2012-11-15T13:13:25-06:00 2011-12-31 381357951 PLANTE & MORAN PLLC 65 EAST STATE STREET SUITE 600 COLUMBUS OH 43215 990 2011-01-01 344441792 H B MAGRUDER MEMORIAL HOSPITAL HBMA 4197343131 615 FULTON STREET PORT CLINTON OH 43452 JON TODD ALMENDINGER 4197343131 2012-11-14 1 BERNIE OSTROWSKI P00366367 6148493000 2011 2016-02-24 21:20:13Z MAGRUDER HOSPITAL MICHAEL E LONG 615 FULTON STREET PORT CLINTON OH 43452 51666707 0 X WWW.MAGRUDERHOSPITAL.COM X 1940 OH MAGRUDER HOSPITAL SHALL PROVIDE COMPASSIONATE CARE WITH EXCELLENT OUTCOMES. 14 14 433 130 0 0 143007 158405 41211223 49814762 316289 184639 546653 1019379 42217172 51177185 8000 12400 0 0 20137071 21418595 0 0 0 24403179 26834882 44548250 48265877 -2331078 2911308 42658459 44578147 10598158 9664454 32060301 34913693 X SEE SCHEDULE OMAGRUDER SHALL:-PROVIDE QUALITY AND COMPASSIONATE MEDICAL CARE AND TREATMENT-PROMOTE HEALTH EDUCATION AND PREVENTATIVE CARE-IMPROVE THE COMMUNITY'S HEALTH STATUS-WORK COLLABORATIVELY AND COOPERATIVELY WITH AREA HEALTH PROVIDERS-STRIVE FOR CONTINUAL QUALITY IMPROVEMENT-BE COST-EFFECTIVE IN HOSPITAL OPERATIONS-ACHIEVE ALIGNMENT WITH THE GOALS AND OBJECTIVES OF THE STAFF PHYSICIANS 0 0 42697434 12400 50904547 SEE SCHEDULE OFOUNDED IN 1940, H B MAGRUDER MEMORIAL HOSPITAL (MAGRUDER) IS A 25 BED, MEDICARE DESIGNATED CRITICAL ACCESS TAX EXEMPT HEALTHCARE FACILITY, LOCATED IN PORT CLINTON, OHIO. THE HOSPITAL PROVIDES DIRECT HEALTHCARE SERVICES TO THE RESIDENTS IN THE COMMUNITIES OF OTTAWA COUNTY THAT INCLUDE BOTH INPATIENT AND OUTPATIENT SERVICES INCLUDING EMERGENCY SERVICES 24 HOURS PER DAY, 7 DAYS PER WEEK. PATIENTS ARE ACCEPTED REGARDLESS OF NATIONAL ORIGIN, AGE, RACE, CREED, SEX, OR ABILITY TO PAY.IN 2011, MAGRUDER EXPERIENCED A TOTAL OF 3545 INPATIENT DAYS, INCLUDING 2701 DAYS TO MEDICARE PATIENTS AND 113 DAYS TO MEDICAID PATIENTS. THE HOSPITAL EXPERIENCED 16,452 VISITS TO THE EMERGENCY DEPARTMENT, AND TREATED A TOTAL OF 77,407 OUTPATIENTS.WHILE MEDICARE, MEDICAID, AND PRIVATE INSURANCE PLANS AND PROGRAMS PAID FOR THE SERVICES OF MOST PATIENTS TREATED AND RELEASED AT MAGRUDER, UNCOMPENSATED CARE WAS PROVIDED BY THE HOSPITAL TO PATIENTS WHO WERE EITHER UNABLE OR UNWILLING TO PAY. THIS REFLECTED THE HOSPITAL'S MISSION TO CARE FOR PATIENTS EVEN IF UNABLE OR UNWILLING TO PAY FOR SERVICES NOT OTHERWISE COVERED BY PRIVATE INSURANCE AND/OR GOVERNMENTAL PROGRAMS.MAGRUDER CONTINUES ITS COMMITMENT TO SERVING THE PUBLIC HEALTH PREVENTION AND HEALTH EDUCATION NEEDS IN THE COMMUNITIES OF OTTAWA COUNTY. MAGRUDER CONTINUES TO KEEP AN ACTIVE ROLE IN THE OTTAWA COUNTY HEALTH PARTNERS, WHICH