2011-05-16T14:55:22-05:00 2010-06-30 PLANTE & MORAN PLLC 65 EAST STATE STREET SUITE 600 COLUMBUS OH 43215 990 2009-07-01 310678022 SOUTHERN OHIO MEDICAL CENTER SOUT 7403567622 1248 KINNEYS LANE PORTSMOUTH OH 45662 DEAN WRAY 7403567622 2011-05-13 1 Bernie Ostrowski 6148493000 2009 2016-02-24 21:20:13Z SEE SCHEDULE O MR RANDAL ARNETT 1805 27TH STREET PORTSMOUTH OH 45662 337994320 0 X WWW.SOMC.ORG X 1954 OH SOUTHERN OHIO MEDICAL CENTER IS AN ACUTE HEALTH CARE SYSTEM LOCATED IN PORTSMOUTH, OHIO. SOMC'S EXEMPT PURPOSE IS TO SERVE SOUTH CENTRAL OHIO AND NORTHEASTERN KENTUCKY WITH STATE-OF-THE-ART FACILITIES AND HEALTH CARE TECHNOLOGIES. 11 7 2394 428 0 0 356826 535488 247806314 269548236 4508343 2884158 6105673 3387408 258777156 276355290 251089 18401525 0 109575345 112908592 0 21259 126876832 135890611 236703266 267200728 22073890 9154562 379138938 393731647 203503649 203016851 175635289 190714796 We will make a difference. At SOMC, our mission is to make a difference. We strive to live out that mission by providing our region with the highest quality of care, delivered by professionals who are among the best in their fields. We extend that care and passion to make a difference in the community by being a very good neighbor, employer, and community supporter. 0 1 211958863 18401525 271636333 Southern Ohio Medical Center takes pride in partnering in many ways with our community. It is due to this partnership that SOMC has been recognized on many levels. Honors such as: Magnet Recognition, Fortune 100 Best Companies to Work For, VPP Star Status, Modern Healthcare Top Places to work in the United States and Best Employers in Ohio. Striving to build relationships between co-workers, with physicians, volunteers and the community is one of SOMC's strategic values. Because of these partnerships, the community has been a valuable asset in many processes and decisions made at SOMC. It is our goal to listen and partner with key customers in order to make a difference to those we serve. Patients and family members can participate in the hospital's inpatient and outpatient evaluation process which is conducted by a third party vendor to ensure benchmarkable data. The community is also invited to participate in SOMC's strategic planning process which allows suggestions and ideas for the organization. The Community Relations Department also conducts focus groups with community memebers to gather information and suggestions for services and technology needs. The SOMC Executive Team also has an "open door" policy for community members to share their ideas and information at any time.SOMC establishes relationships with other organizations throughout the tri-state area to focus on the health and wellness of the community as a whole. Hospital affiliations and partnerships with organizations such as the Ohio River Valley Chapter Red Cross Board, the Chamber of Commerce, Rotary Club, United Way Board, Southern Ohio Light Opera Board, the Arts Council, area school boards and committees and church partnership organizations are just some of the many community interactions in which SOMC is involved. Other participatory programs include Leadership Portsmouth, Ohio Partnership for Excellence, Task Force on Domestic Violence, Portsmouth Kiwanis Service Club, Scioto Residential Services Board, Paramedic Advisory Board, Salvation Army, River Sweep, Habitat for Humanity, Southern Ohio Correctional Facility Ministries Program, Arthritis Foundation, Medical Reserve Corp, Parish Nurse Network, Southern Ohio Diabetes Coalition, Portsmouth Bicentennial Board and the Southern Ohio Correctional Facility Community Advisory Board. Because of these partnerships, many benefits occur within the local area, such as sponsorships for cultural affairs, community health and wellness