2021-11-15T09:41:16-06:00 2020-12-31 381357951 PLANTE & MORAN PLLC 250 S HIGH ST SUITE 100 COLUMBUS OH 43215 990 2020-01-01 341425870 LAKE HOSPITAL SYSTEM INC LAKE 4403541991 3605 WARRENSVILLE CTR RD MSC 9155 SHAKER HEIGHTS OH 44122 ROBERT TRACZ SENIOR VP & CFO 4403541991 2021-11-11 1 ROBERT TRACZ 999009999 AMY CIMINELLO P00796388 6148493000 2021-11-11 2 AAL1 IAL1 2020 2022-09-23 18:48:47Z X LAKE HEALTH CYNTHIA MOORE-HARDY 3605 WARRENSVILLE CTR RD MSC 9155 SHAKER HEIGHTS OH 44122 808276344 0 X WWW.LAKEHEALTH.ORG X 1983 OH TO PROVIDE COMPREHENSIVE HEALTH CARE SERVICES TO THE RESIDENTS OF LAKE COUNTY AND NEIGHBORING COMMUNITIES IN PARTNERSHIP WITH THOSE WHO SHARE A COMMITMENT TO LOCAL ACCESS, HEALING WITH COMPASSION, AND SUPERIOR QUALITY. 11 11 3466 438 867365 0 3225849 12062589 383138453 346342471 10091405 26041896 23653182 26655602 420108889 411102558 5000 158900 0 0 153530797 153691022 0 0 0 257139076 247620636 410674873 401470558 9434016 9632000 620500630 660977812 368953326 413098945 251547304 247878867 X IT IS THE MISSION OF LAKE HOSPITAL SYSTEM TO PROVIDE COMPREHENSIVE HEALTH CARE SERVICES TO THE RESIDENTS OF LAKE COUNTY AND NEIGHBORING COMMUNITIES IN PARTNERSHIP WITH THOSE WHO SHARE A COMMITMENT TO LOCAL ACCESS, HEALING WITH COMPASSION, AND SUPERIOR QUALITY. 0 0 354585234 158900 369750356 AS AN INDEPENDENT, COMMUNITY-BASED HOSPITAL SYSTEM, LAKE HOSPITAL SYSTEM, INC., DBA LAKE HEALTH, HAS HAD A LONG-STANDING TRADITION OF PROVIDING SERVICES AND PROGRAMS BASED ON THE HEALTH CARE NEEDS OF THE COMMUNITIES THAT WE SERVE. WE ARE GUIDED BY OUR MISSION TO PROVIDE LOCAL ACCESS, HEALING WITH COMPASSION AND SUPERIOR QUALITY, AND BY OUR CORE VALUES - RESPECT, INNOVATION, TEAMWORK, STEWARDSHIP AND INTEGRITY. LAKE HEALTH'S GROWTH AS A COMMUNITY-BASED HEALTH CARE SYSTEM CONTINUES TO BUILD ON ITS LONG HISTORY OF PROVIDING PROGRESSIVE, PERSONALIZED CARE THAT YOU NORMALLY WOULDN'T EXPECT TO FIND AT A COMMUNITY HOSPITAL. GUIDED BY A COLLABORATIVE HEALTH NEEDS ASSESSMENT CONDUCTED IN COOPERATION WITH THE LAKE COUNTY GENERAL HEALTH DISTRICT, LAKE HEALTH HAS DEVELOPED PROGRAMS, SERVICES AND PARTNERSHIPS TO ADDRESS THE MOST PRESSING HEALTH ISSUES. THE HIGH PRIORITY AREAS INCLUDE DIABETES, OBESITY, MENTAL HEALTH, HIGH BLOOD PRESSURE, DRUG OVERDOSE DEATHS, AND HEART DISEASE.LAKE HEALTH IS COMPRISED OF 11 FACILITIES IN LAKE, GEAUGA AND CUYAHOGA COUNTIES, WHICH INCLUDE THE FOLLOWING:1. TRIPOINT MEDICAL CENTER (FULL-SERVICE, ACUTE CARE HOSPITAL)2. WEST MEDICAL CENTER (FULL-SERVICE, ACUTE CARE HOSPITAL)3. BEACHWOOD MEDICAL CENTER (FULL-SERVICE ACUTE CARE HOSPITAL)4. MENTOR CAMPUS (OUTPATIENT LAB AND DIAGNOSTICS, PHYSICIAN OFFICES, OUTPATIENT SURGERY, CANCER SERVICES)5. MENTOR WELLNESS CAMPUS (URGENT CARE, OUTPATIENT LAB AND DIAGNOSTICS, PHYSICIAN OFFICES, PHYSICAL THERAPY, OCCUPATIONAL HEALTH SERVICES AND A MEDICALLY BASED FITNESS CENTER)6. MADISON CAMPUS (FREE-STANDING ER, OUTPATIENT LAB AND DIAGNOSTICS, PHYSICIAN OFFICES, PHYSICAL THERAPY)7. WILLOWICK CAMPUS (URGENT CARE, OUTPATIENT LAB AND DIAGNOSTICS, PHYSICIAN OFFICES)8. CHARDON CAMPUS (OUTPATIENT LAB AND DIAGNOSTICS, PHYSICIAN OFFICES)9. PERRICO HEALTH CAMPUS (PHYSICIAN OFFICES, PHYSICAL THERAPY, OUTPATIENT LAB AND DIAGNOSTICS)10. SOM CENTER CAMPUS (PHYSICIAN OFFICES, LAB AND DIAGNOSTICS)11. CONTINUING CARE CAMPUS (COMPREHENSIVE, INPATIENT REHABILITATION; GERIATRIC PSYCHIATRY)ACCESSIBILITY IS KEY TO OUR MISSION. WE HAVE CONTRACTED WITH MOST INSURANCE PROVIDERS TO ENSURE A VAST ARRAY OF PRIMARY CARE PHYSICIANS AND SPECIALISTS. LAKE HEALTH OPERATES THREE FULL-SERVICE EMERGENCY DEPARTMENTS WITHIN LAKE COUNTY AT TRIPOINT MEDICAL CENTER IN CONCORD TOWNSHIP, WEST MEDICAL CENTER IN WILLOUGHBY AND THE FREE-STANDING MADISON EMERGENCY DEPARTMENT IN MADISON, AND A FULL-SERVICE EMERGENCY DEPARTMENT IN CUYAHOGA COUNTY AT BEACHWOOD MEDICAL CENTER IN BEACHWOOD. THESE EMERGENCY DEPARTMENTS ARE OPEN TO ALL PERSONS, REGARDLESS OF ABILITY TO PAY.FOR THE 20TH YEAR IN A ROW, LAKE HEALTH WAS RECOGNIZED AS ONE OF NORTHCOAST 99'S "BEST PLACES TO WORK IN NORTHEAST OHIO". OUR GROWTH AS A HOSPITAL SYSTEM REFLECTS THE MANY WAYS WE ARE BUILDING ON OUR MISSION AND HOW WE ASPIRE TO BE MORE THAN YOUR TYPICAL COMMUNITY HOSPITAL. WE WANT OUR PATIENTS TO RECEIVE SUPERIOR PATIENT CARE WITHOUT HAVING TO LEAVE THE COMMUNITY, AND THAT'S WHY WE ARE COMMITTED TO BRINGING THE BEST RESOURCES TOGETHER TO PROVIDE AN EXPANDED LEVEL OF COMMUNITY CARE.LAKE HEALTH PROVIDES SERVICES AND PROGRAMS BASED ON THE HEALTH CARE NEEDS OF THE COMMUNITIES WE SERVE. BRINGING HEALTH EDUCATION PROGRAMS AND SCREENINGS TO WHERE PEOPLE LIVE, WORK AND PLAY IS FUNDAMENTAL TO OUR MISSION. THE COVID-19 CRISIS DEFINED 2020 FOR ALL HOSPITALS, WHICH RE-SHAPED HOW WE PROVIDED HEALTH EDUCATION PROGRAMS TO OUR COMMUNITIES. INSTEAD OF IN-PERSON PHYSICIAN LECTURES AND SCREENINGS, MORE INFORMATION WAS PROVIDED DIGITALLY THROUGH WEBINARS, E-MAIL AND SOCIAL MEDIA ALONG WITH SENDING PRINT MATERIAL DIRECT TO THE HOME. IN 2020, LAKE HEALTH PROVIDED APPROXIMATELY $200,000 IN COMMUNITY BENEFIT THROUGH HEALTH EDUCATION, WHICH MOSTLY FOCUSED ON HOW TO PREVENT, TREAT AND SLOW THE SPREAD OF COVID-19 IN THE COMMUNITY AND HOW TO SEEK SAFE CARE DURING THE PANDEMIC. LAKE HEALTH CONTRIBUTED APPROXIMATELY $675,000 IN 2020 IN CASH AND IN-KIND DONATIONS TO CIVIC AND COMMUNITY PROGRAMS AND PARTNERSHIPS WITH A HEALTH AND WELLNESS FOCUS. SOME OF THE PROGRAMS AND EVENTS ARE HIGHLIGHTED BELOW. MANY OF THEM ARE FACILITATED THROUGH OUR HEALTH PROMOTION AND MARKETING DEPARTMENTS.COMMUNITY PROGRAMS AND EVENTS: AMERICAN HEART WALKWALK TO END ALZHEIMER'SEND 68 HOURS OF HUNGER INFANT AND CHILDBIRTH PROGRAMS INCLUDING CHILDBIRTH PREPARATION, INFANT CARE, BREASTFEEDINGPROGRAM, SIBLING PROGRAM, INFANT AND CHILD CPR, AND CAR SEAT CHECKS. SUPPORT GROUPS, INCLUDING BREASTFEEDING, BREAST CANCER, DIABETES, STROKE, AND AMPUTEE UNITED WAY DAY OF CARING AND HARVEST FOR HUNGER SCHOOL PARTNERSHIPS MALL WALKING PROGRAM IN PARTNERSHIP WITH GREAT LAKES MALL, WHICH INCLUDES BI-MONTHLY LECTURES/ACTIVITIES AND BLOOD PRESSURE SCREENINGS. BREAST HEALTH FOR HISPANIC WOMEN NUTRITION AND FITNESS EDUCATION SERIES ARTHRITIS EXPO STRESS MANAGEMENT COOKING FOR WELLNESS INTEGRATIVE HEALTH AND WELLNESS TRADITIONAL CHINESE MEDICINE PROBLEM-BASED LEARNING IN ELEMENTARY SCHOOLS 354585234 1 1 0 1 0 0 1 0 0 1 1 0 0 1 1 1 0 1 0 0 1 0 0 0 0 0 1 1 1 1 1 1 0 0 0 0 0 0 0 0 1 0 1 0 0 0 1 1 1 1 0 0 1 156 0 1 3466 1 1 1 1 CJ 0 0 0 0 0 0 0 0 1 0 X 11 11 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 1 1 X LISA MOTHERSBAUGH 4403541984 7590 AUBURN ROAD CONCORD OH 44077 THOMAS P JUBECK CHAIR 5.00 0.00 X X 0 0 0 BRETT HIMES VICE CHAIR 5.00 0.00 X X 0 0 0 DAWN GUBANC-ANDERSON SECRETARY 2.00 0.00 X X 0 0 0 ADAM SANDEN TREASURER 2.00 0.00 X X 0 0 0 MICHAEL E MAYHER TRUSTEE 2.00 0.00 X 0 0 0 RAYMOND PAGANINI TRUSTEE 1.00 0.00 X 0 0 0 CHETAN PATEL MD TRUSTEE 1.00 0.00 X 0 0 0 DAVID ROLLINS MD TRUSTEE 1.00 0.00 X 0 0 0 RAYMOND SINES TRUSTEE 1.00 0.00 X 0 0 0 DAVID STEIGER MD TRUSTEE 1.00 0.00 X 0 0 0 KEITH ZIEGLER TRUSTEE 1.00 0.00 X 0 0 0 RODNEY HOWELL TRUSTEE (THRU 3/31) 0.00 0.00 X 0 0 0 CYNTHIA MOORE-HARDY PRESIDENT AND CEO 55.00 