INITIATED THE COMMUNITY HEALTH NEEDS ASSESSMENT IN 2006. THE GROUP CONTINUES WORKING THROUGH ITS STRATEGIC PLAN AND ADAPTS THE ACTION PLANS BASED ON COMMUNITY NEEDS INFORMATION FROM LOCAL CASE MANAGEMENT AS WELL AS UNITED WAY 2-1-1. AN UPDATED COMMUNITY HEALTH NEEDS ASSESSMENT WAS PLANNED DURING 2011 AND THE REPORT IS SCHEDULED TO BE RELEASED IN OCTOBER 2012.OUR OUTREACH PROGRAMS CONTINUE TO TOUCH HUNDREDS OF LIVES IN OUR COMMUNITIES. -REDUCED FEE CHOLESTEROL SCREENING FOR THE COMMUNITY EACH MONTH (217 PARTICIPANTS)-ANNUAL FREE WOMEN'S HEALTH DAY EDUCATION PROGRAM (117 PARTICIPANTS)-ADMINISTERED FLU SHOTS AT BUSINESSES, HEALTH FAIRS AND PUBLIC CLINICS (470 PARTICIPANTS)-MEDICARE EDUCATION FOR THE COMMUNITY (IN ADDITION TO A LARGE PUBLIC EDUCATIONAL SESSION (57), WE HAD STAFF THROUGHOUT THE END OF THE YEAR OFFERING ONE ON ONE APPOINTMENTS FOR PART D COMPARISONS AND OTHER RESOURCES.)-KIWANIS LAB SCREENING TEST FOR 7 DIFFERENT MEDICAL CONDITIONS (160 PARTICIPANTS)-FREE SKIN CANCER SCREENING TO THE COMMUNITY (133 PARTICIPANTS)-FREE PROSTATE CANCER SCREENING TO THE COMMUNITY (123 PARTICIPANTS)-FREE COLORECTAL HEALTH SCREENING KITS TO THE COMMUNITY (104)-CANCER SUPPORT GROUP (67 PARTICIPANTS)-DIABETES SUPPORT GROUP (36 PARTICIPANTS)-REDUCED FEE WELLNESS CLASSES FOR THE COMMUNITY (1,611 PARTICIPANTS)-GENERAL HEALTH SCREENINGS (USUALLY BLOOD PRESSURE & BLOOD SUGAR) AT COMMUNITY EVENTS (433 PARTICIPANTS)-BOARD INVOLVEMENT IN: AMERICAN CANCER SOCIETY, 3 LOCAL SCHOOL WELLNESS COMMITTEES, COUNCIL OF HEALTH & SOCIAL CONCERNS, AMERICAN HEART ASSOCIATION-MAGRUDER SPONSORED 4 BLOOD DRIVES IN 2010 WHICH INCLUDES NOT ONLY THE SPACE AND PROMOTION FOR THE EVENT BUT ALSO ALLOWED 78 EMPLOYEES TO DONATE ON WORK TIME.-EDUCATION PROGRAMS (OVER 900 PARTICIPANTS) -COMMUNITY EVENTS: DIABETES, HEART HEALTH, WOMEN'S HEALTH, MEDICAL INFORMATION NOTEBOOK, YOUTH NUTRITION, -MONTHLY LUNCHEONS: SLEEP, MEDICARE, ACID REFLUX, STRESS, COMPLIMENTARY & ALTERNATIVE MEDICINE, EXERCISE, GASTROINTESTINAL HEALTH -"TIME FOR HEALTH" TV SHOW: MULTIPLE SCLEROSIS, INSURANCE, EATING HEALTHY ON A BUDGET, COMMUNITY SUPPORTED AGRICULTURE, SENIOR RESOURCES, SCHOOL WELLNESS, PAIN, HEALTHY GROCERY SHOPPING, SLEEP AND GRIEF-MAGRUDER HOSPITAL ALSO SPONSORS OR PARTICIPATES IN THE FOLLOWING COMMUNITY BUILDING ACTIVITIES: -CASA (COURT APPOINTED SPECIAL ADVOCATES) -JOYFUL CONNECTIONS (SUPERVISED VISITATION AND EXCHANGE) -HABITAT FOR HUMANITY -JUVENILE DIABETES -SUSAN G KOMEN -EASTER SEALS -TEEN PEP (PEERS EDUCATING PEERS) -KICK SOME BUTTS (ANTI-TOBACCO COMMERCIAL COMPETITION)OPPORTUNITIES ARE PROVIDED TO ASSIST IN THE DELIVERY OF HEALTHCARE AT THE HOSPITAL THROUGH VOLUNTEER SERVICE COORDINATED BY THE H B MAGRUDER MEMORIAL HOSPITAL AUXILIARY (AUXILIARY). THE AUXILIARY OPERATES THE HOSPITAL'S GIFT SHOP, AND PROVIDES VOLUNTEERS THAT WORK IN VARIOUS HOSPITAL DEPARTMENTS, INCLUDING: TRANSPORT, RADIOLOGY, NURSING, FOOD SERVICE, HEALTH INFORMATION SERVICES, LAB AND THE BUSINESS OFFICE. 