programs, health screenings, education, children's programs and youth activities. Through the SOMC Community Health and Wellness Department, various health screenings and educational sessions are held throughout the community during the year, helping thousands of community members learn more about their health. Each month is focused on a health message and various events are set up and are dedicated to sharing information regarding that particular area. For example, February is dedicated to focusing on heart health. Programs, screenings, commercials, flyers, children's activities for the month of February focus on heart health. This way, a consistent message is shared with the community and SOMC employees in order to fully educate those we serve. Of the 2,233 hospital employees, many are active participants in the community. They can be found at local churches, businesses, and community events. Hospital support and employees can be found participating in many activities such as the Portsmouth Little Theater, Vern Riffe Center for the Arts, Little League games, school honor societies, music/arts programs, literacy programs, parades, county fairs and other events. These people are coaches, tutors, carpenters, caregivers and environmentalists - wherever there is a need there is usually a volunteer who works at Southern Ohio Medical Center.The hospital conducts events such as "Love Your Heart", a program for more than 1,200 kindergarten children. This program takes place in February and is connected to the messaging designated for the month. "Love Your Heart" was developed to specifically promote early childhood, healthy habits. Employees from all over the hospital participate in providing education during this program. The employees in ICU developed this program and feel they are making a difference by providing education and serving as a role model for healthy living. The ICU staff was awarded the American Association of Critical Care Nurses Seabury and Smith National Community Service award for this extraordinary program.Through a collaborative effort with local agencies, SOMC provides adult immunizations including influenza, pneumonia and Hepatitis B. Nurses and physicians volunteer their time and effort to travel around the region and provide this service free of charge or at a reduced rate.SOMC has also donated monetarily and supported staff who serve in the Armed Services. Several employees and physicians have served in the National Guard and have served overseas. Employees have also been involved in volunteer work in other countries, taking donated equipment and supplies to aid in areas of need.SOMC actively seeks grants to use as a means of promoting health and wellness throughout the community. A recent diabetes grant has provided hundreds of community members better knowledge of the disease as well as provided healthy cooking tips and proper exercise. Physicians, medical students and members of various departments at SOMC volunteer for community activities in more than 120 community volunteer areas, such as providing sports physicals and skin, breast and prostate screenings.Each year, SOMC selects chairmen to lead the organization's United Way campaign. More than 98% of the employees at SOMC donate to the campaign each year either through direct monetary contributions or through payroll deduction. Last year's campaign raised more than $94,000 for the Scioto County Chapter of the total county campaign goal of $300,000. Employees who wish to contribute can do so through a single monetary contribution or can choose to have funds taken directly from their pay throughout the year. In addition to this monetary contribution, SOMC also supports the United Way school supply drive. SOMC helped children with basic school supplies in 11 