2011-11-10T11:44:01-06:00 2010-12-31 990 2010-01-01 344428218 FIRELANDS REGIONAL MEDICAL CENTER FIRE 4195577400 1111 HAYES AVENUE SANDUSKY OH 448703323 DANIEL J MONCHER 4195577400 2011-11-09 2010 2016-02-24 21:20:13Z CHARLES A STARK 1111 HAYES AVE SANDUSKY OH 448703323 316725950 0 X WWW.FIRELANDS.COM X 1919 OH THE MISSION OF FIRELANDS REGIONAL MEDICAL CENTER IS TO BE THE LEADING REGIONAL HEALTH CENTER, PROMOTING PHYSICAL, SPIRITUAL AND MENTAL WELL-BEING FOR GENERATIONS. 39 39 2131 268 0 0 1628535 934395 437642899 205088488 6808285 7602252 5623055 6716365 451702774 220341500 156683 277522 0 0 95307216 92333267 0 0 263660 349436215 117492798 444900114 210103587 6802660 10237913 386124489 386862538 233312897 235255372 152811592 151607166 X THE MISSION OF FIRELANDS REGIONAL MEDICAL CENTER IS TO BE THE LEADING REGIONAL HEALTH CENTER, PROMOTING PHYSICAL, SPIRITUAL AND MENTAL WELL-BEING FOR GENERATIONS. 0 0 171298181 227022 205088488 SEE SCHEDULE OFIRELANDS REGIONAL MEDICAL CENTER IS A 400-BED FACILITY SERVING THE GREATER ERIE COUNTY REGION WITH TOP QUALITY HEALTHCARE SERVICES DESIGNED TO HELP THE PEOPLE IN OUR COMMUNITIES LIVE HEALTHIER, HAPPIER LIVES. AS A NON-PROFIT ORGANIZATION, FIRELANDS IS COMMITTED TO ITS MISSION OF PROVIDING PHYSICAL, SPIRITUAL AND MENTAL WELL-BEING NOW AND FOR FUTURE GENERATIONS. FIRELANDS IS DEDICATED TO PROVIDING CARE TO ALL THOSE IN OUR COMMUNITY REGARDLESS OF ABILITY TO PAY.A RESULT OF COMBINING THREE ORIGINAL HOSPITALS: GOOD SAMARITAN HOSPITAL AND MEMORIAL HOSPITAL IN 1985 AND THEN ADDING PROVIDENCE HOSPITAL IN 2001, TODAY'S FIRELANDS REGIONAL MEDICAL CENTER CARRIES ON THE PROUD TRADITION OF DELIVERING A FULL RANGE OF ALLOPATHIC AND OSTEOPATHIC MEDICAL SERVICES TO NEARLY 250,000 RESIDENTS IN THE FIVE-COUNTY AREA.AS THE LARGEST YEAR-ROUND EMPLOYER IN ERIE COUNTY, FIRELANDS REGIONAL MEDICAL CENTER PLAYS AN IMPORTANT ROLE IN THE LOCAL COMMUNITY. WITH OVER 2,035 INDIVIDUALS EMPLOYED IN THE HEALTH SYSTEM IN 2010, FIRELANDS PAID OVER $100 MILLION IN SALARY AND BENEFITS, WHICH HELPS TO SUPPORT THE LOCAL ECONOMICS. IN FACT, $856,351 WAS PAID IN CITY AND SCHOOL PAYROLL TAXES IN 2010, AND NEARLY $3.46 MILLION OF GOODS AND SERVICES WERE PURCHASED FROM BUSINESSES IN FIRELANDS' SERVICE AREA.IN TERMS OF HEALTHCARE SERVICES PROVIDED, FIRELANDS SERVED 132,924 PERSONS IN 2010. OUT OF THESE NUMBERS, INPATIENT CARE WAS GIVEN TO 10,365 INDIVIDUALS, AND THE HEALTH SYSTEM PROVIDED CARE THROUGH 204,518 OUTPATIENT VISITS. THROUGH THE EMERGENCY ROOM, 48,218 PERSONS WERE TREATED AND 687 BABIES WERE BORN AT FIRELANDS.CONSISTENT WITH OUR COMMITMENT TO PROVIDE CARE TO ALL, REGARDLESS OF ABILITY TO PAY, FIRELANDS GAVE THE COMMUNITY BACK OVER $13 MILLION OF SERVICES IN FREE OR DISCOUNTED PROGRAMS OR SERVICES. ADDITIONAL CHARITY CARE WAS PROVIDED BY INDEPENDENT PHYSICIANS WHO ARE ON THE MEDICAL STAFF OF FIRELANDS.SPECIFICALLY, IN TERMS OF FREE OR DISCOUNTED CARE PROVIDED, FIRELANDS SERVED THE FOLLOWING NUMBER OF PERSONS WITHIN EACH CATEGORY, AMOUNTING TO SIGNIFICANT DOLLARS INVESTED IN THE COMMUNITY FOR WHICH FIRELANDS DID NOT RECEIVE COMPENSATION.FOR EXAMPLE, 24,832 PERSONS WERE SERVED WHERE THE COSTS OF SERVICES WERE NOT COVERED BY MEDICARE OR MEDICAID. THE COST TO FIRELANDS OF PROVIDING THIS CARE WAS $5.27 MILLION. FOR HEALTH EDUCATION AND OUTREACH, 25,447 PERSONS WERE SERVED, AND THE COST OF PROVIDING THIS CARE WAS $213,076. FOR PATIENT EDUCATION ON DISEASE PREVENTION & HOMECARE, 1,498 PERSONS WERE SERVED AND THE COST OF PROVIDING THIS CARE WAS $73,633. SUBSIDIZED HEALTH SERVICES (OPERATIONS OF THE FAMILY PRACTICE CLINIC) HELPED SERVE 1,248 PEOPLE, AND THE COST OF PROVIDING THIS CARE WAS $720,661. MEDICAL EDUCATION PROGRAMS SERVED 146 PEOPLE AT A COST OF $2.3 MILLION. THE HOSPITAL ALSO PROVIDED CHARITY