42697434 1 1 0 1 0 0 0 0 0 0 1 0 0 0 1 0 1 0 0 0 0 0 0 0 1 0 1 1 0 1 1 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 91 0 1 433 1 0 0 0 0 1 1 1 1 0 0 0 0 X 14 14 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 0 0 1 0 1 0 OH X TONI MAGSIG ACCOUNTING DIRECTOR 4197343131 615 FULTON STREET PORT CLINTON OH 43452 PAUL DRUCKENMILLER 1.00 X X 0 0 0 BRUCE SMITH 1.00 X X 0 0 0 NANCY OSBORN 1.00 X X 0 0 0 DAVID SODERBERG 1.00 X X 0 0 0 DANIEL ALMENDINGER 1.00 X X 0 0 0 JOHN BODIE MD 1.00 X 0 0 0 EMIL CELLIER 1.00 X 0 0 0 DOUGLAS FOCHT 1.00 X 0 0 0 MARK HABLITZEL DDS 1.00 X 0 0 0 RON MILLER 1.00 X 0 0 0 KEVIN SNEIDER DPM 1.00 X 0 0 0 LOCKWOOD ZEIS 1.00 X 0 0 0 SUE CROSSER 1.00 X 0 0 0 GREG DEERHAKE 1.00 X 0 0 0 JON TODD ALMENDINGER 40.00 X 133919 0 26137 MICHAEL E LONG 40.00 X 180748 0 28276 DR LEONARDO QUE 40.00 X 291899 0 0 DR CHRISTOPHER STRANATHAN 40.00 X 216728 0 27893 DR PANJU PRITHVIRAJ 40.00 X 798903 0 24715 ISIDRO AMIGO 40.00 X 345388 0 40945 STEVEN JACKSON 40.00 X 205853 0 19623 CLIFFORD HARMON 0.00 X 184306 0 15345 2357744 0 182934 21 1 1 0 CERNER CORPORATION 2800 ROCKCREEK PARKWAY NORTH KANSAS CITY MO 64117 SOFTWARE/MAINTENANCE 1855193 PORT CLINTON EMERGENCY PHYSICIANS INC 1364 WOODSTREAM PERRYSBURG OH 43551 EMERGENCY PHYSICIANS 1832816 ADVANCED HEALTH LTD 1325 HULL RD SANDUSKY OH 44870 PHYSICAL THERAPY SERVICES 1217746 ABAN AFFAN MD 4446 MARIN HARBOR UNIT C PORT CLINTON OH 43452 ANESTHESIOLOGY SERVICES 583463 MATRIX GROUP BENEFIT PO BOX 42879 INDIANAPOLIS IN 46242 ADMINISTRATION FEES 341217 17 605 37312 120488 158405 HEALTHCARE SERVICES 622110 49814762 49814762 49814762 123586 123586 396314 466603 -70289 -70289 -70289 61053 0 61053 61053 61053 22802 37312 22919 -117 -117 PAIN MANAGEMENT CLINIC 900099 439554 439554 MOBILE MEALS/FOOD SVC 900099 352709 352709 PASSTHROUGH INCOME 900099 -19131 -19131 316653 316653 1089785 51177185 50904547 0 114233 12400 12400 369080 369080 14335076 12399841 1935235 893925 773245 120680 4500226 3892695 607531 1320288 1142049 178239 24000 24000 172759 172759 106620 106620 9639721 9191671 448050 228883 228883 8585113 7342296 1242817 1059758 921989 137769 1158978 988715 170263 55268 27634 27634 10768 10768 2124956 2124956 345892 345892 