FAIRFIELD MEDICAL CENTER: Form 990, tax year 2011
View the entire original 990 at ProPublica ↗
- Organization
- FAIRFIELD MEDICAL CENTER (EIN 31-0645626)
- Tax period
- 2011-01-01 to 2011-12-31
- Filed
- 2012-08-15
- IRS object ID
- 201222289349300807
- Schema version
- 2011v1.2
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
- Return header
- Form 990
- Schedule A
- Schedule B
- Schedule D
- Schedule H
- Schedule J
- Schedule K
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2012-08-15T08:59:44-00:00 | Timestamp |
| Tax Period End Date | 2011-12-31 | TaxPeriodEndDate |
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2011-01-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 310645626 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Fairfield Medical Center | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | FAIR | NameControl |
| Phone | 7406878000 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 401 North Ewing Street | AddressLine1 |
| City | Lancaster | City |
| State | OH | State |
| ZIP Code | 431303371 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | Sky L Gettys | Name |
| Title | CFO Treasurer | Title |
| Date Signed | 2012-08-10 | DateSigned |
| Authorize Third Party | false | AuthorizeThirdParty |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2011 | TaxYear |
| Build TS | 2016-02-24 21:20:13Z | BuildTS |
Form 990 IRS990
Name Of Principal Officer Business NameOfPrincipalOfficerBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Mina H Ubbing | BusinessNameLine1 |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 401 North Ewing Street | AddressLine1 |
| City | Lancaster | City |
| State | OH | State |
| ZIP Code | 43130 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 225153704 | GrossReceipts |
| Group Return For Affiliates | false | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | www.fmchealth.org | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1982 | YearFormation |
| State Legal Domicile | OH | StateLegalDomicile |
| Activity Or Mission Description | Our mission is to provide efficient, compassionate, safe, high quality healthcare for patients and their families. Fairfield Medical Center provides this care to all patients regardless of race, creed, sex, national origin, handicap, age or ability to pay. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 14 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 14 | NbrIndependentVotingMembers |
| Total Nbr Employees | 2356 | TotalNbrEmployees |
| Total Nbr Volunteers | 177 | TotalNbrVolunteers |
| Total Gross UBI | 369579 | TotalGrossUBI |
| Contributions Grants Prior Year | 222749 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 226761 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 192609502 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 205693710 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 1751291 | InvestmentIncomePriorYear |
| Investment Income Current Year | 1811182 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 3695911 | OtherRevenuePriorYear |
| Other Revenue Current Year | 3667630 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 198279453 | TotalRevenuePriorYear |
| Total Revenue Current Year | 211399283 | TotalRevenueCurrentYear |
| Grants And Similar Amnts CY | 0 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 90639541 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 97776072 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 0 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 98192332 | OtherExpensePriorYear |
| Other Expenses Current Year | 103335318 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 188831873 | TotalExpensesPriorYear |
| Total Expenses Current Year | 201111390 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 9447580 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 10287893 | RevenuesLessExpensesCY |
| Total Assets BOY | 186675728 | TotalAssetsBOY |
| Total Assets EOY | 195128210 | TotalAssetsEOY |
| Total Liabilities BOY | 81905531 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 91249309 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 104770197 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 103878901 | NetAssetsOrFundBalancesEOY |
| Mission Description | Our mission is to provide efficient, compassionate, safe, high quality healthcare for patients and their families. Fairfield Medical Center provides this care to all patients regardless of race, creed, sex, national origin, handicap, age or ability to pay. | MissionDescription |
| Significant New Program Services | false | SignificantNewProgramServices |
| Significant Change | false | SignificantChange |
| Expense | 76459612 | Expense |
| Revenue | 84141740 | Revenue |
| Description | Patient Care Inpatient Medical, Surgical, Emergency, Maternity, ICU, Psychiatry, and Nursing Services 77,022 admissions, procedures visits | Description |
Activity2 Activity2
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | 70055449 | Expense |
| Revenue | 110498084 | Revenue |
| Description | Patient Care Laboratory, Cardiovascular, Radiology, Therapy, Pharmacy, and Medical Supply Services 2,577,144 procedures dosages | Description |
Activity3 Activity3
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | 18739628 | Expense |
| Revenue | 985026 | Revenue |
| Description | Patient Care Nutritional Services 488,562 meals served Patient Care Laundry Services 1,627,100 pounds Patient Care Plant Engineering, Police, Housekeeping, Central Transport, Interest Depreciation 530,700 square feet | Description |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Expense | 165254689 | TotalProgramServiceExpense |
| Described In501 C3 | true | DescribedIn501C3 |
| Schedule B Required | true | ScheduleBRequired |
| Political Activities | false | PoliticalActivities |
| Lobbying Activities | false | LobbyingActivities |
| Donor Advised Funds | false | DonorAdvisedFunds |
| Conservation Easements | false | ConservationEasements |
| Collections Of Art | false | CollectionsOfArt |
| Credit Counseling | false | CreditCounseling |
| Term Or Permanent Endowments | false | TermOrPermanentEndowments |
| Report Land Bldg Equip | true | ReportLandBldgEquip |
| Report Invest Oth Securities | false | ReportInvestOthSecurities |
| Report Prog Rel Invest | false | ReportProgRelInvest |
| Report Other Assets | true | ReportOtherAssets |
| Report Other Liabilities | true | ReportOtherLiabilities |
| Report Fin48 Footnote | false | ReportFin48Footnote |
| Independent Audit Financial Stmt | false | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | true | ConsolidatedAuditFinancialStmt |
| School | false | School |
| Foreign Office | false | ForeignOffice |
| Foreign Activities | false | ForeignActivities |
| More Than5000 K To Organizations | false | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | false | MoreThan5000KToIndividuals |
| Professional Fundraising | false | ProfessionalFundraising |