CARE TO 13,282 PEOPLE, AT A COST OF $5.3 MILLION. FINALLY, IN-KIND DONATIONS TOTALED $34,038.FIRELANDS' COMMUNITY OUTREACH DEPARTMENT IS DEDICATED TO PROVIDING SCREENINGS, COMMUNITY EDUCATION PROGRAMS, AND PREVENTIVE SERVICES ALL DESIGNED TO IMPROVE THE HEALTH OF THE COMMUNITIES SERVED BY FIRELANDS.FIRELANDS' COMMITMENT TO PROVIDE HEALTHCARE TO THE UNDERSERVED IS EVIDENT IN ITS 2010 FUNDING OF $720,661 TO OPERATE THE FAMILY HEALTH SERVICES, A CLINIC FOR LOW INCOME FAMILIES. FAMILY HEALTH SERVICES PROVIDES ACCESS TO PRIMARY CARE PHYSICIANS FOR THOSE WHO OTHERWISE WOULD NOT BE ABLE TO AFFORD A PHYSICIAN. THE CLINIC PROVIDES WELL-CHILD CARE, WOMEN'S HEALTHCARE AND PAP TESTS, TREATMENT OF ACUTE PROBLEMS LIKE COLDS AND FLU, AND MANAGEMENT OF CHRONIC CONDITIONS SUCH AS DIABETES, HIGH BLOOD PRESSURE, DEPRESSION, EMPHYSEMA AND ARTHRITIS. THE CLINIC PROVIDES A MORE APPROPRIATE PLACE OF SERVICE THAN AN EMERGENCY ROOM VISIT, AND AT A MUCH LOWER COST. FIRELANDS IS COMMITTED TO PROVIDING THE BEST QUALITY OF HEALTHCARE TO THE LOCAL COMMUNITY, REGARDLESS OF A PERSON'S ABILITY TO PAY. THE PAST YEAR AT FIRELANDS HAS SEEN SIGNIFICANT GROWTH IN BRINGING ADVANCED PROCEDURES TO THE LOCAL COMMUNITY SO THAT PERSONS RESIDING IN THE FIVE-COUNTY AREA CAN STAY CLOSE TO HOME FOR ADVANCED CARE SUCH AS HEART SURGERIES AND INTERVENTIONAL PROCEDURES, ADVANCED CARE IN MEDICAL ONCOLOGY AND RADIATION ONCOLOGY SERVICES, THE ADDITION OF NEW TECHNOLOGICALLY ADVANCED EQUIPMENT IN THE RADIOLOGY DEPARTMENT AND WOMEN'S HEALTH AND WELLNESS CENTER, AND THE ADDITION OF MANOMETRY EQUIPMENT TO THE DIGESTIVE HEALTH CENTER. DURING 2010, FIRELANDS ALSO EXPANDED SERVICE HOURS FOR NUMEROUS PROGRAMS AND OPENED SATELLITE FACILITIES IN SURROUNDING RURUAL AREAS TO PROVIDE PHYSICAL THERAPY SERVICES, LAB SERVICES, AND DIALYSIS SERVICES. 171298181 1 1 0 1 0 0 0 0 1 1 0 0 0 1 0 0 1 0 0 0 0 0 0 1 0 1 0 1 1 1 1 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 1 1 1 1 0 1 160 0 1 2131 1 0 0 0 0 0 0 0 0 0 0 0 0 0 X 39 39 0 0 0 0 0 0 0 1 1 0 0 0 1 1 1 1 1 1 1 1 1 OH X DENNIS J KOPCO 4195577094 1111 HAYES AVE SANDUSKY OH 448703323 J WILLIAM SPRINGER 2.00 X 0 0 0 JOHN O BACON 2.00 X 0 0 0 THOMAS M WOLF 2.00 X 0 0 0 LEON J WIEBER 2.00 X 0 0 0 GEORGE M MUEHLHAUSER III 2.00 X 0 0 0 GEORGE L MYLANDER 2.00 X 0 0 0 THOMAS AYLWARD 1.00 X 0 0 0 KAMAL CHABAN MD 1.00 X 0 0 0 VINCENTA GASPAR-YOO MD 1.00 X 0 0 0 PATRICK MCGUINN MD 1.00 X 0 0 0 MARK GROSS 1.00 X 0 0 0 ANTHONY S GUERRA 1.00 X 0 0 0 FREDRICK ITZKOWITZ DO 1.00 X 0 0 0 LEE C JEWETT 1.00 X 0 0 0 BRIAN KASPER 1.00 X 0 0 0 DANIEL KELLER 1.00 X 0 0 0 RICHARD R KELLER MD 1.00 X 0 0 0 CARLOS LOWELL DO 1.00 X 0 0 0 M LEE MCDERMOND JR 1.00 X 0 0 0 B JEAN MILLER 1.00 X 0 0 0 ALLEN R NICKLES 1.00 X 0 0 0 BARBARA A NIELSEN 1.00 X 0 0 0 KARL OBERER DO 1.00 X 0 0 0 S BAIRD PFHAL MD 4.00 X 23309 0 1785 JAMES E PRESTON DO 1.00 X 0 0 0 DEAN J REICHENBACH MD 1.00 X 0 0 0 PAULA J RENGAL 1.00 X 0 0 0 THOMAS M ROUTH 1.00 X 0 0 0 WILLIAM P SCHEID SR 1.00 X 0 0 0 GARY K SCHIMMEL SR 1.00 X 0 0 0 LEROY E SIZEMORE JR 1.00 X 0 0 0 CHARLES H STANLEY 1.00 X 0 0 0 MELVIN J STAUFFER 1.00 X 0 0 0 CAROL B STEUK 1.00 X 0 0 0 DAVID A VOIGHT SR 1.00 X 0 0 0 JOHN WALDOCK JR 1.00 X 0 0 0 JOHN WASYLIK DO 1.00 X 0 0 0 ELAINE WATERFIELD 1.00 X 0 0 0 JAMES O WIBLE 1.00 X 0 0 0 CAROL A WOLFE 1.00 X 0 0 0 CHARLES A STARK 40.00 X X 829387 0 44874 DANIEL J MONCHER 40.00 X 340653 0 41787 TAMARA L JACKSON 40.00 X 267615 0 52884 BEV SCHRICKEL 40.00 X 186005 0 53669 ERIC MAST 40.00 X 224439 0 19089 ROBERT M MOORE 40.00 X 224705 0 37678 RYAN CHANDLER 40.00 X 184931 0 19461 ROBERT AYERS 40.00 X 246292 0 55530 2527336 0 326757 38 0 1 0 UNIVERSITY HOSPITALS HEALTH PO BOX 70328 CLEVELAND OH 44190 PHYSICIAN STAFF 3052637 PHYLIPS MEDICAL CAPITAL PO BOX 92449 CLEVELAND