BAD DEBT EXPENSE 3219600 3219600 PHYSICIAN RECRUITMENT 32765 28719 4046 EDUCATION 17551 15269 2282 ADMINISTRATIVE EXPENSE 8515 5021 3494 43735 25791 17944 48265877 42697434 5568443 0 240659 98722 2010661 7641744 8464914 6366083 229443 548645 308675 394231 743183 531872 55819821 32120038 25465635 23699783 4934068 4731442 261221 565625 42658459 44578147 4834927 5400296 3747742 1704948 2015489 2559210 10598158 9664454 X 32031071 34881732 29230 31961 32060301 34913693 42658459 44578147 X 2911308 -57916 X X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 1388 1388 0 EXPLANATION OF LOBBYING ACTIVITIES: PART II-B, LINE 1: A PORTION OF DUES PAID TO THE OHIO HOSPITAL ASSOCIATION RELATES TO LOBBYING. 686533 686533 30750184 14593463 16156721 626816 582719 44097 23704396 16943856 6760540 51892 51892 23699783 ESTIMATED 3RD PARTY PAYOR SETTLEMENTS 2060416 ACCRUED POST-RETIREMENT BEN. OBLIGATION 498794 2559210 51177185 48265877 2911308 -64981 7065 -57916 2853392 48449732 -64981 -3070196 -3135177 51584909 -407724 -407724 51177185 45549352 466603 466603 45082749 3183128 3183128 48265877 PART XI, LINE 8 - OTHER ADJUSTMENTS: POST RETIREMENT RELATED COSTS 29,211. NET ASSETS RELEASED FROM RESTRICTION -3,500. AUXILIARY EQUITY CHANGES -18,646. TOTAL TO SCHEDULE D, PART XI, LINE 8: 7,065. PART XII, LINE 2D - OTHER ADJUSTMENTS: POSTRETIREMENT RELATED COSTS 29,211. BAD DEBT EXPENSES -3,219,600. AUXILIARY GRANT EXPENSE 75,000. RECLASS OF CARDIAC SALARY OFFSET 45,193. PART XII, LINE 4B - OTHER ADJUSTMENTS: RECLASS SPECIAL EVENT EXPENSES -22,919. RECLASS RENTAL EXPENSES -466,603. FUNDRAISING INCOME 22,802. FUNDRAISING CONTRIBUTIONS 37,312. AUXILIARY DUES 605. AUXILIARY OTHER INCOME 14,848. RESTRICTED INVESTMENT 6,231. PART XIII, LINE 2D - OTHER ADJUSTMENTS: RECLASS RENTAL EXPENSES 466,603. PART XIII, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT EXPENSES 3,219,600. RECLASS OF CARDIAC SALARY OFFSET -45,193. AUXILIARY EXPENSES 8,721. CHARITY BALL 36414 26297 10117 10945 GOLF OUTING 23700 11015 12685 11974 60114 37312 22802 22919 22919 -117 1 1 X 1 X 1 X 1 1 1 0 1 1 1894208 935548 958660 0.02130 3984751 2274493 1710258 0.03800 5878959 3210041 2668918 0.05930 416600 7647 408953 0.00910 18690 18690 0.00040 435290 7647 427643 0.00950 6314249 3217688 3096561 0.06880 20 5904 5904 0.00010 1529 1529 0.00000 386 386 0.00000 20 7819 7819 0.00010 0 1598309 86100 6131216 15633590 -9502374 X 1 1 1 MAGRUDER PAIN MANAGEMENT GROUP LLC MEDICAL SERVICES TO TREAT CHRONIC PAIN 0.51000 0.49000 2 OTTAWA COUNTY CARENET GROUP CONTRACTING 0.50000 0.50000 1 1 HB MAGRUDER MEMORIAL HOSPITAL