| Fundraising Activities | false | FundraisingActivities |
| Gaming | false | Gaming |
| Hospital | true | Hospital |
| Financial Stmt Attached | true | FinancialStmtAttached |
| Grants To Organizations | false | GrantsToOrganizations |
| Grants To Individuals | false | GrantsToIndividuals |
| Schedule J Required | true | ScheduleJRequired |
| Tax Exempt Bonds | true | TaxExemptBonds |
| Invest Tax Exempt Bonds | false | InvestTaxExemptBonds |
| Escrow Account | false | EscrowAccount |
| On Behalf Of Issuer | false | OnBehalfOfIssuer |
| Excess Benefit Transaction | false | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | false | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | false | LoanToOfficerOrDQP |
| Grant To Related Person | false | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | false | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | false | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | false | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | false | DeductibleNonCashContributions |
| Deductible Contributions Of Art | false | DeductibleContributionsOfArt |
| Terminated | false | Terminated |
| Partial Liquidation | false | PartialLiquidation |
| Disregarded Entity | true | DisregardedEntity |
| Related Entity | true | RelatedEntity |
| Related Org Controlled Entity | true | RelatedOrgControlledEntity |
| Transaction Related Entity | true | TransactionRelatedEntity |
| Transfers To Exempt Non Chrtbl Org | true | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | false | ActivitiesConductedPartnership |
| Schedule O Required | true | ScheduleORequired |
| Number Forms Transmitted With1096 | 125 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | true | ComplianceWithBackupWitholding |
| Number Of Employees | 2356 | NumberOfEmployees |
| Employment Tax Returns Filed | true | EmploymentTaxReturnsFiled |
| Unrelated Business Income | true | UnrelatedBusinessIncome |
| Form990-T Filed | true | Form990-TFiled |
| Foreign Financial Account | false | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTrans |
| Taxable Party Notification | false | TaxablePartyNotification |
| Non Deductible Contributions | false | NonDeductibleContributions |
| Quid Pro Quo Contributions | false | QuidProQuoContributions |
| Form8282 Property Disposed Of | false | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | false | FundsToPayPremiums |
| Premiums Paid | false | PremiumsPaid |
| Indoor Tanning Services | false | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 14 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 14 | NumberIndependentVotingMembers |
| Family Or Business Relationship | true | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | false | DelegationOfManagementDuties |
| Changes To Organizing Docs | false | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | false | MaterialDiversionOrMisuse |
| Members Or Stockholders | false | MembersOrStockholders |
| Election Of Board Members | false | ElectionOfBoardMembers |
| Decisions Subject To Approval | false | DecisionsSubjectToApproval |
| Minutes Of Governing Body | true | MinutesOfGoverningBody |
| Minutes Of Committees | true | MinutesOfCommittees |
| Officer Mailing Address | false | OfficerMailingAddress |
| Local Chapters | false | LocalChapters |
| Form990 Provided To Governing Body | false | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | true | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | true | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | true | RegularMonitoringEnforcement |
| Whistleblower Policy | true | WhistleblowerPolicy |
| Document Retention Policy | true | DocumentRetentionPolicy |
| Compensation Process CEO | true | CompensationProcessCEO |
| Compensation Process Other | true | CompensationProcessOther |
| Investment In Joint Venture | true | InvestmentInJointVenture |
| Written Policy Or Procedure | true | WrittenPolicyOrProcedure |
| States Where Copy Of Return Is Filed | OH | StatesWhereCopyOfReturnIsFiled |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Person | Sky L Gettys | NamePerson |
| Telephone Number | 7406878011 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 401 North Ewing Street | AddressLine1 |
| City | Lancaster | City |
| State | OH | State |
| ZIP Code | 431303371 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionA (25 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | OfficerOfficer | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | Key EmployeeKeyEmployee | Highest Compensated EmployeeHighestCompensatedEmployee |
|---|---|---|---|---|---|---|---|---|
| David Conley MD | ||||||||
| Chair | 003.00 | X | X | 0 | 0 | 0 | ||
| Carol Seubert Marx | ||||||||
| Vice Chair | 003.00 | X | X | 0 | 0 | 0 | ||
| Debra Smith | ||||||||
| Secretary | 003.00 | X | X | 0 | 0 | 0 | ||
| Lawrence Q Burgess PhD | ||||||||
| Director | 002.00 | X | 0 | 0 | 0 | |||
| Ron Burris | ||||||||
| Director | 002.00 | X | 0 | 0 | 0 | |||
| James Christian | ||||||||
| Director | 002.00 | X | 0 | 0 | 0 | |||
| Adam Custer | ||||||||
| Director | 002.00 | X | 0 | 0 | 0 | |||
| Dave Harcum | ||||||||
| Director | 002.00 | X | 0 | 0 | 0 | |||
| Dave Oehlers | ||||||||
| Director | 002.00 | X | 0 | 0 | 0 | |||
| Barry Ritchey | ||||||||
| Director | 002.00 | X | 0 | 0 | 0 | |||
| Dave Scoggin MD | ||||||||
| Director | 002.00 | X | 0 | 0 | 0 | |||
| Linda Sheridan | ||||||||
| Director | 002.00 | X | 0 | 0 | 0 | |||
| Mina H Ubbing | ||||||||
| President CEO | 055.00 | X | 540191 | 0 | 33250 | |||
| Sky L Gettys | ||||||||
| CFO, Treasurer | 048.00 | X | 260135 | 0 | 26544 | |||
| Steven D Cox MD | ||||||||
| VP - CMO | 042.00 | 306306 | 0 | 27933 | X | |||
| Howard Sniderman | ||||||||
| Chief Operating Officer | 045.00 | 234098 | 0 | 22137 | X | |||
| Cynthia Pearsall | ||||||||
| VP - CNO | 050.00 | 194583 | 0 | 13704 | X | |||
| Jean L Robertson MD | ||||||||
| Chief Med. Info. Officer | 024.00 | 149159 | 0 | 0 | X | |||
| Randy L Brown | ||||||||
| Pharmacy Manager | 040.00 | 152379 | 0 | 23837 | X | |||
| Grace Edwards | ||||||||
| Staff Pharmacist | 039.00 | 146992 | 0 | 7437 | X | |||
| Chris D Anders | ||||||||
| Staff Pharmacist | 039.00 | 130126 | 0 | 19762 | X | |||
| Pamela R Reed | ||||||||
| OP Services Director | 040.00 | 159568 | 0 | 15673 | X | |||
| Betsy L Winsley | ||||||||
| Pharmacy Supervisor | 040.00 | 153050 | 0 | 10495 | X | |||
| Louis Varga | ||||||||
| Director | 002.00 | X | 0 | 0 | 0 | |||
| Molly Weiland | ||||||||
| Director | 002.00 | X | 0 | 0 | 0 | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 2426587 | TotalReportableCompFromOrg |
| Total Other Compensation | 200772 | TotalOtherCompensation |
| Number Individuals GT100 K | 31 | NumberIndividualsGT100K |
| Formers Listed | false | FormersListed |
| Total Comp GT150 K | true | TotalCompGT150K |
| Compensation From Other Sources | false | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (5 entries)