OH 44193 CONSTRUCTION SVCS 2215222 JANOTTA & HERNER INC 309 MONROE ST MONROEVILLE OH 44847 CONSTRUCTION SVCS 1941865 PREMIER ANESTHESIA OF SANDUSKY PO BOX 638144 CINCINNATI OH 45263 ANESTHESIOLOGY SVCS 1589569 BRIDGE HOMECARE PARTNERS 5335 FAR HILLS AVE DAYTON OH 45429 HOME CARE MANAGEMENT 1580027 46 45572 888823 105000 934395 NET PATIENT SVC REV 623000 200339809 200339809 PROGRAM SVC INVESTMENT 525990 2238272 2238272 SCHOOL OF NURSING 611600 768452 768452 1741955 1741955 205088488 2488679 2488679 101349203 104189 96204007 135812 5145196 -31623 5113573 5113573 105923 6410 44631 61292 61292 EMPLOYEE PHARMACY 446110 3440203 3440203 DIETARY SERVICES 722210 1467579 1467579 OFFICE RENTS 531190 1264733 1264733 482558 482558 6655073 220341500 205088488 0 14318617 257022 257022 20500 20500 1577200 473475 1103725 71295659 53645185 17539588 110886 5516975 4108251 1408724 8680605 6479450 2187294 13861 5262828 3901016 1353329 8483 566338 307660 258678 680514 680514 129700 129700 317306 317306 19652765 13429492 6154561 68712 853674 10517 832991 10166 36715798 36259629 409631 46538 2009145 2009145 4065765 668479 3397286 480565 166592 309593 4380 34668 34668 7002975 7002975 14846610 14846610 1231821 896375 335446 CHARITY CARE 16423542 16423542 BAD DEBTS 7654170 7654170 FRANCHISE TAX 2119229 2119229 PHYSICIAN RECRUITMENT 1118548 1118548 INDIGENT FUND 528291 528291 1061374 981173 79567 634 210103587 171298181 38541746 263660 6479 7179 9940553 8844246 406486 422848 32474374 31169878 2338336 2635396 6987815 6538272 307894289 120248899 192071572 187645390 131403074 130293923 8795406 608586 427749 15699820 1707224 1272645 1289776 386124489 386862538 31578195 41227843 157386137 155946598 44348565 38080931 233312897 235255372 X 141038280 138647910 8073481 8948556 3699831 4010700 152811592 151607166 386124489 386862538 X 10237913 -11442339 X 0 1 1 X 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 1 2380 1 1 1 2380 1 PART IV, SUPPLEMENTAL INFORMATION: PART II-B LINE 1 FIRELANDS REGIONAL MEDICAL CENTER PAID MEMBERSHIP DUES TO THE OHIO HOSPITAL ASSOCIATION OF WHICH 5% OR $2,380 WAS USED FOR LOBBYING ACTIVITIES. 10976812 1502602 323668 70714 12085032 9189157 2221977 364993 69329 10976812 13829380 -4095231 467639 77353 9189157 1.00000 1 0 11699226 11699226 142619777 36403457 106216320 2432526 121626 2310900 146071737 80956699 65115038 5071023 2767117 2303906 187645390 CAPITAL LEASE 8670285 SELF-INSURANCE RESERVE 4200000 ACCRUED POST-RETIREMENT AND PENSION 22638562 DEFERRED INCOME GUARANTEE 2494145 DUE TO RELATED PARTIES 77939 38080931 DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: PART V, LINE 4: ENDOWMENT FUND EXPENDITURES FOR FACILITIES AND PROGRAMS ARE USED TO PROMOTE PHYSICAL AND MENTAL WELL-BEING IN THE COMMUNITY. PART XI, LINE 10: FINANCIAL STATEMENTS FOR FIRELANDS REGIONAL MEDICAL CENTER ARE PART OF THE CONSOLIDATED AND AUDITED FINANCIAL STATEMENTS OF FIRELANDS REGIONAL HEALTH SYSTEM. RECONCILIATION IS NOT REQUIRED FOR PARTS XI, XII AND XIII. FASHION SHOW 52465 52465 2295 7790 7992 1478 FITNESS PLEDGE 20687 20687 612 850 8543 3 39181 6410 32771 94 1149 7454 1709 4665 112333 6410 105923 2389 1149 15856 10551 14686 44631 61292 1 1 1 X 1 X 1 1 1 0 1 1 13282 7226807 1954205 5272602 0.02830 24832 14648823 9334361 5314462 0.02860 38114 21875630 11288566 10587064 0.05690 26945 305429 49768 255661 0.00140 146 4929157 2668097 2261060 0.01220 1248 767910 47249 720661 0.00390 34030 34030 0.00020 28339 6036526 2765114 3271412 0.01770 66453 27912156 14053680 13858476 0.07460 1 3 750 750 0.00000 32 31048 31048 0.00010 33 3 31798 31798 0.00010 0 2627269 1600451 72934820 93396455 -20461635 X 1 1 2 NORTHERN OHIO SURGICAL PROPERTIES PROPERTY OWNERSHIP/MANAGEMENT 0.50000 0.00000 0.50000 1 1 FIRELANDS REGIONAL MEDICAL CENTER