615 FULTON STREET PORT CLINTON OH 43452

X HB MAGRUDER MEMORIAL HOSPITAL 1 1 1 100.000000000000 1 400.000000000000 0 1 1 X X 1 0 1 X 0 0 7 PHYSICIAN OFFICE

611 E 6TH STREET PORT CLINTON OH 43452

PHYSICIAN OFFICE PHYSICIAN OFFICE

621 FULTON STREET PORT CLINTON OH 43452

PHYSICIAN OFFICE PHYSICAL THERAPY

7725 W STATE ROUTE 163 OAK HARBOR OH 43449

PHYSICAL THERAPY PHYSICIAN OFFICE

11697 W STATE ROUTE 163 OAK HARBOR OH 43449

PHYSICIAN OFFICE PHYSICAL THERAPY

4058 E HARBOR RD PORT CLINTON OH 43452

PHYSICAL THERAPY PHYSICIAN OFFICE

1297 W MAIN STREET LAKESIDE MARBLEHEAD OH 43440

PHYSICIAN OFFICE PHYSICIAN OFFICE

2861 EAST HARBOR ROAD PORT CLINTON OH 43452

PHYSICIAN OFFICE PART I, LINE 3C: N/A PART I, LINE 6A: N/A PART I, LINE 7: TOTAL COMMUNITY BENEFIT EXPENSE RELATED TO CHARITY CARE WAS CALCULATED USING A COST-TO-CHARGE RATIO. TOTAL COMMUNITY BENEFIT RELATED TO MEDICAID WAS CALCULATED FROM THE MEDICAID COST REPORT. THE COST-TO-CHARGE RATIO WAS DERIVED FROM WORKSHEET 2. PART I, LINE 7, COLUMN (F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $ 3219600. PART II: THE COMMUNITY BUILDING ACTIVITIES THAT MAGRUDER HOSPITAL SUPPORTS ENCOURAGE EXERCISE (AREA SCHOOL ATHLETIC BOOSTERS), EDUCATION (AREA SCHOOLS HONOR BANQUETS), SAFETY (OFFICER PHIL), AND OTHER HEALTH-RELATED ORGANIZATIONS (EMS, EASTER SEALS, HOSPICE). PART III, LINE 4: ACCOUNTS RECEIVABLE FOR PATIENTS, INSURANCE COMPANIES, AND GOVERNMENTAL AGENCIES ARE BASED ON GROSS CHARGES. AN ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS IS ESTABLISHED ON AN AGGREGATE BASIS BY USING HISTORICAL WRITE-OFF RATE 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 HOSPITAL'S 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. AN ALLOWANCE FOR CONTRACTUAL ADJUSTMENTS AND INTERIM PAYMENT ADVANCES IS BASED ON EXPECTED PAYMENT RATES FROM PAYORS BASED ON CURRENT REIMBURSEMENT METHODOLOGIES. THIS AMOUNT ALSO INCLUDES AMOUNTS RECEIVED AS INTERIM PAYMENTS AGAINST UNPAID CLAIMS BY CERTAIN PAYORS.BAD DEBT AT COST WAS CALCULATED USING A COST-TO-CHARGE RATIO DERIVED FROM WORKSHEET 2 TO DETERMINE THE AMOUNTS REPORTED IN PART III, LINES 2 AND 3. THE HOSPITAL APPLIES ANY DISCOUNTS/PAYMENTS RECEIVED AGAINST PATIENT ACCOUNTS BEFORE DETERMINING BAD DEBT EXPENSE. MAGRUDER HOSPITAL DOES NOT BELIEVE BAD DEBT SHOULD BE INCLUDED AS A COMMUNITY BENEFIT.ADDITIONAL BAD DEBT ATTRIBUTABLE TO PATIENTS IDENTIFIED UNDER CHARITY CARE WAS CALCULATED USING ACTUAL COSTS FROM SPECIFICALLY IDENTIFIED PATIENTS THAT WERE MISCLASSIFIED AS BAD DEBT