| Address Line1AddressOfContractor/AddressUS/AddressLine1 | CityAddressOfContractor/AddressUS/City | StateAddressOfContractor/AddressUS/State | ZIP CodeAddressOfContractor/AddressUS/ZIPCode | Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|---|---|---|---|
| McKesson | |||||
| PO Box 98347 | Chicago | IL | 606930001 | Information Technology Services | 3202578 |
| Aramark Healthcare | |||||
| 12483 Collections Center Drive | Chicago | IL | 60693 | Biomedical Services | 2904049 |
| Fairfield Emergency Physicians | |||||
| 401 North Ewing Street | Lancaster | OH | 43130 | Emergency Physician Services | 860080 |
| Bricker & Eckler | |||||
| 100 South Third Street | Columbus | OH | 43215 | Legal Services | 446506 |
| East Main Shopping | |||||
| 123 Broad Street Suite 211 | Lancaster | OH | 43130 | Rent | 366300 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 14 | NumberOfContractorsGT100K |
| All Other Contributions | 226761 | AllOtherContributions |
| Total Contributions | 226761 | TotalContributions |
Program Service Revenue ProgramServiceRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | Patient Service Revenue Net | Description |
| Total Revenue Column | 205693710 | TotalRevenueColumn |
| Related Or Exempt Function Income | 205693710 | RelatedOrExemptFunctionIncome |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 205693710 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 1042584 | TotalRevenueColumn |
| Exclusion | $1,042,584 | ExclusionAmount |
Gross Rents GrossRents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 646556 | Real |
Less Rental Expenses LessRentalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 349009 | Real |
Rental Income Or Loss RentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 297547 | Real |
Net Rental Income Or Loss NetRentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 297547 | TotalRevenueColumn |
Gross Amount Sales Assets GrossAmountSalesAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 14163610 | Securities |
| Other | 10400 | Other |
Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 13396467 | Securities |
| Other | 8945 | Other |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 767143 | Securities |
| Other | 1455 | Other |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 768598 | TotalRevenueColumn |
Other Revenue Misc OtherRevenueMisc (3 entries)
| DescriptionDescription | Total Revenue ColumnTotalRevenueColumn | ExclusionExclusionAmount | Business CodeBusinessCode | Unrelated Business RevenueUnrelatedBusinessRevenue |
|---|---|---|---|---|
| Cafeteria Sales | 844731 | $844,731 | ||
| Patronage Dividends | 320451 | $320,451 | 900099 | |
| Outside Reference Lab | 329647 | 621500 | 329647 |
Miscellaneous Revenue MiscellaneousRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 1875254 | TotalRevenueColumn |
| Related Or Exempt Function Income | 1835322 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 39932 | UnrelatedBusinessRevenue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 3370083 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 211399283 | TotalRevenueColumn |
| Related Or Exempt Function Income | 207529032 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 369579 | UnrelatedBusinessRevenue |
| Exclusion | $2,207,766 | ExclusionAmount |
Grants To Domestic Orgs GrantsToDomesticOrgs
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Grants To Domestic Individuals GrantsToDomesticIndividuals
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Foreign Grants ForeignGrants
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Benefits To Members BenefitsToMembers
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1817001 | Total |
| Program Services | 951307 | ProgramServices |
| Management And General | 865694 | ManagementAndGeneral |
Comp Disqual Persons CompDisqualPersons
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 76843579 | Total |
| Program Services | 68324833 | ProgramServices |
| Management And General | 8518746 | ManagementAndGeneral |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 4206722 | Total |
| Program Services | 3726669 | ProgramServices |
| Management And General | 480053 | ManagementAndGeneral |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 9190223 | Total |
| Program Services | 6344040 | ProgramServices |
| Management And General | 2846183 | ManagementAndGeneral |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 5718547 | Total |
| Program Services | 4966463 | ProgramServices |
| Management And General | 752084 | ManagementAndGeneral |
Fees For Services Management FeesForServicesManagement
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 879780 | Total |
| Management And General | 879780 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 92800 | Total |
| Management And General | 92800 | ManagementAndGeneral |
Fees For Services Lobbying FeesForServicesLobbying
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Fees For Services Prof Fundraising | FeesForServicesProfFundraising |
Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 15880087 | Total |
| Program Services | 7281676 | ProgramServices |
| Management And General | 8598411 | ManagementAndGeneral |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Royalties Royalties
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3181980 | Total |
| Program Services | 2911938 | ProgramServices |
| Management And General | 270042 | ManagementAndGeneral |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Travel Entrtnmnt Public Officials TravelEntrtnmntPublicOfficials
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Conferences Meetings ConferencesMeetings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2765537 | Total |
| Program Services | 2544294 | ProgramServices |
| Management And General | 221243 | ManagementAndGeneral |
Payments To Affiliates PaymentsToAffiliates
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 11230549 | Total |
| Program Services | 7213757 | ProgramServices |
| Management And General | 4016792 | ManagementAndGeneral |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1347062 | Total |
| Management And General | 1347062 | ManagementAndGeneral |
Other Expenses OtherExpenses (4 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral |
|---|---|---|---|
| Supplies | 41007921 | 40892410 | 115511 |
| Physician Fees | 5923628 | 5833439 | 90189 |
| Other Expenses | 8394289 | 1632178 | 6762111 |
| Provision for Bad Debt | 12631685 | 12631685 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 201111390 | Total |
| Program Services | 165254689 | ProgramServices |
| Management And General | 35856701 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 13451382 | BOY |
| EOY | 13064912 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 10438478 | BOY |
| EOY | 9555987 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 20805007 | BOY |
| EOY | 19507703 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2293361 | BOY |
| EOY | 3488639 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2694109 | BOY |
