2011-09-15T13:15:51-00:00 2010-12-31 990 2010-01-01 310645626 Fairfield Medical Center FAIR 7406878000 401 North Ewing Street Lancaster OH 431303371 Sky L Gettys 2011-08-11 false 2010 2016-03-07 17:11:31Z Mina H Ubbing 401 North Ewing Street Lancaster OH 43130 210426571 false X www.fmchealth.org X 1982 OH 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. 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. 15 15 2251 173 350037 93587 222749 182559275 192609502 -1037698 1751291 3913215 3695911 185528379 198279453 0 0 87969383 90639541 0 0 91341628 98192332 179311011 188831873 6217368 9447580 178309898 186675728 77736262 81905531 100573636 104770197 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. false false 70071796 76258550 Patient Care Inpatient Medical, Surgical, Emergency, Maternity, ICU, Psychiatry, and Nursing Services 74,184 admissions, procedures visits 69514805 116743239 Patient Care Laboratory, Cardiovascular, Radiology, Therapy, Pharmacy, and Medical Supply Services 2,550,998 procedures dosages 17828130 450128 Patient Care Nutritional Services 490,173 meals served Patient Care Laundry Services 1,599,908 pounds Patient Care Plant Engineering, Police, Housekeeping, Central Transport, Interest Depreciation 523,325 square feet 157414731 true true false false false false false false false true false false true true false false true false false false false false false false false true false false false true true false false false false false false false false false false false false false false true true true true true false true 110 0 true 2251 true true true false false false false false false false false false X 15 15 true false false false false false false true true false false true true true true true true true true true true OH X Sky L Gettys 7406878011 401 North Ewing Street Lancaster OH 431303371 David Conley MD 003.00 X X 0 0 0 Carol Seubert Marx 003.00 X X 0 0 0 Debra Smith 003.00 X X 0 0 0 Lawrence Q Burgess PhD 002.00 X 0 0 0 Ron Burris 002.00 X 0 0 0 James Christian 002.00 X 0 0 0 Dean Cochenour 002.00 X 0 0 0 Shashi Gogate MD 002.00 X 0 0 0 Dave Harcum 002.00 X 0 0 0 Dave Oehlers 002.00 X 0 0 0 Barry Ritchey 002.00 X 0 0 0 Dave Scoggin MD 002.00 X 0 0 0 Mina H Ubbing 055.00 X X 530763 0 32125 Sky L Gettys 048.00 X X 215277 0 24728 Jerome J Roche MD 050.00 X 335564 0 17385 Howard Sniderman 045.00 X 190420 0 18461 Cynthia Pearsall 050.00 X 176200 0 12982 Steven D Cox MD 024.00 X 247383 0 8588 Randy L Brown 040.00 X 151885 0 20068 Grace Edwards 039.00 X 150522 0 10228 Heather B Schultz 040.00 X 140077 0 9727 Pamela R Reed 037.00 X 138007 0 13625 Betsy L Winsley 040.00 X 137537 0 9744 Linda Sheridan 002.00 X 0 0 0 Loiuis Varga 002.00 X 0 0 0 Molly Weiland 002.00 X 0 0 0 2413635 177661 27 false true false McKesson PO Box 98347 Chicago IL 606930001 Information Technology Services 2868926 Aramark Healthcare 12483 Collections Center Drive Chicago IL 60693 Biomedical Services 2734873 Fairfield Emergency Physicians 401 North Ewing Street Lancaster OH 43130 Emergency Physician Services 812480 Bricker & Eckler 100 South Third Street Columbus OH 43215 Legal Services 539648 East Main Shopping 123 Broad Street Suite 211 Lancaster OH 43130 Rent 364238 11 222749 222749 Patient Service Revenue Net 192609502 192609502 192609502 1075560 1075560 715837 373400 342437 342437 12007158 442291 11341133 432585 666025 9706 675731 Cafeteria Sales 846356 846356 Patronage Dividends 900099 293103 293103 Outside Reference Lab 621500 307479 307479 1906536 1863978 42558 3353474 198279453 194473480 350037 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0.00010 7 23429 360119 360119 0.00200 true 4412022 520618 50355936 53936495 -3580559 X true true Southeast Ohio Sleep Disorders Sleep Lab 0.51000 0.49000 Fairfield Diagnostic Imaging Imaging Center 0.65000 0.35000 1 1 Fairfield Medical Center

401 North Ewing Street Lancaster OH 43130

X X X 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, at cost, represents total uncollected charges multiplied by a cost-to-charge ratio. Fairfield County has 11.8 of the population living below the poverty level. Bad debt was multiplied times that percentage, then that amount was reduced to cost using a cost-to-charge ratio. 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 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 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 2 FMC partnered with the Fairfield Co. Health Dept. and Fairfield Co. Health Clinic to assess the physical health needs of the community. The University of Toledo was hired to send out 2,500 questionnaires across the area asking about what diseases and needs are present. They also visited schools to survey students asking if the students drink, smoke or take drugs for which they do not have a prescription. The results were tabulated and evaluated in 2010 to see if the medical needs are being met and, if not, what needs to be done in order to meet the needs addressed. Obesity was found to be a major concern, so FMC joined with other counties including Fairfield, Hocking, Perry and Pickaway Counties to help families learn tools for a healthy lifestyle. Part VI Line 3 A poster is prominently displayed at every registration desk, asking the patient to inform us if he or she thinks they may be eligible for HCAP or other financial assistance. It further states that financial counselors are available to help with the application process. This information, along with eligibility criteria, is also included on all bills and collection letters. Every effort is made to inform patients of the availability of financial help with his or her bill when the criteria is met. Patients are asked to fill out a Request for Determination of Eligibility for Uncompensated Services in order for staff to identify those eligible, while at the same time preserving their 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 is approximately 143,712. About 17,246 people live at or below the poverty level. 