ORIGINALLY. MAGRUDER HOSPITAL DOES NOT BELIEVE BAD DEBT IDENTIFIED UNDER CHARITY CARE SHOULD BE INCLUDED AS A COMMUNITY BENEFIT. PART III, LINE 8: BASED ON A COST TO CHARGE RATIO CALCULATED AS REQUIRED UNDER MEDICARE RULES, THE COSTS OF PROVIDING CARE TO THE MEDICARE POPULATION IN 2011 WAS $15,633,590. THE PAYMENTS RELATED TO THESE SERVICES WERE $6,131,216. LEAVING A MEDICARE SHORTFALL OF $9,502,374 FOR THE YEAR. MAGRUDER HOSPITAL DOES NOT BELIEVE THE MEDICARE SHORTFALL SHOULD BE INCLUDED AS A COMMUNITY BENEFIT DUE TO THE ELDERLY POPULATION OF PERSONS OVER 65 YEARS OLD. PART III, LINE 9B: EVEN IF THE HOSPITAL KNOWS A PATIENT QUALIFIES FOR FINANCIAL AID, IT IS NOT PROVIDED WITHOUT A SIGNED APPLICATION. MAGRUDER HOSPITAL DOES MAKE AN EFFORT TO GET THE APPLICATION TO ALL PATIENTS. THE FINANCIAL COUNSELORS WILL TRY TO MAKE PHONE CONTACT WITH THOSE WHO ARE KNOWN TO QUALIFY TO ENCOURAGE COMPLETION OF THE FORMS. HOWEVER, THE PROCESS IS THE SAME FOR ALL PATIENTS. MAGRUDER HOSPITAL UTILIZES INTERNAL AND EXTERNAL COLLECTION EFFORTS (INCLUDING COLLECTION AGENCIES) FOR ALL PATIENTS. HB MAGRUDER MEMORIAL HOSPITAL PART V, SECTION B, LINE 19D: ALL PATIENTS ARE CHARGED AT GROSS CHARGES PER THE CHARGEMASTER. THOSE APPROVED FOR FINANCIAL ASSISTANCE ARE THEN GIVEN THE APPROPRIATE ALLOWANCE AND BILLED ANY REMAINING AMOUNT. PART VI, LINE 2: MAGRUDER IS PART OF A GROUP CALLED OTTAWA COUNTY COMMUNITY HEALTH PARTNERS, WHICH IS LEAD BY THE OTTAWA COUNTY HEALTH DEPARTMENT. OTHER MEMBERS INCLUDE: MENTAL HEALTH, NURSING FACILITIES, UNITED WAY, BOARD OF DEVELOPMENTAL DISABILITIES, JOB & FAMILY SERVICES AND SEVERAL SCHOOL DISTRICTS. MOST RECENTLY WE HAVE COMPLETED COMMUNITY HEALTH NEEDS ASSESSMENTS IN 2001 AND 2006. THE HOSPITAL COUNCIL OF NORTHWEST OHIO AND THE UNIVERSITY OF TOLEDO CARRY OUT THE ASSESSMENTS AND PROVIDE DATA BACK TO THE OTTAWA COUNTY COMMUNITY HEALTH PARTNERS. THE ASSESSMENT CONSISTS OF SELF-ADMINISTERED SURVEYS OF ADULTS (AGE 19 AND OLDER) AND ALSO YOUTH (AGES 12-18). THE QUESTIONS ARE MODELED AFTER THE SURVEY INSTRUMENTS USED BY THE CDC FOR THEIR NATIONAL AND STATE BEHAVIORAL RISK FACTOR SURVEILLANCE SYSTEM AND YOUTH RISK BEHAVIOR SURVEILLANCE SURVEY. THE RESULTS WERE ROLLED OUT TO THE COMMUNITY IN OCTOBER OF 2006 AND THE COMMUNITY HEALTH PARTNERS NARROWED DOWN A FOCUS OF OBESITY AND ALCOHOL USE (FOR YOUTH) AND ABUSE (FOR ADULTS). THEY DID A COMMUNITY RESOURCE ASSESSMENT AS WELL AS A GAP ANALYSIS AND CAME UP WITH SOME PLANS TO ADDRESS OBESITY AND ALCOHOL. THE GROUP HAS MET SEVERAL TIMES TO REVIEW PROGRAMS