UNIVERSITY HOSPITALS HEALTH SYSTEM INC: Form 990, tax year 2017
View the entire original 990 at ProPublica ↗
- Organization
- UNIVERSITY HOSPITALS HEALTH SYSTEM INC (EIN 34-1425870)
- Tax period
- 2017-01-01 to 2017-12-31
- Filed
- 2018-11-15
- IRS object ID
- 201813199349316431
- Schema version
- 2017v2.3
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
- Return header
- Form 990
- Schedule A
- Schedule B
- Schedule C
- Schedule D
- Schedule F
- Schedule H
- Schedule J
- Schedule K
- Schedule L
- Schedule M
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2018-11-15T16:26:41-06:00 | ReturnTs |
| Tax Period End | 2017-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 381357951 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | PLANTE & MORAN PLLC | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 250 S HIGH ST SUITE 100 | AddressLine1Txt |
| City | COLUMBUS | CityNm |
| State Abbreviation | OH | StateAbbreviationCd |
| ZIP | 43215 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2017-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 341425870 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | LAKE HOSPITAL SYSTEM INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | LAKE | BusinessNameControlTxt |
| Phone | 4403541991 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 7590 AUBURN ROAD | AddressLine1Txt |
| City | CONCORD | CityNm |
| State Abbreviation | OH | StateAbbreviationCd |
| ZIP | 44077 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | ROBERT TRACZ | PersonNm |
| Person Title | SENIOR VP & CFO | PersonTitleTxt |
| Phone | 4403541991 | PhoneNum |
| Signature | 2018-11-15 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | BERNIE OSTROWSKI | PreparerPersonNm |
| PTIN | P00366367 | PTIN |
| Phone | 6148493000 | PhoneNum |
| Preparation | 2018-11-14 | PreparationDt |
Filing Security Information FilingSecurityInformation
IP Address IPAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| I Pv4 Address | 67.59.56.30 | IPv4AddressTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| IP | 2018-11-15 | IPDt |
| IP Tm | 06:59:27 | IPTm |
| IP Timezone | ES | IPTimezoneCd |
| Filing License Type | P | FilingLicenseTypeCd |
| At Submission Creation Device Id | DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 | AtSubmissionCreationDeviceId |
| At Submission Filing Device Id | DCADD2CDA100FC630949EB2812E82144C693340D | AtSubmissionFilingDeviceId |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2017 | TaxYr |
| Build TS | 2019-02-21 02:37:17Z | BuildTS |
Form 990 IRS990
Doing Business As Name DoingBusinessAsName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | LAKE HEALTH | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | CYNTHIA MOORE-HARDY | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 7590 AUBURN ROAD | AddressLine1Txt |
| City | CONCORD | CityNm |
| State Abbreviation | OH | StateAbbreviationCd |
| ZIP | 44077 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $511,854,344 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.LAKEHEALTH.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1983 | FormationYr |
| Legal Domicile State | OH | LegalDomicileStateCd |
| Activity Or Mission | 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. | ActivityOrMissionDesc |
| Voting Members Governing Body | 11 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 11 | VotingMembersIndependentCnt |
| Total Employee | 3222 | TotalEmployeeCnt |
| Total Volunteers | 927 | TotalVolunteersCnt |
| Total Gross UBI | $2,803,215 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $2,061,715 | PYContributionsGrantsAmt |
| CY Contributions Grants | $2,246,424 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $356,065,510 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $367,307,188 | CYProgramServiceRevenueAmt |
| PY Investment Income | $35,962,483 | PYInvestmentIncomeAmt |
