2020-11-10T14:49:15-06:00 2019-12-31 410746749 CLIFTONLARSONALLEN LLP 388 SOUTH MAIN STREET SUITE 420 AKRON OH 44311 990 2019-01-01 340726081 ASHTABULA COUNTY MEDICAL CENTER ASHT 4409972262 2420 LAKE AVENUE ASHTABULA OH 44004 DON KEPNER VP FINANCE/CFO 4409972262 2020-11-05 1 LISA HILLING P01624111 3303760100 67.137.57.251 2020-11-05 18:54:26 ES P 5EFBF20E7B7089C5FF7EB8F48BDE01CCFE2FE862 3831879B2016D50AA8F47187482EA58FBB174852 2019 2021-01-29 14:40:06Z MICHAEL HABOWSKI 2420 LAKE AVENUE ASHTABULA OH 44004 198897434 0 6026 X WWW.ACMCHEALTH.ORG X 1902 OH FULL-SERVICE ACUTE CARE HOSPITAL. 16 11 1328 217 265328 -48238 10927688 9968215 144371460 155593403 2185731 566083 425268 516373 157910147 166644074 300083 200000 0 0 79118964 80618229 0 0 0 67668786 78639624 147087833 159457853 10822314 7186221 147662470 166897449 54867025 56893703 92795445 110003746 ASHTABULA COUNTY MEDICAL CENTER PROVIDES QUALITY HEALTHCARE TO POSITIVELY IMPACT THE HEALTH OF OUR COMMUNITY. 0 0 110720530 200000 155593403 ASHTABULA COUNTY MEDICAL CENTER (ACMC) IS A PRIVATE, NOT-FOR-PROFIT, COMMUNITY-ORIENTED MEDICAL CENTER THAT PROVIDES THE BEST POSSIBLE MEDICAL CARE THROUGH ALL PHASES OF LIFE TO THOSE SEEKING HELP. IN 2019 WE MET OUR MISSION OF MEETING OUR COMMUNITY'S HEALTH CARE NEEDS AS EVIDENCED BY APPROXIMATELY 32,996 EMERGENCY DEPARTMENT VISITS, 6,071 INPATIENT DISCHARGES, 8,118 SURGICAL PROCEDURES (INCLUDING ENDOSCOPY), 312 BIRTHS, 75,137 RADIOLOGY PROCEDURES, AND 322,357 OUTPATIENT PROVIDER ENCOUNTERS. 110720530 1 1 0 0 0 0 0 0 0 0 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 0 0 0 0 0 0 1 0 0 0 0 0 0 1 1 1 0 0 1 124 0 1328 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 16 11 0 1 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 OH X DON KEPNER VP FINANCECFO 4409972262 2420 LAKE AVENUE ASHTABULA OH 44004 X NANCY KISTER CHAIRPERSON 0.30 0.30 X X 0 0 0 CRAIG SERNIK VICE CHAIRPERSON 0.30 0.30 X X 0 0 0 ROGER CORLETT SECRETARY/TREASURER 0.30 0.30 X X 0 0 0 MICHAEL HABOWSKI PRESIDENT/CEO 40.00 0.30 X X 0 0 0 PEG CARLO BOARD MEMBER 0.30 0.30 X 0 0 0 BILL DINGLEDINE BOARD MEMBER 0.30 0.30 X 0 0 0 JOE GIANGOLA BOARD MEMBER 0.30 0.30 X 0 0 0 REV VERNON PALO BOARD MEMBER 0.30 0.30 X 0 0 0 MARLENE SARTINI BOARD MEMBER 0.30 0.30 X 0 0 0 DAVID PONTIUS BOARD MEMBER 0.30 0.30 X 0 0 0 JIM TIMONERE BOARD MEMBER 0.30 0.30 X 0 0 0 RICHARD PARKER MD BOARD MEMBER/CCF REPRESENTATIVE 0.30 0.30 X 0 0 0 KELLY HANCOCK BOARD MEMBER/CCF REPRESENTATIVE 0.30 0.30 X 0 0 0 JASON HERGENROEDER BOARD MEMBER/CCF REPRESENTATIVE 0.30 0.30 X 0 0 0 SATHISH ADIGOPULA MD CHIEF OF STAFF (THROUGH 12/2020) 60.00 0.30 X 597401 0 18754 ALEXANDER TAICH MD VICE CHIEF OF STAFF 60.00 0.30 X 1223931 0 20629 DON KEPNER VP FINANCE/CFO 40.00 0.60 X 0 0 0 JACQUELYN DIFIORE CNO 40.00 0.66 X 0 0 0 NATHANIEL S FRANLEY MD PHYSICIAN 60.00 X 713486 0 18288 LAXMAN R CINGIREDDI MD PHYSICIAN 60.00 X 751278 0 17454 RAJWINDER KAUR MD PHYSICIAN 60.00 X 623271 0 9878 PAZHANIAANDI TIROUNILACANDIN MD PHYSICIAN 60.00 X 701615 0 18271 PREETHA MUTHUSAMY MD PHYSICIAN 60.00 X 623855 0 12144 5234837 0 115418 83 0 1 0 AMERISOURCEBERGEN 25199 NETWORK PLACE CHICAGO IL 60673 MEDICAL 16819472 CLEVELAND CLINIC FOUNDATION PO BOX 931760 CLEVELAND OH 44193 ADMINISTRATIVE AND CLINICAL SERVICES 6987424 ANSETHESIA CONSULTANTS EFT 5168 STANSBURG RD SOLON OH 44139 MEDICAL 3012818 CARDINAL HEALTH MEDICAL PRODUCTS AND SER PO BOX 70539 CHICAGO IL 60673 MEDICAL 2910744 ARAMARK CORP 27310 NETWORK PLACE CHICAGO IL 60673 CAFETERIA AND DIETARY SERVICES 1807119 85 9898028 70187 9968215 NET PATIENT SERVICE REVENUE 624100 144247404 144247404 MISC OPERATING REVENUE 624100 10940572 10940572 REBATES AND REFUNDS 624100 405427 405427 155593403 2252982 2252982 251045 0 251045 251045 251045 30566461 32251054 2306 -1684593 -2306 -1686899 -1686899 PREMIER FITNESS 713940 265328 265328 265328 166644074 155593403 265328 817128 X 200000 200000 2373787 2373787 63160099 52773489 10386610 1834824 1834824 9283179 9283179 3966340 3966340 1833431 1833431 402420 402420 47511 47511 17721843 13935941 3785902 290190 3864 286326 249137 152752 96385 2060969 36802 2024167 114194 58496 55698 4837500 4837500 4277109 3444294 832815 1542834 916041 626793 SUPPLIES 