county schools. Several employees, including the United Way chairmen, help in delivery of the supplies throughout the county.Several guilds have been formed to assist SOMC through time, gifts and dollars to purchase medical equipment, assist with patient needs and provide various community services to aid in making a difference. Volunteers, 759 in all, have given 84,132 hours of their time providing assistance to departments, patients and community members. Community events held at the Friends Center, such as the Martin Luther King Scholarship breakfast and Election Day polls for the precinct, are rent-free. One of Southern Ohio Medical Center's five strategic values is Relationships. We strive to build relationships between co-workers, with physicians, with our volunteers and the community. Establishing strong relationships with the community is one of many ways SOMC is making a difference in the communities we serve. 211958863 1 1 0 1 0 0 0 0 1 1 0 1 0 0 0 0 0 0 1 0 1 1 1 1 1 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 1 1 1 0 1 135 0 1 2394 1 0 0 0 0 0 1 0 0 0 0 11 7 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 OH X RICHARD GILCHER 7403567622 1248 KINNEYS LANE PORTSMOUTH OH 45662 ROBERT E DEVER 1.00 X X 0 0 0 RANDAL ARNETT 40.00 X X 638464 0 284902 STEVEN A CONLEY 1.00 X 0 0 0 GARY DUZAN 1.00 X X 0 0 0 DAVID HANZEL MD 1.00 X 0 0 0 GEORGE LAWSON 1.00 X X 0 0 0 RITA RICE-MORRIS PHD 1.00 X 0 0 0 HARRY DRIEDGER MD 1.00 X X 0 0 0 ERNESTO BANALAGAY MD 1.00 X X 0 0 0 DAVID FOWLER 1.00 X 0 0 0 RONALD ARRICK MD 1.00 X 0 0 0 JAMES W STAKER 1.00 X 0 0 0 DEAN WRAY 40.00 X 318671 0 117966 KENDALL L STEWART 40.00 X 373814 0 139765 CLAUDIA L BURCHETT 40.00 X 231035 0 106608 VICKI A NOEL 40.00 X 189038 0 69052 LEEANN L SAMMONS 40.00 X 170465 0 61045 RORY E PHILLIPS 40.00 X 161372 0 37703 JEREMY K JANNEY 40.00 X 129550 0 32148 CRAIG E GILLILAND 40.00 X 132411 0 28494 KEITH A HILES 40.00 X 129507 0 27723 BRIAN P MISSLER 40.00 X 130379 0 29907 HAROLD B SYLVIA 40.00 X 377620 0 0 2982326 0 935313 52 1 1 0 REHABCARE GROUP INC 7733 FORSYTH BLVD SUITE 1700 ST LOUIS MO 63105 INPATIENT/OUTPATIENT THERAPY SERVICES 5576532 UNITED COLLECTION BUREAU INC 4100 HORIZON DR SUITE 101 COLUMBUS OH 43220 COLLECTION SERVICES 1734507 MAYO COLLABORATIVE SERVICES 200 SW FIRST STREET ROCHESTER MN 55905 LABORATORY SERVICES 1469460 MEDICAL DOCTOR ASSOCIATES INC 145 TECHNOLOGY PKWY NW NARCROSS GA 30092 LOCUM TENENS (PHYSICIAN COVERAGE) 1392251 EMERGENCY PHYSICIANS MEDICAL GROUP PC 200 GREEN ANN ARBOR MI 48105 EMERGENCY ROOM PHYSICIANS 844334 54 43528 257080 234880 535488 PATIENT SERVICES 621300 265215794 265215794 PHARMACY 900099 1910130 1910130 LIFE CENTER 900099 1506245 1506245 RENTAL INCOME 531110 916067 916067 269548236 3170738 3170738 37905 37905 37905 37905 61267424 33640 61359093 228551 -91669 -194911 -286580 -286580 71593 51386 20207 20207 CAFETERIA SALES 900099 1241199 1241199 2088097 2088097 3329296 276355290 271636333 0 4183469 18384325 18384325 17200 17200 2706195 2706195 82774809 63137881 19636928 3852921 2938883 914038 17415479 13336391 4079088 6159188 4698029 1461159 14277 14277 354598 354598 144791 144791 20260249 15801168 4459081 1915101 1915101 49215495 37539949 11675546 1262465 542817 719648 9352454 7133742 2218712 458737 307249 151488 195161 68456 126705 9134030 7874447 1259583 17404694 15005233 2399461 1572690 1572690 BAD DEBT EXPENSE 20887568 20887568 OHIO FRANCHISE TAX 2538176 2538176 PHYSICIAN RECRUITMENT 645659 645659 EDUCATION 45065 30517 14548 489401 121558 346584 21259 267200728 211958863 55220606 21259 7375 7150 16721345 12285182 70924 29100 28495770 28215477 768528 280827 4536505 4091909 1201240 1252384 308383603 128225110 188419310 180158493 112337360 140134533 14837004 14961588 1372777 1567184 10370800 10747820 379138938 393731647 26330549 26081243 157804416 155380402 2260056 2117591 17108628 19437615 203503649 203016851 X 175564365 190685696 70924 29100 175635289 190714796 379138938 393731647 X 0 1 1 X 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 1 3981 0 0 0 3981 0 Part II-B, Line 1i: Explanation of Other Lobbying Activities: MEMBERSHIP DUES IN THE AMOUNT OF $42,696 AND $56,771 WERE PAID TO THE AMERICAN HOSPITAL ASSOCIATION AND THE OHIO HOSPITAL ASSOCIATION, RESPECTIVELY. OF THESE DUES, $1,708 AND $2,273 WERE RELATED TO LOBBYING ACTIVITIES. 