1111 HAYES AVENUE SANDUSKY OH 44870

X X X X FIRELANDS REGIONAL MEDICAL CENTER 1 1 1 200.000000000000 1 400.000000000000 1 X X 1 1 X X X X 1 X X X 1 X X X X X X 1 X 0 1 17 FIRELANDS REG MED CTR SURGERY CENTER

2800 HAYES AVE BLD E SANDUSKY OH 44870

OUTPATIENT SURGERY FIRELANDS REG MED CTR OUTPAT DIALYSIS

904 PIERCE ST SANDUSKY OH 44870

OUTPATIENT DIALYSIS FIRELANDS REG MED CTR OUTPAT DIALYSIS

290 PROGRESS DR STE A BELLEVUE OH 44811

OUTPATIENT DIALYSIS FIRELANDS REG MED CTR HOME HEALTH

1031 PIERCE ST SANDUSKY OH 44870

HOME HEALTH AGENCY FIRELANDS COUNS & REC SVCS OF ERIE CO

1925 HAYES AVE SANDUSKY OH 44870

OP MENTAL HEALTH & CD FIRELANDS COUNS & REC SVCS OF OTTAWA CO

127 WEST PERRY ST STE 106 PORT CLINTON OH 43452

OP MENTAL HEALTH & CD FIRELANDS COUNS & REC SVCS OF HURON CO

292 BENEDICT AVE NORWALK OH 44857

OP MENTAL HEALTH & CD FIRELANDS COUNS & REC SVCS OF HURON CO

290 PROGRESS DR STE B BELLEVUE OH 44811

OP MENTAL HEALTH & CD FIRELANDS COUNS & REC SVCS OF HURON CO

390 E HOWARD ST STE B WILLARD OH 44890

OP MENTAL HEALTH & CD FIRELANDS COUNS & REC SVCS OF SENECA CO

76 ASHWOOD RD TIFFIN OH 44883

OP MENTAL HEALTH & CD FIRELANDS COUNS & REC SVCS OF SAND CO

675 BARSTON RD FREMONT OH 43420

OP MENTAL HEALTH & CD FIRELANDS COUNS & REC SVCS OF LORAIN CO

315 LEAVITT RD STE A AMHERST OH 44001

OP MENTAL HEALTH & CD FIRELANDS COUNS & REC SVCS OF SENECA CO

125 WEST CENTER ST FOSTORIA OH 44830

OP MENTAL HEALTH & CD FIRELANDS REG MED CTR OP PHYS THERAPY

2012 CLEVELAND RD W HURON OH 44839

OP PHYSICAL THERAPY FIRELANDS COUNS & REC SVCS OF WYANDOT CO

777 NORTH SANDUSKY AVE UPPER SANDUSKY OH 43351

OP MENTAL HEALTH & CD FIRELANDS REG MED CTR OP PHYS THERAPY

101 S WASHINGTON ST CASTALIA OH 44824

OP PHYSICAL THERAPY FIRELANDS REG MED CTR OP PHYS THERAPY

348 MILAN AVE 2 NORWALK OH 44857

OP PHYSICAL THERAPY PART I, LINE 3C: FIRELANDS REGIONAL MEDICAL CENTER DOES USE FEDERAL POVERTY GUIDELINES TO DETERMINE ELIGIBILITY FOR FREE OR DISCOUNTED CARE.PART I, LINE 6A: FIRELANDS REGIONAL MEDICAL CENTER PREPARES AN ANNUAL COMMUNITY BENEFIT REPORT. PART I, LINE 7: TO DERIVE COSTS OF CHARITY CARE AND OTHER COMMUNITY BENEFITS, A COMBINATION OF COST ACCOUNTING SYSTEM AND COST-TO-CHARGE RATIOS WAS USED. THE LATTER WAS DERIVED FROM WORKSHEET 2, RATIO OF PATIENT CARE COST-TO-CHARGES. OUR COST ACCOUNTING SYSTEM ADDRESSES ALL PATIENT TYPES AND PAYER SOURCES.PART I, LINE 7G: SUBSIDIZED HEALTH SERVICES PERTAINS ENTIRELY TO OUR FAMILY HEALTH SERVICES CLINIC THAT SERVES INDIGENT AND LOW-INCOME MEMBERS OF THE COMMUNITY.PART I, LINE 7, COLUMN (F): CHARITY CARE ($16,423,542) AND BAD DEBT ($7,654,170) THAT WERE INCLUDED IN PART IX TOTAL FUNCTIONAL EXPENSES WERE SUBTRACTED FOR THE PURPOSE OF CALCULATING THE NET COMMUNITY BENEFIT EXPENSE PERCENTAGE OF TOTAL FUNCTIONAL EXPENSE. PART III, LINE 4: 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 SYSTEM'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. PART III, LINE 8: FIRELANDS REGIONAL MEDICAL CENTER'S COST ACCOUNTING SYSTEM WAS USED TO DETERMINE MEDICARE COSTS REFLECTED IN PART III, LINE 6. THE ORGANIZATION BELIEVES THAT ALL OF THE MEDICARE SHORTFALL SHOULD BE TREATED AS A COMMUNITY BENEFIT SINCE THESE SERVICES ARE RENDERED IN CONJUNCTION WITH THE ORGANIZATION'S CHARITABLE TAX-EXEMPT PURPOSES AND PROMOTE THE WELL-BEING OF THE COMMUNITY. FURTHERMORE, IT RELIEVES THE BURDEN ON LOCAL GOVERNMENTS. PART III, LINE 9B: WHEN A PATIENT IS UNINSURED OR INSURANCE PAYMENTS HAVE BEEN RECEIVED AND APPLIED, THEY ARE CLASSIFIED AS SELF PAY. OVER A 90-DAY PERIOD EACH PATIENT RECEIVES A MINIMUM OF 2 BALANCE DUE STATEMENTS AND 1 FINAL STATEMENT. DURING THAT PERIOD THE PATIENT HAS THE OPPORTUNITY TO PAY THE ACCOUNT IN FULL, SET UP PAYMENT ARRANGEMENTS, OR