27765592 26811343 954249 BAD DEBT EXPENSE 9214640 9214640 EQUIP REPAIRS & MAINT 4701483 2085995 2615488 LICENSES & PERMITS 2173495 170552 2002943 1407276 916321 490955 159457853 110720530 48737323 0 18341038 22200055 2143007 616302 20766998 23759126 2065875 2497649 1960965 2079060 106709618 73998621 31280601 32710997 59677710 69470446 3146515 2896249 8279761 10667565 147662470 166897449 16983075 19682306 65611 21563 37818339 37189834 54867025 56893703 X 92781143 109989444 14302 14302 92795445 110003746 147662470 166897449 X 7186221 8718601 1303479 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1 9718 9718 0 PART II-B, LINE 1: TOTAL DUES OF $38,310 WERE PAID TO THE OHIO HOSPITAL ASSOCIATION BY ACMC, OF WHICH 5.9% WERE RELATED TO LOBBYING ACTIVITIES. TOTAL DUES OF $31,980 WERE PAID TO THE AMERICAN HOSPITAL ASSOCIATION BY ACMC, OF WHICH 23.32% WERE RELATED TO LOBBYING ACTIVITIES. 2519092 2519092 38929056 24758521 14170535 4264081 3528088 735993 58730716 45712012 13018704 2266673 2266673 32710997 SELF-INSURANCE INVESTMENTS 6115891 DEFERRED COMPENSATION 4317014 DUE FROM AFFLIATES 234660 10667565 RESERVE FOR SELF-INSURANCE LIABILITIES 11220195 DEFERRED COMPENSATION 3182381 DISTRIBUTION PAYABLE TO THE CLEVELAND CLINIC FOUNDATION 4837500 INVESTMENT FROM CLEVELAND CLINIC FOUNDATION 15000000 THIRD-PARTY PAYABLES 2949758 37189834 X PART X, LINE 2: WHEN TAX RETURNS ARE FILED, IT IS HIGHLY CERTAIN THAT SOME POSITIONS TAKEN WOULD BE SUSTAINED UPON EXAMINATION BY THE TAXING AUTHORITIES, WHILE OTHERS ARE SUBJECT TO UNCERTAINTY ABOUT THE MERITS OF THE POSITION TAKEN OR THE AMOUNT OF THE POSITION THAT WOULD BE ULTIMATELY SUSTAINED. IN ACCORDANCE WITH THE INCOME TAXES TOPIC OF THE FINANCIAL ACCOUNTING STANDARDS BOARD (FASB) ACCOUNTING STANDARDS CODIFICATION, THE BENEFIT OF A TAX POSITION IS RECOGNIZED IN THE FINANCIAL STATEMENTS IN THE PERIOD DURING WHICH, BASED ON ALL AVAILABLE EVIDENCE, MANAGEMENT BELIEVES IT IS MORE LIKELY THAN NOT THAT THE POSITION WILL BE SUSTAINED UPON EXAMINATION, INCLUDING THE RESOLUTION OF APPEALS OR LITIGATION PROCESSES, IF ANY. TAX POSITIONS TAKEN ARE NOT OFFSET OR AGGREGATED WITH OTHER POSITIONS. TAX POSITIONS THAT MEET THE MORE-LIKELY-THAN-NOT RECOGNITION THRESHOLD ARE MEASURED AS THE LARGEST AMOUNT OF TAX BENEFIT THAT IS MORE THAN 50% LIKELY OF BEING REALIZED UPON SETTLEMENT WITH THE APPLICABLE TAXING AUTHORITY. THE PORTION OF THE BENEFITS ASSOCIATED WITH TAX POSITIONS TAKEN THAT EXCEEDS THE AMOUNT MEASURED AS DESCRIBED ABOVE IS RECORDED AS A LIABILITY FOR UNRECOGNIZED TAX BENEFITS ALONG WITH ANY ASSOCIATED INTEREST AND PENALTIES THAT WOULD BE PAYABLE TO THE TAXING AUTHORITIES UPON EXAMINATION. 1 1 X 1 X 0 1 1 0 0 753122 753122 0.00500 25622790 17315588 8307202 0.05530 192933 1155495 0 0.00000 26568845 18471083 9060324 0.06030 3463422 3463422 0.02310 44681 44681 0.00030 190688 190688 0.00130 0 3698791 3698791 0.02470 30267636 18471083 12759115 0.08500 1 9214640 0 36051886 36256435 -204549 X 1 1 1 1 ASHTABULA COUNTY MEDICAL CENTER 2420 LAKE AVENUE ASTHABULA OH 44004 WWW.ACMCHEALTH.ORG 360125 X X X ASHTABULA COUNTY MEDICAL CENTER 1 0 0 1 X X X X X X X X X 19 1 0 0 1 X WWW.ACMCHEALTH.ORG/ABOUT-US/COMMUNITY-HEALTH-NEEDS-ASSESSMENT/ X 1 19 1 WWW.ACMCHEALTH.ORG/ABOUT-US/COMMUNITY-HEALTH-NEEDS-ASSESSMENT/ 0 1 X 200.000000000000 X X 1 1 X X X X 1 X WWW.ACMCHEALTH.ORG/PATIENTS-VISITORS/FINANCIAL-SERVICES/ X WWW.ACMCHEALTH.ORG/PATIENTS-VISITORS/FINANCIAL-SERVICES/ X WWW.ACMCHEALTH.ORG/PATIENTS-VISITORS/FINANCIAL-SERVICES/ X X X X X 1 X 0 X X X X X 1 X 0 1 ASHTABULA COUNTY MEDICAL CENTER PART V, SECTION B, LINE 5: THE 2019 COMMUNITY HEALTH NEEDS ASSESSMENT RELIED ON MULTIPLE DATA SOURCES AND COMMUNITY INPUT GATHERED BETWEEN JANUARY AND AUGUST 2019. INPUT FROM 6 PERSONS REPRESENTING THE BROAD INTERESTS OF THE COMMUNITY, AS WELL AS A FOCUS GROUP OF KEY CONSTITUENTS, WAS TAKEN INTO ACCOUNT THROUGH KEY INFORMANT INTERVIEWS. INTERVIEWS INCLUDED INDIVIDUALS WITH SPECIAL KNOWLEDGE OR EXPERTISE IN PUBLIC HEALTH, LOCAL PUBLIC HEALTH DEPARTMENTS, AGENCIES WITH CURRENT DATA OR INFORMATION ABOUT THE HEALTH AND SOCIAL NEEDS OF THE COMMUNITY, REPRESENTATIVES OF SOCIAL SERVICE ORGANIZATIONS, AND LEADERS, REPRESENTATIVES AND MEMBER OF