AND TACTICS BEING CARRIED OUT THROUGHOUT THE COUNTY TO ADDRESS THOSE ISSUES. PART VI, LINE 3: MAGRUDER HOSPITAL USES THE SAME APPLICATION FOR ALL FORMS OF ASSISTANCE. APPLICATIONS FOR ASSISTANCE ARE AVAILABLE TO ALL PATIENTS AT REGISTRATION. THE REGISTRARS WILL MAKE A POINT TO GIVE THE APPLICATION TO ANY SELF PAY PATIENT. ALONG WITH THE APPLICATION THERE ARE BUSINESS CARDS OF OUR FINANCIAL COUNSELORS IN REGISTRATION, SO PATIENTS KNOW WHO TO CONTACT WITH QUESTIONS.FINANCIAL COUNSELORS REVIEW THE PREVIOUS DAY'S REGISTRATIONS AND WILL ALSO CONTACT THE PATIENT AGAIN. THEY ARE PREPARED TO ANSWER QUESTIONS, OR SEND A COPY OF THE APPLICATION AND BUSINESS CARD TO THE PATIENT.THE APPLICATION IS ALSO PRINTED ON THE REVERSE SIDE OF THE STATEMENTS, SO IF AN ELIGIBLE PATIENT IS MISSED, THEY WILL KNOW MAGRUDER HOSPITAL WILL HELP AND TO CALL FOR ASSISTANCE. PART VI, LINE 4: MAGRUDER HOSPITAL IS A CRITICAL ACCESS HOSPITAL LOCATED IN PORT CLINTON, OHIO SERVING THE HEALTHCARE NEEDS OF OTTAWA COUNTY. OTTAWA COUNTY IS LOCATED ON LAKE ERIE ABOUT 15 MILES SOUTHEAST OF TOLEDO, OHIO AND IS MADE UP OF VARIOUS COMMUNITIES THAT INCLUDE SEVEN VILLAGES, TWELVE TOWNSHIPS AND THE ONLY CITY IN OTTAWA COUNTY, PORT CLINTON. THE POPULATION OF 40,000 HAS EASY ACCESS TO MAJOR STATE ARTERIES TO TOLEDO AND CLEVELAND. PART VI, LINE 5: MAGRUDER HOSPITAL ACTIVELY RECRUITS PHYSICIANS WITH THE SPECIALTIES NEEDED WITHIN THE COMMUNITY, SO THE COMMUNITY CAN ACCESS THE HEALTHCARE IT NEEDS. EXCESS FUNDS ARE PUT INTO STATE OF THE ART TECHNOLOGY TO BETTER SERVE OUR COMMUNITY. PART VI, LINE 6: N/A REPORTS FILED WITH STATES PART VI, LINE 7 OH 1 SCHOLARSHIPS 20 12400 PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, PART I, LINE 2: THE ROY SCHOLARSHIP IS FUNDED BY A TRUST, AND IS RELEASED ONLY TO NURSING STUDENTS PURSUING THEIR RN DEGREE BASED ON FINANCIAL NEED AS DETERMINED THROUGH AN APPLICATION PROCESS. THE AUXILIARY ALSO AWARDS SCHOLARSHIPS BASED ON AN APPLICATION PROCESS TO QUALIFIED STUDENTS PERSUING A HEALTH-RELATED DEGREE. X 1 0 X X X X 1 0 0 0 0 0 0 0 0 JON TODD ALMENDINGER 133919 0 0 0 0 0 9569 0 16568 0 160056 0 0 0 MICHAEL E LONG 180748 0 0 0 0 0 11677 0 16599 0 209024 0 0 0 DR LEONARDO QUE 291899 0 0 0 0 0 0 0 0 0 291899 0 0 0 DR CHRISTOPHER STRANATHAN 216728 0 0 0 0 0 8270 0 19623 0 244621 0 0 0 DR PANJU PRITHVIRAJ 495527 0 303376 0 0 0 4900 0 19815 0 823618 0 0 0 ISIDRO AMIGO 345388 0 0 0 0 0 21124 0 19821 0 386333 0 0 0 STEVEN JACKSON 205853 0 0 0 0 0 0 0 19623 0 225476 0 0 0 CLIFFORD HARMON 0 0 0 0 184306 0 