APPLY FOR FINANCIAL AID. IN THE EVENT THE PATIENT DOES NOT PAY THE ACCOUNT IN FULL, SET UP PAYMENT ARRANGEMENTS, APPLY FOR FINANCIAL AID, OR MAKE AN EFFORT TO CONTACT THE FACILITY WITH SPECIAL CIRCUMSTANCES CONCERNING THE UNPAID BALANCE, THE ACCOUNT IS PLACED IN BAD DEBT COLLECTION AT OR ABOUT 120 DAYS FROM THE FIRST STATEMENT OR LAST PAYMENT.SHOULD AN ACCOUNT BE PLACED IN COLLECTION, THE PATIENT HAS AN ADDITIONAL OPPORTUNITY TO APPLY FOR FINANCIAL AID, SET UP PAYMENT ARRANGEMENTS, OR SUPPLY ADDITIONAL INFORMATION RELATED TO THE ACCOUNT. IF ANY OF THESE EVENTS OCCUR, THE COLLECTION ACCOUNT IS EITHER PLACED ON HOLD, BILLED TO INSURANCE, UPDATED WITH THE PAYMENT ARRANGEMENT, OR TAKEN OUT OF BAD DEBT AND ADJUSTED ACCORDING TO FINANCIAL AID GUIDELINES.PART V: DIALYSIS CENTER - FIRELANDS REGIONAL MEDICAL CENTER DIALYSIS PROVIDES INDIVIDUALIZED IN-CENTER HEMODIALYSIS TREATMENTS AND MEDICAL CARE TO ADULT PATIENTS THAT ARE DIAGNOSED WITH END STAGE RENAL DISEASE. THE NURSING CARE DELIVERY SYSTEM IN THE DIALYSIS UNIT IS HOLISTIC AND FAMILY CENTERED, WITH PRIMARY NURSING CARE BEING ENCOURAGED. THIS RESULTS IN GREATER CONTINUITY OF CARE FOR THE DIALYSIS PATIENT AND FAMILY MEMBERS. FIRELANDS REGIONAL MEDICAL CENTER HOME HEALTH SERVICES PROVIDES CARE TO PERSONS LIVING WITHIN ERIE COUNTY AND 12 SURROUNDING COUNTIES. HOME CARE SERVICES ARE PROVIDED ON AN INTERMITTENT BASIS TO PATIENTS IN THEIR PLACE OF RESIDENCE AND INCLUDE SKILLED NURSING, PHYSICAL THERAPY, OCCUPATIONAL THERAPY, SPEECH THERAPY, HOME HEALTH AIDE , AND MEDICAL SOCIAL SERVICE. FIRELANDS COUNSELING AND RECOVERY SERVICES PROVIDES A CONTINUUM OF CARE OF OUTPATIENT AND INPATIENT MENTAL HEALTH SERVICES FOR CHILDREN, ADOLESCENTS, ADULTS AND OLDER ADULTS. ALL COUNSELING SERVICES ARE PROVIDED BY APPROPRIATELY CREDENTIALED OR LICENSED PROFESSIONALS. SERVICES ARE ALSO AVAILABLE TO PROVIDE TREATMENT IN A SUPPORTIVE AND THERAPEUTIC ENVIRONMENT FOR INDIVIDUALS EXPERIENCING ADDICTION TO ALCOHOL AND/OR OTHER DRUGS WHICH MAY RESULT IN THE LOSS OF THE INDIVIDUAL'S FAMILY, JOB, HEALTH, FRIENDS, MONEY, SELF-ESTEEM, OR EVEN LIFE ITSELF. CHEMICAL DEPENDENCY SERVICES ARE OFFERED FOR ADULTS, ADOLESCENTS, AND THEIR FAMILIES. FIRELANDS COUNSELING AND RECOVERY SERVICES ARE AVAILABLE IN THE CITIES OF SANDUSKY, NORWALK, WILLARD, BELLEVUE, TIFFIN, FOSTORIA, FREMONT, UPPER SANDUSKY, PORT CLINTON AND AMHERST. PART VI, LINE 2: FIRELANDS REGIONAL MEDICAL CENTER USES SEVERAL RESOURCES TO DETERMINE THE HEALTHCARE NEEDS OF THE COMMUNITY IN WHICH IT SERVES. IT WORKS IN CONJUNCTION WITH THE LOCAL HEALTH DEPARTMENT AND HELPS TO FUND A COMMUNITY NEEDS ASSESSMENT WHICH IS DONE EVERY FEW YEARS. RESULTS OF THE ASSESSMENT ARE ANALYZED AND USED TO DETERMINE THE NEED FOR NEW PROGRAMS, SERVICES, EDUCATIONAL PROGRAMS, AND ACCESS NEEDS. THE MEDICAL CENTER ALSO COMMISSIONS A PHYSICIAN NEEDS STUDY EVERY FEW YEARS TO DETERMINE THE TYPES AND NUMBERS OF PHYSICIANS NEEDED TO ADEQUATELY MEET THE NEEDS OF THE COMMUNITY. ADDITIONALLY, EVERY THREE YEARS A COMMUNITY RESEARCH STUDY IS PERFORMED WHICH ASKS LOCAL RESIDENTS THEIR PERCEPTIONS OF HEALTHCARE SERVICES IN THE AREA AND DETERMINES IF ADDITIONAL SERVICES ARE NEEDED. SECONDARY DATA OF THE REGION IS ANALYZED ANNUALLY TO DETERMINE UTILIZATION OF SPECIFIC SERVICES, OUTMIGRATION OF LOCAL RESIDENTS TO RECEIVE SERVICES, ETC. PROJECTED UTILIZATION STUDIES ENSURE THAT ANY NEW PROGRAMS OR SERVICES EXPLORED MEET THE NEEDS OF THE COMMUNITY.PART VI LINE 2, PART V, LINES 19D AND 21 - WE GENERATE A BILL WITH THE SAME CHARGE FOR THE SAME SERVICE FOR ALL PATIENTS. ANY DISCOUNTS GIVEN ARE BASED UPON COMPLETION OF A FINANCIAL ASSISTANCE APPLICATION. PART VI, LINE 3: HOSPITAL CARE ASSURANCE PROGRAM SIGNS ARE POSTED IN ALL REGISTRATION AND EMERGENCY