2011-07-29T11:33:46-05:00 2010-09-30 Blue & Co LLC One American Square 2200 Indianapolis IN 46282 990 2009-10-01 350900741 Fayette Memorial Hospital Association Inc FAYE 7658255131 1941 Virginia Ave Connersville IN 47331 Randall white 7658255131 2011-07-29 1 Carrie A Merrill CPA 3176334705 2009 2016-02-24 21:20:13Z Fayette Regional Hospital System Randall White 1941 Virginia Ave Connersville IN 47331 58437009 0 X www.FAYETTEREGIONAL.org X 1913 IN Fayette Regional Health System's (FRHS) vision is for our team to serve the health needs of the Whitewater Valley residents by providing compassionate, high quality, cost effective care. FRHS is committed to the healthcare that the community wants and deserves; achieving this goal by continuing to provide a full continuum of inpatient and outpatient healthcare services to Connersville and the surrounding area' residents. At FRHS, we are committed to providing the care for the needs of the community throughout its lifetime. Founded in 1913, FRHS has been providing quality and compassionate health care for almost 100 years. The main hospital is located in the heart of Connersville, Indiana, with facilities in three additional counties in order to provide quality services close to home. The equipment and facilities enables us to live our mission, "To care, to serve, to heal." 10 6 731 78 -2332 -2332 247693 911650 57974191 54725044 -660984 797760 1942666 1343176 59503566 57777630 190763 161888 0 35237844 30934028 0 0 27439871 28202630 62868478 59298546 -3364912 -1520916 62666061 61043758 32466604 33883764 30199457 27159994 Fayette Regional Health System is a multi-faceted health care center which provides safe, accurate and compassionate health care through service excellence to the citizens of East Central Indiana to promote healing and healthy living. 0 0 54420383 161888 54799738 The hospital provides inpatient and outpatient services and acute rehab services. Medicare and Medicaid amounted to approximately 70% of total services provided by the hospital. Uninsured care was approximately $1.76 million, as calculated by gross charges, for the year ended September 30, 2010. Total community benefit contributions are $161,888. 54420383 1 1 0 1 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 1 1 1 1 0 0 0 0 0 1 0 0 0 0 0 0 0 1 1 0 0 1 95 0 731 1 1 1 0 0 0 0 0 0 0 0 10 6 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 IN X Vicky Hopkins 7658277709 1941 VIRGINIA AVENUE CONNERSVILLE IN 47331 Charles Brochin 1.00 X 12000 0 0 Louise Whitaker 1.00 X 7500 0 0 Jerry Smith 1.00 X 7500 0 0 Malcolm Miles 1.00 X 7500 0 0 Arlene Bliven 1.00 X 6000 0 0 Joel Long 1.00 X 6000 0 0 Jim Thomas 1.00 X 1500 0 0 Dr Steven Johnson 40.00 X 312078 0 11500 Jag Patel MD 40.00 X 286090 0 11500 David Brandon 0.00 X 385110 0 22703 Randall White 40.00 X X 198987 0 18316 John Jeffries 40.00 X 160519 0 16058 Beth Wampler 40.00 X 161912 0 16862 Rhonda McPherson 40.00 X 133853 0 11510 John Landry 40.00 X 315099 0 11500 Abdul Khan 40.00 X 308913 0 11500 Petronio Ilagan 40.00 X 278468 0 11500 Michael Rowe 40.00 X 275077 0 11500 Thomas Skeen 40.00 X 202984 0 10149 3067090 0 164598 32 1 1 0 AMERISOURCE-Bergen 21978 Network PL Chicago IL 60673 Pharmaceutical Provider 1873438 Philips Medical Capital PO Box 92449 Cleveland OH 44193 Medical Leasing Company 1227782 Key Benefit Administrators PO Box 55210 Indianapolis IN 46205 Insurance Provider 859804 Cardinal Health PO Box 70539 Chicago IL 60673 Product Supplier 717359 Duke Energy PO Box 9001076 Louisville KY 40290 Electric Company 709565 47 911650 911650 Net Patient Revenue 900099 54725044 54725044 54725044 553481 553481 119074 46712 72362 72362 74694 -2332 834737 22209 385496 227171 449241 -204962 244279 244279 Billing Services 900099 353363 353363 Cafeteria Revenue 900099 219685 219685 Employee Pharmacy Reve 900099 135402 135402 562364 562364 1270814 57777630 54799738 -2332 2068574 161888 161888 806853 742305 64548 24938267 22943206 1995061 873886 803975 69911 2470631 2272981 197650 1844391 1696840 147551 343433 315958 27475 196365 180656 15709 4270928 3929254 341674 256087 235600 20487 6154375 5662025 492350 4326581 3980455 346126 101348 93240 8108 1415218 1302001 113217 3655578 3363132 292446 798980 735062 63918 Bad Debt 6357976 5849338 508638 Dues & Sub. 135882 125011 10871 189879 27456 162423 59298546 54420383 4878163 0 641873 10046584 9891702 886622 583856 934480 907770 587541 1215190 75293523 45144038 33216970 30149485 13807419 13619983 1897340 1059834 647232 3615938 62666061 61043758 3586187 3213272 22747577 21879540 1000425 760055 5132415 8030897 32466604 33883764 X 28352453 26154457 1847004 1005537 30199457 27159994 62666061 61043758 X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 1582 1582 0 Part II-B, Line 1i: Explanation of Other Lobbying Activities: Pay membership dues to trade organizations of which a portion of the dues are used for lobby expenses by the trade organizations. 