10.00 X 1033579 0 97131 ROBERT TRACZ SR. VP/CFO 50.00 10.00 X 534753 0 13142 JOHN BANIEWICZ MD SR VP, MEDICAL AFFAIRS 45.00 10.00 X 542103 0 13149 RICHARD D CICERO SR VP, MARKETING & BUSINESS 45.00 10.00 X 360270 0 10573 ADETINUKE TADESE CHIEF MEDICAL INFORMATICS OFFICER 40.00 5.00 X 304694 0 11863 BILL OSTERMAN VP, ACUTE CARE SERVICES 40.00 0.00 X 257469 0 8763 DAVID HERMAN VP, FINANCE 40.00 10.00 X 229862 0 6124 JOYCE A TAYLOR VP, QUALITY SERVICES, CQO 40.00 0.00 X 220692 0 4932 CYNTHIA J RACER VP, CLINICAL SERVICES 40.00 0.00 X 206283 0 4612 DINO DISANTO VP, MARKETING & GOVERNMENT AFFAIRS 40.00 0.00 X 217601 0 398 JERROLD PETERS VP, HUMAN RESOURCES 40.00 0.00 X 211630 0 4819 4118936 0 175506 163 0 1 0 COMMUNITY HOSPITALISTS LLC 30680 BAINBRIDGE ROAD SOLON OH 44139 HOSPITAL MEDICAL STAFFING COVERAGE AND M 6679695 CROTHALL HEALTHCARE INC 13028 COLLECTIONS CENTER DR CHICAGO IL 60693 HOUSEKEEPING SERVICES 3987690 SODEXO INC AND AFFILIATES PO BOX 360170 PITTSBURG PA 152516170 NUTRITION SERVICES OPERATIONS 3085102 PHILIPS MEDICAL CAPITAL LLC 1111 OLD EAGLE SCHOOL ROAD WAYNE PA 19087 HOSPITAL WIDE UPGRADE INSTALLATION SERVI 2198290 PHILIPS MEDICAL SYSTEMS 595 MINER RD CLEVELAND OH 44143 SERVICE AGREEMENTS: INSPECTIONS, MAINTEN 2145535 59 2291667 9176796 594126 1621703 12062589 PATIENT CARE 621110 346342471 346342471 346342471 6044594 6044594 4913 4913 2656397 0 2656397 2656397 412850 2243547 411390103 5776072 391397268 5776518 19992835 -446 19992389 19992389 SALES AND SERVICES 621110 10354353 8137458 2080090 136805 PURCHASE DISCOUNTS 621110 5626684 5626684 CMS INCENTIVE PAYMENTS 621110 4766531 4766531 3251637 4877212 -1625575 23999205 411102558 369750356 867365 28422248 X 153900 153900 5000 5000 3122205 3122205 127927577 114849441 13078136 962569 843576 118993 12471867 10930098 1541769 9206804 8068661 1138143 1952745 1562188 390557 855118 769606 85512 220750 220750 1330195 1330195 83765844 82061303 1704541 1263175 164668 1098507 1523130 1523130 10688735 158722 10530013 12302883 7440153 4862730 400928 267564 133364 114372 36682 77690 5330704 5246699 84005 21921553 14815699 7105854 527298 527298 MEDICAL SUPPLIES 64713644 64713644 BAD DEBT 32733411 32733411 HOSPITAL FRANCHISE FEE 6741152 6741152 MEMBERSHIP DUES 1234999 169742 1065257 401470558 354585234 46885324 0 1300677 13258149 38208399 38112459 5064514 6527097 23639830 21044664 502437115 306670726 205916588 195766389 253965238 275224064 16519042 92405384 94525948 620500630 660977812 40756799 53168378 783877 195490 211081787 206205555 116330863 153529522 368953326 413098945 X 251547304 247878867 251547304 247878867 620500630 660977812 X 9632000 -1403544 -11896893 X X 0 1 X 1 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 20023 20023 0 PART II-B, LINE 1: LINE 1I: MEMBERSHIP DUES PAID TO HOSPITAL INDUSTRY ASSOCIATIONS AND ORGANIZATIONS, THE PERCENTAGE OF WHICH IS REPORTED UNDER IRS RULES AS LOBBYING EXPENSE. X 1 1507.00 0 0 0 1 1 0.00 0 6503815 1793553 402960 73639 1440035 7186654 6272122 541913 606520 87443 829297 6503815 6834614 829389 -207803 26377 1157701 6272122 6265843 1432011 434510 30544 1267206 6834614 4930675 1469849 235080 5200 364561 6265843 0.00000 0.50200 0.49800 0 1 1 13668329 13668329 207436030 90002646 117433384 8392717 3491993 4900724 248632691 200317516 48315175 24307348 12858571 11448777 195766389 DEFERRED COMPENSATION 2922283 FINANCE RIGHT OF USE ASSETS NET 1448166 INVESTMENTS IN AFFILIATES 36691127 OPERATING RIGHT OF USE ASSETS 53464372 94525948 THIRD PARTY SETTLEMENTS 18954375 WORKERS COMPENSATION LIABILITY 1714114 DEFERRED COMPENSATION 5566688 LEASE OBLIGATION 54750606 ACCRUED SELF-INSURANCE 685961 MARKETING LIABILITY 10000 INTEREST RATE SWAP 52805965 PAYER ADVANCES 14729994 DEFERRED PAYROLL TAX 4311819 153529522 X PART V, LINE 4: LAKE HEALTH'S ENDOWMENT FUNDS WITH DONOR RESTRICTIONS ARE HELD BY THE LAKE HOSPITAL FOUNDATION, INC. DBA LAKE HEALTH FOUNDATION (THE "FOUNDATION"), A RELATED ORGANIZATION. THE FOUNDATION'S MISSION IS TO SECURE FINANCIAL AND NON-FINANCIAL SUPPORT FOR USE IN REALIZING LAKE HEALTH'S VISION OF PROVIDING HEALTH CARE FOR THE COMMUNITY. THE FOUNDATION'S SOLE MEMBER IS LAKE HEALTH. PART X, LINE 2: THE SYSTEM, THE FOUNDATION , AND LH PHYSICIAN GROUP ARE NOT-FOR-PROFIT CORPORATIONS, AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND ARE EXEMPT FROM FEDERAL INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE CODE. THE CAPTIVE IS AN EXEMPTED COMPANY UNDER THE LAWS OF THE CAYMAN ISLANDS AND OPERATES UNDER THE TERMS OF A CAYMAN ISLANDS CLASS "B(I)" INSURER'S LICENSE. ACCORDINGLY, NO PROVISION FOR INCOME TAXES HAS BEEN INCLUDED IN THE CONSOLIDATED FINANCIAL STATEMENTS FOR THESE ENTITIES. NEW MANNA IS A FOR-PROFIT LIMITED LIABILITY COMPANY. THE ENTITY IS TREATED AS A PARTNERSHIP FOR FEDERAL INCOME TAX PURPOSES. CONSEQUENTLY, FEDERAL INCOME TAXES ARE NOT PAYABLE OR PROVIDED FOR BY THE ENTITY. MEMBERS ARE TAXED INDIVIDUALLY ON THEIR PRO RATA OWNERSHIP SHARE OF THE ENTITY'S EARNINGS. THE ENTITY'S NET INCOME OR LOSS IS ALLOCATED AMONG THE MEMBERS IN ACCORDANCE WITH THE ENTITY'S OPERATING AGREEMENT. ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA REQUIRE MANAGEMENT TO EVALUATE TAX POSITIONS TAKEN BY THE SYSTEM AND RECOGNIZE A TAX LIABILITY IF THE SYSTEM HAS TAKEN AN UNCERTAIN POSITION THAT MORE LIKELY THAN NOT WOULD NOT BE SUSTAINED UPON EXAMINATION BY THE IRS OR OTHER APPLICABLE TAXING AUTHORITIES. CENTRAL AMERICA AND THE CARIBBEAN - ANTIGUA & BARBUDA, ARUBA, BAHAMAS, 0 0 PROGRAM SERVICES PROGRAM-RELATED INVESTMENTS 22472561 CENTRAL AMERICA AND THE CARIBBEAN - ANTIGUA & BARBUDA, ARUBA, BAHAMAS, 0 0 PROGRAM SERVICES MANAGEMENT FEES RELATED TO LHS ASSURANCE, LTD. 134220 0 0 0 0 0 0 22606781 0 22606781 0 0 1 0 0 0 PART III ACCOUNTING METHOD: 1 1 X 1 X 250.000000000000 1 X 1 1 0 1 1 1654060 148581 1505479 0.00410 62967977 36029182 26938795 0.07310 64622037 36177763 28444274 0.07720 203480 203480 0.00060 2568112 2449452 118660 0.00030 539130 539130 0.00150 3310722 2449452 861270 0.00240 67932759 38627215 29305544 0.07960 147873 147873 0.00040 147873 147873 0.00040 1 32733411 0 61347326 76602728 -15255402 X 1 1 1 MENTOR SURGERY CENTER LLC OUTPATIENT SURGICAL CENTER 0.42000 0.00000 0.58000 2 LAKE WEST MEDICAL SPECIALISTS MEDICAL OFFICE BUILDING 0.12000 0.00000 0.88000 3 CONCORD MEDICAL CAMPUS PHYSICIAN BUILDING LLC MEDICAL OFFICE BUILDING 0.51470 0.00000 0.48530 4 MENTOR MEDICAL CAMPUS PHYSICIAN BUILDING LLC MEDICAL OFFICE BUILDING 0.40390 0.00000 0.39610 5 LAKE PHO INC PHYSICIAN SERVICES 0.50000 0.00000 0.50000 6 LAKE WILLOUGHBY PROPERTIES LLC MEDICAL OFFICE BUILDING 0.35000 0.00000 0.65000 7 NEW MANNA CLG LLC MEDICAL OFFICE BUILDING 0.51000 0.00000 0.49000 2 1 WEST MEDICAL CENTER 36000 EUCLID AVENUE WILLOUGHBY OH 44094 WWW.LAKEHEALTH.ORG X X X 2 TRIPOINT MEDICAL CENTER 7590 AUBURN ROAD CONCORD OH 44077 WWW.LAKEHEALTH.ORG X X X WEST MEDICAL CENTER 1 0 0 1 X X X X X X X X X 19 1 1 0 1 X HTTPS://LAKEHEALTH.ORG/ABOUT/HEALTH-NEEDS-ASSESSMENT X 1 20 1 HTTPS://LAKEHEALTH.ORG/ABOUT/HEALTH-NEEDS-ASSESSMENT 0 1 X 250.000000000000 400.000000000000 X X X X X X 1 1 X X X X 1 X HTTPS://LAKEHEALTH.ORG/PATIENTS/FINANCIAL-INFORMATION/FINANCIAL-AID