| EOY | 2762580 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 211153703 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 127400735 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 80572055 | BOY |
| EOY | 83752968 | EOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 38459801 | BOY |
| EOY | 41230021 | EOY |
Intangible Assets IntangibleAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | 4185642 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 17961535 | BOY |
| EOY | 17579758 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 186675728 | BOY |
| EOY | 195128210 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 10784841 | BOY |
| EOY | 11162242 | EOY |
Tax Exempt Bond Liabilities TaxExemptBondLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 57709201 | BOY |
| EOY | 65036346 | EOY |
Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1495810 | BOY |
| EOY | 1320504 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 11915679 | BOY |
| EOY | 13730217 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 81905531 | BOY |
| EOY | 91249309 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 104770197 | BOY |
| EOY | 103878901 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 104770197 | BOY |
| EOY | 103878901 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 186675728 | BOY |
| EOY | 195128210 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | 10287893 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | -11179189 | ReconcilationOtherChanges |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | false | AccountantCompileOrReview |
| FS Audited | true | FSAudited |
| Audit Committee | true | AuditCommittee |
| Financial Statement Consolidated | X | FinancialStatementConsolidated |
| Federal Grant Audit Required | false | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital170b1 Aiii | X | Hospital170b1Aiii |
| Public Support Pertcentage170 | 0.00000 | PublicSupportPertcentage170 |
| Public Support Percentage509 | 0.00000 | PublicSupportPercentage509 |
| Investment Income Percentage | 0.00000 | InvestmentIncomePercentage |
Schedule B IRS990ScheduleB
Contributor Info ContributorInfo
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor Number | RESTRICTED | ContributorNumber |
Contributor Name Business ContributorNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor Address US ContributorAddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Aggregate Contributions | RESTRICTED | AggregateContributions |
Schedule D IRS990ScheduleD
| Field | Value | IRS element (for citing) |
|---|---|---|
| Included On FS | false | IncludedOnFS |
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 4458469 | OtherCostOrOtherBasis |
| Book Value | 4458458 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | 87455 | InvestmentCostOrOtherBasis |
| Other Cost Or Other Basis | 94039114 | OtherCostOrOtherBasis |
| Depreciation | 46420145 | Depreciation |
| Book Value | 47706424 | BookValue |
Leasehold Improvements LeaseholdImprovements
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 3155699 | OtherCostOrOtherBasis |
| Depreciation | 2968080 | Depreciation |
| Book Value | 187619 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 106005668 | OtherCostOrOtherBasis |
| Depreciation | 75054924 | Depreciation |
| Book Value | 30950744 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 3407298 | OtherCostOrOtherBasis |
| Depreciation | 2957575 | Depreciation |
| Book Value | 449723 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 83752968 | TotalOfBookValueLandBuildings |
Other Assets OtherAssets (6 entries)
| DescriptionDescription | Book ValueBookValue |
|---|---|
| Unamortized bond financing expense | 2250837 |
| Due from related organizations | 6559230 |
| Physician loan/income guarantee FASB | |
| Notes receivable/income guarantee | 3247674 |
| Investment in subsidiary | 5154289 |
| Other receivables | 367728 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | 17579758 | TotalBookValueOtherAssets |
Other Liabilities OtherLiabilities (2 entries)
| DescriptionDescription | AmountAmount |
|---|---|
| Accrued payroll and benefits | $13,623,644 |
| Third Party settlements | $106,573 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 13730217 | TotalOfAmounts |
| Total Revenue | 211399283 | TotalRevenue |
| Total Expenses | 201111390 | TotalExpenses |
| Excess Or Deficit For Year | 10287893 | ExcessOrDeficitForYear |
| Excess Or Deficit Per FS | 10287893 | ExcessOrDeficitPerFS |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Charity Care Policy | true | CharityCarePolicy |
| Written Policy | true | WrittenPolicy |
| FPG Reference Free Care | true | FPGReferenceFreeCare |
| Pcent100 | X | Pcent100 |
| FPG Reference Discounted Care | true | FPGReferenceDiscountedCare |
| Pcent200 D | X | Pcent200D |
| Free Disc Care Medically Indigent | true | FreeDiscCareMedicallyIndigent |
| Amounts Budgeted For Charity Care | true | AmountsBudgetedForCharityCare |
| Expenses Exceeded Budget | false | ExpensesExceededBudget |
| Annual Community Benefit Report | true | AnnualCommunityBenefitReport |
| Report Publically Available | true | ReportPublicallyAvailable |
Charity Care At Cost CharityCareAtCost
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 1 | NumberOfActivitiesOrPrograms |
| Persons Served | 2023 | PersonsServed |
| Total Community Benefit Expense | 5250262 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 2325166 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 2925096 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.01450 | PercentOfTotalExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 1 | NumberOfActivitiesOrPrograms |
| Persons Served | 38741 | PersonsServed |
| Total Community Benefit Expense | 22513132 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 18840392 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 3672740 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.01830 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 2 | NumberOfActivitiesOrPrograms |
| Persons Served | 40764 | PersonsServed |
| Total Community Benefit Expense | 27763394 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 21165558 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 6597836 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.03280 | PercentOfTotalExpense |
Community Health Services CommunityHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 14 | NumberOfActivitiesOrPrograms |
| Persons Served | 49155 | PersonsServed |
| Total Community Benefit Expense | 1216298 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 42073 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 1174225 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00580 | PercentOfTotalExpense |
Health Professions Education HealthProfessionsEducation
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 5 | NumberOfActivitiesOrPrograms |
| Persons Served | 932 | PersonsServed |