1410452 1410452 52001745 28524619 23477126 21842854 16619419 5223435 38472 38472 30149485 Bond Issue Costs 607948 Estimated Third Party Settlement 3007990 3615938 Line of Credit 4382268 Deriviative Liability 3582950 Cash Overdraft 65679 8030897 57777630 59298546 -1520916 -677079 -841468 -1518547 -3039463 57155859 -677079 -677079 57832938 196365 -251673 -55308 57777630 59353855 251674 251674 59102181 196365 196365 59298546 Part XI, Line 8 - Other Adjustments: Change in Temporarily Restricted Net ASsets: -841468. Part XII, Line 4b - Other Adjustments: Loss on Fixed Assets : -204961. Rental Expenses: -46712. Part XIII, Line 2d - Other Adjustments: Rental Expenses: 46713. Loss on Fixed Assets: 204961. 1 1 1 X 1 X 1 0 0 1 1 810601 810601 0.01530 9153810 3817831 5335979 0.10080 9964411 3817831 6146580 0.11610 4 5000 5000 0.00010 44 12543 12543 0.00020 48 17543 17543 0.00030 48 9981954 3817831 6164123 0.11640 5 109710 109710 0.00210 5 109710 109710 0.00210 0 2748753 0 11227409 11882703 -655294 X 1 0 Fayette Regional Hospital System

1941 Virginia Ave Connersville IN 47331

X X X Part I, Line 3c: The hospital has a sliding scale based on the Federal Poverty Guidelines with free care to individuals who have income between 100% and 133% of poverty and provide discounted care up to income of 300% of poverty. The largest number of the organization's patients meet the Federal Poverty Guidelines for discounted care around 200% depending on the household size. Part I, Line 6a: Organization's community benefit report is available upon request. Part III, Line 4: Footnote to organization's financial statements that describes bad debt expenses: The System evaluates the collectability of its accounts receivable based on certain factors, such as payer type, historical collection trends and aging categories. The allowance that is applied to the receivable balances is based on the historical experience and time limits, if any, for each particular payer source, such as private, insurance, Medicare and Medicaid. Actual results could differ from the estimated allowances.Part III, Line 3: Rational for including other bad debt amount in community benefit: None has been included. The hospital has a detailed Charity Care Policy which states that to participate in charity care candidates must cooperate fully. In addition the hospital educates patients will limited ability to pay regarding financial assistance. For this reason the organization believes that it accurately captures all charity care deductions provided according to the financial assistance policy and the amount of bad debt expense attributable to patients eligible under the organization's charity care policy is negligible. Part III, Line 8: The source used to determine the amount of Medicare allowable costs reported for Part III, Section B, Medicare has been provided from the Year Ended September 30, 2010 report: Hospital Statement of Reimbursable Cost. Part VI, Line 2: The organization assesses the health care needs of the communities it serves through ongoing communication with local community leaders and originations. The hospital team members regularly participate in community events and local civic organizations including Rotary, Kiwanis, and Chamber of Commerce. Community needs are disseminated through these local community organizations and events providing the Hospital with feedback regarding the needs of the community. In addition the hospital completes and submits annually a community benefit plan to the Indiana State Department of Health which addresses the goals set to focus on the needs of the community.FRHS recognizes five primary areas of concern facing its community as the FRHS emphasis in the implementation of the Community Benefit Plan: 1. Citizens who are medically underserved. 