X HTTPS://LAKEHEALTH.ORG/PATIENTS/FINANCIAL-INFORMATION/FINANCIAL-AID X HTTPS://LAKEHEALTH.ORG/PATIENTS/FINANCIAL-INFORMATION X X X X X X 1 X 0 X X X X 1 X 0 0 TRIPOINT MEDICAL CENTER 2 0 0 1 X X X X X X X X X 19 1 1 0 1 X HTTPS://LAKEHEALTH.ORG/ABOUT/HEALTH-NEEDS-ASSESSMENT X 1 20 1 HTTPS://LAKEHEALTH.ORG/ABOUT/HEALTH-NEEDS-ASSESSMENT 0 1 X 250.000000000000 400.000000000000 X X X X X X 1 1 X X X X 1 X HTTPS://LAKEHEALTH.ORG/PATIENTS/FINANCIAL-INFORMATION/FINANCIAL-AID X HTTPS://LAKEHEALTH.ORG/PATIENTS/FINANCIAL-INFORMATION/FINANCIAL-AID X HTTPS://LAKEHEALTH.ORG/PATIENTS/FINANCIAL-INFORMATION X X X X X X 1 X 0 X X X X 1 X 0 0 WEST MEDICAL CENTER PART V, SECTION B, LINE 5: LAKE HEALTH IDENTIFIED COMMUNITY HEALTH NEEDS BY UNDERGOING A NEEDS ASSESSMENT PROCESS. THIS PROCESS INCORPORATED A COMPREHENSIVE REVIEW BY LAKE HEALTH'S SENIOR LEADERSHIP TEAM ALONG WITH SECONDARY AND PRIMARY DATA INPUT COMPILED USING THE EXPERTISE OF DIXON HUGHES GOODMAN, LLP ("DHG") AND ARTOWER ADVISORY SERVICES, LLC ("ARTOWER"). THE COLLECTIVE COMMUNITY HEALTH NEEDS ASSESSMENT ("CHNA")TEAM REVIEWED SEVERAL SOURCES OF QUANTITATIVE HEALTH, AS WELL AS SOCIAL AND DEMOGRAPHIC DATA SPECIFIC TO LAKE HEALTH'S SERVICE AREA. LAKE HEALTH ALSO TOOK ADVANTAGE OF THIS OPPORTUNITY TO COLLABORATE WITH ITS ADMINISTRATORS, PHYSICIANS, PUBLIC HEALTH AGENCIES, AND LOCAL ORGANIZATIONS IN IDENTIFYING AND ADDRESSING THE NEEDS OF THE COMMUNITY. TRIPOINT MEDICAL CENTER PART V, SECTION B, LINE 5: LAKE HEALTH IDENTIFIED COMMUNITY HEALTH NEEDS BY UNDERGOING A NEEDS ASSESSMENT PROCESS. THIS PROCESS INCORPORATED A COMPREHENSIVE REVIEW BY LAKE HEALTH'S SENIOR LEADERSHIP TEAM ALONG WITH SECONDARY AND PRIMARY DATA INPUT COMPILED USING THE EXPERTISE OF DIXON HUGHES GOODMAN, LLP ("DHG") AND ARTOWER ADVISORY SERVICES, LLC ("ARTOWER"). THE COLLECTIVE COMMUNITY HEALTH NEEDS ASSESSMENT ("CHNA")TEAM REVIEWED SEVERAL SOURCES OF QUANTITATIVE HEALTH, AS WELL AS SOCIAL AND DEMOGRAPHIC DATA SPECIFIC TO LAKE HEALTH'S SERVICE AREA. LAKE HEALTH ALSO TOOK ADVANTAGE OF THIS OPPORTUNITY TO COLLABORATE WITH ITS ADMINISTRATORS, PHYSICIANS, PUBLIC HEALTH AGENCIES, AND LOCAL ORGANIZATIONS IN IDENTIFYING AND ADDRESSING THE NEEDS OF THE COMMUNITY. WEST MEDICAL CENTER PART V, SECTION B, LINE 6A: AS ALLOWED BY IRS GUIDELINES, LAKE HEALTH DECIDED TO PRODUCE A JOINT CHNA REPORT FOR ITS TWO LAKE COUNTY HOSPITALS, WEST MEDICAL CENTER AND TRIPOINT MEDICAL CENTER. GUIDELINES STATE THAT COLLABORATING FACILITIES MUST DEFINE THEIR COMMUNITIES TO BE THE SAME AND CONDUCT A JOINT CHNA PROCESS. TRIPOINT MEDICAL CENTER PART V, SECTION B, LINE 6A: AS ALLOWED BY IRS GUIDELINES, LAKE HEALTH DECIDED TO PRODUCE A JOINT CHNA REPORT FOR ITS TWO LAKE COUNTY HOSPITALS, WEST MEDICAL CENTER AND TRIPOINT MEDICAL CENTER. GUIDELINES STATE THAT COLLABORATING FACILITIES MUST DEFINE THEIR COMMUNITIES TO BE THE SAME AND CONDUCT A JOINT CHNA PROCESS. WEST MEDICAL CENTER PART V, SECTION B, LINE 11: IN ACKNOWLEDGING THE WIDE RANGE OF PRIORITY HEALTH ISSUES THAT EMERGED FROM THE CHNA PROCESS, LAKE HEALTH WILL FOCUS ON THOSE MOST WITHIN ITS IMMEDIATE ABILITY TO INFLUENCE. TRIPOINT MEDICAL CENTER PART V, SECTION B, LINE 11: IN ACKNOWLEDGING THE WIDE RANGE OF PRIORITY HEALTH ISSUES THAT EMERGED FROM THE CHNA PROCESS, LAKE HEALTH WILL FOCUS ON THOSE MOST WITHIN ITS IMMEDIATE ABILITY TO INFLUENCE. WEST MEDICAL CENTER PART V, SECTION B, LINE 15E: THE CONTACT INFORMATION FOR SOURCES OF ASSISTANCE WITH FAP APPLICATIONS IS ON THE LAKE HEALTH WEBSITE BUT NOT CURRENTLY ON THE FAP OR FAP APPLICATION. TRIPOINT MEDICAL CENTER PART V, SECTION B, LINE 15E: THE CONTACT INFORMATION FOR SOURCES OF ASSISTANCE WITH FAP APPLICATIONS IS ON THE LAKE HEALTH WEBSITE BUT NOT CURRENTLY ON THE FAP OR FAP APPLICATION. PART V, SECTION B, LINE 22D UNINSURED PATIENTS WHO DO NOT QUALIFY FOR LAKE HEALTH'S FINANCIAL ASSISTANCE PROGRAM ARE BILLED FOR GROSS CHARGES AND ARE OFFERED A 30% PROMPT PAY DISCOUNT IF PAYMENT IS RECEIVED WITHIN 30 DAYS OF THE FIRST PATIENT STATEMENT OR A PAYMENT PLAN IS AGREED UPON. THEMAXIMUM AMOUNTS THAT CAN BE CHARGED TO FAP-ELIGIBLE INDIVIDUALS FOR EMERGENCY OR OTHER MEDICALLY NECESSARY CARE ARE THE AMOUNTS GENERALLY BILLED TO INDIVIDUALS WHO HAVE INSURANCE COVERING SUCH CARE. 53 1 - MENTOR MEDICAL CAMPUS 9485 MENTOR AVENUE SUITE 101 MENTOR OH 44060 GENERAL MEDICAL & SURGICAL OUTPATIENT 2 - MADISON MEDICAL CAMPUS 6270 NORTH RIDGE RD MADISON OH 44057 GENERAL MEDICAL & EMERGENCY DEPARTMENT 3 - LAKE COUNTY FAMILY PRACTICE 9500 MENTOR AVENUE SUITE 100 MENTOR OH 44060 PHYSICIAN OFFICE 4 - WILLOWICK URGENT CARE 29804 LAKESHORE BLVD WILLOWICK OH 44095 URGENT CARE CENTER 5 - LHPG OBGYN WOMEN'S HEALTH SPECIALISTS 4176 STATE ROUTE 306 WILLOUGHBY OH 44094 PHYSICIAN OFFICE 6 - WILLOUGHBY DIAGNOSTIC SERVICES 4176 STATE ROUTE 306 WILLOUGHBY OH 44094 DIAGNOSTIC CENTER 7 - LHPG MENTOR IMED 9485 MENTOR AVENUE SUITE 210 MENTOR OH 44060 PHYSICIAN OFFICE 8 - LHPG MENTOR PEDIATRICS 9485 MENTOR AVENUE SUITE 101 MENTOR OH 44060 PHYSICIAN OFFICE 9 - LHPG NORTH COAST FAMILY PRACTICE 7580 AUBURN RD SUITE 202 CONCORD OH 44077 PHYSICIAN OFFICE 10 - CHARDON URGENT CARE 510 FIFTH AVENUE CHARDON OH 44024 URGENT CARE CENTER 11 - LHPG MADISON FAMILY PRACTICE 6270 NORTH RIDGE RD MADISON OH 44057 PHYSICIAN OFFICE 12 - LHPG WILLOUGHBY IMED 36100 EUCLID AVENUE SUITE 240 WILLOUGHBY OH 44094 PHYSICIAN OFFICE 13 - LHPG WILLOUGHBY PEDIATRICS 36100 EUCLID AVENUE SUITE 300 WILLOUGHBY OH 44094 PHYSICIAN OFFICE 14 - LHPG IMED AT PERRICO 4176 STATE ROUTE 306 WILLOUGHBY OH 44094 PHYSICIAN OFFICE 15 - LHPG CHARDON FAMILY PRACTICE 510 FIFTH AVENUE SUITE 130 CHARDON OH 44024 PHYSICIAN OFFICE 16 - LHPG MENTOR FAMILY PRACTICE 8655 MARKET STREET MENTOR OH 44060 PHYSICIAN OFFICE 17 - LHPG MADISON PEDIATRICS 6270 NORTH RIDGE RD MADISON OH 44057 PHYSICIAN OFFICE 18 - LHPG MENTOR GENERAL SURGERY 9500 MENTOR AVENUE SUITE 300 MENTOR OH 44060 PHYSICIAN OFFICE 19 - LHPG WILLOWICK FAMILY PRACTICE 29804 LAKESHORE BLVD WILLOWICK OH 44095 PHYSICIAN OFFICE 20 - LHPG PLASTIC SURGERY 36060 EUCLID AVENUE SUITE 204 WILLOUGHBY OH 44094 PHYSICIAN OFFICE 21 - LHPG SOM GENERAL SURGERY 2105 SOM CENTER ROAD SUITE 107 WILLOUGHBY OH 44094 PHYSICIAN OFFICE 22 - LHPG CHARDON PEDIATRICS 510 FIFTH AVENUE CHARDON OH 44024 PHYSICIAN OFFICE 23 - LAKE WELLNESS AND REHABILITATION 5105 SOM CENTER ROAD WILLOUGHBY OH 44094 REHABILITATION CLINIC 24 - LHPG WEST CARDIO ELECTROPHYSIOLOGY 36100 EUCLID AVENUE SUITE 400 WILLOUGHBY OH 44094 PHYSICIAN OFFICE 25 - LHPG WEST IMED 36100 EUCLID AVENUE SUITE 210 WILLOUGHBY OH 44094 PHYSICIAN OFFICE 26 - LHPG ORTHOPEDIC SURGERY 36060 EUCLID AVENUE SUITE 203 WILLOUGHBY OH 44094 PHYSICIAN OFFICE 27 - LHPG MENTOR OBGYN 9485 MENTOR AVENUE SUITE 202 MENTOR OH 44060 PHYSICIAN OFFICE 28 - LHPG SPORTS MEDICINE & REHAB 36060 EUCLID AVENUE SUITE 105 WILLOUGHBY OH 44094 PHYSICIAN OFFICE 29 - LHPG INTEGRATIVE MEDICINE 8655 MARKET STREET MENTOR MENTOR OH 44060 PHYSICIAN OFFICE 30 - MENTOR MEDICAL PHYSICIAN BUILDING 9485 MENTOR AVENUE SUITES 200 203 MENTOR OH 44060 PHYSICIAN OFFICE 31 - LHPG OBGYN WILLOUGHBY 5105 SOM CENTER ROAD SUITE 201 WILLOUGHBY OH 44094 PHYSICIAN OFFICE 32 - CHARDON RADIOLOGY 