11.8 of the population is uninsured. 90.9 have graduated from high school. 18 are smokers and over 30 are obese. About 6.3 of the population is less than five years old 24.7 are less than 18 years old. Additionally, approximately 12.1 are age 65 or older. So there is a wide demographic range of people, but quite evenly spaced, also. 5.9 of the population has major depression, further reinforcing the need for psychiatric care in the community. Sources US Census Bureau website for 2009, OHA Uninsured Fact Sheet, US Dept of Health Human Services website and County Health Rankings.org Part VI Line 5 With an unemployment rate of 9.2 for Fairfield Co., Leadership Development/Training for Community Members and Workforce Development is vital to the health and well being of the community. We support various economic entities which are dedicated to bringing new business to Fairfield Co. and others which are dedicated to helping existing businesses increase their businesses. As the largest employer in the area, FMC is committed to doing whatever we can to share our time and expertise for the benefit ofthe community. Part VI Line 5 Together we are stronger, so FMC is dedicated to building coalitions with area organizations to help build on each others strengths. We do many things to help the environment that cannot be quantified, such as working with area organizations in recycling what used to be considered waste. We also do whatever possible to save energy, whether it be reclaiming heat in the laundry or utilizing motion detectors to turn lights on and off. FMC was recognized for being mercury free, as well as receiving other awards for being environmentally friendly. Part VI Line 6 FMC is committed to educating the public regarding various health issues. We educate heart patients, parents, grandparents and students. We welcome the opportunity to improve the health and well-being of our community our goal is meet people in our education classes, not in a hospital room. We would much rather help someone quit smoking than to have to treat them or a family member for smoking-related illnesses. The more we learn about stress, the more we realize its capacity to affect all areas of health. Because of that we teach classes on stress relief and exercise to help peoples overall health and mental health. Part VI Line 6 We also supervise and/or host many varied support groups for the community. One of the most rewarding is the Look Good, Feel Better program which helps women with cancer look her best, which has been shown to affect her overall health in the process. Part VI Line 6 We cooperate with other area agencies for a larger impact, such as our Opiate Task Force, which brought together law enforcement and treatment specialists, along with health care professionals to attack opiate addiction in the area. Part VI Line 7 N/A Part VI Line 8 Part VI Line 8, OH X X X X false true false false false false false true false Mina H Ubbing 448595 29447 52721 17150 14975 562888 Sky L Gettys 198216 15527 1534 15343 9385 240005 Jerome J Roche MD 311339 23025 1200 16195 1190 352949 Howard Sniderman 178349 10621 1450 13630 4831 208881 Cynthia Pearsall 162718 11855 1627 12444 538 189182 Steven D Cox MD 246783 600 8588 255971 Randy L Brown 146710 4575 600 10708 9360 171953 Grace Edwards 150036 486 10228 160750 Pamela R Reed 114683 6539 16785 9596 4029 151632 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 current year capital. false false County of Fairfield Ohio 316400066 2010-12-22 10000000 To fund current year capital. false false 30161142 1815250 2507003 1123902 29037240 2005 false false true true false false false false true true false false false false true true false false false false true true false false false false false false false false false false false false false false false false false false 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. 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, unrealized gains on investments, and other intercompany transactions. Home Health Resources 401 North Ewing Street Lancaster OH 43130 311159707 Durable Med. Equip. OH Zane Properties Corporation 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 N/A false 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 N/A Related 38 38 false false 0.38000 Fairfield Diagnostic Imaging LLC 1241 River Valley Blvd Lancaster OH 43130 311584889 Radiology OH Fairfield Medical Center Related 65 65 false false 0.65000 Zane Properties Corporation 401 North Ewing Street Lancaster OH 43130 311202009 Holding Company OH Fairfield Medical Center C Corp 1.00000 Fairfield Center for Health & Healing 401 North Ewing Street Lancaster OH 43130 200247412 Alternative Healthcare OH Fairfield Medical Center C Corp 1.00000 true false false false false true false false false false false false false true false true true false Southeast Ohio Sleep Disorders Center LLC a 47220 Fairfield Healthcare Professionals Inc a 72307 Fairfield Healthcare Professionals Inc f 1335102 Fairfield Healthcare Professionals Inc n 2737070 Fairfield Healthcare Professionals Inc p 1696309 Zane Properties Corporation p 89386 Fairfield Healthcare Professionals Inc q 1720000