2. Issues that impact adolescents including education, pregnancy and general behavioral concepts specific to this age group. 3. Childhood growth and development, as well as abuse and neglect prevention. 4. Health issues that require increased awareness in the general community population. 5. Challenges impacting employment which directly relate to the community's ability to obtain comprehensive medical care Part VI, Line 3: Eligibility for assistance under Federal, State, or local government programs or under the organization's charity care policy is discussed with patients or guarantors to inform and educate patients and persons who may be billed for patient care. Charity Care Applications and Pamphlets detailing billing procedures and contact information for the billing office are made available to patients. Any questions regarding the organization's written charity care policy can be directed and answered by a member of the Patient Accounts' personnel. Patient Accounts' personnel will notify individuals with approved applications qualifying for reduced liability under the charity care policy Part VI, Line 4: FRHS's main areas of service are Fayette, Franklin and Union counties serving an approximate population of 54,000. Fayette County has ranked in the top two counties for unemployment in the past several years and has a high number of private pay individuals. Union County and Franklin County have little to no industry. Part VI, Line 5: FRHS employees participate in community building activities to promote the health of the communities it serves including:**Health Fair, Connersville, IN, 150 hrs; Brookville, IN, 68.5 hrs; Liberty, IN, 65.25hrs: FRHS team members sponsor a health fair for our community annually. Booths are set up for the screens and testing of blood pressure, cholesterol, computerized health risk appraisal, cataract, glaucoma, colorectal, blood sugar, peripheral vascular disease, TB, immunizations for children, body fat analysis, chemical dependency, and numerous educational and demonstration booths.**Blood Drive, Connersville, IN, 23.75 hrs: Donated blood.**Pretty in Pink Pajama Party, Connersville, IN, 129.5 hrs: Team members organized, set-up and participated in the pretty in pink pajama party event for breast cancer survivors.**Frazee Elementary School, Connersville, IN, 3 hrs: Team members visited Frazee Elementary School to demonstrate proper hand washing.**Junior Achievement bowl-a-thon, Connersville, IN, 5 hrs: Team member participated during bowling event and dietary department baked cookies for the event.Angel Food Ministries, Connersville, IN 18.5 hrs: Team member help distribute food.**Breast Cancer Awareness, Connersville, IN, 7.5 hrs: Team members helped register guests and provided tours at the Breast Cancer Awareness event at Fayette Regional Health System.**Volunteer Luncheon, Connersville, IN, 1 hr: Team members helped organizer and work the Fayette Regional Health System volunteer lunch at the Miller Building.**Diabetes Support Group, Connersville, IN, 2 hrs: Team member spoke at the diabetes support group November meeting on "Carb counting for Diabetics".**Public Speaking, Brookville & Laurel, IN, 3 hrs: Team member was guest speaker at the Brookville and laurel public libraries. Speaking on health, fitness/wellness, and nutrition; gave out information on ways to improve overall health and well-being.**Brookville High School, Brookville, IN, 14 hrs: Team member taught CPR to the students.**Senior Center, Connersville, IN, 3 hrs: Team member handed out programs for Nutrition Awareness Day.**Frazee Elementary School Connersville, IN, 16.5 hrs: Annual Bike Rodeo-instructed students on bike safety.**Fayette County Optimist Club, Connersville, IN, 1 hr: Team member was guest speaker at weekly meeting.** Connersville High School, Connersville, IN 10 hrs: Team member prepared presentation and spoke to students about career opportunities in health care.**Physical Night, Connersville, IN, 67.75 hrs: Team members assisted with High School and Middle school physical nights.**Optimist Club, Connersville, IN, 1.5 hrs: Team member spoke about Fayette Regional Health System Cancer Center and cancer issues at the Optimist Club meeting. **Relay for Life, Connersville, IN & Brookville, IN, 114 hrs: Team members walked, provided blood pressure screenings, and assisted in the events that were held in conjunction with the relay, as well as, taking photos of survivors.