1640677 75282 -62236 35626 1618097 1555536 65883 51298 32039 1640678 1.00000 1 0 4773459 4773459 94355173 26200490 68154683 151301 102561 48740 108065972 36057597 72008375 101037698 65864462 35173236 180158493 PENSION 14909908 COST REPORT SETTLEMENTS 4451702 INTERCOMPANY PAYABLES 76005 19437615 276355290 267200728 9154562 8993145 -3068200 5924945 15079507 Part V, Line 4: Description of Intended Use of Endowment Funds: ENDOWMENT FUNDS ARE TO BE SPENT AT THE BOARD'S DISCRETION, AND ARE INTENDED TO BE RETAINED FOR FUTURE NEEDS OF THE ORGANIZATION. THE ENDOWMENT FUNDS ARE HELD AND ADMINISTERED BY THE SCIOTO FOUNDATION. Part XI, Line 8 - Other Adjustments: CHANGE IN ACTUARIAL VALUE OF PENSION: -3068200. HIKE FOR HOSPICE 35469 35469 2383 11207 GOLF TOURNAMENT - LIFE CENTER 18044 18044 3366 5994 11961 3 18080 18080 16475 71593 71593 5749 5994 39643 51386 20207 1 1 X 1 X 125.000000000000 1 X 125.000000000000 1 1 0 1 1 4650 4184740 2532014 1652726 0.00670 48272884 28530113 19742771 0.08020 4650 52457624 31062127 21395497 0.08690 473942 2939 471003 0.00190 699836 0 699836 0.00280 1173778 2939 1170839 0.00470 4650 53631402 31065066 22566336 0.09160 0 7687769 77677 75086914 75657356 -570442 X 1 1 SOUTHERN OHIO MEDICAL CENTER

1805 27TH STREET PORTSMOUTH OH 45662

X X X X X URGENT CARE

8770 OHIO RIVER ROAD WHEELERSBURG OH 45694

URGENT CARE SOMC CANCER CENTER

1121 KINNEYS LANE PORTSMOUTH OH 45662

CANCER TREATMENT & CARE HOSPICE IN-PATIENT

2201 25TH STREET PORTSMOUTH OH 45662

HOSPICE IN-PATIENT HEALTH CARE CENTER

1212 18TH STREET PORTSMOUTH OH 45662

HEALTH CARE CENTER WOUND HEALING & SLEEP LAB

1745 27TH STREET PORTSMOUTH OH 45662

SLEEP LAB Part I, Line 3c: NOT APPLICABLE Part I, Line 6a: NOT APPLICABLE Part I, Line 7: CHARITY CARE AND MEDICAID COSTS WERE CALCULATED USING A COST TO CHARGE RATIO USING THE WORKSHEET 2 METHOD TO CALCULATE THE COST TO CHARGE RATIO. Part I, Line 7g: NOT APPLICABLE Part I, Line 7f: THE PERCENTAGE CALCULATED ON LINE 7F IS BASED ON TOTAL EXPENSES FROM FORM 990, PART IX, LESS BAD DEBTS OF $20,887,568. Part III, Line 4: TOTAL BAD DEBT EXPENSE RECORDED AT GROSS CHARGES EXCLUDES AMOUNTS KNOWN TO QUALIFY FOR CHARITY DISCOUNTS. ANY PARTIAL PAYMENTS THAT ARE SUBSEQUENTLY RECEIVED ARE APPLIED AS AN OFFSET TO BAD DEBT AT CHARGES. BAD DEBT AT COST IS CALCULATED USING A COST-TO-CHARGE RATIO. NONE OF THE BAD DEBT AT COST IS TREATED AS A COMMUNITY BENEFIT. THE ESTIMATED AMOUNT OF BAD DEBT AT COST ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S CHARITY CARE POLICY REPRESENTES ACCOUNTS THAT WERE DEEMED TO BE BAD DEBT WHICH SUBSEQUENTLY APPLIED FOR FINANCIAL ASSISTANCE. THE ACCOUNTS WERE BELIEVED TO QUALIFY FOR CHARITY CARE HOWEVER WERE NOT MOVED FROM BAD DEBTS.FOOTNOTE TO FINANCIAL STATEMENTS: 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 ORGANIZATION'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. Part III, Line 8: MEDICARE COSTS WERE TAKEN FROM THE MEDICARE COST REPORT, WHICH USES A COST TO CHARGE RATIO ALLOWED UNDER MEDICARE COST REPORT METHODOLOGY. NONE OF THE SHORTFALL IS TREATED AS COMMUNITY BENEFIT. Part III, Line 9b: WE TREAT ALL PATIENTS THE SAME. IF THERE IS INSURANCE COVERAGE, WE BILL THE CLAIMS FOR PAYMENT. IF THERE IS NO INSURANCE - OF IF THERE IS A BALANCE REMAINING