| CY Investment Income | $5,721,441 | CYInvestmentIncomeAmt |
| PY Other Revenue | $12,046,201 | PYOtherRevenueAmt |
| CY Other Revenue | $17,646,600 | CYOtherRevenueAmt |
| PY Total Revenue | $406,135,909 | PYTotalRevenueAmt |
| CY Total Revenue | $392,921,653 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $151,141,353 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $180,076,116 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $241,814,547 | PYOtherExpensesAmt |
| CY Other Expenses | $211,660,742 | CYOtherExpensesAmt |
| PY Total Expenses | $392,955,900 | PYTotalExpensesAmt |
| CY Total Expenses | $391,736,858 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $13,180,009 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $1,184,795 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $539,165,156 | TotalAssetsBOYAmt |
| Total Assets EOY | $549,215,936 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $320,583,857 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $311,984,993 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $218,581,299 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $237,230,943 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | IT IS LAKE HOSPITAL SYSTEM'S MISSION 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. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $339,392,108 | ExpenseAmt |
| Grant | $0 | GrantAmt |
| Revenue | $380,153,047 | RevenueAmt |
| Desc | 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 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, CONGESTIVE HEART FAILURE, HEART DISEASE, ACCESS TO PREVENTIVE SCREENINGS, AND HIGH BLOOD PRESSURE. LAKE HEALTH IS COMPRISED OF 12 FACILITIES IN LAKE AND GEAUGA COUNTIES, WHICH INCLUDE THE FOLLOWING:1. TRIPOINT MEDICAL CENTER (FULL-SERVICE, ACUTE CARE HOSPITAL)2. WEST MEDICAL CENTER (FULL-SERVICE, ACUTE CARE HOSPITAL)3. MENTOR CAMPUS (OUTPATIENT LAB AND DIAGNOSTICS, PHYSICIAN OFFICES, CANCER SERVICES)4. MENTOR WELLNESS CAMPUS (URGENT CARE, OUTPATIENT LAB AND DIAGNOSTICS, PHYSICIAN OFFICES, PHYSICAL THERAPY, OCCUPATIONAL HEALTH SERVICES AND A MEDICALLY BASED FITNESS CENTER)5. MADISON CAMPUS (FREE-STANDING ER, OUTPATIENT LAB AND DIAGNOSTICS, PHYSICIAN OFFICES, PHYSICAL THERAPY)6. WILLOWICK CAMPUS (URGENT CARE, OUTPATIENT LAB AND DIAGNOSTICS, PHYSICIAN OFFICES)7. CHARDON CAMPUS (URGENT CARE, OUTPATIENT LAB AND DIAGNOSTICS, PHYSICIAN OFFICES)8. PAINESVILLE QUICK CARE CENTER (WALK-IN CARE)9. PERRICO HEALTH CAMPUS (PHYSICIAN OFFICES, PHYSICAL THERAPY, LAB)10. SOM CENTER CAMPUS (PHYSICIAN OFFICES, LAB AND DIAGNOSTICS)11. CONTINUING CARE CAMPUS (COMPREHENSIVE, INPATIENT REHABILITATION; GERIATRIC PSYCHIATRY)12. WILLOUGHBY HILLS DIAGNOSTICS (OUTPATIENT IMAGING)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 ALSO 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 WITHIN THE MADISON CAMPUS. THESE EMERGENCY DEPARTMENTS ARE OPEN TO ALL PERSONS, REGARDLESS OF ABILITY TO PAY.FOR THE 16TH YEAR IN A ROW, LAKE HEALTH WAS HONORED 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. IN FACT, TAKING HEALTH EDUCATION PROGRAMS AND SCREENINGS TO WHERE PEOPLE LIVE, WORK AND PLAY IS FUNDAMENTAL TO OUR MISSION. IN 2017, WE PROVIDED OVER $450,000 IN COMMUNITY BENEFIT THROUGH HEALTH EDUCATION PROGRAMS, EXCLUDING BLOOD DRIVES. THIS INCLUDES PHYSICIAN LECTURES, FREE OR LOW-COST SCREENINGS, PRINTED MATERIALS, AMENITIES, ETC. LAKE HEALTH CONTRIBUTED APPROXIMATELY $300,000 IN 2017 IN CASH AND IN-KIND DONATIONS TO CIVIC AND COMMUNITY EVENTS, 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 DEPARTMENT AND/OR OUR COMMUNITY OUTREACH COORDINATOR.COMMUNITY PROGRAMS AND EVENTS: AMERICAN HEART WALK INFANT AND CHILDBIRTH PROGRAMS INCLUDING CHILDBIRTH PREPARATION, INFANT CARE, BREASTFEEDING PROGRAM, SIBLING PROGRAM, INFANT AND CHILD CPR, AND CAR SEAT CHECKS. BE FIT FOR LIFE HEART SMART KIDS ASSEMBLY (FORMERLY HEALTHY HEART