**Optimist Club, Connersville, IN 2 hrs: Team member spoke to the club on Rehab Services.**SAPA Health Fair, Connersville, IN 9 hrs: Dietary team donated time to prepare food items and work at the health fair.**Celebrate Women, Connersville, IN 5 hrs: Team member volunteered her time at the event to raise women health awareness.**SAPA Health Fair, Connersville, IN, 20 hrs: Team members volunteered time at health fair.**IWIN Foundation, Connersville, IN, 8 hrs: Team member spoke at fundraiser about breast cancer.*Tri-Kappa Sorority, Connersville, IN 1 hr: Team member spoke at benefit about breast cancer.**TV-3, Connersville, IN, .75 hrs: Team member did a community service spot for TV station.**Community Bike Rodeo, Robert Park Connersville, IN, 20.5 hrs: Team member volunteered time at the community bike rodeo giving safety tips.Part VI, Line 6: During the fiscal year FRHS has demonstrated continued community stewardship through the attainment of many goals that address the needs of our community. We continue to strive for excellence in the contributions and services that we provide to area citizens. Details for furthering FRHS's exempt purpose for **Medically underserved citizen: The Franklin Co. community has continued to benefit from the development and implementation of services at the Brookville HealthPlex facility with the latest healthcare technology including a 64 slice CT scan, ultrasound, open MRI and laboratory services. The lab participated in two major external inspections with improvements noted in the use of electronic data calculations, documentation of proficiencies and various quality controls to better serve the community. Multiple community meetings continue since 2009 including citizens of Franklin Co and FRHS leadership to discuss ways in which FRHS can better meet the health needs of this county. Sustained cardiology and oncology services with the FRHS Care Centers enabling patients to be seen locally for more accessible care with less travel, time and expense. Immediate care facilities have remained open in two local communities to assist patients in to better access care without expensive travel and transportation arrangements for those without vehicles. Sponsorship of the annual community health fairs in Fayette, Union and Franklin counties with extensive representation of FRHS services by staff. There was an increase in physician participation this year as well. A wide array of screenings offered included blood pressure, blood sugar, cholesterol, and bone density. Team members were available to help participants utilize health risk surveys as well as to educate them on a variety of health issues. All attempts are made to offer free health aides such as pill dispensers, nutritional guides for fast food restaurants, etc. Two cardiac scoring procedures, female wellness exam, and cholesterol screening certificates were among the booth prizes given away at the event. Multiple volunteer involvements in food pantries, and ministries to assist low income individuals with nutritional aid which impact their general health. A Food is held in February to assist with the post holiday need for food. This service cannot be undervalued at an economic time when many families have basic nutritional needs that are not being met in a more traditional fashion. A bake sale for Hospice was held in the Fall to assist those with end of Life needs. Fund raising for charitable organizations involved in educational assistance through scholarship programs. Increased participation for the Fayette and Franklin Co. Relay for Life Cancer Society events to raise funds to enable care/services for oncology patients and survivors of cancer. Raffle baskets were submitted by various FRHS departments with a total donation of $1500. Additionally, FRHS assisted further through advertisement for the Relay and a monetary gift. Many FRHS team members and leadership staff contributed time to walk during the 24 hour event as they did in 2009. Several community service groups including Psi Iota Xi and Eta Pi Kappa were assisted with programs and projects that directly improved the medical outcome for community members while also increasing health education. A donation was given to the Crossroads Shelter for their Day of Celebration