER GROUPS, CASH COMPENSATION REPORTED IN AVAILABLE SALARY SURVEYS FOR THE PEER GROUP, AND TRENDS IN BENEFITS AND PERQUISITE PROGRAMS CUSTOMARILY AVAILABLE AMONG THE PEER GROUP FOR EXECUTIVES. RECOMMENDATIONS BY THE CONSULTANT ARE PRESENTED TO THE JOINT PERSONNEL COMMITTEE WHICH PREPARES MINUTES OF ITS DELIBERATIONS REGARDING EXECUTIVE COMPENSATION INCLUDING RECOMMENDATIONS THAT ARE PROVIDED TO EACH OF THE DIRECTORS OF FTMC AND NAHS. THE RECOMMENDATIONS TO BE ACTED ON MUST BE APPROVED FIRST BY THE JOINT PERSONNEL COMMITTEE AND THEN BY THE MEDICAL CENTER'S BOARD OF DIRECTORS BEFORE FINALLY BEING CONSIDERED BY THE SYSTEM'S BOARD OF DIRECTORS. THE MINUTES OF EACH BOARD MEETING WHERE ACTION IS TAKEN REFLECT SUCH ACTION. THE PROCESS IS PERFORMED ANNUALLY IN THE SPRING AND WAS LAST DONE IN MAY 2011. FORM 990, PART VI, SECTION C, LINE 19 WE ISSUE AN ANNUAL REPORT TO THE COMMUNITY THAT IS PLACED IN THE LOCAL NEWSPAPER AND ON OUR WEBSITE THAT PROVIDES OUR OPERATING FINANCIAL STATEMENT, COMMUNITY BENEFIT FIGURES BROKEN DOWN BY CHARITY CARE & FINANCIAL ASSISTANCE, UPAID COSTS OF MEDICAID, COMMUNITY HEALTH & OUTREACH PROGRAMS, DONATIONS & COMMUNITY SUPPORT, SUBSIDIZED HEALTH SERVICES & PROFESSIONAL MEDICAL EDUCATION, & UNPAID COSTS OF MEDICARE & BAD DEBT. AS REQUIRED, WE OFFER A TIMELY RESPONSE TO WRITTEN REQUESTS FOR COPIES OF THE 990S AS WELL AS HAVING THE 990S AVAILABLE UPON THE PREMISES FOR THE PUBLIC TO REVIEW AND ON THE GUIDESTAR INTERNET WEBSITE. ADDITIONALLY, OUR CONFLICT OF INTEREST POLICY, CODE OF REGULATIONS, AND GOVERNING DOCUMENTS ARE ALSO AVAILABLE UPON WRITTEN REQUEST. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED LOSSES ON INVESTMENTS: -306,869. FASB #158 ADJUSTMENT -4,775,201. TRANSFER OF FUNDS TO AFFILIATED ORGANIZATION, NORWALK AREA HEALTH SYSTEMS -500,000. AUDIT ADJUSTMENT EXPENSE ERROR 16,210. AUDIT CONSOLIDATING ADJUSTMENT TO DONATIONS OF NEGATIVE -9,907. PAIN MANAGEMENT LLC DIVIDEND PAYMENT TO JOINT VENTURE MEMBER NORWALK PAIN M 397,755. NET ASSETS BALANCE SHEET CHANGE FOR HEALTH PROMOTIONS 50,000. TOTAL TO FORM 990, PART XI, LINE 5: -5,128,012. 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