| Total Community Benefit Expense | 3354609 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 103066 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 3251543 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.01620 | PercentOfTotalExpense |
Subsidized Health Services SubsidizedHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 1616 | PersonsServed |
| Total Community Benefit Expense | 8644544 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 4757924 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 3886620 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.01930 | PercentOfTotalExpense |
Research Research
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 1 | NumberOfActivitiesOrPrograms |
| Persons Served | 63 | PersonsServed |
| Total Community Benefit Expense | 26111 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 1260 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 24851 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00010 | PercentOfTotalExpense |
Cash And In Kind Contributions CashAndInKindContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 4 | NumberOfActivitiesOrPrograms |
| Persons Served | 82678 | PersonsServed |
| Total Community Benefit Expense | 232716 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 232716 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00120 | PercentOfTotalExpense |
Total Other Benefits TotalOtherBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 24 | NumberOfActivitiesOrPrograms |
| Persons Served | 134444 | PersonsServed |
| Total Community Benefit Expense | 13474278 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 4904323 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 8569955 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.04260 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 24 | NumberOfActivitiesOrPrograms |
| Persons Served | 175208 | PersonsServed |
| Total Community Benefit Expense | 41237672 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 26069881 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 15167791 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.07540 | PercentOfTotalExpense |
Economic Development EconomicDevelopment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 1 | NumberOfActivitiesOrPrograms |
| Persons Served | 3815 | PersonsServed |
| Total Community Building Expense | 20321 | TotalCommunityBuildingExpense |
| Direct Offsetting Revenue | 794 | DirectOffsettingRevenue |
| Net Community Building Expense | 19527 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00010 | PercentOfTotalExpense |
Community Support CommunitySupport
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 1 | NumberOfActivitiesOrPrograms |
| Persons Served | 20 | PersonsServed |
| Total Community Building Expense | 66 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 66 | NetCommunityBuildingExpense |
Environmental Improvements EnvironmentalImprovements
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 1 | NumberOfActivitiesOrPrograms |
| Total Community Building Expense | 13316 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 13316 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00010 | PercentOfTotalExpense |
Leadership Development LeadershipDevelopment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 2 | NumberOfActivitiesOrPrograms |
| Persons Served | 9816 | PersonsServed |
| Total Community Building Expense | 377686 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 377686 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00190 | PercentOfTotalExpense |
Coalition Building CoalitionBuilding
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 1 | NumberOfActivitiesOrPrograms |
| Persons Served | 478 | PersonsServed |
| Total Community Building Expense | 4087 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 4087 | NetCommunityBuildingExpense |
Total Total
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 6 | NumberOfActivitiesOrPrograms |
| Persons Served | 14129 | PersonsServed |
| Total Community Building Expense | 415476 | TotalCommunityBuildingExpense |
| Direct Offsetting Revenue | 794 | DirectOffsettingRevenue |
| Net Community Building Expense | 414682 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00210 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | false | BadDebtExpenseReported |
| Bad Debt Expense | $4,493,874 | BadDebtExpenseAmount |
| Amount Attributable To | 467363 | AmountAttributableTo |
| Amount Reimbursed By Medicare | 51409893 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 55074443 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | -3664550 | MedicareSurplusOrShortfall |
| Written Debt Collection Policy | true | WrittenDebtCollectionPolicy |
| Provision For Charity Care | true | ProvisionForCharityCare |
Form990 Schedule H Part IV Form990ScheduleHPartIV (2 entries)
| Description Ent Primary ActivityDescriptionEntPrimaryActivity | Organization Profit Or OwnershipOrganizationProfitOrOwnership | Physicans Profit Or OwnershipPhysicansProfitOrOwnership |
|---|---|---|
| Southeast Ohio Sleep Disorders | ||
| Sleep Lab | 0.51000 | 0.49000 |
| Fairfield Diagnostic Imaging | ||
| Imaging Center | 0.65000 | 0.35000 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Hospital Facilities | 1 | NumberOfHospitalFacilities |
Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility Number | 1 | FacilityNumber |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Fairfield Medical Center | BusinessNameLine1 |
Address Address
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 401 North Ewing Street | AddressLine1 |
| City | Lancaster | City |
| State | OH | State |
| ZIP Code | 43130 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Licensed Hospital | X | LicensedHospital |
| General Medical And Surgical | X | GeneralMedicalAndSurgical |
| Er24 Hours | X | Er24Hours |
Form990 Schedule H Part VI Form990ScheduleHPartVI (12 entries)
| IdentifierIdentifier | ExplanationExplanation |
|---|---|
| Part I line 3c | Fairfield Medical Center uses Federal Poverty Guidelines to assess Charity Care eligibility. |
| Part III line 4 | An allowance for uncollectible accounts is established on an aggregate basis by using historical write-off factors applied to unpaid accounts based on aging. Loss rate factors are based on historical loss experience and adjusted for economic conditions and other trends affecting the Centers ability to collect outstanding amounts. Uncollectible amounts are written off against the allowance for doubtful accounts in the period they are determined to be uncollectible. |
| Part III line 4 | Bad debt expense represents total estimated uncollected charges AT COST. Fairfield Co has 10.4 of the population living below the poverty level, so that percentage was applied in order to approximate Charitable Bad Debt. Because we cant require patients to disclose their income, we were not able to determine exact amounts, but we believe our methodology to be reasonable and supportable. Since we do not choose our patients, we consider it fair to include bad debt as a part of Community Benefit. |