AREAS. BILLING AND FINANCIAL ASSISTANCE BROCHURES ARE AVAILABLE WITH INSTRUCTIONS ON WHOM TO CONTACT AND HOW TO APPLY FOR SERVICES. FINANCIAL ASSISTANCE GUIDELINES AND APPLICATIONS ARE ALSO AVAILABLE ON OUR WEBSITE (WWW.FIRELANDS.COM). EVERY PATIENT STATEMENT CONTAINS CHARITY GUIDELINES AND AN APPLICATION.SELF-PAY INPATIENTS ARE SEEN ON-SITE BY A CONTRACTED AGENCY THAT DISCUSSES AND ASSISTS PATIENTS WITH APPLICATIONS FOR MEDICAID OR DISABILITY. THESE PATIENTS ARE ALSO SEEN BY A FINANCIAL COUNSELOR WHO EXPLAINS THE HOSPITAL CHARITY POLICY, ASSISTS WITH THE APPLICATION AND/OR SUPPLIES THEM WITH A CONTACT IF QUESTIONS SHOULD ARISE AFTER DISCHARGE. SELF-PAY INPATIENT ACCOUNTS ARE MONITORED DAILY TO IDENTIFY PATIENTS THAT ARE ELIGIBLE FOR MEDICAID AND HAVE NO PRIOR INSURANCE COVERAGE.ALL SELF-PAY OUTPATIENT ACCOUNTS WITH A BALANCE OF $1,500 OR MORE ARE SCREENED BY A THIRD PARTY AND A MEDICAID APPLICATION IS STARTED FOR THOSE THAT MEET ELIGIBILITY GUIDELINES. DURING THE SCHEDULING PROCESS, IF THE PATIENT STATES THAT THEY HAVE NO INSURANCE OR ARE CONCERNED ABOUT THEIR FINANCIAL LIABILITY, THE PATIENT CALL IS FORWARDED TO A FINANCIAL COUNSELOR WHO WILL EXPLAIN OUR CHARITY PROGRAM AND OFFER TO ASSIST WITH AND/OR MAIL THE FINANCIAL ASSISTANCE APPLICATION.A FINANCIAL COUNSELOR IS AVAILABLE DURING THE FIRST SHIFT IN THE EMERGENCY DEPARTMENT TO ASSIST PATIENTS WITH CHARITY CARE APPLICATIONS. REGISTRATION STAFF SUPPLIES THE PATIENT WITH A BROCHURE AND APPLICATION IF A FINANCIAL COUNSELOR IS NOT AVAILABLE UPON DISCHARGE. FINANCIAL COUNSELING STAFF IS AVAILABLE MONDAY THROUGH FRIDAY FROM 7:30 AM TO 5:00 PM. PART VI, LINE 4: FIRELANDS REGIONAL MEDICAL CENTER SERVES A FIVE-COUNTY AREA OF APPROXIMATELY 243,000 RESIDENTS. THE PRIMARY SERVICE AREA IS ERIE COUNTY, WHICH HAS A POPULATION OF NEARLY 79,000 PERSONS AND IS LOCATED ON THE SOUTHERN SHORELINE OF LAKE ERIE, HALFWAY BETWEEN CLEVELAND, OH AND TOLEDO, OH. BASED UPON THE LATEST CENSUS DATA, THE MAJORITY OF THE POPULATION'S RACE IS CAUCASIAN, WITH 12% MINORITY. SIXTY (60)% OF THE POPULATION HAS A HIGH SCHOOL EDUCATION OR SOME COLLEGE. THE COUNTY'S MEDIAN AGE IS 39.5 AND THE MEDIAN HOUSEHOLD INCOME IS $42,746. APPROXIMATELY 65% OF THE COUNTY'S RESIDENTS OWN THEIR OWN HOME, WITH THE MEDIAN HOME VALUE OF $109,800.SECONDARY SERVICE AREAS CONSIST OF THE CONTIGUOUS COUNTIES OF OTTAWA, HURON AND SANDUSKY, WHICH HAVE A COMBINED POPULATION OF APPROXIMATELY 164,000 INDIVIDUALS. FIRELANDS BEHAVIORAL HEALTH SERVICES REACHES EVEN FURTHER, SERVING 7 SURROUNDING COUNTIES INCLUDING THE COUNTIES OF SENECA, WYANDOT AND LORAIN. HOME HEALTH SERVICES PROVIDED BY THE MEDICAL CENTER REACH INTO 13 DIFFERENT COUNTIES. DEMOGRAPHICS OF THE COUNTIES ARE SIMILAR TO THE PRIMARY SERVICE AREA OF ERIE COUNTY. PART VI, LINE 6: PART II, LINE 1 - FIRELANDS REGIONAL MEDICAL CENTER ESTABLISHED THE FIRELANDS GARDEN DISTRICT PLAN IN 2007 WITH THE GOAL OF ENHANCING AND REVITALIZING THE MEDICAL CENTER'S NEIGHBORHOOD IN TERMS OF ATTRACTIVENESS, CHARM AND SAFETY. THIS REVITALIZATION IS ACCOMPLISHED THROUGH A PROGRAM PROVIDING FIRELANDS' EMPLOYEES THE RESOURCES NEEDED TO MAKE A DOWN PAYMENT FOR THE PURCHASE OR RESTORATION OF HOMES FOR OCCUPANCY.PART VI, LINE 5: PART II, LINE 3 - FIRELANDS PARTICIPATES IN THE NORTHWEST OHIO PUBLIC INFORMATION OFFICER COMMITTEE TO BRING ADDITIONAL SKILLS TO THE AREA REGARDING DISASTER READINESS. IN ADDITION TO MEETING THE REQUIRED INCIDENT COMMAND TRAINING COURSES, THE MEDICAL CENTER HAS GONE ABOVE AND BEYOND BY ATTENDING REGIONAL MEETINGS, COMPLETING CRISIS AND EMERGENCY RISK COMMUNICATION TRAINING, PUBLIC INFORMATION OFFICER TRAINING THROUGH THE OHIO EMERGENCY MANAGEMENT AGENCY AND THROUGH THE DEPARTMENT OF HOMELAND SECURITY, AS WELL AS INCORPORATING SOCIAL MEDIA IN ITS CRISIS COMMUNICATION METHODS.PART VI, LINE 5: MANAGEMENT STAFF OF FIRELANDS REGIONAL MEDICAL CENTER IS ENCOURAGED TO PARTICIPATE IN LOCAL AND REGIONAL BOARDS AND ACTIVITIES THAT IMPROVE THE LOCAL COMMUNITY. ADVOCACY INCLUDES SUCH ACTIVITIES AS A SEAT ON THE OHIO HOSPITAL ASSOCIATION BOARD, EFFORTS TO ORGANIZE A FEDERALLY QUALIFIED HEALTH CENTER FOR THE COMMUNITY, BOARD LEVEL WORK FOR COMMUNITY HEALTH EDUCATION ENTITIES AND AREA NON-PROFIT ORGANIZATIONS WHICH WORK TO IMPROVE THE HEALTH OF THE COMMUNITY. 