AFTER INSURANCE PAYS - THE PATIENT IS SENT THE SAME AMOUNT OF STATEMENTS OVER A PERIOD OF TIME, PHONE ATTEMPTS ARE MADE AND, IF THERE IS NO RESPONSE TO OUR EFFORTS, THE ACCOUNTS ARE PLACED WITH OUTSIDE AGENCIES FOR COLLECTION. Part VI, Line 2: The Community Relations and the Workforce Development Departments conduct annual focus groups with our key customers as well as evaluate the disease processes effecting our community. Data for these disease processes is collected through internal data bases as well as through the CDC and Portsmouth Health Department. Community focus groups are contracted through a third party vendor and are held each year after Southern Ohio Medical Center's strategic planning process. Part VI, Line 3: SOMC contracts with Eligibility Assistance Program (EAP) whose staff is located on-site to see patients inhouse, offer assistance with applications for Ohio Medicaid, HCAP and/or Charity funding. They also contact outpatients with large balances to offer the same assistance. Each billing statement mailed to patients also offers the Financial Assistance Application (for HCAP and Charity funding) for the patient to complete and return to the business office. Part VI, Line 4: Southern Ohio Medical Center is located along the Ohio River in rural southern Ohio. SOMC's largest paying group are Medicare and Medicaid recipients. National census data shows the Scioto County residents have a mean household income nearly 20,000 less than the national average, as well as 16.9% of families below poverty level, which is almost double that of the national average of 9.6%. Professional Research Consultants (PRC) found that 26.2% of adults, age 18-64, lack healthare insurance coverage in Scioto County. This nearly doubles the state of Ohio's percentage of 14.6%. Southern Ohio Medical Center provided more than $21 million in charity care over the last year. Part VI, Line 5: NOT APPLICABLE Part VI, Line 6: One of Southern Ohio Medical Center's five strategic values is Relationships. We strive to build relationships between co-workers, with physicians, with our volunteers and the community. One way employees establish strong relationships with the community is through volunteerism. This fiscal year alone, employees have donated more than 4,000 hours to the community by serving in various capacities of volunteering. This number includes the reported hours collected through our Community Benefits report and doesn't include the countless hours spent in school systems, church functions and other personally committed events each year. Through the use of PTO and flexible scheduling, employees have the ability to volunteer in various ways during the work week. Many times, employees take on projects on their day off because they feel passionate about a project or event. These are often supported by SOMC through a monetary donation or donation of supplies.Each year, SOMC selects chairmen to lead the organization's United Way campaign. Chairmen lead the charge with the selection of a theme for the event and hold drawings for small prizes such as gas cards and movie passes throughout the campaign. Leaders are selected by their peers for each department to serve as liaisons during the campaign and collect donation cards within their department. More than 98% of the employees at SOMC donate to the campaign each year either through direct monetary contributions or through payroll deduction. Last year's campaign raised more than $94,000 for the Scioto County Chapter of the total county campaign goal of $300,000. Southern Ohio Medical Center is the largest contributor to the program each year and celebrates with employees, the appreciation for their contributions through pool parties, cookouts and major prize drawings for trips. Employees who wish to