| Part III line 8 | We believe the entire amount on line 7 should be considered Community Benefit. As a smaller regional hospital, we are limited in the quantities of scale that we have access to, which could decrease our expenses. In spite of all the cost-cutting measures we have implemented, we still lose money in our Medicare program. Because we treat patients for the good of the community, we believe the total Medicare shortfall should be considered Community Benefit. We use the Ohio Hospital Association model to compute Medicare shortfall using the Medicare Cost Report as submitted to Medicare. |
| Part III line 8 | The total for Medicare Cost is taken directly from the Medicare Cost Report, which is an exhaustive analysis. We believe that the shortfall should be included as Community Benefit because we cannot choose our patients. The cost report shows that our costs are in line with Medicare allowances and are therefore as low as possible. We cannot and would not want to turn Medicare patients away, but we treat them as part of our community service. |
| Part III line 9b | In all instances of debt collection, patients are given information regarding financial assistance available. In addition, patients are made aware of the availability of financial assistance with an acknowledgement letter of services rendered, regardless of ability to pay or payment source. FMC will do everything possible to help those who qualify for charity care to be made aware of the assistance available. We also provide financial counselors to assist patients in filling out the necessary forms for assistance. |
| Part III line 9b | We do all we can to work with the patient and have the following options available A. Payment in the form of cash, credit card or checks. A discount is offered with payment at the time of service and within 15 days. B. H.E.L.P. Bank Financial Program C. Hospital Payment Program D. Assistance with application to Medicare or Medicaid E. Hospital Care Assurance Program HCAP F. Hospital Assistance Program summary defining Fairfield Medical Centers financial opportunities. G. Assistance for the uninsured patient. |
| Part VI Line 3 | A representative from the Contracts and Collections Department meets with patients before discharge and explains the financial assistance available. That information is also on the back of each bill sent out by the hospital, along with eligibility guidelines. A poster is prominently displayed at each registration area asking people to inform us of financial need at the time of registration. It further states that financial counselors are available to help with the application process. Every effort is made to inform patients of the availability of financial assistance when the criteria is met. Patients are asked to fill out a Determination of Eligibility for Uncompensated Services in order for staff to identify those who are eligible, while at the same time preserving his or her dignity. If a patient is determined to be eligible for HCAP, he or she is asked to complete an application and verification of Ohio residency. Those persons stating they have no income are required to submit a notarized statement. |
| Part VI Line 4 | The geographic area of Fairfield Co. is 505.11 square miles. The overall population isapproximately 147,066. About 15,295 people live at or below the poverty level. 35.4 of thepopulation do not have employer-based insurance. 90.9 have graduated from high school. 18 are smokers and over 30 are obese.About 6.2 of the population is less than five years old 25.7 are less than 18 years old.Additionally, approximately 12.6 are age 65 or older, so there is a wide demographic range,but quite evenly spaced, also. Sources US Census Bureau website for 2011 and Ohio County Profiles. |
| Part VI Line 5 | Fairfield Medical Centers greatest asset has always been its compassionate, caring and dynamic employees who are passionate about sharing what they know with the community around them. Our Contracts and Collections Dept. is active in the Ohio Senior Health Insurance Information OSHIIP program through the Ohio Insurance Association. This program helps our senior citizens better understand their options with Medicare in order to make a more informed decision regarding the best program for them. We are only one of six hospitals in Ohio participating in the program and have won awards for our participation. The 2010 Community Health Needs Assessment revealed an alarming rate of obesity in our area of over 30 of the respondents. FMC quickly joined forces with other area hospitals to form FitTogether to educate and motivate the population to decrease their weight and increase their activity levels. Weve also partnered with area restaurants to offer Fit menu selections. This program will be an on-going partnership for healthier area residents. Opiate usage in Fairfield County is among the |
| Part VI Line 5 | highest in Ohio. FMC has been active in the community to educate the population regarding drug usage. Its heart-breaking to see drug addicted infants in the nursery and to know the damage the drugs are doing to our residents. Our staff is active in the Tour de Cause bicycle race each summer to raise funds for the Recovery Center of Fairfield Co. who help addicts break the addiction. We also have several staff members on the Opiate Awareness Task Force, as well as employees who speak to area organizations regarding the epidemic to raise awareness. Those employees have been featured in newspaper articles which further increase awareness. During 2011, we saw the need to increase medical availability to our lower income population. The Fairfield Community Health Center already had a good direction for doing this, so FMC engineered a grant to not only increase their funds, but also provided doctors and clinic space to greatly improve the Health Centers community impact. FMC partners with many community organizations to maximize the benefits to our community. Though insurance coverage ends with |
| Part VI Line 5 | discharge, we realize that its important to the health of new mothers and infants for a nurse to check them again to assure all is well after discharge. To that end, a maternity nurse visits each mother and newborn after discharge. When an out-of-town relative visits a hospital patient, there is often limited means for staying in a hotel after traveling. FMC offers a Hospitality House for out-of-town guests. We look for opportunities to improve the health of our community. We would rather meet them at an educational class than in a hospital room. To that end, we offer numerous educational classes on various health topics, such as stress reduction and Living Wills. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Committee | X | CompensationCommittee |
| Independent Consultant | X | IndependentConsultant |