510 FIFTH AVE SUITE 110 CHARDON OH 44024 PHYSICIAN OFFICE 33 - LHPG BARIATRIC SURGERY 36100 EUCLID AVENUE SUITE 170 WILLOUGHBY OH 44094 PHYSICIAN OFFICE 34 - LAKE AMBULATORY BLDG PHLEBOTOMIST 9500 MENTOR AVE SUITE 220 MENTOR OH 44060 DIAGNOSTIC CENTER 35 - LAKE WEST MEDICAL CENTER REFERENCE LAB 36100 EUCLID AVE SUITE 190 WILLOUGHBY OH 44094 DIAGNOSTIC CENTER 36 - LAKE WELLNESS & REHAB PT (WILLOUGHBY YMCA) 37100 EUCLID AVE WILLOUGHBY OH 44094 REHABILITATION CLINIC 37 - LHPG NORTHEAST OHIO HEART ASSOCIATES 36100 EUCLID AVENUE SUITE 120 WILLOUGHBY OH 44094 PHYSICIAN OFFICE 38 - LHPG SPORTS MEDICINE 8655 MARKET STREET MENTOR OH 44060 PHYSICIAN OFFICE 39 - BEACON HEALTH 36100 EUCLID AVENUE SUITE 120 WILLOUGHBY OH 44094 PHYSICIAN OFFICE 40 - OPHTHALMOLOGY ASSOCIATES 36100 EUCLID AVE SUITE 450 WILLOUGHBY OH 44094 PHYSICIAN OFFICE 41 - LHPG NORTHEAST OHIO HEART ASSOCIATES 7580 AUBURN ROAD SUITE 106 CONCORD OH 44077 PHYSICIAN OFFICE 42 - MENTOR MEDICAL PHYSICAL FITNESS CENTE 8655 MARKET STREET MENTOR MENTOR OH 44060 MEDICAL FITNESS CENTER 43 - PERRICO HEALTH CENTER 4176 STATE ROUTE 306 WILLOUGHBY OH 44060 PHYSICIAN OFFICE 44 - ARTHRITIS ASSOCIATES 5105 SOM CENTER ROAD SUITE 200 WILLOUGHBY OH 44094 PHYSICIAN OFFICE 45 - LHPG OHIO HAND AND SHOULDER CENTER 13170 RAVENNA ROAD CHARDON OH 44024 PHYSICIAN OFFICE 46 - CONCORD CONTINUING CARE CAMPUS 10977 CAPITAL PARKWAY CONCORD OH 44077 REHABILITATION AND PSYCHIATRIC DEPARTMENTS 47 - LHPG MIDDLEFIELD FAMILY PRACTICE 16030 EAST HIGH STREET MIDDLEFIELD OH 44062 PHYSICIAN OFFICE 48 - LHPG HACKETT MEDICAL GROUP 8300 TYLER BOULEVARD SUITE 300 MENTOR OH 44060 PHYSICIAN OFFICE 49 - AGM PHYSICAL THERAPY 6000 HEISLEY ROAD MENTOR OH 44060 REHABILITATION CLINIC 50 - WELLNESS CLINIC AT MHS 8655 MARKET STREET MENTOR MENTOR OH 44060 WALK IN CLINIC 51 - LHPG PAIN MANAGEMENT 5105 SOM CENTER ROAD SUITE 202 WILLOUGHBY OH 44094 PHYSICIAN OFFICE 52 - LHPG PAIN MANAGEMENT 9485 MENTOR AVE SUITE 103 MENTOR OH 44060 PHYSICIAN OFFICE 53 - LHPG MENTOR ENDOCRINOLOGY 8300 TYLER BOULEVARD SUITE 102 MENTOR OH 44060 PHYSICIAN OFFICE PART I, LINE 3C: THE FOLLOWING STEPS WILL BE FOLLOWED TO EVALUATE PATIENT'S REQUESTS FOR CONSIDERATION UNDER THE UNINSURED/UNCOMPENSATED CARE GUIDELINES: FINANCIAL INTERVIEW: A HOSPITAL REPRESENTATIVE WILL DISCUSS WITH PATIENTS THEIR INDIVIDUAL FINANCIAL POSITION AND OBTAIN FROM THEM INFORMATION REGARDING THEIR FINANCES. THIS INFORMATION WILL BE RECORDED ON THE HCAP APPLICATION. PATIENTS WILL BE REQUESTED TO SUPPLY COPIES OF THEIR TWO MOST RECENT PAY STUBS FOR ALL FAMILY MEMBERS EMPLOYED, COPIES OF THE PREVIOUS YEAR'S TAX RETURN AND ANY OTHER PERTINENT DOCUMENTATION SUPPORTING THEIR FINANCIAL POSITION. EVALUATION PROCESS: THE HOSPITAL REPRESENTATIVE WILL COMPLETE THE FINANCIAL INTERVIEW FORM. THE HOSPITAL REPRESENTATIVE WILL EVALUATE THE APPLICATION TO DETERMINE WHETHER THE PATIENT MAY BE ELIGIBLE FOR WELFARE OR MEDICAID COVERAGE. IF THIS COVERAGE IS AVAILABLE, THE REPRESENTATIVE WILL MAKE ARRANGEMENTS WITH THE PATIENT FOR COMPLETION OF THE MEDICAID ELIGIBILITY FORMS. IF WELFARE OR MEDICAID ELIGIBILITY IS NOT AVAILABLE, THE PATIENT WILL BE SENT AN APPLICATION AND WILL BE CONSIDERED FOR UNCOMPENSATED CARE. A COPY OF THE APPLICATION WILL BE FORWARDED TO THE PATIENT ACCOUNTING DEPARTMENT. DETERMINATION OF ELIGIBILITY: THE PATIENT ACCOUNTING DEPARTMENT WILL REVIEW THE APPLICATION AND THE PATIENT'S QUALIFICATION STATUS UNDER THE UNINSURED/UNCOMPENSATED CARE GUIDELINES. IF THE PATIENT QUALIFIES FOR UNINSURED/UNCOMPENSATED CARE AND SERVICES ARE PROVIDED, THEN THE ADJUSTMENT WILL BE RECORDED AS AN ADJUSTMENT FROM CHARGES FOR LAKE HOSPITAL'S UNINSURED/UNCOMPENSATED CHARITY CARE. PATIENTS NOT ELIGIBLE: PATIENTS WHO ARE DETERMINED NOT TO BE ELIGIBLE UNDER THE GUIDELINES WILL BE REQUESTED TO PAY A DEPOSIT EQUAL TO 50% OF THE ESTIMATED PATIENT RESPONSIBILITY FOR EITHER THE ELECTIVE INPATIENT OR OUTPATIENT SERVICES, AND TO MAKE ARRANGEMENTS FOR A PAYMENT PLAN TO SATISFY THE REMAINING BALANCE AFTER SERVICES ARE PROVIDED. ELIGIBILITY: EACH ADMISSION REPRESENTS A SEPARATE FINANCIAL ENCOUNTER AND WILL BE EVALUATED WITH NEW DATA TO DETERMINE IF A CHANGE HAS TAKEN PLACE. EACH OUTPATIENT APPLICATION WILL BE REVIEWED TO DETERMINE IF THERE HAS BEEN ANY CHANGE IN FINANCIAL STATUS. A NEW APPLICATION WILL BE REQUIRED EACH MONTH. PART I, LINE 7: A COST-TO-CHARGE RATIO IS USED. THIS RATIO TAKES THE TOTAL COSTS, INCLUDING ALLOCATED COSTS FROM OVERHEAD DEPARTMENTS, OF PROVIDING PATIENT CARE DIVIDED BY TOTAL GROSS REVENUE. PART I, LINE 7G: SUBSIDIZED HEALTH SERVICES INCLUDE VARIOUS FREE COMMUNITY SCREENING EVENTS FOR HEALTH CONDITIONS SUCH AS BLOOD PRESSURE, CHOLESTEROL, BONE DENSITY, PROSTATE CANCER, SKIN CANCER, HEART DISEASE AND OBESITY. PART I, LN 7 COL(F): AN ESTIMATED PROVISION FOR UNCOLLECTIBLE ACCOUNTS IS RECORDED THAT RESULTS IN NET PATIENT SERVICE REVENUE BEING REPORTED AT THE ESTIMATED AMOUNTS EXPECTED TO BE COLLECTED. PATIENT ACCOUNTS RECEIVABLE ARE REDUCED BY AN ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS. THE ESTIMATION OF THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS IS BASED PRIMARILY ON THE TYPE AND AGE OF THE PATIENT ACCOUNTS RECEIVABLE AND THE EFFECTIVENESS OF COLLECTION EFFORTS. THE POLICY IS TO RESERVE A PORTION OF ALL SELF-PAY RECEIVABLES, INCLUDING AMOUNTS DUE FROM THE UNINSURED AND AMOUNTS RELATED TO CO-PAYMENTS AND DEDUCTIBLES, AS THESE CHARGES ARE RECORDED. PATIENT ACCOUNTS RECEIVABLE BALANCES AND THE EFFECTIVENESS OF THE RESERVE POLICIES ARE REVIEWED ON A MONTHLY BASIS, AND VARIOUS ANALYTICS SUPPORT THE BASIS FOR THE ESTIMATES. ROUTINE HINDSIGHT PROCEDURES ARE PERFORMED TO EVALUATE HISTORICAL WRITE-OFF AND COLLECTION EXPERIENCE TO DETERMINE THE REASONABLENESS OF THE PROCESS FOR ESTIMATING THE ALLOWANCE FOR BAD DEBT. CHARITY CARE AND OTHER COMMUNITY BENEFITS AS A PERCENTAGE OF EXPENSE IS CALCULATED USING TOTAL EXPENSES FROM FORM 990, PART IX LESS BAD DEBT EXPENSE OF $32,733,411 FROM PART IX. PART II, COMMUNITY BUILDING ACTIVITIES: COMMUNITY BUILDING ACTIVITIESLAKE HEALTH PROVIDES SERVICES AND PROGRAMS BASED ON THE HEALTH CARE NEEDS OF THE COMMUNITIES IT SERVES. TAKING HEALTH EDUCATION PROGRAMS AND SCREENINGS TO WHERE PEOPLE LIVE, WORK AND PLAY IS FUNDAMENTAL TO THE LAKE HEALTH MISSION. THE COVID-19 CRISIS DEFINED 2020 FOR ALL HOSPITALS, WHICH RE-SHAPED HOW WE PROVIDED HEALTH EDUCATION PROGRAMS TO OUR COMMUNITIES. INSTEAD OF IN-PERSON PHYSICIAN LECTURES AND SCREENINGS, WE PROVIDED MORE INFORMATION DIGITALLY THROUGH WEBINARS, E-MAIL AND SOCIAL MEDIA ALONG WITH SENDING PRINT MATERIAL DIRECT TO THE HOME. IN 2020, LAKE HEALTH PROVIDED APPROXIMATELY $200,000 IN COMMUNITY BENEFIT THROUGH HEALTH EDUCATION, WHICH MOSTLY FOCUSED ON HOW TO PREVENT, TREAT AND SLOW THE SPREAD OF COVID-19 IN THE COMMUNITY AND HOW TO SEEK SAFE CARE DURING THE PANDEMIC. LAKE HEALTH ALSO CONTRIBUTED OVER $539,000 IN CASH AND IN-KIND DONATIONS TO CIVIC AND COMMUNITY PROGRAMS AND PARTNERSHIPS WITH A HEALTH AND WELLNESS FOCUS. COALITION BUILDING LAKE HEALTH IS COMMITTED TO BRINGING THE BEST RESOURCES TOGETHER TO PROVIDE AN EXPANDED LEVEL OF COMMUNITY CARE, WHICH IS WHY IT IS INVOLVED IN MANY