event. Many hours were donated by FRHS staff to the local pregnancy crises center for programs and projects to help meet the needs of this population. A local Golf tourney and the Annual Gala event have raised funds to provide additional health services to the community. Area 9 Agency was given a donation for their Senior Picnic and Music event. FRHS team members enjoyed a Bowling Tournament with proceeds going to the Fayette Co. Cancer Society. **Adolescent population issues: The Whitewater Care Pavilion offers comprehensive behavioral health services for adolescents including residential, acute inpatient care and outpatient therapy options. Many local youth groups and individual children were assisted by FRHS staff through activities such as 4H Fair, Junior Achievement and the Drug Coalition for Fayette County School Corporation. Three sports physicals for local youth enabling them to participate in school sports programs were completed by FRHS physicians. A wide variety of community service opportunities including coaching sports for youth are regularly supported by FRHS staff volunteers. Health care professionals spoke at local classes, and participated in fundraising for scholarships. FRHS funds seven separate scholarships for area youth. FRHS purchased a new ice machine for the Connersville School Athletics Association to support healthy lifestyles for youth by participating in sports activities. Food, clothing, and shelter provisions are provided in cooperation with community churches, missions, Lions Club, sorority activities, Kiwanis and school corporation projects. Part VI, Line 6: **Continue** FRHS staff donated time to the local Hope Pregnancy Care Center for programs and projects to help meet the needs of this population. A Baby Formula program through the Hope Pregnancy Center is available for teen mothers for their baby's nutritional needs. A monetary donation from FRHS also supports this center. Fourteen AEDs are in use at Fayette Co schools as a results of a FRHS donation. Strong participation in the 4-H Fair by purchasing livestock from Team members children that participate in these programs as well as painting at the 4-H buildings. Also offered sponsorship in Franklin Co 4-H Fair activities. Sponsorship of a soccer team thru the Connersville Park and Recreation and area youth swim team. Donation of pies and cookies for the handicapped children's Christmas party. Quarterback Club Youth League was sponsored by FRHS. Sponsored After Prom for Union County High School students. Laurel Music Festival sponsorship thru the Laurel Youth Council. Team members took youth to various functions in Indianapolis including the symphony. Donation of time to help with the Free Speech Clinic for youth in Rush County.**Childhood issues: Christmas giving to the Division of Family and Children initiative where departments sponsor needy children at the holiday with shoes, clothing, books and toys. Community Bike Rodeo safety program and the Fayette Co. Basketball Camp were supported by FRHS staff through our dietary team contribution. Children's activities such as Bowling for Kids, church holiday programs, the 4H Fair, Girl Scouts and Cub Scouts, local festivals, and Head Start. Staff members assisted with the Speech and Hearing Clinic offered through collaboration with FRHS, Psi Beta Xi sorority and Fayette schools. Education opportunities that FRHS staff members supported include tutoring students, reading enhancement programs, Body Safety program, Boys and Girls Club reading program. Donated to the Ride for a Child Community Benefit. Purchased a table for the St Gabriel elementary school fund raiser. Cancer Education program presented to the students at St Gabriel School. A back to school program conducted by the Connersville FOP called Shop with a Cop was supported by FRHS to allow students to purchase needed school supplies.