| Written Employment Contract | X | WrittenEmploymentContract |
| Board Or Committee Approval | X | BoardOrCommitteeApproval |
| Severance Payment | false | SeverancePayment |
| Supplemental Nonqual Retire Plan | true | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | false | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | false | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | false | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | false | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | false | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | true | AnyNonFixedPayments |
| Initial Contract Exception | false | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (9 entries)
| Base Compensation Filing OrgBaseCompensationFilingOrg | Bonus Filing OrgBonusFilingOrg | Other Compensation Filing OrgOtherCompensationFilingOrg | Deferred Comp Filing OrgDeferredCompFilingOrg | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg | Total Compensation Filing OrgTotalCompensationFilingOrg |
|---|---|---|---|---|---|
| Mina H Ubbing | |||||
| 426217 | 51003 | 62971 | 17150 | 16100 | 573441 |
| Sky L Gettys | |||||
| 233044 | 25891 | 1200 | 17150 | 9394 | 286679 |
| Steven D Cox MD | |||||
| 276512 | 28594 | 1200 | 16866 | 11067 | 334239 |
| Howard Sniderman | |||||
| 210446 | 22452 | 1200 | 16660 | 5477 | 256235 |
| Cynthia Pearsall | |||||
| 175140 | 17243 | 2200 | 13167 | 537 | 208287 |
| Randy L Brown | |||||
| 146538 | 5241 | 600 | 10902 | 12935 | 176216 |
| Grace Edwards | |||||
| 146992 | 7437 | 154429 | |||
| Pamela R Reed | |||||
| 136014 | 7498 | 16056 | 11399 | 4274 | 175241 |
| Betsy L Winsley | |||||
| 153050 | 10099 | 396 | 163545 | ||
Schedule K IRS990ScheduleK
Form990 Schedule K Part I Form990ScheduleKPartI (3 entries)
| Issuer EINIssuerEIN | CUSIP NumberCUSIPNumber | Date IssuedDateIssued | Issue PriceIssuePrice | Description Of PurposeDescriptionOfPurpose | DefeasedDefeased | On Behalf Of IssuerOnBehalfOfIssuer |
|---|---|---|---|---|---|---|
| County of Fairfield Ohio | ||||||
| 316400066 | 304286AK3 | 2003-12-23 | 34490356 | To construct a parking garage and add additional space to hospital. | false | false |
| County of Fairfield Ohio | ||||||
| 316400066 | 2010-06-30 | 20000000 | To refund prior issue to fund capital purchases. | false | false | |
| County of Fairfield Ohio | ||||||
| 316400066 | 2010-12-22 | 10000000 | To fund capital purchases. | false | false | |
Form990 Schedule K Part II Form990ScheduleKPartII (3 entries)
| Total ProceedsTotalProceeds | Amount In Reserve FundAmountInReserveFund | Issuance Costs From ProceedsIssuanceCostsFromProceeds | Working Capital ExpendituresWorkingCapitalExpenditures | Capital ExpendituresCapitalExpenditures | Year Of Subst CompletionYearOfSubstCompletion | Current RefundingCurrentRefunding | Advance RefundingAdvanceRefunding | Final Allocation MadeFinalAllocationMade | Adequate Books And Recds MaintaindAdequateBooksAndRecdsMaintaind | Amount RetiredAmountRetired |
|---|---|---|---|---|---|---|---|---|---|---|
| 30161142 | 1815250 | 2507003 | 1123902 | 29037240 | 2005 | false | false | true | true | |
| 20000000 | 91148 | 7303244 | 2010 | true | false | true | 12605608 | |||
| 10000000 | 57471 | 9942529 | 2011 | false | false | false |
Form990 Schedule K Part III Form990ScheduleKPartIII (3 entries)
| Owning Bond Financed PropertyOwningBondFinancedProperty | Any Lease ArrangementsAnyLeaseArrangements | Mngment Cntrct Bond Financd PrprtyMngmentCntrctBondFinancdPrprty | Any Research AgreementsAnyResearchAgreements | Engage Bond Counsel ResearchEngageBondCounselResearch |
|---|---|---|---|---|
| false | false | false | false | true |
| false | false | false | false | true |
| false | false | false | false | true |
Form990 Schedule K Part IV Form990ScheduleKPartIV (3 entries)
| Form8038 T FiledForm8038TFiled | Variable Rate IssueVariableRateIssue | Hedge Identified In Books And RecdsHedgeIdentifiedInBooksAndRecds | Gross Proceeds Invested In GICGrossProceedsInvestedInGIC | Gross Proceeds InvestedGrossProceedsInvested | Exception To RebateExceptionToRebate |
|---|---|---|---|---|---|
| false | false | false | false | false | false |
| false | false | false | false | false | false |
| false | false | false | false | false | false |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (7 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| Form 990 Part VI | 2 | Various members of the Board of Directors are key employees and/or officers of organizations that may conduct normal, arms length transactions with one another. |
| Form 990 Part VI | 11b | The 990 is reviewed by the President and Treasurer of the organization after review by the Controller. Then it is made available for Board Member review prior to filing. |
| Form 990 Part VI | 12c | Directors, President, Vice Presidents, Managers, Case Management employees, Contracts Collections employees, employees with direct purchasing responsibilities, employed physicians, and employees who are contracted or shared with other organizations are required to complete an annual questionnaire disclosing potential conflicts of interest. If a known or perceived conflict of interest arises, the Compliance Officer investigates, documents, and works to resolve the conflict of interest. |
| Form 990 Part VI | 15a b | Annually, the Compensation Committee compares officer and key employee compensation to regional industry averages. This committee consists of independent members of the Board of Directors. Compensation adjustment recommendations are submitted, to be included in the budget, to the Finance and Audit Committee. Compensation adjustments are taken to the Board of Directors for final approval, and if approved are then implemented. |
| Form 990 Part VI | 19 | The governing documents, conflict of interest, and financials are made available to the public by requests made to FMC management. |
| Form 990 Part XI | 5 | The other change in net assets reported represents intercompany transfers between Fairfield Medical Center and related organizations see Schedule R for fixed asset purchases, shared employees, expenses, and other intercompany transactions. |