COMMUNITY COALITIONS AND PARTNERSHIPS TO IMPROVE THE HEALTH OF INDIVIDUALS IN THE SERVICE AREA. SOME OF THESE INCLUDE PARTICIPATION IN THE LAKE COUNTY STRATEGIC PLAN, ACHIEVE (A COMMUNITY COALITION TO IMPROVE THE ENVIRONMENT IN LAKE COUNTY), AND UNITED WAY PROGRAMS DESIGNED TO IMPROVE HEALTH, PARTICULARLY IN VULNERABLE COMMUNITIES.UNEQUIVOCALLY, 2020 WAS A YEAR LIKE NO OTHER. FOR LAKE HEALTH, WE SUDDENLY FOUND OURSELVES ON THE FRONT LINES OF A GLOBAL BATTLE, NOT ONLY AGAINST COVID-19, BUT AGAINST UNCERTAINTY, FEAR AND SHORTAGES THAT THREATENED OUR ENTIRE STATE. WE KNEW EARLY ON THAT THE COVID-19 CRISIS WOULD DEMAND OUR UNWAVERING FOCUS AND ACTION. ONE OF OUR FIRST STEPS WAS TO FORM A MULTIDISCIPLINARY RESPONSE TEAM CONSISTING OF PHYSICIANS, NURSES, ADMINISTRATORS AND CLINICAL LEADERS. THIS TEAM MET MULTIPLE TIMES A DAY TO COORDINATE OUR RESPONSE, SHAPE BEST PRACTICES, MANAGE OUR RESOURCES AND GUIDE US THROUGH UNCERTAINTY. WE ALSO PARTICIPATED IN AD HOC COMMITTEES WITH OTHER HEALTH CARE SYSTEMS TO SHARE BEST PRACTICES ACROSS THE REGION. AS PART OF ITS MISSION, LAKE HEALTH HAS A LONG HISTORY OF PARTNERING WITH OTHERS IN THE COMMUNITY WHO SHARE OUR VALUES OF PROVIDING LOCAL ACCESS, HEALING WITH COMPASSION AND SUPERIOR QUALITY. THESE PARTNERSHIPS PROVED TO BE INVALUABLE DURING THIS CHALLENGING TIME. OUR PARTNERSHIP WITH THE LAKE COUNTY ALCOHOL, DRUG ADDICTION, AND MENTAL HEALTH SERVICES (ADAMHS) BOARD ALLOWED US TO PROVIDE IMMEDIATE SUPPORT TO OUR TEAM MEMBERS COPING WITH THE STRESS OF THE PANDEMIC, ALONG WITH LAKE HEALTH'S BEHAVIORAL HEALTH AND CRISIS INTERVENTION TEAM. A RAPID ASSESSMENT TEAM WAS QUICKLY DEPLOYED TO PROVIDE ASSISTANCE AND GUIDANCE TO NURSING HOMES IN LAKE COUNTY AND SURROUNDING COMMUNITIES. LAKE HEALTH COORDINATED WITH THE LAKE COUNTY GENERAL HEALTH DISTRICT, LAKE COUNTY COMMISSIONERS, LAKE COUNTY EMERGENCY MANAGEMENT AGENCY AND LOCAL FIRE DEPARTMENTS TO ADMINISTER VACCINES. PART III, LINE 2: BAD DEBT IS ESTIMATED USING A HINDSIGHT ANALYSIS ON PREVIOUS YEARS ACCOUNTS RECEIVABLE. THOSE PERCENTAGES ARE THEN APPLIED TO CURRENT YEAR ACCOUNTS RECEIVABLE BY PAYOR TO ESTIMATE THE AMOUNT OF UNCOLLECTIBLE. ANYTHING OVER 365 DAYS IS FULLY RESERVED. PART III, LINE 4: PAGE 13 OF ATTACHED AUDITED FINANCIAL STATEMENTS, NOTE 2 - SIGNIFICANT ACCOUNTING POLICIES, NET PATIENT SERVICE REVENUE ON THE BASIS OF HISTORICAL EXPERIENCE, A SIGNIFICANT PORTION OF THE SYSTEM'S UNINSURED PATIENTS WILL BE UNABLE OR UNWILLING TO PAY FOR THE SERVICES PROVIDED. THUS, THE SYSTEM RECORDS A SIGNIFICANT PROVISION FOR BAD DEBTS RELATED TO UNINSURED PATIENTS IN THE PERIOD THE SERVICES ARE PROVIDED. PART III, LINE 8: BASED ON A COST TO CHARGE RATIO DETERMINED IN ACCORDANCE WITH MEDICARE COST REPORT REQUIREMENTS, THE COSTS OF PROVIDING CARE TO THE MEDICARE POPULATION IN 2020 WAS $61,347,326 THE PAYMENTS RELATED TO THESE SERVICES WERE $76,602,728 LEAVING A MEDICARE SHORTFALL OF $15,255,402 FOR THE YEAR. PART III, LINE 9B: PROVISIONS ON COLLECTION PRACTICES FOR QUALIFIED PATIENTS: PATIENTS WHO DO NOT HAVE THE MEANS TO PAY FOR SERVICES PROVIDED AT LAKE HOSPITAL SYSTEM REQUEST TO BE CONSIDERED UNDER THE UNINSURED/UNCOMPENSATED CHARITY CARE GUIDELINES. THESE GUIDELINES DEFINE LAKE HOSPITAL SYSTEM'S COMMITMENT TO PROVIDING CARE TO PATIENTS WHO ARE IN THE GREATEST FINANCIAL NEED. PATIENTS WHO DO NOT HAVE INSURANCE COVERAGE, OR WHOSE OUT OF POCKET RESPONSIBILITY IS SUBSTANTIAL AFTER INSURANCE COVERAGE, OR WHOSE INCOME LEVEL IS AT OR BELOW 250% OF THE FEDERAL INCOME POVERTY GUIDELINES, ARE ELIGIBLE TO APPLY FOR UNINSURED CHARITY CARE ASSISTANCE.THE UNINSURED/UNCOMPENSATED CHARITY CARE PROGRAM DOES NOT RELIEVE NOR FORGIVE POINT-OF-SERVICE COPAYMENTS THAT THE PATIENT MAY BE REQUIRED TO PAY UNDER THE TERMS OF THEIR INSURANCE BENEFIT PLAN. PER VISIT COPAYMENTS WILL BE COLLECTED AT THE POINT OF SERVICE IN COMPLIANCE WITH THE INSURANCE BENEFIT TERMS.PROCEDURE ELIGIBILITY FOR LAKE'S UNINSURED/UNCOMPENSATED CARE IS DETERMINED BY THE FOLLOWING TWO-PART TEST. THE LAKE HOSPITAL SYSTEMS UNINSURED/UNCOMPENSATED CARE PROGRAM REQUIRES PATIENTS TO MEET AT LEAST ONE CONDITION IN BOTH PART ONE AND PART TWO:PART ONE: INSURANCE TEST 1. PATIENT DOES NOT HAVE GOVERNMENTAL OR PRIVATE INSURANCE COVERAGE; OR2. PATIENT'S INSURANCE DOES NOT COVER THE MEDICALLY NECESSARY SERVICE; OR3. PATIENT'S INSURANCE BENEFITS ARE EXHAUSTED (I.E. LIFETIME RESERVE DAYS, MEDICARE); OR4. PATIENT HAS OR WILL OBTAIN MEDICALLY NECESSARY SERVICES FROM THE HOSPITAL FOR WHICH THEY DO NOT HAVE THE FINANCIAL MEANS TO PAY; OR5. PATIENT IS RESPONSIBLE FOR CO-PAYMENTS AND DEDUCTIBLES, CARRIES NO SECONDARY INSURANCE COVERAGE AND ONLY SOURCE OF INCOME IS SOCIAL SECURITY.PART TWO: INCOME TEST (RELATIVE TO LAKE HOSPITAL CHARGES)1. FAMILY INCOME IS COMPARED TO THE FEDERAL POVERTY INCOME GUIDELINES (FAMILY INCLUDES PATIENT, PATIENT'S SPOUSE, AND ALL OF THE PATIENT'S CHILDREN, NATURAL OR ADOPTIVE, UNDER THE AGE OF EIGHTEEN WHO LIVE IN THE HOME). THE SCHEDULE SHOWN BELOW WILL BE USED TO COMPARE FAMILY INCOME TO A SLIDING SCALE BASED UPON THE FEDERAL POVERTY INCOME GUIDELINES. IFFAMILY INCOME IS AT OR BELOW THE DESIGNATED THRESHOLD, THE PATIENT IS ELIGIBLE FOR THE PERCENT CHARITY DISCOUNT ASSOCIATED WITH THAT LEVEL OF INCOME; OR2. THE RELATIONSHIP BETWEEN THE PATIENT'S MEDICAL BILLS, FAMILY INCOME AND FAMILY ASSETS (INCLUDING, BUT NOT LIMITED TO SUCH ITEMS AS BANK ACCOUNTS, TRUSTS, PROPERTY, HOME EQUITY, ESTATE OR INVESTMENTS) INDICATES THAT THE PURSUIT OF PAYMENT WOULD ADVERSELY AFFECT THE WELL BEING OF THE PATIENT AND FAMILY MEMBERS, AND WHERE THE PAYMENT OF LAKE HOSPITAL'S BILL WOULD RESULT IN UNDUE HARDSHIP; OR3. PATIENT'S FAMILY INCOME EXCEEDS 250% OF THE FEDERAL INCOME POVERTY GUIDELINES, HOWEVER PATIENT HAS SUPPLIED INFORMATION TO SUPPORT EXCEPTIONAL LIVING CIRCUMSTANCES (I.E. TERMINAL ILLNESS, EXCESSIVE MEDICAL BILLS AND/OR MEDICATIONS, ETC.) OR 100% OF INCURRED CHARGES GREATER THAN 25% OF ANNUAL FAMILY INCOME (INCLUDING BANK ACCOUNTS, TRUSTS AND INVESTMENTS, BUT EXCLUDING PRIMARY RESIDENCE). BEFORE UNINSURED/UNCOMPENSATED CARE CAN BE AWARDED, THE FOLLOWING CONDITIONS MUST BE MET:1. IF LAKE HOSPITAL DETERMINES THAT THE PATIENT IS POTENTIALLY ELIGIBLE FOR MEDICAL ASSISTANCE, THE PATIENT MUST COOPERATE WITH LAKE HOSPITAL'S EFFORTS TO ESTABLISH ELIGIBILITY FOR GOVERNMENT ASSISTANCE PROGRAMS.2. IF LAKE HOSPITAL AWARDS UNINSURED/UNCOMPENSATED CARE, IT WILL ONLY COVER THE SERVICES PROVIDED UNDER THE ACCOUNT NUMBER(S) SHOWN ON THE ACCOMPANYING APPLICATION.3. PROOF OF INCOME AND FINANCIAL DOCUMENTATION WILL BE REQUESTED. (SEE HOSPITAL CARE ASSURANCE POLICY.) PART VI, LINE 2: AS AN INDEPENDENT, COMMUNITY-BASED HOSPITAL SYSTEM, LAKE HEALTH HAS HAD A LONG-STANDING TRADITION OF PROVIDING SERVICES AND PROGRAMS BASED ON THE HEALTH CARE NEEDS OF THE COMMUNITIES WE SERVE. WE ARE GUIDED BY OUR MISSION TO PROVIDE LOCAL ACCESS, HEALING WITH COMPASSION AND SUPERIOR QUALITY, AND OUR CORE VALUES - RESPECT, INNOVATION, TEAMWORK, STEWARDSHIP AND INTEGRITY. THE SYSTEM HAS MADE SIGNIFICANT STRATEGIC ADVANCEMENTS IN SERVING THE RESIDENTS OF LAKE COUNTY AND SURROUNDING COMMUNITIES, RANGING FROM A CLINICAL INTEGRATION INITIATIVE TO