MEDICALLY UNDERSERVED, LOW-INCOME, AND MINORITY POPULATIONS. SEE PAGE 9 OF THE 2019 CHNA FOR A LIST OF PARTICIPATING ORGANIZATIONS AND AGENCIES. ASHTABULA COUNTY MEDICAL CENTER PART V, SECTION B, LINE 11: ASHTABULA COUNTY MEDICAL CENTER HAS A 115-YEAR HISTORY OF PROVIDING SIGNIFICANT AMOUNTS OF COMMUNITY BENEFIT TO THE COMMUNITIES IT SERVES. ACMC WILL CONTINUE THIS COMMITMENT BY ALLOCATING APPROPRIATE HUMAN AND FINANCIAL RESOURCES TO MEET THOSE NEEDS THROUGH THE IMPLEMENTATION OF THE FOLLOWING STRATEGY:IMPROVE ACCESS TO COMPREHENSIVE PRIMARY CARE- OPEN ORWELL FAMILY HEALTH CENTER TO ADDRESS HEALTHCARE PROFESSIONAL SHORTAGE AREA IN SOUTHERN ASHTABULA COUNTY- CREATE PRIMARY CARE TEAM MODEL CONCEPT TO REDUCE WAIT TIME FOR NEW PATIENT APPOINTMENT- CONNECT EXPRESS CARE (WALK-IN CLINIC FOR MINOR ILLNESS/INJURY) TO A PRIMARY CARE PROVIDER- CONNECT EMPLOYEES OF WORKPLACE WELLNESS CLIENTS TO A PRIMARY CARE PROVIDER- CONNECT COMMUNITY MEMBERS AT OUTREACH EVENTS TO A PRIMARY CARE PROVIDER- CONTINUE TO RECRUIT FOR FAMILY MEDICINE, INTERNAL MEDICINE, AND PEDIATRICSIMPROVE ACCESS TO SPECIALTY CARE- CONTINUE TO RECRUIT SPECIALTY PHYSICIANS TO ENSURE ASHTABULA COUNTY RESIDENTS DO NOT HAVE TO LEAVE THE COUNTY FOR SPECIALTY CARE- CONTINUE TO COLLABORATE WITH CLEVELAND CLINIC TO PROVIDE SPECIALISTS AND SPECIALTY CLINICS FOR SERVICES NOT AVAILABLE IN THE COMMUNITYPREVENT HEART DISEASE- IMPLEMENT PRE-HYPERTENSION AND HYPERTENSION PATIENT EDUCATION- PROVIDE FREE HYPERTENSION SCREENINGS AT ACMC EXPRESS CARE LOCATIONS- PROVIDE FREE HYPERTENSION SCREENINGS AT COMMUNITY OUTREACH EVENTS- CONTINUE FREE EXERCISE PRESCRIPTION PROGRAM AT ACMC-OWNED FITNESS CENTERREDUCE THE PREVALENCE OF DIABETES- CONTINUE TO OFFER INPATIENT AND OUTPATIENT DIABETES EDUCATION- INCREASE NUMBER OF PROVIDERS PRESCRIBING EXERCISE- EXPLORE IMPLEMENTATION OF A PRE-DIABETES RISK ASSESSMENT AT PRIMARY CARE APPOINTMENTSREDUCE OBESITY- COLLABORATE WITH THE INTERVENTION AND PREVENTION OF ONGOING DISEASES (IPOD) COMMITTEE OF THE ASHTABULA COUNTY HEALTH DEPARTMENT TO RAISE AWARENESS OF FOOD PANTRIES AND FARMERS' MARKETS, DISTRIBUTE INFORMATION ON WHERE TO OBTAIN FRESH FRUIT AND VEGETABLES, AND DEVELOP A UNIFIED HEALTH CHOICES CAMPAIGN TO INCLUDE PRINT AND SOCIAL MEDIADECREASE DRUG OVERDOSE DEATHS- CONTINUE TO COLLABORATE WITH, AND SUPPORT INITIATIVES OF, THE ASHTABULA COUNTY MENTAL HEALTH RECOVERY SERVICES BOARD AND THE ASHTABULA COUNTY SUBSTANCE ABUSE LEADERSHIP TEAM- EXPLORE THE INCORPORATION OF A SCREENING FOR DRUG USE AND ABUSE FOR ALL PATIENTS AGE 12 AND OLDER- PROVIDE TRAINING TO PROVIDERS ON GUIDELINES FOR OPIOID PRESCRIBINGDECREASE SUICIDE- COLLABORATE WITH ONE ASHTABULA COUNTY SCHOOL DISTRICT EACH YEAR TO IMPLEMENT THE SIGNS OF SUICIDE PREVENTION PROGRAM- CONTINUE TO COLLABORATE WITH, AND SUPPORT INITIATIVES OF, THE ASHTABULA COUNTY MENTAL HEALTH RECOVERY SERVICES BOARD AND THE ASHTABULA COUNTY PREVENTION COALITION ASHTABULA COUNTY MEDICAL CENTER CANNOT ADDRESS ALL OF THE HEALTH NEEDS PRESENT IN THE COMMUNITY. TO ENSURE ACMC REMAINS FINANCIALLY VIABLE AND IN A POSITION TO ENHANCE CURRENT SERVICES, DEVELOP NEW SERVICES AND CONTINUE TO PROVIDE A WIDE RANGE OF COMMUNITY BENEFITS, THE HOSPITAL'S IMPLEMENTATION STRATEGY FOCUS WILL NOT ADDRESS THE FOLLOWING NEEDS:- DENTAL SERVICES- TOBACCO USE- ALCOHOL CONSUMPTION- POVERTY- FOOD INSECURITY- ADVERSE CHILDHOOD EXPERIENCES ASHTABULA COUNTY MEDICAL CENTER PART V, SECTION B, LINE 20E: THE ORGANIZATION PROVIDES NOTIFICATION REGARDING THE FAP THROUGH SIGNAGE AND OTHER MECHANISMS. THERE ARE A NUMBER OF WRITTEN CORRESPONDENCES THAT GO OUT TO PATIENTS OVER THE COURSE OF 120 DAYS ONCE THE PATIENT RESPONSIBILITY IS DETERMINED FOR THE AMOUNT DUE RELATED TO SERVICES PROVIDED.PART V, SECTION B, LINE 20C: IF AN INCOMPLETE FAP APPLICATION IS RECEIVED, THE ORGANIZATION'S FINANCIAL COUNSELORS CONTACT THE PATIENT FOR ADDITIONAL INFORMATION. ASHTABULA COUNTY MEDICAL CENTER PART V, SECTION B, LINE 24: ALL PATIENTS ARE CHARGED THE SAME, STANDARD RATE, FOR A PARTICULAR SERVICE. 