| Form 990 Part VI Section A Line 2 Various members of the Board of Directors are key employees and/or officers of organizations that may conduct normal, arms length transactions with one another. Form 990 Part VI Section B Line 11b The 990 is reviewed by the President and Treasurer of the organization after review by the Controller. Then it is made available for Board Member review prior to filing. Form 990 Part VI Section B Line 12c Directors, President, Vice Presidents, Managers, Case Management employees, Contracts Collections employees, employees with direct purchasing responsibilities, employed physicians, and employees who are contracted or shared with other organizations are required to complete an annual questionnaire disclosing potential conflicts of interest. If a known or perceived conflict of interest arises, the Compliance Officer investigates, documents, and works to resolve the conflict of interest. Form 990 Part VI Section B Line 15a b Annually, the Compensation Committee compares officer and key employee compensation to regional industry averages. This committee consists of independent members of the Board of Directors. Compensation adjustment recommendations are submitted, to be included in the budget, to the Finance and Audit Committee. Compensation adjustments are taken to the Board of Directors for final approval, and if approved are then implemented. Form 990 Part VI Section C Line 19 The governing documents, conflict of interest, and financials are made available to the public by requests made to FMC management. Form 990 Part XI Line 5 The other change in net assets reported represents intercompany transfers between Fairfield Medical Center and related organizations see Schedule R for fixed asset purchases, shared employees, expenses, and other intercompany transactions. |
Schedule R IRS990ScheduleR
Form990 Schedule R Part I Form990ScheduleRPartI
Name Of Disregarded Entity NameOfDisregardedEntity
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Home Health Resources | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 401 North Ewing Street | AddressLine1 |
| City | Lancaster | City |
| State | OH | State |
| ZIP Code | 43130 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 311159707 | EIN |
| Primary Activities | Durable Med. Equip. | PrimaryActivities |
| Legal Domicile State | OH | LegalDomicileState |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Zane Properties Corporation | BusinessNameLine1 |
Form990 Schedule R Part II Form990ScheduleRPartII (2 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivities | Legal Domicile StateLegalDomicileState | Exempt Code SectionExemptCodeSection | Public Charity StatusPublicCharityStatus | Business Name Line1DirectControllingEntityName/BusinessNameLine1 | Controlled OrgControlledOrg | Direct Controlling Entity NADirectControllingEntityNA |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Fairfield Healthcare Professionals Inc | |||||||||||
| 401 North Ewing Street | Lancaster | OH | 43130 | 311425884 | Physician Practices | OH | 501c3 | 11a | Fairfield Medical Center | false | |
| Fairfield Medical Center Foundation | |||||||||||
| 401 North Ewing Street | Lancaster | OH | 43130 | 208952945 | Fundraising | OH | 501c3 | 7 | false | N/A | |
Form990 Schedule R Part III Form990ScheduleRPartIII (6 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivityPrimaryActivity | Legal Domicile StateLegalDomicileState | Business Name Line1DirectControllingEntityName/BusinessNameLine1 | Predominant Income TypePredominantIncomeType | Share Of Total IncomeShareOfTotalIncome | Share Of EOY AssetsShareOfEOYAssets | Disproportionate AllocationsDisproportionateAllocations | General Or Managing PartnerGeneralOrManagingPartner | Percentage OwnershipPercentageOwnership | Direct Controlling Entity NADirectControllingEntityNA |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Southeast Ohio Sleep Disorders Center LLC | ||||||||||||||
| 135 North Ewing Street FL 3 | Lancaster | OH | 43130 | 311639116 | Sleep disorder trmt | OH | Fairfield Medical Center | Related | 51 | 51 | false | true | 0.51000 | |
| Simplified Healthcare Solutions LLC | ||||||||||||||
| 5980 Wilcox Place Suite F | Dublin | OH | 43016 | 201720030 | Claims review/processing | OH | Fairfield Medical Center | Related | 100 | 100 | false | true | 1.00000 | |
| Access Health Fairfield LLC | ||||||||||||||
| 401 North Ewing Street PO Box 2003 | Lancaster | OH | 43130 | 311682788 | Coordination | OH | Related | 38 | 38 | false | false | 0.37500 | N/A | |
| Fairfield Diagnostic Imaging LLC | ||||||||||||||
| 1241 River Valley Blvd | Lancaster | OH | 43130 | 311584889 | Radiology | OH | Fairfield Medical Center | Related | 65 | 100 | false | false | 1.00000 | |
| Gordon B Snider Cardio Inst Co-Mgt Co LLC | ||||||||||||||
| 401 North Ewing Street | Lancaster | OH | 43130 | 274462210 | Management | OH | Related | 21 | 21 | false | false | 0.20930 | N/A | |
| FMC Surgical Svcs Co-Mgt Co LLC | ||||||||||||||
| 401 North Ewing Street | Lancaster | OH | 43130 | 450672131 | Management | OH | Related | 50 | 50 | false | false | 0.50000 | N/A | |
Form990 Schedule R Part IV Form990ScheduleRPartIV
Name Of Related Org NameOfRelatedOrg
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Zane Properties Corporation | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 401 North Ewing Street | AddressLine1 |
| City | Lancaster | City |
| State | OH | State |
| ZIP Code | 43130 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 311202009 | EIN |
| Primary Activity | Holding Company | PrimaryActivity |
| Legal Domicile State | OH | LegalDomicileState |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Fairfield Medical Center | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Type Of Entity | C Corp | TypeOfEntity |
| Share Of Total Income | 100 | ShareOfTotalIncome |
| Share Of EOY Assets | 100 | ShareOfEOYAssets |
| Percentage Ownership | 1.00000 | PercentageOwnership |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | true | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | true | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | false | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | false | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | false | LoansOrGuaranteesFromOtherOrg |
| Sale Of Assets To Other Org | true | SaleOfAssetsToOtherOrg |
| Purchase Of Assets From Other Org | false | PurchaseOfAssetsFromOtherOrg |
| Exchange Of Assets | false | ExchangeOfAssets |
| Rental Of Facilities To Other Orgs | false | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | false | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | false | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | false | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | false | SharingOfFacilities |
| Sharing Of Paid Employees | true | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | false | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | true | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | true | OtherTransferToOtherOrg |
| Other Transfer From Other Org | false | OtherTransferFromOtherOrg |
Transactions Related Orgs Table TransactionsRelatedOrgsTable (9 entries)
| Transaction TypeTransactionType | Amount InvolvedAmountInvolved |
|---|---|
| Southeast Ohio Sleep Disorders Center LLC | |
| a | 47220 |
| Fairfield Healthcare Professionals Inc | |
| a | 28500 |
| Gordon B Snider Cardiovascular Institute Co-Mgt Co LLC | |
| b | 31500 |
| FMC Surgical Services Co-Mgt Co LLC | |
| b | 161000 |
| Fairfield Healthcare Professionals Inc | |
| f | 946170 |
| Fairfield Healthcare Professionals Inc | |
| n | 3461978 |
| Fairfield Healthcare Professionals Inc | |
| p | 1760000 |
| Zane Properties Corporation | |
| p | 176885 |
| Fairfield Healthcare Professionals Inc | |
| q | 1364141 |