INVESTMENTS IN NEW FACILITIES AND PROVIDER-CENTERED TECHNOLOGIES. RATHER THAN FOCUSING ON EPISODES OF CARE, THE SYSTEM AND ITS PHYSICIAN PARTNERS PROVIDE A LIFETIME OF HEALTH AND WELLNESS, EMBRACING A PHILOSOPHY OF PATIENT AND FAMILY-CENTERED CARE. THE SYSTEM AND ITS PHYSICIAN PARTNERS CONTINUE TO MOVE FORWARD IN FURTHER DEVELOPING A STRATEGIC PLAN THAT INCLUDES A FOCUS ON VALUE-BASED PURCHASING AND EVOLVING CARE MODELS.GUIDED BY A COLLABORATIVE HEALTH NEEDS ASSESSMENT CONDUCTED IN COOPERATION WITH THE LAKE COUNTY GENERAL HEALTH DISTRICT, LAKE HEALTH HAS DEVELOPED PROGRAMS, SERVICES AND PARTNERSHIPS TO ADDRESS THE MOST PRESSING HEALTH ISSUES IN OUR SERVICE AREAS AND THE SURROUNDING COMMUNITIES. THE HIGH PRIORITY AREAS INCLUDE ACCESS TO CARE, ALCOHOL ABUSE, DIABETES, DRUG OVERDOSE DEATHS, HEART DISEASE, HIGH BLOOD PRESSURE, LIMITED ACCESS TO HEALTHY FOODS, MENTAL HEALTH AND OBESITY. OUR GROWTH AS A HEALTH SYSTEM REFLECTS THE MANY WAYS WE ARE BUILDING ON OUR MISSION AND HOW WE ASPIRE TO BE MORE THAN YOUR TYPICAL COMMUNITY HOSPITAL. WE WANT OUR PATIENTS AND THEIR FAMILIES TO RECEIVE SUPERIOR CARE WITHOUT HAVING TO LEAVE THE COMMUNITY. LAKE HEALTH AND ITS PARTNERS ARE COMMITTED TO OFFERING THE BEST RESOURCES TO PROVIDE AN EXPANDED LEVEL OF CARE TO MEET THE NEEDS OF THE COMMUNITY. PART VI, LINE 3: 1. SIGNAGE POSTED AT FACILITY ACCESS POINTS FOR PATIENTS WHO CANNOT AFFORD TO PAY FOR MEDICAL CARE.2. CHARITY/HCAP APPLICATION FORMS GIVEN TO SELF-PAY PATIENTS AT TIME OF REGISTRATION. EXPLANATION OF ASSISTANCE PROVIDED TO COMPLETE APPLICATION IF NEEDED.3. UNINSURED INPATIENTS ARE VISITED BEDSIDE TO ASSIST WITH THE COMPLETION OF THE CHARITY/HCAP APPLICATION AND TO PROVIDE APPLICATION ASSISTANCE WITH OTHER PROGRAMS SUCH AS MEDICAID, FOOD STAMPS, ETC.4. UNINSURED PATIENTS WHO RECEIVE OUTPATIENT SERVICES ARE CONTACTED BY PHONE TO ASSIST WITH THE CHARITY/HCAP APPLICATION AND OTHER PROGRAMS LISTED ABOVE.5. CHARITY/HCAP APPLICATION APPEARS ON THE BACK OF ALL PATIENT STATEMENTS.6. CHARITY/HCAP APPLICATION APPEARS ON LAKE HEALTH WEBSITE. PART VI, LINE 4: LAKE HEALTH'S PRIMARY SERVICE AREA IS LAKE COUNTY (POPULATION ABOUT 232,600) AND SELECTED ZIP CODES IN ITS SECONDARY SERVICE AREAS (CUYAHOGA, ASHTABULA AND GEAUGA COUNTIES WITH A POPULATION IN THE DEFINED ZIP CODES) OF 125,000. (POPULATION FIGURES ARE AS OF 2020.) PART VI, LINE 5: PRIOR TO 1985, LAKE HEALTH'S FACILITIES WERE PUBLICLY OPERATED AS LAKE COUNTY MEMORIAL HOSPITALS. HOWEVER, IN 1985 THE BOARD OF COUNTY COMMISSIONERS AND HOSPITAL TRUSTEES AGREED TO PRIVATIZE THE HOSPITAL TO ENSURE THE VIABILITY OF A TECHNOLOGICALLY PROGRESSIVE HOSPITAL SYSTEM FOR LAKE COUNTY RESIDENTS. COUNTY COMMISSIONERS SERVE AS MEMBERS OF THE LAKE HOSPITAL CORPORATION AND, AS SUCH, APPOINT THE COMMUNITY LEADERS WHO SERVE ON THE SYSTEM'S GOVERNING BOARD.LAKE HEALTH HAS AN OPEN MEDICAL STAFF WITH PRIVILEGES AVAILABLE TO ALL QUALIFIED PHYSICIANS IN THE AREA. OVER 725 PHYSICIANS/ADVANCE PRACTICE PROVIDERS COMPRISE LAKE HEALTH'S MEDICAL STAFF.LAKE HEALTH'S COMMITMENT TO THE COMMUNITY IS READILY APPARENT IN THE BOARD OF TRUSTEES, WHICH IS COMPRISED SOLELY OF COMMUNITY MEMBERS, APPOINTED BY THE COUNTY COMMISSIONERS. ALL PROCEEDS ARE REINVESTED IN CAPITAL OR OTHER PROGRAMS AND SERVICES DESIGNED TO MEET THE COMMUNITIES WE SERVE.LAKE HEALTH PROVIDES SERVICES AND PROGRAMS BASED ON THE HEALTH CARE NEEDS OF THE COMMUNITIES WE SERVE. IN FACT, TAKING HEALTH PROGRAMS AND SCREENINGS TO WHERE PEOPLE LIVE, WORK AND PLAY IS FUNDAMENTAL TO OUR MISSION. THE COVID-19 CRISIS DEFINED 2020 FOR ALL HOSPITALS, WHICH RE-SHAPED HOW WE PROVIDED HEALTH EDUCATION PROGRAMS TO OUR COMMUNITIES. INSTEAD OF IN-PERSON PHYSICIAN LECTURES AND SCREENINGS, WE PROVIDED MORE INFORMATION DIGITALLY THROUGH WEBINARS, EMAIL AND SOCIAL MEDIA ALONG WITH SENDING PRINT MATERIAL DIRECT TO THE HOME. IN 2020, WE PROVIDED APPROXIMATELY $200,000 IN COMMUNITY BENEFIT THROUGH HEALTH EDUCATION PROGRAMS, EXCLUDING BLOOD DRIVES, WHICH MOSTLY FOCUSED ON HOW TO PREVENT, TREAT AND SLOW THE SPREAD OF COVID-19 IN THE COMMUNITY AND HOW TO SEEK SAFE CARE DURING THE PANDEMIC. LAKE HEALTH'S COMMITMENT TO HEALTH IMPROVEMENT SERVICES THAT PROVIDE A DEMONSTRATED COMMUNITY BENEFIT CAN BE BROADLY CATEGORIZED INTO THREE AREAS: COMMUNITY HEALTH EDUCATION, COMMUNITY-BASED CLINICAL SERVICES, AND CASH AND IN-KIND GIFTS. SOME OF THE PROGRAMS AND EVENTS ARE HIGHLIGHTED BELOW.COMMUNITY HEALTH EDUCATIONLAKE HEALTH HAS AN EXTENSIVE COMMUNITY HEALTH PROGRAM THAT PROVIDES HEALTH SCREENINGS, PHYSICIAN LECTURES, SELF-HELP AND EXERCISE PROGRAMS IN MULTIPLE COMMUNITY LOCATIONS THROUGHOUT LAKE COUNTY AND SURROUNDING AREAS. OUR SUPPORT GROUPS HELP MEET EDUCATIONAL AND EMOTIONAL NEEDS RELATED TO A VARIETY OF CONDITIONS. WE ALSO PARTNER WITH MANY LOCAL ORGANIZATIONS, INCLUDING THE UNITED WAY, THE AMERICAN RED CROSS, THE AMERICAN HEART ASSOCIATION, THE ARTHRITIS FOUNDATION, THE ALZHEIMER'S ASSOCIATION, THE LAKE COUNTY YMCA, LAKE COUNTY GENERAL HEALTH DISTRICT AND THE LAKE METROPARKS TO INCREASE AWARENESS OF HEALTH ISSUES IN THE COMMUNITY. THESE PROGRAMS AND SERVICES INCLUDE:A. COMMUNITY CALENDARS AND NEWSLETTERS MONTHLY E-NEWSLETTER REGARDING IMPORTANT HEALTH ISSUES AND UPCOMING HEALTH AND WELLNESS EVENTS, EMAILED TO APPROXIMATELY 55,000 PEOPLE IN OUR PRIMARY AND SECONDARY SERVICE AREASB. EDUCATION ON SPECIFIC DISEASE CONDITIONS ARTHRITIS EXPO (VIRTUAL) STRESS MANAGEMENT BREAST HEALTH FOR HISPANIC WOMEN NUTRITION AND FITNESS EDUCATION SERIES INFANT AND CHILDBIRTH PROGRAMS COVID-19C. HEALTH PROMOTION AND WELLNESS PROGRAMS COOKING FOR WELLNESS SERIES INTEGRATIVE HEALTH & WELLNESS SERIES TRADITIONAL CHINESE MEDICINE SERIES MALL WALKING PROGRAM LIVEHEALTHY MUSIC THERAPYE. EDUCATION TO THE PUBLIC ABOUT HEALTH ISSUES INFORMATION THROUGH MEDIA RELEASES WEBSITE SOCIAL MEDIA (FACEBOOK, TWITTER, GOOGLE+) DIRECT MAIL DIGITAL (SEARCH AND DISPLAY) E-NEWSLETTERS AND E-BLASTS VIDEOF. SCHOOL HEALTH EDUCATION PROGRAMS PROBLEM-BASED LEARNING IN ELEMENTARY SCHOOLS 68 HOURS OF HUNGER SUPPORT SPORTS MEDICINE TRAINERSG. DIGITAL CONSUMER HEALTH INFORMATION MONTHLY E-NEWSLETTER E-BLASTS SOCIAL MEDIA (FACEBOOK, TWITTER, GOOGLE+) WEBSITE VIDEOS SEARCH AND DISPLAYH. SOCIAL MEDIA CONSUMER HEALTH INFORMATION FACEBOOK POSTS AND REMINDERS TWITTER POSTS AND REMINDERS GOOGLE+ VIDEOSI. SELF-HELP GRATITUDE PROJECT PART VI, LINE 6: LAKE HOSPITAL SYSTEM, INC. DBA LAKE HEALTH IS THE PRIMARY HEALTHCARE-PROVIDING ENTITY WHICH OPERATES TWO HOSPITAL FACILITIES, A FREE-STANDING EMERGENCY DEPARTMENT, AND SEVERAL OTHER OUTPATIENT, URGENT CARE AND PHYSICIAN CLINICS THROUGHOUT LAKE COUNTY AND THE SURROUNDING COMMUNITY. LAKE HEALTH IS THE SOLE MEMBER OF LAKE HEALTH FOUNDATION, INC. DBA LAKE HEALTH FOUNDATION, A NOT-FOR-PROFIT ORGANIZATION WHICH IS THE FUNDRAISING ARM OF LAKE HEALTH. LAKE HEALTH IS ALSO THE SOLE MEMBER OF PRIMEHEALTH, INC. DBA LAKE HEALTH PHYSICIAN GROUP ("LHPG") WHICH EMPLOYS LAKE HEALTH'S NETWORK OF PHYSICIANS. LAKE HEALTH IS A 50% SHAREHOLDER IN LAKE PHO, INC. DBA LAKE HEALTH PHO ("THE PHO") WHICH IS A PHYSICIAN CREDENTIALING AND MEMBERSHIP ORGANIZATION. PHYSICIANS MUST BE A MEMBER OF THE PHO IN ORDER TO PRACTICE MEDICINE AT A LAKE HEALTH HOSPITAL OR PHYSICIAN CLINIC. THE LAKE HEALTH / UNIVERSITY HOSPITALS SEIDMAN CANCER CENTER IS A JOINT VENTURE BETWEEN LAKE HEALTH AND UNIVERSITY HOSPITALS HEALTH SYSTEM OF CLEVELAND THAT PROVIDES CANCER TREATMENT IN MENTOR, OHIO.MENTOR SURGERY CENTER, LLC, MENTOR MEDICAL CAMPUS PHYSICIAN BUILDING, LLC, LAKE WEST MEDICAL SPECIALISTS, INC., AND CONCORD MEDICAL CAMPUS PHYSICIANS BUILDING, INC. ARE ENTITIES IN WHICH LAKE HEALTH OWNS A MINORITY STAKE. THESE ENTITIES LEASE MEDICAL OFFICE SPACE AT WHICH BOTH LAKE HEALTH AND NON-AFFILIATED PRACTITIONERS PRACTICE. 