contribute can do so through a single monetary contribution or can choose to have funds taken directly from their pay throughout the year. In addition to this monetary contribution, SOMC also supports the United Way school supply drive. For the 2009-10 school year, SOMC helped 5,000 children with basic school supplies in 11 county schools. This year, with the slowing economy, SOMC anticipates a growing need and will be hosting a drive for the 2010-11 school year with this in mind. Several employees, including the United Way chairmen, help in delivery of the supplies throughout the county.SOMC also partners with several non-profit groups in the county to make our area a place to live, work and visit. Last year, SOMC donated to Main Street Portsmouth for a city beautification project. The money was used to plant trees, flowers and shrubs and enhance the city streets and parks in town. SOMC also donated to the Portsmouth Kiwanis to build a playground in Tracy Park for all to use. SOMC also donated to the area arts programs to bring culture and programming to the area. Many school children and adults alike would not be able to experience these programs without the local Arts Council partnering with SOMC to bring them to the area. Part VI, Line 7: SOUTHERN OHIO MEDICAL CENTER IS A SINGLE ACUTE CARE PROVIDER OF HEALTH SERVICES AT TWO FACILITIES IN THE PORTSMOUTH, OHIO AREA. SOMC IS THE PARENT ORGANIZATION OF FRIENDS OF SOMC, SOMC MEDICAL CARE FOUNDATION, INC., SOMC TITLE HOLDING COMPANY, AND THE SOLE BENEFICIARY OF SOMC FOUNDATION.THE FRIENDS OF SOMC RENDER SERVICE TO SOUTHERN OHIO MEDICAL CENTER OF PORTSMOUTH, OHIO AND ITS PATIENTS AND TO ASSIST THE HOSPITAL IN PROMOTING HEALTH AND WELFARE OF THE COMMUNITY IN ACCORDANCE WITH THE OBJECTIVES ESTABLISHED BY THE GOVERNING BOARD OF TRUSTEES OF SOUTHERN OHIO MEDICAL CENTER. IN ADDITION, THE FRIENDS OF SOMC CREATE, RECEIVE AND MAINTAIN A FUND OR FUNDS OF REAL OR PERSONAL PROPERTY OR BOTH, AND TO USE AND APPLY THE WHOLE OR ANY PART OF THE INCOME THERE FROM AND THE PRINCIPAL THEREOF EXCLUSIVELY FOR THE USE AND BENEFIT OF SOUTHERN OHIO MEDICAL CENTER.SOMC MEDICAL CARE FOUNDATION is organized and operates exclusively for charitable, educational and scientific purposes for the benefit of SOMC, an Ohio non-profit corporation including (a) providing medical, surgical and other health care and treatment of the sick, disabled, and injured, regardless of race, color, religion, national origin, age, handicap, sex, or the ability to pay for services; (b) conducting educational activities related to healthcare and treatment of the sick, disabled, injured and to promote and carry on medical, scientific and clinical research related to health care and treatment of the sick, disabled, and injured; and (c) engaging in any lawful activities for which corporations may be formed under Chapter 1785 of the Ohio Revised Code that are not consistent with the foregoing.SOMC TITLE HOLDING COMPANY OWNS AND MANAGES REAL ESTATE ON BEHALF OF SOUTHERN OHIO MEDICAL CENTER.SOMC FOUNDATION SUPPORTS SOUTHERN OHIO MEDICAL CENTER WITH FINANCIAL TRANSFERS. 1 AMERICAN RED CROSS 614 GLOVER ST PORTSMOUTH OH 45662 314414096 501(c)(3) 21167 YEARLY PLEDGE, DONATIONS, AND SPONSORSHIP OF "TOGETHER WE CAN." NOTRE DAME SCHOOLS 2220 SUNRISE AVE PORTSMOUTH OH 45662 314395524 501(c)(3) 5340 SPONSORSHIP OF HOLE AT GOLF TOURNAMENT AND CASH DONATION FOR "BID YOUR HEART OUT." PORTSMOUTH RIVER DAYS INC PO BOX 132 PORTSMOUTH OH 45662 311068766 501(c)(3) 15000 SPONSORSHIP OF RIVER DAYS COMMUNITY FESTIVAL. SHAWNEE STATE UNIVERSITY 940 2ND STREET PORTSMOUTH OH 45662 311115810 501(c)(3) 56900 VARIOUS SPONSORSHIPS AND DONATIONS. SOUTHERN OHIO GROWTH PARTNERSHIP PO BOX 509 PORTSMOUTH OH 45662 310916197 501(c)(3) 5000 PROGRAM DONATION. LITERACY COUNCIL OF