1 FAMILY HEALTH SERVICES OF ERIE 1912 HAYES AVE SANDUSKY OH 44870 263607741 501(C)(3) 250812 GENERAL SUPPORT 1 0 SCHOLARSHIPS TO BEGIN OR CONTINUE COURSE WORK 21 20500 OTHER INFORMATION: PART IV: PART II LINE 1. TO EXPAND THE DELIVERY OF HEALTH CARE SERVICES AND PROMOTE A HEALTHY QUALITY OF LIFE FOR THE MEDICALLY UNDERSERVED PERSONS OF ERIE COUNTY, OHIO. FIRELANDS REGIONAL MEDICAL CENTER WILL SUPPORT THE MISSION OF FAMILY HEALTH SERVICES OF ERIE COUNTY TO ATTAIN THE DESIGNATION OF FEDERALLY QUALIFIED HEALTH CENTER AND DELIVER ITS INTENDED SERVICES. THE USE OF ALL FUNDS CONTRIBUTED UNDER THIS LIMITED AGREEMENT IS MONITORED BY THE REVIEW OF FINANCIAL AND PERFORMANCE REPORTS. PART III LINE 1. SCHOLARSHIPS - TO BE ELIGIBLE FOR THE EDUCATION PAYMENT PROGRAM, A CANDIDATE MUST BE A QUALIFIED FAMILY MEMBER OF A CURRENT ACTIVE EMPLOYEE AND BE SPONSORED BY THEIR FIRELANDS-EMPLOYED FAMILY MEMBER; BE A HIGH SCHOOL GRADUATE (OR EQUIVALENT) OR A HIGH SCHOOL SENIOR PLANNING TO BEGIN OR CONTINUE COURSE WORK AT AN ACCREDITED EDUCATIONAL INSTITUTION WITHIN ONE YEAR OF SUBMITTING A PROGRAM APPLICATION; AND HAVE A CUMMULATIVE ACADEMIC AVERAGE OF "C" OR BETTER. PART III LINE 1. AWARD RECIPIENTS ARE SELECTED BASED ON APPLICATION, PAST ACADEMIC PERFORMANCE, FIELD OF STUDY, EDUCATIONAL INSTITUTION, ECONOMIC NEED AND AVAILABILITY OF FUNDS. THIS PROGRAM IS ADMINISTERED WITHOUT REGARD TO RACE, COLOR, RELIGION, SEX, AGE, ANCESTRY, NATIONAL ORIGIN OR DISABILITY. FUNDS ARE PAID DIRECTLY TO THE SCHOOL. X X X X X 1 0 0 0 0 0 0 0 0 CHARLES A STARK 665672 0 135000 0 28715 0 17000 0 27874 0 874261 0 0 0 DANIEL J MONCHER 290333 0 19689 0 30631 0 21000 0 20787 0 382440 0 0 0 TAMARA L JACKSON 214606 0 29022 0 23987 0 36000 0 16884 0 320499 0 0 0 BEV SCHRICKEL 158013 0 9811 0 18181 0 38000 0 15669 0 239674 0 0 0 ERIC MAST 219489 0 4472 0 478 0 0 0 19089 0 243528 0 0 0 ROBERT M MOORE 205849 0 9959 0 8897 0 19000 0 18678 0 262383 0 0 0 RYAN CHANDLER 158649 0 22113 0 4169 0 1000 0 18461 0 204392 0 0 0 ROBERT AYERS 122812 0 2407 0 121073 0 39000 0 16530 0 301822 0 0 0 COUNTY OF ERIE OHIO 346400428 29514PAR3 2002-05-22 79190180 HOSPITAL FACILITIES REVENUE BONDS SERIES 2002 0 1 0 COUNTY OF ERIE OHIO 346400428 29514PAU6 2006-06-01 65951557 HOSPITAL FACILITIES REVENUE BONDS SERIES 2006A 0 1 0 COUNTY OF ERIE OHIO 346400428 29514PAW2 2006-06-01 15000000 HOSPITAL FACILITIES REVENUE BONDS SERIES 2006B 0 1 0 COUNTY OF ERIE OHIO 346400428 2008-04-29 20000000 TAX EXEMPT CAPITAL LEASE 0 1 0 83989980 5528525 30671606 915000 46874849 46874849 2006 0 1 1 1 65951556 3368356 715000 61868200 61868200 2008 0 0 1 1 15000000 15000000 15000000 2008 0 0 1 1 20000000 20000000 20000000 2008 0 0 1 1 0 0 0 0 1 1 0 0 0 0 1 1 0 0 0 0 1 1 0 0 0 0 1 1 0 0 0 NA 0 NA 0 0 0 0 0 NA 0 NA 0 0 0 0 0 NA 0 NA 0 0 0 0 0 NA 0 NA 0 0 X 1 105000 FMV APPRAISAL 0 0 1 0 FORM 990 PART I LINE 9 FOR 2010, GROSS PROGRAM SERVICE REVENUE OF $470,033,482 IS SHOWN NET OF CONTRACTUAL ALLOWANCES IN THE AMOUNT OF $269,693,673. IN PREVIOUS YEARS, GROSS PROGRAM SERVICE REVENUE WAS REPORTED WHILE CONTRACTUAL ALLOWANCES WERE INCLUDED WITH TOTAL OTHER EXPENSES. THIS RE-CLASSIFICATION HAS NO IMPACT ON LINE 19 REVENUE LESS EXPENSES. FORM 990 PART I LINE 17 IN 2010, OTHER