1 SIGNATURE HEALTH INC 24200 CHAGRIN BLVD BEACHWOOD OH 44122 341751703 153900 COMMUNITY OPIOID CARE FACILITY PROJECT 1 COLLEGE TUITION GRANTS TO MARKETING CONTEST WINNERS 1 5000 PART I, LINE 2: IN COOPERATION WITH LAKELAND COMMUNITY COLLEGE AND LAKE ERIE COLLEGE, TUITION GRANTS WERE AWARDED TO THE FIRST BABY BORN AT EACH LOCATION OF LAKE HEALTH IN THE NEWLY RENOVATED LABOR AND DELIVERY WINGS. THE GRANTS ARE MONITORED THROUGH SUBMISSION OF INFORMATION SUPPORTING THE RELEASE OF FUNDS OVER A FOUR YEAR PERIOD DIRECTLY TO AN INSTITUTION OF HIGHER LEARNING FOR BENEFIT OF THE WINNERS. TUITION REIMBURSEMENT PROGRAMS FOR EMPLOYEES ARE AVAILABLE THROUGH SUBMISSION OF AN APPLICATION TO HUMAN RESOURCES, REVIEWED BY A COMMITTEE FOR APPLICABILITY TO THE CRITERIA, FOR BENEFITS OF THE COMMUNITY AND LAKE HEALTH. X 1 1 X X X X X 0 1 0 0 0 0 0 1 0 CYNTHIA MOORE-HARDY PRESIDENT AND CEO 917681 0 60638 0 55260 0 87209 0 9922 0 1130710 0 0 0 JOHN BANIEWICZ MD SR VP, MEDICAL AFFAIRS 472647 0 44200 0 25256 0 6231 0 6918 0 555252 0 0 0 ROBERT TRACZ SR. VP/CFO 480643 0 34250 0 19860 0 6469 0 6673 0 547895 0 0 0 RICHARD D CICERO SR VP, MARKETING & BUSINESS 316447 0 23400 0 20423 0 5498 0 5075 0 370843 0 0 0 ADETINUKE TADESE CHIEF MEDICAL INFORMATICS OFFICER 293283 0 9300 0 2111 0 0 0 11863 0 316557 0 0 0 BILL OSTERMAN VP, ACUTE CARE SERVICES 238399 0 11500 0 7570 0 0 0 8763 0 266232 0 0 0 DAVID HERMAN VP, FINANCE 212890 0 11150 0 5822 0 0 0 6124 0 235986 0 0 0 JOYCE A TAYLOR VP, QUALITY SERVICES, CQO 201932 0 8400 0 10360 0 0 0 4932 0 225624 0 0 0 DINO DISANTO VP, MARKETING & GOVERNMENT AFFAIRS 203359 0 7350 0 6892 0 0 0 398 0 217999 0 0 0 JERROLD PETERS VP, HUMAN RESOURCES 193585 0 9000 0 9045 0 0 0 4819 0 216449 0 0 0 CYNTHIA J RACER VP, CLINICAL SERVICES 189124 0 7600 0 9559 0 0 0 4612 0 210895 0 0 0 PART I, LINE 1A CYNTHIA MOORE-HARDY, RECEIVED THE FOLLOWING TAXABLE BENEFIT IN 2020: SOCIAL CLUB DUES OF $12,230 PART I, LINE 4B THE FOLLOWING INDIVIDUALS PARTICIPATED IN A 457(F) NON-QUALIFIED DEFERRED COMPENSATION ARRANGEMENT : CYNTHIA MOORE-HARDY : $80,850 PART I, LINE 7 DISCRETIONARY BONUS MAY BE AWARDED BASED ON PERFORMANCE. THOSE BONUSES ARE DETERMINED BY THE STRATEGIC LEADERSHIP TEAM. THE FOLLOWING INDIVDUALS RECEIVED THESE BONUSES: - CYNTHIA MOORE-HARDY: $60,638 RETENTION BONUS - ROBERT TRACZ: $34,250 RETENTION BONUS - JOHN BANIEWICZ MD: $44,200 RETENTION BONUS - RICHARD CICERO: $23,400 RETENTION BONUS - ADETINUKE TADESE: $9,300 RETENTION BONUS - WILLIAM OSTERMAN: $11,500 RETENTION BONUS - DAVID HERMAN: $11,150 RETENTION BONUS - JOYCE TAYLOR: 8,400 RETENTION BONUS - CYNTHIA RACER: $7,600 RETENTION BONUS - DINO DISANTO: $7,350 RETENTION BONUS A COUNTY OF LAKE OHIO SERIES 2008 346001618 50943PBL2 2008-06-26 187820719 SEE PART VI 1 0 0 B COUNTY OF LAKE OHIO SERIES 2015 346001618 50943PCC1 2015-08-03 69960181 SEE PART VI 0 0 0 C COUNTY OF LAKE OHIO SERIES 2017 346001618 2017-12-19 138445000 SEE PART VI 0 0 0 A 132215000 60245000 193519247 888050 1808396 57940 190764861 2009 1 0 1 1 B 4655000 70003111 268650 19190260 50544201 2016 0 1 1 1 C 4670000 138445000 138445000 2017 1 0 1 1 A 0 0 1 1 0 0.00000 0.00000 0.00000 0 0 1 B 0 0 1 1 0 0.00000 0.00000 0.00000 0 0 1 C 0 0 1 1 0 0.00000 0.00000 0.00000 0 0 1 A 0 0 0 1 0 0 0 0 1 B 0 0 0 1 0 0 0 0 1 C 0 1 0 0 1 1 0 0 0 0 1 A 1 B 1 C 1 DATE REBATE COMPUTATION PERFORMED ISSUER NAME: COUNTY OF LAKE, OHIO SERIES 2008 DATE THE REBATE COMPUTATION WAS PERFORMED: 06/26/2018 ISSUER NAME: COUNTY OF LAKE, OHIO SERIES 2015 DATE THE REBATE COMPUTATION WAS PERFORMED: 08/01/2020 SCHEDULE K, PART I, BOND ISSUES: (A) ISSUER NAME: COUNTY OF LAKE, OHIO SERIES 2008 (B) ISSUER NAME: COUNTY OF LAKE, OHIO SERIES 2015 (C) ISSUER NAME: COUNTY OF LAKE, OHIO SERIES 2017 SCHEDULE K, PART I, LINE A, COLUMN (F) DESCRIPTION OF PURPOSE: CONSTRUCT A HOSPITAL; REFUNDING OF SERIES 2004 (ISSUED ON 08/15/2004) AND SERIES 2007 (ISSUED ON 08/15/2007). LINE B, COLUMN (F) DESCRIPTION OF PURPOSE: CONSTRUCTION, REMODELING, IMPROVEMENT, AND EQUIPPING OF HOSPITAL FACILITIES; PARTIAL REFUNDING OF SERIES 2008C (ISSUED ON 08/15/2008). LINE C, COLUMN (F) DESCRIPTION OF PURPOSE: REFUNDING OF SERIES 2012A (ISSUED ON 06/15/2012) AND SERIES 2012C (ISSUED ON 06/15/2012), REISSUANCE FOR FEDERAL INCOME TAX PURPOSES OF SERIES 2012B (ISSUED ON 06/05/2012). SCHEDULE K, PART I, COLUMN (E) & SCHEDULE K, PART, II, LINE 3: THE DIFFERENCE BETWEEN ISSUE PRICE IN PART I, COLUMN (E) AND THE TOTAL PROCEEDS OF ISSUE IN PART II, LINE 3 IS INVESTMENT INCOME EARNED ON BOND FUNDS BEFORE THE BOND PROCEEDS WERE EXPENDED. SCHEDULE K, PART IV, COLUMN C, LINES 4B AND 4C: SERIES 2017 PROVIDER KEYBANK, NATIONAL ASSOCIATION, TERM 20.48 YEARS; SERIES 2017 PROVIDER PNC BANK, TERM 28.81 YEARS; AND SERIES 2017 PROVIDER PNC BANK, TERM 29.15 YEARS. SCHEDULE K, PART II, COLUMN A, LINE 6: PROCEEDS IN REFUNDING ESCROWS PROCEEDS IN REFUNDING ESCROWS - A PORTION OF THE AMOUNT SHOWN CONSISTS OF REPLACEMENT PROCEEDS OF THE 2008 BONDS SCHEDULE K, PART II, COLUMN A, LINE 11: THESE BOND PROCEEDS WERE USED TO CURRENT REFUND PRIOR DEBT, AS NOTED IN THE NOTES FOR PART I. SCHEDULE K, PART II, COLUMN B, LINE 10: CAPITAL EXPENDITURES FROM PROCEEDS LINE INCLUDES $24,000 OF INTEREST ON THE 2015 BONDS AND INVESTMENT SCHEDULE K, PART II, COLUMN B, LINE 11: OTHER SPENT PROCEEDS - THESE BOND PROCEEDS WERE USED TO CURRENT REFUND PRIOR DEBT, AS NOTED IN THENOTES FOR PART I, AND INCLUDES INVESTMENT EARNINGS IN THE AMOUNT OF $1,185 SCHEDULE K, PART II, COLUMN C, LINE 11: OTHER SPENT PROCEEDS - THESE BOND PROCEEDS WERE USED TO CURRENT REFUND PRIOR DEBT, AS NOTED IN THE NOTES FOR PART I. IN ADDITION, THE SERIES 2012B BONDS WERE REISSUED FOR FEDERAL INCOME TAX PURPOSES ON THE DATE OF ISSUE OF THE SERIES 2017 BONDS, AND THOSE REISSUED SERIES 2012B BONDS ARE PART OF A SINGLE ISSUE OF OBLIGATIONS WITH THE SERIES 2017 BONDS. MATT J CICERO FAMILY MEMBER OF KEY EMPLOYEE, RICHARD D. CICERO 66093 SEE PART V 0 ABIGAIL CICERO FAMILY MEMBER OF KEY EMPLOYEE, RICHARD D. CICERO 90850 SEE PART V 0 PART IV, COLUMN D MATT J. CICERO, WHO HAS A FAMILY RELATIONSHIP WITH RICHARD D. CICERO, SERVED AS A HOSPITAL EMPLOYEE DURING 2020 AND RECEIVED COMPENSATION.ABIGAIL CICERO, WHO HAS A FAMILY RELATIONSHIP WITH RICHARD D. CICERO, SERVED AS A HOSPITAL EMPLOYEE DURING 2020 AND RECEIVED COMPENSATION. X COVID-19 PPE 1 1246028 ESTIMATE QTY X MKT C X WALK NONCASH VENDOR DONATIONS 7 51390 RETAIL VALUE 0 0 0 FORM 990, PART VI, SECTION B, LINE 11B THE PROCESS FOLLOWED BEFORE FILING THE LAKE HEALTH FORM 990 INCLUDES A DETAILED REVIEW COMPLETED BY AN INDEPENDENT OUTSIDE CPA