0 0 15345 0 199651 0 0 0 PART I, LINE 1A THE CEO RECEIVES REIMBURSEMENT FOR SOCIAL CLUB DUES; REIMBURSEMENT IS TREATED AS TAXABLE COMPENSATION TO THE CEO. THE ORGANIZATION USES FACILITY FOR VARIOUS STAFF FUNCTIONS THROUGHOUT THE YEAR. THIS TRANSACTION IS ANNUALLY BOARD APPROVED. PART I, LINE 4A SEVERANCE AMOUNT PAID IN ACCORDANCE WITH WRITTEN AGREEMENT: CLIFFORD HARMON - $184,306 CHRISTOPHER STRANATHAN RETENTION INCENTIVE X 50000 833 0 1 1 833 FORM 990, PART VI, SECTION B, LINE 11 THE VP OF FINANCE REVIEWED THE FORM 990 WITH THE BOARD TREASURER TO THE LEVEL OF DETAIL REQUESTED BY THE BOARD TREASURER. THE FORM 990 WAS THEN PROVIDED TO EACH MEMBER OF THE BOARD WITH A DISCUSSION OF KEY POINTS PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C WRITTEN DISCLOSURE OF CONFLICTS OF INTEREST ARE REQUESTED ANNUALLY FOR ALL BOARD MEMBERS. THE CEO REVIEWS ALL DISCLOSURES. THE CODE OF REGULATIONS ASKS FOR PROMPT DISCLOSURE IF SITUATIONS CHANGE DURING THE YEAR. ANY BOARD MEMBER WITH A CONFLICT OR POTENTIAL CONFLICT IS RESTRICTED FROM PARTICIPATING IN VOTING ON MATTERS WHERE THERE IS A CONFLICT OR POTENTIAL CONFLICT. DOUG FOCHT, DIRECTOR, IS RESTRICTED FROM PARTICIPATING IN DECISIONS IN REGARDS TO BUILDING CONSTRUCTION TRANSACTIONS (SEE SCHEDULE L, PART VI DISCLOSURE). FORM 990, PART VI, SECTION B, LINE 15A THE CEO'S COMPENSATION IS APPROVED BY THE BOARD. THE EXECUTIVE COMMITTEE REVIEWS THE OHA SALARY SURVEY FOR COMPARISON. RECOMMENDATIONS TO THE FULL BOARD ARE MADE BASED ON SALARY SURVEY FINDINGS, MARKET FINDINGS, AND PERFORMANCE REVIEW FOR EXECUTIVES; ALL OTHER EMPLOYEES' SALARIES ARE DETERMINED IN A SIMILAR FASHION EXCLUDING BOARD APPROVAL. CONTEMPORANEOUS DOCUMENTATION AND RECORDKEEPING IS COMPLETED WITH RESPECT TO THIS PROCESS. THIS PROCESS WAS LAST PERFORMED IN 2010. FORM 990, PART VI, SECTION C, LINE 18 FORM 1023 AND FORM 990 ARE AVAILABLE UPON REQUEST. FORM 990, PART VI, SECTION C, LINE 19 GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE PROVIDED TO THE PUBLIC UPON REQUEST. AN ABBREVIATED FINANCIAL STATEMENT IS INCLUDED IN THE HOSPITAL'S ANNUAL REPORT. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED LOSSES ON INVESTMENTS: -64,981. POST RETIREMENT RELATED COSTS 29,211. NET ASSETS RELEASED FROM RESTRICTION -3,500. AUXILIARY EQUITY CHANGES -18,646. TOTAL TO FORM 990, PART XI, LINE 5: -57,916. FORM 990, PART XI, LINE 2C MEMBERS OF THE HOSPITAL'S BOARD OVERSEE THE AUDIT PROCESS AND THE SELECTION OF THE INDEPENDENT ACCOUNTANT. THIS PROCESS HAS NOT CHANGED SINCE THE PRIOR YEAR.