8 1 - JEFFERSON FAMILY HEALTH CENTER 234 NORTH CHESTNUT STREET JEFFERSON OH 44047 FAMILY HEALTH CENTER 2 - CONNEAUT FAMILY HEALTH CENTER 354 W MAIN ROAD CONNEAUT OH 44030 FAMILY HEALTH CENTER 3 - ASHTABULA WOMEN'S HEALTH CENTER 524 W 24TH STREET ASHTABULA OH 44004 WOMEN'S HEALTH CENTER 4 - ACMC CENTER FOR DIGESTIVE HEALTH 2112 LAKE AVENUE ASHTABULA OH 44004 GASTROENTEROLOGY HEALTH CENTER 5 - GENEVA FAMILY HEALTH CENTER 1028 S BROADWAY GENEVA OH 44041 FAMILY HEALTH CENTER 6 - ASHTABULA FAMILY HEALTH CENTER 2259 LAKE AVENUE ASHTABULA OH 44004 FAMILY HEALTH CENTER 7 - THE ASHTABULA CLINIC 2422 LAKE AVENUE ASHTABULA OH 44004 PAIN MANAGEMENT, OCCUPATIONAL HEALTH 8 - ACMC OCCUPATIONAL HEALTH SERVICES 2422 LAKE AVENUE ASHTABULA OH 44004 OCCUPATIONAL HEALTH PART I, LINE 3C: TO QUALIFY FOR THE HOSPITAL CARE ASSURANCE PROGRAM, AN INDIVIDUAL MUST (A) BE A RESIDENT OF THE STATE OF OHIO, (B) NOT BE ENROLLED IN THE MEDICAID (INCLUDING MEDICAID HMO) PROGRAM, AND (C) HAVE FAMILY/HOUSEHOLD INCOME LESS THAN 200% OF FEDERAL POVERTY GUIDELINES. IN ADDITION, BEFORE GRANTING FINANCIAL ASSISTANCE, THE HOSPITAL HAS THE RIGHT TO REQUIRE (A) PROOF OF INCOME, (B) A WRITTEN STATEMENT FOR CLAIMS OF $0 INCOME, (C) INFORMATION ABOUT HSA AND HFSA ACCOUNTS, AND/OR (D) THAT AN INDIVIDUAL APPLY FOR MEDICAID. PART I, LINE 6A: N/A PART I, LINE 7: ACMC ESTIMATED CHARITY CARE COSTS BY CALCULATING A RATIO OF COST TO GROSS CHARGES AND THEN MULTIPLYING THAT RATIO BY THE GROSS UNCOMPENSATED CHARGES ASSOCIATED WITH PROVIDING CARE TO CHARITY PATIENTS.ACMC IS PAID A PROSPECTIVELY DETERMINED RATE FOR THE MAJORITY OF INPATIENT ACUTE CARE AND OUTPATIENT, SKILLED NURSING, AND REHABILITATION SERVICES PROVIDED FOR MEDICAID. THESE RATES VARY ACCORDING TO A PATIENT CLASSIFICATION SYSTEM THAT IS BASED ON CLINICAL, DIAGNOSTIC, AND OTHER FACTORS. MEDICAID PAYMENTS FOR CAPITAL ARE RECEIVED ON A COST REIMBURSEMENT METHODOLOGY. PAYMENTS ARE RECEIVED ON A PROSPECTIVE BASIS FOR ACMC'S MEDICAL EDUCATION COSTS, SUBJECT TO CERTAIN LIMITS. PROVISION FOR ESTIMATED RETROACTIVE ADJUSTMENTS, IF ANY, RESULTING FROM REGULATORY MATTERS OR OTHER ADJUSTMENTS UNDER PAYMENT AGREEMENTS ARE ESTIMATED IN THE PERIOD THE RELATED SERVICES ARE PROVIDED. PART I, LINE 7G: ACMC PROVIDES AN ATHLETIC TRAINER TO THREE HIGH SCHOOLS AT NO COST TO THE SCHOOL DISTRICTS FOR THIS SERVICE. PART I, LINE 7, COLUMN (F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $ 9,214,640. PART I, LINE 7C: ACMC PARTICIPATES IN THE HOSPITAL CARE ASSURANCE PROGRAM (HCAP) TO FINANCIALLY SUPPORT THOSE HOSPITALS THAT SERVICE A DISPROPORTIONATE SHARE OF LOW-INCOME PATIENTS UNABLE TO PAY FOR CARE. HCAP FUNDS BASIC, MEDICALLY NECESSARY HOSPITAL SERVICES FOR PATIENTS WHOSE FAMILY INCOME IS AT OR BELOW THE FEDERAL POVERTY LEVEL, WHICH INCLUDES MEDICAID PATIENTS AND PATIENTS WITHOUT HEALTH INSURANCE. PART I, LINE 7E: ACMC PROVIDES A SIGNIFICANT RECRUITING SUBSIDY AND GUARANTEE FOR ALL NEW PHYSICIANS THE HOSPITAL RECRUITS. IN ADDITION, THE HOSPITAL PROVIDES A GUARANTEE AFTER THE INITIAL RECRUITMENT FOR SOME PHYSICIANS DUE TO THE PRESSING NEED FOR THE PHYSICIAN'S SPECIALTY. WITHOUT THE HOSPITAL DOING THIS, ACMC WOULD NOT BE ABLE TO PROVIDE MANY OF THESE SERVICES LOCALLY. THE RECRUITMENT AND GUARANTEE COSTS ACMC INCURS REDUCES GEOGRAPHIC AND FINANCIAL BARRIERS TO ACCESSING HEALTH CARE AND IMPROVES THE AVAILABILITY OF HEALTH SERVICES IN THE AREA ACMC SERVES. PART III, LINE 2: TOTAL BAD DEBT EXPENSE FOR THE ENTIRE HOSPITAL COMPLEX IS EQUAL TO THE TOTAL GROSS CHARGES WRITTEN OFF AS REPORTED ON THE 2019 MEDICARE COST REPORT. PART III, LINE 3: ASHTABULA COUNTY MEDICAL CENTER DOES NOT HAVE A METHOD TO REASONABLY ESTIMATE THE PORTION OF BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENTS WHO WOULD QUALIFY FOR FINANCIAL ASSISTANCE BUT DID NOT COMPLETE AN APPLICATION. PART II: N/A PART III, LINE 4: SEE THE "PATIENT SERVICE REVENUE AND PATIENT RECEIVABLES" PARAGRAPHS IN NOTE 1 ON PAGES 12-14 IN THE ATTACHED AUDITED FINANCIAL STATEMENTS.ACMC PROVIDES CARE TO PATIENTS WHO DO NOT HAVE THE ABILITY TO PAY AND WHO QUALIFY FOR CHARITY SERVICES PURSUANT TO ESTABLISHED POLICIES OF ACMC. CHARITY SERVICES ARE DEFINED AS THOSE FOR WHICH PATIENTS HAVE THE OBLIGATION AND WILLINGNESS TO PAY BUT DO NOT HAVE THE ABILITY TO DO SO. ACMC DOES NOT INCLUDE CHARITY CARE IN NET PATIENT SERVICE REVENUE. PART III, LINE 8: MEDICARE SURPLUS IS NOT TREATED AS