FIRM, PRESENTATION TO AND REVIEW BY THE LAKE HEALTH CFO AND CEO, PRESENTATION AND REVIEW BY THE LAKE HEALTH FINANCE COMMITTEE, AND PRESENTATION TO THE LAKE HEALTH BOARD OF TRUSTEES. FORM 990, PART VI, SECTION B, LINE 12C THE LAKE HOSPITAL SYSTEM, INC. BOARD OF TRUSTEES COMPLETE A CONFLICT OF INTEREST QUESTIONNAIRE ANNUALLY, WHICH IS THEN REVIEWED BY THE LHS CFO AND A DIRECTOR OF THE BOARD OF TRUSTEES. BOARD MEMBERS WILL EXCUSE THEMSELVES FROM THE BOARD MEETING WHEN A TOPIC OF POTENTIAL CONFLICT IS PRESENTED AND RETURN TO THE MEETING FOLLOWING THE COMPLETION OF DISCUSSION, MOTION, AND VOTE. COMPLIANCE WITH THE LHS CONFLICT OF INTEREST POLICY MONITORED AND ENFORCED BY THE BOARD CHAIR, COMMITTEE CHAIRS, AND THE DIRECTOR RESPONSIBLE FOR BOARD OF TRUSTEE MATTERS. FORM 990, PART VI, SECTION B, LINE 15 THE PROCESS FOR DETERMINING COMPENSATION OF THE LAKE HOSPITAL SYSTEM, INC. CEO, OTHER OFFICERS, AND KEY EMPLOYEES INCLUDES MARKET RESEARCH, REVIEW, AND ASSESSMENT BY AN INDEPENDENT CONSULTING FIRM TO MAKE A RECOMMENDATION TO THE LHS BOARD OF DIRECTORS. THE BOARD REVIEWS THE REPORT PROVIDED IN CONJUNCTION WITH PERFORMANCE ASSESSMENTS, AND UTILIZES THIS INFORMATION TO DETERMINE COMPENSATION LEVEL. IN ADDITION, THE PROCEDURE FOR OTHER OFFICERS AND KEY EMPLOYEES INCLUDES REVIEW BY THE CEO. THE REVIEW WAS LAST CONDUCTED IN NOVEMBER 2020. FORM 990, PART VI, SECTION C, LINE 19 LAKE HOSPITAL SYSTEM, INC. MAKES ITS FORM 990, FORM 990-T, AND FORM 1023 AVAILABLE TO THE PUBLIC UPON REQUEST, FOR THE SAME PERIOD OF TIME AS SET FORTH IN THE INTERNAL REVENUE CODE SECTION 6104(D), IN ADDITION TO FILING QUARTERLY FINANCIAL INFORMATION WITH THE ELECTRONIC MUNICIPAL MARKET ACCESS SYSTEM FOR COMPLIANCE WITH BOND ISSUES AND ANNUAL FINANCIAL INFORMATION WITH THE ATTORNEY GENERAL OF THE STATE OF OHIO. GOVERNING DOCUMENTS FOR LAKE HOSPITAL SYSTEM, INC. ARE AVAILABLE THROUGH THE WEBSITE OF THE OHIO SECRETARY OF STATE. FORM 990, PART IX, LINE 11G OUTSOURCED SERVICES: PROGRAM SERVICE EXPENSES 12,083,950. MANAGEMENT AND GENERAL EXPENSES 203,848. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 12,287,798. PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 11,725,097. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 11,725,097. CONSULTING: PROGRAM SERVICE EXPENSES 4,924,938. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 4,924,938. MAINTENANCE & REPAIR: PROGRAM SERVICE EXPENSES 7,064,091. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 7,064,091. DATA PROCESSING & COLLECTION: PROGRAM SERVICE EXPENSES 2,756,394. MANAGEMENT AND GENERAL EXPENSES 897,577. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,653,971. RESEARCH & MARKETING: PROGRAM SERVICE EXPENSES 676,457. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 676,457. SUBSCRIPTIONS & PUBLICATIONS: PROGRAM SERVICE EXPENSES 418,919. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 418,919. MISCELLANEOUS OTHER: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 603,116. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 603,116. PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 42,411,457. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 42,411,457. FORM 990, PART XI, LINE 9: NET GAIN FROM AFFILIATED ENTITIES 591,433. DERIVATIVE INSTRUMENTS LOSS -13,808,809. UNDERWRITING SUPPORT OF FOUNDATION -305,092. NEW MANNA UBI 1,625,575. FORM 990, PART XII, LINE 2C: LAKE HEALTH'S BOARD OF DIRECTORS OVERSEES THE AUDIT PROCESS AND APPROVES THE INDEPENDENT AUDIT FIRM. THIS PROCESS HAS NOT CHANGED FROM PRIOR YEAR. FORM 990, PAGE 12, PART XII, LINE 3B THE REQUIRED SINGLE AUDIT AS SET FORTH IN THE SINGLE AUDIT ACT AND OMB CIRCULAR A-133 HAS NOT BEEN COMPLETED YET, BUT PLANS HAVE BEEN MADE TO HAVE IT COMPLETED BY THE EXTENDED DUE DATE AS ESTABLISHED IN OMB M-20-26. LAKE HEALTH IPHE 3605 WARRENSVILLE CTR RD MSC 9155 SHAKER HEIGHTS OH 44122 PHYSICIAN SERVICES OH -18375 0 LAKE HOSPITAL SYSTEM INC LAKE HEALTH UNIVERSITY HOSPITALS SEIDMAN CANCER CENTER 3605 WARRENSVILLE CTR RD MSC 9155 SHAKER HEIGHTS OH 44122 311565964 TREATMENT OF CANCER PATIENTS OH 501(C)(3) LINE 3 N/A 0 LAKE HOSPITAL FOUNDATION INC DBA LAKE HEALTH FOUNDATION 3605 WARRENSVILLE CTR RD MSC 9155 SHAKER HEIGHTS OH 44122 341425872 FUNDRAISING FOR BENEFIT OF LAKE HOSPITAL SYSTEM, INC. OH 501(C)(3) LINE 12A, I LAKE HOSPITAL SYSTEM INC DBA LAKE HEALTH 1 PRIMEHEALTH INC 3605 WARRENSVILLE CTR RD MSC 9155 SHAKER HEIGHTS OH 44122 341778204 PHYSICIAN CORPORATION OH 501(C)(3) LINE 3 LAKE HOSPITAL SYSTEM INC DBA LAKE HEALTH 1 THE AUXILIARY OF LAKE HOSPITAL SYSTEM INC 3605 WARRENSVILLE CTR RD MSC 9155 SHAKER HEIGHTS OH 44122 341605226 SUPPORT SERVICES FOR LAKE HEALTH HOSPITALS OH 501(C)(3) LINE 10 LAKE HOSPITAL SYSTEM INC DBA LAKE HEALTH 1 CONCORD MEDICAL CAMPUS PHYSICIAN BUILDING LLC 3605 WARRENSVILLE CTR RD MSC 9155 SHAKER HEIGHTS OH 44122 260550261 OFFICE SPACE OH N/A EXCLUDED 253262 1738599 0 0 0.51470 LAKE WEST MEDICAL SPECIALISTS LLC 36060 EUCLID AVE WILLOUGHBY OH 44094 341964657 OFFICE SPACE OH N/A EXCLUDED 9175 0 0 0.12000 MENTOR MEDICAL CAMPUS PHYSICIAN BUILDING LLC 9485 MENTOR AVE MENTOR OH 44060 341958475 OFFICE SPACE OH N/A UBI 100702 0 0 0.40390 MENTOR SURGERY CENTER LLC 9485 MENTOR AVE MENTOR OH 44060 341863257 OUTPATIENT SURGERY OH N/A RELATED 406985 1249825 0 0 0.42210 LAKE WILLOUGHBY PROPERTIES LLC 4166 CHILLICOTHE RD WILLOUGHBY OH 44094 364837155 OFFICE SPACE OH N/A UBI 78042 0 0 0.35000 NEW MANNA CLG LLC DBA LAKE HEALTH BEACHWOOD MEDICAL CENTER 25501 CHAGRIN BLVD BEACHWOOD OH 44122 371848577 SPECIALTY HOSPITAL OH YES UBI -1625575 442889 0 1 0.51000 LHS ASSURANCE LTD 23 LIME TREE BAY AVENUE GRAND CAYMAN CJ 980456229 INSURANCE COMPANY CJ LAKE HOSPITAL SYSTEM INC DBA LAKE HEALTH C 25646874 1.00000 1 LAKE PHO INC DBA LAKE HEALTH PHYSICIAN HOSPITAL ORGANIZATION 3605 WARRENSVILLE CTR RD MSC 9155 SHAKER HEIGHTS OH 44122 341696001 PHYSICIAN SERVICES OH N/A C 215426 2116084 0.50000 0 0 1 1 1 0 1 0 0 0 1 1 1 1 1 1 1 1 1 0 PRIMEHEALTH INC P 30763559 BOOK VALUE LHS ASSURANCE LTD C 500000 BOOK VALUE LAKE HEALTH FOUNDATION C 1791667 BOOK VALUE LAKE HEALTH FOUNDATION M 305092 BOOK VALUE LAKE WEST MEDICAL SPECIALISTS LLC F 57000 BOOK VALUE LAKE WEST MEDICAL SPECIALISTS LLC K 310521 BOOK VALUE LAKE WEST MEDICAL SPECIALISTS LLC J 38854 BOOK VALUE LAKE WEST MEDICAL SPECIALISTS LLC D 118511 BOOK VALUE LHUH SEIDMAN CANCER CENTER J 942072 BOOK VALUE MENTOR SURGERY CENTER LLC F 517223 BOOK VALUE MENTOR SURGERY CENTER LLC J 480804 BOOK VALUE MENTOR MEDICAL CAMPUS PHYSICIAN BUILDING LLC F 171949 BOOK VALUE MENTOR MEDICAL CAMPUS PHYSICIAN BUILDING LLC J 83102 BOOK VALUE MENTOR MEDICAL CAMPUS PHYSICIAN BUILDING LLC K 592313 BOOK VALUE MENTOR MEDICAL CAMPUS PHYSICIAN BUILDING LLC D 558866 BOOK VALUE LAKE WILLOUGHBY PROPERTIES LLC K 753788 BOOK VALUE LAKE WILLOUGHBY PROPERTIES LLC F 81550 BOOK VALUE CONCORD MEDICAL CAMPUS PHYSICIAN BUILDING LLC D 1087194 BOOK VALUE CONCORD MEDICAL CAMPUS PHYSICIAN BUILDING LLC F 197421 BOOK VALUE CONCORD MEDICAL CAMPUS PHYSICIAN BUILDING LLC J 129260 BOOK VALUE CONCORD MEDICAL CAMPUS PHYSICIAN BUILDING LLC K 1381189 BOOK VALUE NEW MANNA CLG LLC D 5614920 BOOK VALUE NEW MANNA CLG LLC L 2693601 BOOK VALUE