**Increasing healthcare-related issues awareness and education: FRHS presents ongoing updates on the local television station to assure that Fayette County residents are aware of healthcare changes. Speaking engagements by staff on a variety of health issues at local school, events and community groups. FRHS has coordinated Living through Grief and Living through Cancer groups for eight years to counsel and support families through difficult family situations. Provides monetary assistance as well as other types of support for the ministerial association's efforts to encourage spiritual well-being and meet community needs. Smoking Cessation program is available through the FRHS Health Works department. The FRHS Speaker's Bureau continued to offer services on health-related topics to community programs. Topics included stress management, stroke issues, smoking cessation, diabetes, and influenza. FRHS Home Health offers blood pressure and blood glucose clinics at various sites in Franklin, Fayette and Union county on a monthly basis. Maintained sponsorship of the Community Education Coalition including their annual Gala. Breast Cancer Awareness table in the atrium to educate as well as the Race for a Cure event. A Team member is on the local Cancer Society Board. Team member spoke at the Kiwanis Club benefit regarding the benefits of exercise and good posture. Nutritional programs at the Fayette Co Courthouse and several other community centers were presented in the past year. FRHS Health Works facility donated gift certificates to the FRHS Foundation Gala, for the Bowl for Kid's Sake and the Pet Walk in the Park events and a Wii fitness system for community fitness festival tournaments.**Community challenges impacting employment which directly relate to the community's ability to obtain continued medical care: FRHS continues to work with Carbon Motors in an effort to increase employment in Connersville and surrounding communities. **Other areas of participation beyond the previously stated goals include: The FRHS Foundation is a cause that FRHS staff supports annually through a variety of functions such as the Golf outing, Gala fundraiser and the Hometown Competitiveness program. Another local hospital foundation also had an "Art to Heart fundraiser for cardiac issues and FRHS contributed monetarily towards that event. The Franklin Co. Foundation Humanitarian award banquet was supported as well. Staffed a booth at the Rush Co Garden Festival. Participation in the other area Relay for Life, Plan for Life and Stand for Life events. Contributed to the local Chamber Of Commerce Whitewater Walk in addition to other C of C events including the Chamber Golf Classic, Chamber Annual Banquet Dinner for the Citizen of the Year and for their booth rental at the John Conner Festival. Two teams were sponsored for the Golf Tournament. Donations to local community club events such as Salvation Army. 28 units of blood were donated for the Blood Drive sponsored by FRHS and another drive at the Health Fair. Worked at the local animal shelter and aided in fund raising activities. Assisting elderly shut-ins regarding their medications. Several Team members spent two days assisting Rush Memorial Hospital when that neighboring hospital's basement flooded. Participated and contributed to the Canoe Fest in Brookville (Franklin Co). Staff was involved in the Link Spelling Bee to promote literacy at the Whitewater Technical Career Center. Sponsorship for the K Miller Circus thru the Connersville Optimists Club. Part VI, Line 7: NOT APPLICABLE. ORGANIZATION IS NOT PART OF AN AFFILIATED HEALTH CARE SYSTEM. IN 0 Franklin County High School 1941 Virginia Ave Connersville IN 47331 350900741 36876 2210 cost food and supplies Contributions for donated food and supplies at cost for football fundraising events, sponsorship donations, and pay salary & benefits for Athletic Director. Connersville High School 1941 Virginia Ave Connersville IN 47331 350900741 61909 2052 cost food and supplies Contributions for donated food and supplies at cost for football, Marching Band and After-Prom events, sponsorship donations, and pay salary & benefits for Athletic Director. Fayette County Ministerial Association 1941 Virginia Ave Connersville IN 47331 350900741 14300 Contributions to pay salary & benefits for Reverend. 