COMMUNITY BENEFIT. THE AMOUNTS REPORTED WERE GENERATED FROM THE MEDICARE COST REPORT FILED FOR 2019. ACMC IS PAID A PROSPECTIVELY DETERMINED RATE FOR THE MAJORITY OF INPATIENT ACUTE CARE AND OUTPATIENT, SKILLED NURSING, AND REHABILITATION SERVICES PROVIDED FOR MEDICARE. THESE RATES VARY ACCORDING TO A PATIENT CLASSIFICATION SYSTEM THAT IS BASED ON CLINICAL, DIAGNOSTIC, AND OTHER FACTORS. MEDICARE PAYMENTS FOR CAPITAL ARE RECEIVED ON A PROSPECTIVE BASIS. PAYMENTS ARE RECEIVED ON A PROSPECTIVE BASIS FOR ACMC'S MEDICAL EDUCATION COSTS, SUBJECT TO CERTAIN LIMITS. ACMC IS PAID FOR COST REIMBURSABLE ITEMS AT A TENTATIVE RATE, WITH FINAL SETTLEMENT DETERMINED AFTER SUBMISSION OF ANNUAL COST REPORTS BY ACMC AND AUDITS THEREOF BY THE MEDICARE FISCAL INTERMEDIARY. PROVISION FOR ESTIMATED RETROACTIVE ADJUSTMENTS, IF ANY, RESULTING FROM REGULATORY MATTERS OR OTHER ADJUSTMENTS UNDER PAYMENT AGREEMENTS ARE ESTIMATED IN THE PERIOD THE RELATED SERVICES ARE PROVIDED.LAWS AND REGULATIONS GOVERNING MEDICARE ARE COMPLEX AND SUBJECT TO INTERPRETATION AS WELL AS SIGNIFICANT REGULATORY ACTION, AND, IN THE NORMAL COURSE OF BUSINESS, ACMC IS SUBJECT TO CONTRACTUAL REVIEWS AND AUDITS. AS A RESULT, THERE IS AT LEAST A REASONABLE POSSIBILITY THAT RECORDED ESTIMATES WILL CHANGE IN THE NEAR TERM. ACMC BELIEVES IT IS IN COMPLIANCE WITH APPLICABLE LAWS AND REGULATIONS GOVERNING THE MEDICARE PROGRAM AND THAT ADEQUATE PROVISIONS HAVE BEEN MADE FOR ANY ADJUSTMENTS THAT MAY RESULT FROM FINAL SETTLEMENTS. PART III, LINE 9B: REASONABLE EFFORTS ARE PERFORMED TO DETERMINE THE PATIENT'S ELIGIBILITY UNDER THE HOSPITAL'S FAP AND THE HOSPITAL DOES NOT PERFORM DEBT COLLECTION PROCEDURES BEFORE MAKING THESE REASONABLE EFFORTS. THIS IS ACHIEVED THROUGH THE HCAP APPLICATION. DOCUMENTATION OF THE PATIENT OR FAMILY INCOME FOR HCAP ELIGIBILITY WILL BE BASED UPON A BEST EVIDENCE METHODOLOGY. HOSPITAL EMPLOYEES WILL PROCEED THROUGH THE FOLLOWING IN AN EFFORT TO SECURE THE BEST EVIDENCE AVAILABLE FOR THE PATIENT OR GUARANTOR AT THE TIME OF THEIR ENCOUNTER. 1. A COMPLETED HCAP APPLICATION INCLUSIVE OF THE PATIENT OR GUARANTOR'S SIGNATURE. 2. A COMPLETED HCAP APPLICATION, WHICH INCLUDES THE SIGNATURE OF THE PATIENT REPRESENTATIVE SECURING THE INFORMATION FROM THE RESPONSIBLE PARTY. IF THE APPLICATION CANNOT BE SECURED AT THE TIME OF THE ENCOUNTER, THE RESPONSIBLE PARTY WILL BE PROVIDED WITH A RETURN ENVELOPE. THEY WILL BE ASKED TO PROVIDE THIS INFORMATION UPON THEIR RETURN TO THEIR HOME. IN THE EVENT THAT THE INFORMATION IS RECEIVED, IT IS TO BE REVIEWED AND CONSIDERED AGAINST THE ABOVE-DEFINED ELIGIBILITY DETERMINATION CRITERIA. IF IT IS NOT RETURNED WITHIN 14 DAYS OF DISCHARGE, ACMC CONTACTS THE PATIENT VIA TELEPHONE TO COMPLETE THE APPLICATION. FOR OUTPATIENT HOSPITAL SERVICES, THE ELIGIBILITY DETERMINATION IS EFFECTIVE FOR NINETY DAYS FROM THE INITIAL SERVICE DATE. DURING THIS PERIOD A NEW ELIGIBILITY DETERMINATION NEED NOT BE COMPLETED. ELIGIBILITY FOR INPATIENT HOSPITAL SERVICES MUST BE DETERMINED SEPARATELY FOR EACH ADMISSION, UNLESS THE PATIENT IS READMITTED WITHIN FORTY-FIVE DAYS OF DISCHARGE FOR THE SAME UNDERLYING CONDITION. ELIGIBILITY FOR RECIPIENTS OF THE DISABILITY ASSISTANCE PROGRAM MUST BE VERIFIED ON A MONTHLY BASIS. IN THE EVENT THE PATIENT DOES NOT COMPLETE AN APPLICATION DURING THE ENCOUNTER, AND AS A RESULT OF THE HCAP COMMUNICATION, PATIENT STATEMENTS, OR RESULT OF COLLECTION EFFORTS, HOSPITAL STAFF WILL COMPLETE THE HCAP APPLICATION, OVER THE TELEPHONE OR IN-PERSON, ON BEHALF OF THE RESPONSIBLE PARTY. PART VI, LINE 2: ACMC USES MARKET DATA THAT REFLECTS ACTUAL PATIENT VISITS (DATA THAT IS SUBMITTED TO THE OHIO HOSPITAL ASSOCIATION BY ALL HOSPITALS IN THE STATE). MANAGEMENT REVIEWS THE NUMBER OF PATIENTS FROM THE MARKET WHO LEAVE ASHTABULA COUNTY FOR HEALTHCARE, AND WHAT SERVICES THEY LEAVE FOR. ACMC CONDUCTS A MEDICAL STAFF DEVELOPMENT PLAN (APPROXIMATELY EVERY THREE YEARS) IN WHICH PHYSICIANS ARE ASKED ABOUT THEIR PRACTICE PLANS (PLANNING TO RETIRE, BECOME EMPLOYED, GO INDEPENDENT, EXPAND) AND WHAT SPECIALISTS ARE NEEDED IN THE COMMUNITY TO BETTER SERVE THEIR PATIENTS. THIS HELPS GUIDE THE PHYSICIAN RECRUITMENT EFFORTS TO ENSURE THE HOSPITAL IS MEETING THE