SOUTHERN OHIO 940 2ND STREET PORTSMOUTH OH 45662 311652882 501(c)(3) 5878 MATCHING DONATION - PROGRAM SERVICES. PORTSMOUTH AREA ARTS COUNCIL PO BOX 1258 PORTSMOUTH OH 45662 237073017 501(c)(3) 6000 SPONSORSHIP OF "JACK SPRAT" PRESENTATION. SCIOTO COUNTY JUNIOR FAIR 602 7TH STREET COURTHOUSE ROOM 7 PORTSMOUTH OH 45662 316401779 501(c)(3) 6500 SPONSORSHIP OF CIRCUS AND BUYER'S RECOGNITION DINNER. SOUTHERN OHIO MEDICAL CENTER TITLE HOLDING COMPANY 1805 27TH STREET PORTSMOUTH OH 45662 311417566 501(c)(3) 1255048 INTERCOMPANY SUPPORT. SOMC MEDICAL CARE FOUNDATION INC 1248 KINNEYS LANE PORTSMOUTH OH 45662 311374523 501(c)(3) 16843770 INTERCOMPANY SUPPORT. 10 0 EMPLOYEE RELIEF FUND 18 17200 Procedure for Monitoring Grants in the U.S.: Part I, Line 2: Schedule I, Part I, Line 2: SOUTHERN OHIO MEDICAL CENTER MAY MAKE CONTRIBUTIONS IN SUPPORT OF ORGANIZATIONS IN THE COMMUNITY. FOR GRANTS TO INDIVIDUALS, FUNDS ARE DONATED BY EMPLOYEES. IN THE EVENT AN EMPLOYEE EXPERIENCES AN EMERGENCY WHERE THEY ARE IN SERIOUS FINANCIAL NEED, A COMMITTEE MAY APPROVE GRANTS FROM THE EMPLOYEE RELIEF FUND. X 0 0 X X X X X 0 1 0 0 0 0 0 0 0 RANDAL ARNETT 499005 0 117193 0 22266 0 258430 0 26472 0 923366 0 0 0 DEAN WRAY 251692 0 48840 0 18139 0 97957 0 20009 0 436637 0 0 0 KENDALL L STEWART 298946 0 55530 0 19338 0 120856 0 18909 0 513579 0 0 0 CLAUDIA L BURCHETT 196386 0 33752 0 897 0 81950 0 24658 0 337643 0 0 0 VICKI A NOEL 159028 0 29707 0 303 0 40751 0 28301 0 258090 0 0 0 LEEANN L SAMMONS 143588 0 26332 0 545 0 35904 0 25141 0 231510 0 0 0 RORY E PHILLIPS 143546 0 17688 0 138 0 11770 0 25933 0 199075 0 0 0 JEREMY K JANNEY 123014 0 6488 0 48 0 6715 0 25433 0 161698 0 0 0 CRAIG E GILLILAND 118136 0 14215 0 60 0 7957 0 20537 0 160905 0 0 0 KEITH A HILES 127735 0 1772 0 0 0 5308 0 22415 0 157230 0 0 0 BRIAN P MISSLER 128325 0 1772 0 282 0 9092 0 20815 0 160286 0 0 0 HAROLD B SYLVIA 0 0 0 0 377620 0 0 0 0 0 377620 0 0 0 Part I, Line 1a THE ORGANIZATION PAYS A COUNTRY CLUB MEMBERSHIP DUE ON THE CEO'S BEHALF FOR THE CEO AS A MEANS TO NETWORK WITH PHYSICIANS. NONE OF THE COUNTRY CLUB MEMBERSHIP DUES WERE TREATED AS TAXABLE COMPENSATION TO THE CEO. Part I, Line 1b SOUTHERN OHIO MEDICAL CENTER DOES NOT FOLLOW A WRITTEN POLICY FOR REIMBURSEMENT OR A PROVISION OF THE BENEFIT. THE ORGANIZATION PAYS THE COUNTRY CLUB MEMBERSHIP DIRECTLY ON BEHALF OF THE CEO, SO NO REIMBURSEMENT POLICY IS IN PLACE. THE CEO'S EMPLOYMENT CONTRACT SETS FORTH THE DECISION FOR THE ORGANIZATION TO FOLLOW TO PROVIDE THE PAYMENT OF THE COUNTRY CLUB DUES AS A PERK TO THE CEO. Part I, Line 4a THE ORGANIZATION MADE CONTRIBUTIONS TO A SERP FOR THE FOLLOWING INDIVIDUALS: RANDAL ARNETT: 242,030 KENDALL STEWART: 106,756 DEAN WRAY: 83,857 CLAUDIA BURCHETT: 64,328 VICKI NOEL: 31,610 LEEANN SAMMONS: 27,927 HAROLD SYLVIA'S SERP WAS PAID OUT DURING THE CALENDAR YEAR IN THE AMOUNT OF $377,620. THE AMOUNTS LISTED ABOVE ARE INCLUDED IN COMPENSATION REPORTED IN SCHEDULE J, PART II. COUNTY OF SCIOTO OHIO 316400086 808878FL1 2008-07-23 154655000 HOSPITAL ADDITION & RENOVATIONS 0 0 160223001 10899838 43820197 6866163 2814000 95822779 2009 1 0 1 1 0 0 0 0 1 0.00000 0.00000 0.00000 1 0 1 0 0 0 1 BANNON HOWLAND & DEVER BOARD CHAIR ROBERT DEVER IS SENIOR PARTNER OF BANNON, HOWLAND, & DEVER 240299 $20,000 PER MONTH RETAINER AS GENERAL COUNSEL TO SOUTHERN OHIO MEDICAL CENTER AND ITS RELATED ENTITIES. 0 PORTSMOUTH INSURANCE AGENCY BOARD MEMBER GARY DUZAN IS A PARTNER OF PORTSMOUTH INSURANCE AGENCY 401064 INSURANCE PROVIDER 0 US BANK BOARD MEMBER DAVID FOWLER IS AN OFFICER AT US BANK'S PORTSMOUTH BRANCH 224727 SERVICE CHARGES, INTEREST, AND FEES ASSOCIATED WITH SEVERAL DIFFERENT BANK ACCOUNTS. 