EXPENSES INCLUDES A RE-CLASSIFICATION OF CONTRACTUAL ALLOWANCES IN THE AMOUNT OF $269,693,673 FROM TOTAL EXPENSE TO OFFSET PROGRAM SERVICE REVENUE. THIS RE-CLASSIFICATION DOES NOT CHANGE LINE 19 REVENUE LESS EXPENSES. FORM 990, PART VI, SECTION B, LINE 11 THE BOARD OF DIRECTORS HAS DELEGATED THE RESPONSIBILITY FOR REVIEWING FORM 990 PRIOR TO FILING TO THE AUDIT AND CORPORATE COMPLIANCE COMMITTEE. AFTER REVIEW, THE AUDIT AND CORPORATE COMPLIANCE COMMITTEE MAKES A REPORT TO THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION B, LINE 12C THE AUDIT AND CORPORATE COMPLIANCE COMMITTEE ANNUALLY REVIEWS ALL CONFLICT OF INTEREST STATEMENTS FOR ALL APPROPRIATE INDIVIDUALS TO ASSURE PERSONS IDENTIFIED IN THE CONFLICT OF INTEREST POLICY ARE IN COMPLIANCE. FORM 990, PART VI, SECTION B, LINE 15 THE PROCESS FOR DETERMINING COMPENSATION IS DELEGATED BY THE BOARD OF DIRECTORS TO THE EXECUTIVE COMMITTEE. THE EXECUTIVE COMMITTEE APPOINTS A COMPENSATION SUB-COMMITTEE WHICH UTILIZES AN INDEPENDENT THIRD PARTY TO EVALUATE THE APPROPRIATE PAY RANGE FOR THE CEO AND OTHER KEY MANAGEMENT POSITIONS AT LIKE-SIZED AND SIMILAR HOSPITALS IN THE SAME GEOGRAPHIC REGION OF THE UNITED STATES. THIS SUB-COMMITTEE MAKES A RECOMMENDATION TO THE EXECUTIVE COMMITTEE BASED ON THEIR RESEARCH AND FINDINGS. THE EXECUTIVE COMMITTEE APPROVES THE ANNUAL SALARIES OF THE CEO AND ALL VICE PRESIDENTS. THIS PROCESS IS DONE ANNUALLY AND WAS COMPLETED DURING 2010. FORM 990, PART VI, SECTION C, LINE 19 FINANCIAL STATEMENTS OF THE ORGANIZATION ARE MADE AVAILABLE VIA A QUARTERLY "REPORT TO BOND HOLDERS" WHICH IS SENT TO ANY CONSTITUENTS, BOND HOLDERS, OR INTERESTED PARTIES WHO REQUEST TO BE ON THE DISTRIBUTION LIST. QUARTERLY REPORTS ALONG WITH THE AUDITED CONSOLIDATED FINANCIAL STATEMENTS ARE ALSO POSTED TIMELY AT HTTP://WWW.MSRB.ORG/ UTILIZING THE EMMA SYSTEM. GOVERNING DOCUMENTS AND THE CONFLICT OF INTEREST POLICY ARE AVAILABLE TO THE PUBLIC BY SPECIAL REQUEST. FORM 990 PART X LINE 14 WITH THE ACQUISITION OF THE REMAINING 45% OF THE OUTSTANDING INTEREST, FIRELANDS REGIONAL MEDICAL CENTER'S INVESTMENT IN NORTHERN OHIO SURGICAL CENTER WAS RE-CLASSIFIED AS A PROGRAM SERVICE INVESTMENT. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED LOSSES ON INVESTMENTS: -10,385,488. SCHOOL OF NURSING FUNDING 46,895. POST RETIREMENT ADJUSTMENTS 2,957,743. TRANSFER (TO) FROM AFFILIATES -3,883,986. FUND BALANCE RE-CLASS -177,500. ROUNDING -3. TOTAL TO FORM 990, PART XI, LINE 5: -11,442,339. NORTHERN OHIO SURGICAL CENTER LTD 2800 HAYES AVE BLD E SANDUSKY OH 44870 870630291 SURGICAL CENTER OH 835559 1432888 N/A FIRELANDS REGIONAL HEALTH SYSTEM 1111 HAYES AVE SANDUSKY OH 44870 341401659 HOSPITAL SUPPORT OH 501(C)(3) 11-I N/A 1 THE FOUNDATION FOR FIRELANDS (FKA FIRELANDS FUND) 1111 HAYES AVE SANDUSKY OH 44870 341401660 HOSPITAL SUPPORT OH 501(C)(3) 11-I N/A 1 HAYES AVENUE PROFESSIONAL CORP 1111 HAYES AVE SANDUSKY OH 44870 341843103 HOSPITAL SUPPORT OH 501(C)(3) 11-I N/A 1 NORTHERN OHIO SURGICAL CENTER 2800 HAYES AVE BLD E SANDUSKY OH 44870 870630291 PHYSICIAN PRACTICE OH N/A RELATED 1295924 94043 0 0 0.55000 NORTH COAST PROFESSIONAL CO LLC 1111 HAYES AVE SANDUSKY OH 44870 341608091 PHYS PRAC MANAGEMENT OH N/A C CHOICE DIAGNOSTICS INC 1111 HAYES AVE SANDUSKY OH 44870 510638893 OUTREACH LAB OH N/A C 1.00000 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 1 0 HAYES AVENUE PROFESSIONAL CORP C 56220 CASH BASIS NORTH COAST PROFESSIONAL COMPANY LLC O 499261 CASH BASIS THE FOUNDATION FOR FIRELANDS Q 3940207 CASH BASIS PART I ON OCTOBER 1, 2010, FIRELANDS REGIONAL MEDICAL CENTER ACQUIRED THE REMAINING 45 PERCENT OF THE OUTSTANDING INTEREST OF NORTHERN OHIO SURGICAL CENTER (NOSC) AND BECAME THE SOLE MEMBER OF NOSC AS A RESULT OF THIS ACQUISITION.