HEALTH NEEDS OF THE MARKET. MEMBERS OF THE MANAGEMENT TEAM ACTIVELY SERVE ON THE BOARDS OF COMMUNITY ORGANIZATIONS, MANY OF WHICH HAVE A MISSION TO ADDRESS COMMUNITY NEED; HEALTHCARE BEING ONE OF THOSE NEEDS (COMMUNITY ACTION, SALVATION ARMY, UNITED WAY, CATHOLIC CHARITIES, SENIOR ADVOCACY AND PROTECTIVE NETWORK, ETC.). EVERY 3 YEARS ACMC CONDUCTS A COMMUNITY HEALTH NEEDS ASSESSMENT. THE FINDINGS FROM THAT ASSESSMENT ARE USED TO DEVELOP AN IMPLEMENTATION PLAN TO ADDRESS THE KEY HEALTH NEEDS IN THE COMMUNITY. PART VI, LINE 3: INFORMATION ABOUT ELIGIBILITY FOR ASSISTANCE UNDER FEDERAL, STATE OR LOCAL GOVERNMENT PROGRAMS IS DESCRIBED ON THE PATIENT'S BILL, THE POLICY IS POSTED ON THE HOSPITAL'S WEBSITE AND IS ALSO AVAILABLE UPON REQUEST. THE NOTICE, BOTH IN ENGLISH AND SPANISH, IS POSTED AT THE FOLLOWING LOCATIONS: EMERGENCY DEPARTMENT, ALL ADMISSIONS/REGISTRATION AREAS, PATIENT FINANCIAL SERVICES DEPARTMENT. ACMC FINANCIAL COUNSELORS MEET WITH ANY PATIENT THAT MAY NEED ANY FORM OF FINANCIAL AID PRIOR TO DISCHARGE AND EDUCATE THEM ON FINANCIAL ASSISTANCE. PART VI, LINE 4: AFFILIATED WITH THE CLEVELAND CLINIC, ACMC IS THE LARGEST AND MOST ADVANCED HOSPITAL IN ASHTABULA COUNTY. ACMC OPENS THE DOOR TO THE WORLD'S BEST HEALTHCARE BY APPLYING CLEVELAND CLINIC'S CLINICAL INFORMATION AND STATE-OF-THE-ART STANDARDS OF CARE. THE PRIMARY MARKET IS COMPRISED OF THE FOLLOWING ZIP CODES: 44004, 44005, 44010, 44030, 44032, 44041, 44048, 44068, 44082. THE SECONDARY MARKET IS COMPRISED OF THE FOLLOWING ZIP CODES: 44003, 44076, 44084, 44085, 44093, 44099. THE PAYER MIX IS 50.71% MEDICARE, 24.06% MEDICAID, 23.62% COMMERCIAL, 1.61% SELF PAY. STATISTICS INCLUDED IN THE 2019 CHNA SHOW THAT ASHTABULA COUNTY'S POVERTY RATE IS 19.8% (AMONG THE HIGHEST IN THE STATE), 85.7% OF COUNTY RESIDENTS HAVE A HIGH SCHOOL DIPLOMA, THE MEDIAN HOUSEHOLD INCOME IS $43,017, AND THE MEDIAN PER CAPITA INCOME IS $21,936. PART VI, LINE 5: ACMC IS AN ACTIVE PARTICIPANT AND SPONSOR OF EVENTS LIKE RELAY FOR LIFE AND AMERICAN HEART WALK AND SPONSOR OF HEALTH-RELATED EVENTS OF COMMUNITY ORGANIZATIONS (EXAMPLE: ZONTA WOMEN'S HEALTH DAY). ACMC PUBLISHES A COMMUNITY MAGAZINE TWICE A YEAR WITH HEALTHCARE INFORMATION AND TIPS FOR HEALTHY LIVING. THE WEBSITE CONTAINS HEALTH INFORMATION AND DOWNLOADABLE RESOURCES. THE HOSPITAL HOLDS A WOMEN'S HEART HEALTH EVENT EACH YEAR AND HELD A MEN'S EVENT FOR THE FIRST TIME IN 2017. ACMC STAFF MAKE MONTHLY PRESENTATIONS AT SENIOR CENTERS IN ASHTABULA, CONNEAUT AND JEFFERSON. ACMC PARTICIPATES IN NUMEROUS HEALTH FAIRS AND COMMUNITY EVENTS AT WHICH THE HOSPITAL PROVIDES FREE SCREENINGS (BLOOD PRESSURE, BLOOD SUGAR, BODY MASS INDEX, BACK STRENGTH, CHOLESTEROL). STAFF (PHYSICIANS, CLINICIANS, ETC.) APPEAR ON LOCAL CABLE TV SHOW 2X/MONTH TO SHARE HEALTH INFORMATION. ACMC ALSO PROVIDES AN ATHLETIC TRAINER TO THREE HIGH SCHOOLS (NO COST TO THE SCHOOL DISTRICTS FOR THIS SERVICE). ADDITIONALLY, ACMC PARTICIPATES WITH LOCAL SOCIAL SERVICE AGENCIES ON THEIR PROGRAMS THAT ARE DESIGNED TO IMPROVE THE HEALTH AND WELL-BEING OF ASHTABULA COUNTY RESIDENTS. EXAMPLES INCLUDE: FEED THE HOPE, BRIDGES OUT OF POVERTY, REMOTE AREA MEDICAL CLINIC. PART VI, LINE 6: ACMC IS AN AFFILIATE OF THE CLEVELAND CLINIC. THE CLEVELAND CLINIC HEALTH SYSTEM ENGAGES IN MANY COMMUNITY OUTREACH PROGRAMS, INCLUDING INITIATIVES DESIGNED TO SERVE THE VULNERABLE AND AT-RISK POPULATIONS IN OUR COMMUNITIES. CLEVELAND CLINIC'S OUTREACH PROGRAMS RANGE FROM FREE HEALTH SCREENINGS AND CLINICAL SERVICES TO ENROLLMENT ASSISTANCE FOR GOVERNMENT-FUNDED HEALTH PROGRAMS. COMMUNITY OUTREACH PROGRAMS ARE ALSO THOSE PROGRAMS THAT IMPROVE ACCESS TO HEALTH SERVICES. CLEVELAND CLINIC CAREGIVERS COLLABORATE WITH COMMUNITY ORGANIZATIONS TO PROVIDE A CONTINUUM OF CARE THAT SUPPORTS ECONOMICALLY AND MEDICALLY UNDERSERVED AREAS. THE 2018 COMMUNITY BENEFIT REPORT PUBLISHED BY THE CLEVELAND CLINIC STATED $1.04 BILLION WAS SPENT BY THE CLEVELAND CLINIC IN 2018 ON COMMUNITY BENEFIT PROGRAMS. PART VI, LINE 7: N/A 1 ASHTABULA REGIONAL HOME HEALTH SERVICES PO BOX 1428 ASHTABULA OH 440051428 341143158 501(C)(3) 200000 GENERAL OPERATING SUPPORT 1 0 PART I, LINE 2: DON KEPNER, THE VICE PRESIDENT AND CFO OF THE ASHTABULA COUNTY