0 Form 990, Part III, line 3 Changes in Program Services SOMC CLOSED THE MERCY HEALTH CARE CENTER AND CONVERTED IT TO AN URGENT CARE FACILITY. Form 990, Part VI, Section B, line 11 FORM 990 INFORMATION IS COMPILED IN THE ACCOUNTING DEPARTMENT THEN SENT TO THE INDEPENDENT TAX ACCOUNTANTS TO ANALYZE THE INFORMATION AND COMPLETE THE RETURN. THE FORM IS THEN REVIEWED BY FINANCIAL STAFF AND E-MAILED TO THE BOARD, AND THE CFO PRESENTED FORM 990 TO THE COMPENSATION COMMITTEE BEFORE THE TAX RETURN IS FILED. IN ADDITION, THE ACCOUNTING DEPARTMENT REVIEWED THE NUMBERS TO TIE OUT TO THE TRIAL BALANCE. Form 990, Part VI, Section B, line 12c CONFLICT OF INTEREST STATEMENTS ARE FILLED OUT ANNUALLY IN JANUARY FOR NEW AND RETURNING BOARD MEMBERS, DIRECTORS, AND KEY PERSONNEL. THESE STATEMENTS ARE REVIEWED BY THE AUDIT AND COMPLIANCE COMMITTEE. CONFLICTS OF INTEREST ARE RAISED BY BOARD MEMBERS ONCE THEY ARE KNOWN BY THE INDIVIDUAL. ANY CONFLICTS ARE DOCUMENTED. BOARD MEMBERS ABSTAIN FROM VOTING IF A CONFLICT IS IDENTIFIED THAT THE BOARD MEMBER IS INVOLVED WITH. Form 990, Part VI, Section B, line 15 AN INDEPENDENT CONSULTANT ANNUALLY PROVIDES THE BOARD COMPENSATION COMMITTEE WITH COMPARABLE DATA AND OTHER FACTS WHICH ARE USED BY THE COMMITTEE TO DETERMINE EXECUTIVE PAY PHILOSOPHY. THE DECISIONS REGARDING OFFICER COMPENSATION ARE DOCUMENTED IN THE BOARD COMPENSATION COMMITTEE MINUTES, AS WELL AS THE BOARD MEETING MINUTES. THIS COMMITTEE DETERMINES THE CEO'S PAY AND SETS PAY RANGES FOR THE OTHER EXECUTIVES. THE PROCESS WAS LAST UNDERTAKEN DURING 2010. Form 990, Part VI, Section C, line 19 SOUTHERN OHIO MEDICAL CENTER PROVIDES ITS FINANCIAL STATEMENTS TO THE PUBLIC THROUGH THE FILING OF ITS FORM 990 AS WELL AS ITS BOND DISCLOSURE. GOVERNING DOCUMENTS AND THE CONFLICT OF INTEREST POLICY ARE MADE AVAILABLE TO THE PUBLIC ON SOUTHERN OHIO MEDICAL CENTER'S WEBSITE. FORM 990, PART XI, LINE 2B: SOUTHERN OHIO MEDICAL CENTER DID NOT HAVE AN AUDIT COMPLETED ON A STAND-ALONE BASIS BUT THE ORGANIZATION WAS INCLUDED IN A CONSOLIDATED AUDIT WITH SOMC MEDICAL CARE FOUNDATION, INC., THE FRIENDS OF SOMC, SOMC FOUNDATION, INC., AND SOMC TITLE HOLDING COMPANY. FORM 990, PART XI, LINE 2C: THE AUDIT OVERSIGHT PROCESS AND THE PROCESS OF SELECTION OF AN INDEPEDENT ACCOUNTANT HAVE NOT CHANGED FROM THE PRIOR YEAR. FORM 990, SCH. K, PAGE 1, PART 1: SOUTHERN OHIO MEDICAL CENTER HAD MULTIPLE BONDS ISSUED FROM THE COUNTY OF SCIOTO, OHIO (31-6400086) WITH DIFFERENT CUSIPS NUMBERS BUT ALL ISSUED ON THE SAME DATE, WHICH INCLUDE: CUSIP # 808878FL1 808878FM9 808878FN7 808878FP2 808878FQ0 808878FR8 808878FS6 808878FT4 808878FU1 808878FV9 808878FW7 808878FX5 808878FY3 808878FZ0 FORM 990, PAGE 1, LINE C: DOING BUSINESS AS: SOMC CANCER CENTER, SOMC HOME HEALTH SERVICES, SOMC L.I.F.E. CENTER, RIVERVIEW RETIREMENT CENTER, SOMC URGENT CARE CENTER, SOMC HOSPICE CENTER, SOMC WOUND HEALING CENTER. SOMC FOUNDATION INC 1805 27TH STREET PORTSMOUTH OH 45662 311564440 HOLD INVESTMENTS FOR BENEFIT OF SOUTHERN OHIO MEDICAL CENTER OH 501(C)(3) 11 N/A THE FRIENDS OF SOUTHERN OHIO MEDICAL CENTER 1805 27TH STREET PORTSMOUTH OH 45662 310677520 FUNDRAISING OH 501(C)(3) 11 N/A SOMC MEDICAL CARE FOUNDATION INC 1248 KINNEYS LANE PORTSMOUTH OH 45662 311374523 MEDICINE AND SURGERY OH 501(C)(3) 11 N/A SOUTHERN OHIO MEDICAL CENTER TITLE HOLDING COMPANY 1805 27TH STREET PORTSMOUTH OH 45662 311417566 MANAGE REAL ESTATE OH 501(C)(2) N/A N/A 0 1 0 0 0 0 0 0 0 1 1 1 0 1 1 1 1 1 SOMC MEDICAL CARE FOUNDATION B 16843770 SOMC MEDICAL CARE FOUNDATION J 175724 SOMC MEDICAL CARE FOUNDATION K 56817 SOMC MEDICAL CARE FOUNDATION L 139252 SOMC MEDICAL CARE FOUNDATION N 3193993 SOMC MEDICAL CARE FOUNDATION O 9794862 SOMC MEDICAL CARE FOUNDATION P 28702798 SOMC TITLE HOLDING COMPANY J 1433712 SOMC TITLE HOLDING COMPANY B 1255048 SOMC TITLE HOLDING COMPANY P 2688761 THE FRIENDS OF SOUTHERN OHIO MEDICAL CENTER N 124961 THE FRIENDS OF SOUTHERN OHIO MEDICAL CENTER P 53502