3 3 Nursing scholarships 4 5000 Procedure for Monitoring Grants in the U.S.: Part I, Line 2: Schedule I, Part I, Line 2: All grants to entities in the U.S. are provided to 501(c)(3) public charities for general support. The organization does not monitor the use of these funds by these public charities. In addition the organization makes scholarships and student loans available to eligible persons to further healthcare in the community. The organization does monitor the use of the scholarships and students loans. X 0 1 X X X X 1 0 0 0 0 0 0 1 0 Dr Steven Johnson 300078 0 0 0 12000 0 11500 0 0 0 323578 0 0 0 Jag Patel MD 280090 0 0 0 6000 0 11500 0 0 0 297590 0 0 0 David Brandon 245003 0 45410 0 94697 0 11500 0 11203 0 407813 0 0 0 Randall White 183532 0 0 0 15455 0 8892 0 9424 0 217303 0 0 0 John Jeffries 137657 0 0 0 22862 0 7284 0 8774 0 176577 0 0 0 Beth Wampler 140351 0 0 0 21561 0 7287 0 9575 0 178774 0 0 0 John Landry 300099 0 15000 0 0 0 11500 0 0 0 326599 0 0 0 Abdul Khan 308913 0 0 0 0 0 11500 0 0 0 320413 0 0 0 Petronio Ilagan 272604 0 0 0 5864 0 11500 0 0 0 289968 0 0 0 Michael Rowe 275077 0 0 0 0 0 11500 0 0 0 286577 0 0 0 Thomas Skeen 202984 0 0 0 0 0 10149 0 0 0 213133 0 0 0 Part I, Line 1a Tax indemnification and gross-up payments were made during the year and were approved by the board. Part I, Line 4a: Former CEO received severance payments during the year. Part I, Line 7 Performance Incentive pay is a goal-based non-fixed payment that is directly tied to the performance of the individual in achieving personal and organizational goals. The program is governed by the board of trustees and delegated to the executive committee of the board to be reviewed and approved. Payouts are based on each individual's performance against pre-defined goals and objectives aligned with the overall mission, vision, and strategic goals of the organization and the profitability of FRHS for the fiscal year. If the hospital meets or exceeds budget with respect to excess revenue over expenses excluding any interest income, each employee will receive on week's pay based upon an average number of regular scheduled hours worked per week. The board has the authority to approve payments at its discretion with regards to courageous actions by employees at anytime in accordance with the oganization's whistle blowers policy. Dr Jag Patel Board member and Employee 32500 Dr. Patel owns a building which he rents to the hospital for physician offices. 0 Form 990, Part VI, Section B, line 11 The process of reviewing the Form 990 entails a detailed review of the Form 990 by the organization's CFO and Controller. The governing body reviews and approves the Form 990 including requested schedules, as ultimately filed with the IRS, and are provided to each voting member of the organization's governing body prior to filing. Form 990, Part VI, Section B, line 12c Annual information about the conflict of interest and disclosure are provided to Members of the Board of Trustees, Chief Executive Officer, Administrative staff, All department managers, Individuals with influence over purchasing, and Individuals with contracts to FRHS. Annual questionnaires are to be completed by each individual and returned to the CEO's office which are reviewed by the Chair of the Board of Trustees. In addition, any indiviudal associated with Fayette Regional Health System is to declare situations of actual or potential conflicts of interest as they arise, in writing, and in sufficient detail. Form 990, Part VI, Section B, line 15 The process for determining compensation for the CEO is governed by the Board of Trustees and delegated to the Executive Committee of the board to review and approve annually. In addition, all employment contracts and amendments for the CEO will be reviewed and approved by the Executive Committee of the Board and co-signed by the Chair of the Board of Trustees and the Secretary of the Board. The process for determining compensation for other officers/key employees is reviewed annually by the Executive Committee and CEO. The Secretary of the board of Trustees is responsible for recording in the minutes the deliberation and decisions. Form 990, Part VI, Section C, line 19 The organization makes the governing documents, conflict of interest policy, or financial statements available upon request. Part XI, line 2c Oversight of the Audit The audit committee assumes responsibility for oversight of the audit of the financial statements and selection of the independent accountant; and no processes have changed from prior year. Fayette Memorial Hospital Foundation 1941 Virginia Avenue Connersville IN 47331 311010071 To benefit Fayette Regional Hospital System IN 501(c)(3) Line 11a, I Fayette Regional Hospital 0 0 1 0 0 0 0 0 0 0 1 0 1 1 0 0 0 0 Fayette Memorial Hospital Foundation C 911650 Fayette Memorial Hospital Foundation K 163950