MEDICAL CENTER, IS AN EMPLOYEE OF THE CLEVELAND CLINIC. THIS OVERLAP IN RESPONSIBILITY ENSURES PROPER USE OF DISTRIBUTED FUNDS. X X X 0 0 0 0 0 0 0 0 0 SATHISH ADIGOPULA MD CHIEF OF STAFF (THROUGH 12/2020) 584771 0 0 0 12630 0 12000 0 6754 0 616155 0 0 0 ALEXANDER TAICH MD VICE CHIEF OF STAFF 1223751 0 0 0 180 0 12000 0 8629 0 1244560 0 0 0 NATHANIEL S FRANLEY MD PHYSICIAN 647789 0 0 0 65697 0 12000 0 6288 0 731774 0 0 0 LAXMAN R CINGIREDDI MD PHYSICIAN 750864 0 0 0 414 0 10700 0 6754 0 768732 0 0 0 RAJWINDER KAUR MD PHYSICIAN 536584 0 10335 0 76352 0 9856 0 22 0 633149 0 0 0 PAZHANIAANDI TIROUNILACANDIN MD PHYSICIAN 672607 0 0 0 29008 0 12000 0 6271 0 719886 0 0 0 PREETHA MUTHUSAMY MD PHYSICIAN 623693 0 0 0 162 0 10314 0 1830 0 635999 0 0 0 PART I, LINE 3 SALARIES ARE REVIEWED APPROXIMATELY EVERY TWO YEARS. SALARIES ARE COMPARED TO LOCAL, REGIONAL, AND NATIONAL MARKET RATES AND IN CONJUNCTION WITH THE CEO AND CFO TO DETERMINE COMPENSATION. WHEN OPENINGS FOR KEY POSITIONS BECOME AVAILABLE, THE HUMAN RESOURCES DEPARTMENT EXAMINES THE MARKET RATES TO DETERMINE A STARTING SALARY. KIMBERLY GIANGOLA FAMILY MEMBER OF JOSEPH GIANGOLA, ACMC TRUSTEE 31576 EMPLOYMENT AGREEMENT WITH ACMC 0 BRITTANY GILBERT FAMILY MEMBER OF PEG CARLO, ACMC TRUSTEE 70371 EMPLOYMENT AGREEMENT WITH ACMC 0 FORM 990, PART VI, SECTION A, LINE 3 THE CLEVELAND CLINIC FOUNDATION HOLDS AND EXERCISES A MANAGEMENT AGREEMENT WITH ACMC. FORM 990, PART VI, SECTION A, LINE 6 THE CLEVELAND CLINIC FOUNDATION IS THE SOLE SPECIAL MEMBER OF ASHTABULA COUNTY MEDICAL CENTER. FORM 990, PART VI, SECTION A, LINE 7A THE BOARD MEMBERS ARE APPOINTED BY THE CLEVELAND CLINIC FOUNDATION, THE SPECIAL MEMBER. FORM 990, PART VI, SECTION A, LINE 7B THE FOLLOWING MATTERS REQUIRE THE APPROVAL OF THE CLEVELAND CLINIC FOUNDATION, THE SPECIAL MEMBER: (A) CHANGES TO THE ARTICLES OF INCORPORATION OR THE CODE OF REGULATIONS THAT WOULD HAVE A MATERIAL ADVERSE IMPACT ON THE SPECIAL MEMBER'S RIGHTS; (B) ANY AFFILIATION OF ACMC OR ITS SUBSIDIARIES OR AFFILIATES WITH ANY OTHER HOSPITAL, HOSPITAL SYSTEM, OR HEALTH CARE SYSTEM WHICH INCLUDES HOSPITALS AS PART OF SUCH SYSTEM; (C) ANY MATERIAL CHANGE TO ACMC'S OPERATION OR PURPOSE SUCH THAT ACMC'S PRINCIPAL ACTIVITY CEASES TO BE AN ACUTE CARE INPATIENT HOSPITAL OF NO LESS THAN 200 LICENSED BEDS; (D) SELECTION OF ACMC'S PRESIDENT/CEO; AND (E) REVIEW AND COORDINATION WITH ACMC OF ALL MANAGED CARE AND EMPLOYER CONTRACTS. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 REPORT IS PUBLISHED TO THE BOARD OF DIRECTORS' WEBSITE PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C EACH TRUSTEE, PRINCIPAL OFFICER, MEMBER OF A COMMITTEE WITH BOARD-DELEGATED POWERS, AND KEY EMPLOYEE SHALL ANNUALLY SIGN A STATEMENT, WHICH AFFIRMS THAT SUCH PERSON HAS RECEIVED A COPY OF THE CONFLICTS OF INTEREST POLICY, HAS READ AND UNDERSTANDS THE POLICY, HAS AGREED TO COMPLY WITH THE POLICY, AND UNDERSTANDS THAT THE CORPORATION IS A CHARITABLE ORGANIZATION AND THAT IN ORDER TO MAINTAIN ITS FEDERAL TAX EXEMPTION IT MUST ENGAGE PRIMARILY IN ACTIVITIES WHICH ACCOMPLISH ONE OR MORE OF ITS TAX-EXEMPT PURPOSES. IF A PERSON COVERED BY THE CONFLICT OF INTEREST POLICY BELIEVES HE OR SHE HAS A POTENTIAL CONFLICT OF INTEREST, THAT PERSON IS TO DISCLOSE THE CONFLICT TO THE BOARD. AFTER DISCLOSURE OF THE FINANCIAL INTEREST AND ALL MATERIAL FACTS, AND AFTER ANY DISCUSSION WITH THE INTERESTED PERSON, HE OR SHE SHALL LEAVE THE BOARD OR COMMITTEE MEETING WHILE THE DETERMINATION OF A CONFLICT OF INTEREST IS DISCUSSED AND VOTED UPON. THE REMAINING BOARD OR COMMITTEE MEMBERS SHALL DECIDE IF A CONFLICT OF INTEREST EXISTS. THE DISCLOSING PERSON MAY MAKE A PRESENTATION REGARDING THE PROPOSED TRANSACTION/POTENTIAL CONFLICT OF INTEREST AT THE BOARD OR COMMITTEE MEETING, BUT AFTER SUCH PRESENTATION, HE OR SHE SHALL LEAVE THE MEETING DURING THE DISCUSSION OF, AND THE VOTE ON, THE PROPOSED TRANSACTION OR ARRANGEMENT THAT RESULTS IN THE CONFLICT OF INTEREST. THE CHAIRPERSON OF THE BOARD OR COMMITTEE SHALL, IF APPROPRIATE, APPOINT A DISINTERESTED PERSON OR COMMITTEE TO INVESTIGATE ALTERNATIVES TO THE PROPOSED TRANSACTION OR ARRANGEMENT. AFTER EXERCISING DUE DILIGENCE, THE BOARD OR COMMITTEE SHALL DETERMINE WHETHER THE CORPORATION CAN OBTAIN A MORE ADVANTAGEOUS TRANSACTION OR ARRANGEMENT WITH REASONABLE EFFORTS FROM A PERSON OR ENTITY THAT WOULD NOT GIVE RISE TO A CONFLICT OF INTEREST. IF A MORE ADVANTAGEOUS TRANSACTION OR ARRANGEMENT IS NOT REASONABLY ATTAINABLE UNDER CIRCUMSTANCES THAT WOULD NOT GIVE RISE TO A CONFLICT OF INTEREST, THE BOARD OR COMMITTEE SHALL DETERMINE BY A MAJORITY VOTE OF THE DISINTERESTED TRUSTEES WHETHER THE TRANSACTION OR ARRANGEMENT IS IN THE CORPORATION'S BEST INTEREST AND FOR ITS OWN BENEFIT AND WHETHER THE TRANSACTION IS FAIR AND REASONABLE TO THE CORPORATION AND SHALL MAKE ITS DECISION AS TO WHETHER TO ENTER INTO THE TRANSACTION OR ARRANGEMENT IN CONFORMITY WITH SUCH DETERMINATION. IF THE BOARD OR COMMITTEE HAS REASONABLE CAUSE TO BELIEVE THAT A MEMBER HAS FAILED TO DISCLOSE ACTUAL OR POSSIBLE CONFLICTS OF INTEREST, IT SHALL INFORM THE MEMBER OF THE BASIS FOR SUCH BELIEF AND AFFORD THE MEMBER AN OPPORTUNITY TO EXPLAIN THE ALLEGED FAILURE TO DISCLOSE. IF, AFTER HEARING THE RESPONSE OF THE MEMBER AND MAKING SUCH FURTHER INVESTIGATION AS MAY BE WARRANTED IN THE CIRCUMSTANCES, THE BOARD OR COMMITTEE DETERMINES THAT THE MEMBER HAS IN FACT FAILED TO DISCLOSE AN ACTUAL OR POSSIBLE CONFLICT OF INTEREST, IT SHALL TAKE APPROPRIATE DISCIPLINARY AND CORRECTIVE ACTION. FORM 990, PART VI, SECTION B, LINE 15 SALARIES ARE REVIEWED APPROXIMATELY EVERY TWO YEARS. SALARIES ARE COMPARED TO LOCAL, REGIONAL, AND NATIONAL MARKET RATES AND IN CONJUNCTION WITH THE CEO AND CFO TO DETERMINE COMPENSATION. WHEN OPENINGS FOR KEY POSITIONS BECOME AVAILABLE, THE HUMAN RESOURCES DEPARTMENT EXAMINES THE MARKET RATES TO DETERMINE A STARTING SALARY. FORM 990, PART VI, SECTION C, LINE 19 ALL REQUESTS ARE SENT TO THE CEO FOR DISTRIBUTION. FORM 990, PART VII, SECTION A THE FOLLOWING OFFICERS WORKING FULL-TIME FOR ACMC ARE EMPLOYED BY THE CLEVELAND CLINIC AND ARE COMPENSATED THROUGH EMPLOYMENT AGREEMENTS WITH THE CLEVELAND CLINIC: MICHAEL HABOWSKI, PRESIDENT/CEO; DON KEPNER, VP FINANCE/CFO; JACQUELYN DIFIORE, CNO. IN ADDITION, OTHER EXECUTIVES WORK FULL TIME FOR ACMC AND ARE EMPLOYED BY THE CLEVELAND CLINIC, THOSE EXECUTIVES ARE LEW HUTCHISON, VP OF OPERATIONS AND QUALITY AND JONATHAN FORBES, DIRECTOR OF HUMAN RESOURCES. FORM 990, PART IX, LINE 11G MEDICAL SERVICES & FEES: PROGRAM SERVICE EXPENSES 7,896,152. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 7,896,152. OTHER PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 5,389,225. MANAGEMENT AND GENERAL EXPENSES 3,785,902. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 9,175,127. CONSULTING FEES: PROGRAM SERVICE EXPENSES 650,564. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 650,564. FORM 990, PART XI, LINE 9: EQUITY INCOME IN AFFLIATE -250,266. EFFECT OF RECOGNITION PROVISION AT MEASUREMENT DATE OF PENSION OBLIGATION 1,553,745. FEDERAL ELECTIONS SECTION 1.263(A)-1(F) DE MINIMIS SAFE HARBOR ELECTION ASHTABULA COUNTY MEDICAL CENTER 2420 LAKE AVENUE ASHTABULA, OH 44004 EMPLOYER IDENTIFICATION NUMBER: 34-0726081 FOR THE YEAR ENDING DECEMBER 31, 2019. ASHTABULA COUNTY MEDICAL CENTER IS MAKING THE DE MINIMIS SAFE HARBOR ELECTION UNDER REG. SEC. 1.263(A)-1(F). ASHTABULA COUNTY MEDICAL CENTER FOUNDATION 2420 LAKE AVENUE ASHTABULA OH 44004 341392784 SUPPORT THE ASHTABULA COUNTY MEDICAL CENTER OH 501(C)(3) LINE 12A, I ASHTABULA COUNTY MEDICAL CENTER 1 ROCK CREEK MEDICAL CENTER (DBA GLENBEIGH HEALTH SOURCES) 2863 STATE ROUTE 45 ROCK CREEK OH 44084 341789783 OPERATE AND MAINTAIN A HOSPITAL AND OUTPATIENT CENTERS OH 501(C)(3) LINE 3 ASHTABULA COUNTY MEDICAL CENTER 1 ASHTABULA REGIONAL HOME HEALTH SERVICES 3949 JEFFERSON ROAD ASHTABULA OH 44004 341143158 HOME HEALTH SERVICES OH 501(C)(3) LINE 10 ASHTABULA COUNTY MEDICAL CENTER 1 0 1 1 0 0 0 0 0 0 0 0 0 0 1 1 0 1 1 1 ASHTABULA COUNTY MEDICAL CENTER FOUNDATION Q 187948 CASH RECEIVED ASHTABULA REGIONAL HOME HEALTH SERVICES Q 200820 CASH RECEIVED ASHTABULA REGIONAL HOME HEALTH SERVICES B 200000 CASH CONTRIBUTED ROCK CREEK MEDICAL CENTER (DBA GLENBEIGH HEALTH SOURCES) Q 1012604 CASH RECEIVED ROCK CREEK MEDICAL CENTER (DBA GLENBEIGH HEALTH SOURCES) C 9800000 CASH RECEIVED ASHTABULA COUNTY MEDICAL CENTER FOUNDATION C 98028 CASH RECEIVED