PROGRAM) LIFECYCLES FOR WOMEN EVENT SENIOR CONNECTION LUNCH & LEARN PROGRAMS COMMUNITY HEALTH LECTURES SUPPORT GROUPS, INCLUDING BREAST CANCER, DIABETES, STROKE, AMPUTEE AND PULMONARY PARTICIPATION IN THE 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 MONTHLY BLOOD PRESSURE SCREENINGS.LAKE HEALTH JOINED FORCES WITH LAKE METROPARKS, LAKE COUNTY YMCA AND THE LAKE COUNTY GENERAL HEALTH DISTRICT AGAIN IN 2017 TO CONTINUE BE FIT FOR LIFE (FORMERLY GET HEALTHY LAKE COUNTY), A COUNTYWIDE INITIATIVE THAT FEATURES EDUCATION, PREVENTION AND WELLNESS PROGRAMS TO ENHANCE AND IMPROVE THE QUALITY OF LIFE IN LAKE COUNTY AND NEIGHBORING COMMUNITIES. THE INITIATIVE INCLUDES THE B FIT 4 LIFE FITNESS CHALLENGE IN WHICH AREA BUSINESSES VIE FOR THE MOST POINTS AS THEIR EMPLOYEES EXERCISE THEIR WAY TO BETTER HEALTH. | Desc |
| Total Program Service Expenses | $339,392,108 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | Yes (1) | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Temp Or Permanent Endowments | Yes (1) | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | 0 | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (1) | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | Yes (1) | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | Yes (1) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (1) | AuditedFinancialStmtAttInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | Yes (1) | TaxExemptBondsInd |
| Invest Tax Exempt Bonds | 0 | InvestTaxExemptBondsInd |
| Escrow Account | 0 | EscrowAccountInd |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuerInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | Yes (1) | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | 0 | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | Yes (1) | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | Yes (1) | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | Yes (1) | RelatedOrganizationCtrlEntInd |
| Transaction With Control Ent | Yes (1) | TransactionWithControlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 302 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 3222 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | Yes (1) | UnrelatedBusIncmOverLimitInd |
| Form990 T Filed | Yes (1) | Form990TFiledInd |
| Foreign Financial Account | Yes (1) | ForeignFinancialAccountInd |
| Foreign Country | CJ | ForeignCountryCd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 11 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 11 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | 0 | MembersOrStockholdersInd |
| Election Of Board Members | 0 | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | 0 | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | 0 | CompensationProcessCEOInd |
| Compensation Process Other | 0 | CompensationProcessOtherInd |
| Investment In Joint Venture | Yes (1) | InvestmentInJointVentureInd |
| Written Policy Or Procedure | Yes (1) | WrittenPolicyOrProcedureInd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | LISA MOTHERSBAUGH | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 4403541984 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 7590 AUBURN ROAD | AddressLine1Txt |
| City | CONCORD | CityNm |
| State Abbreviation | OH | StateAbbreviationCd |
| ZIP | 44077 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (26 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Key EmployeeKeyEmployeeInd | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|---|
| MICHAEL E MAYHER | |||||||||
| CHAIR | 5.00 | 0.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| DAVID STEIGER MD | |||||||||
| VICE CHAIR | 5.00 | 0.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| LISA KLAMMER ESQ | |||||||||
| SECRETARY | 2.00 | 0.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| BRETT HIMES | |||||||||
| TREASURER | 2.00 | 0.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| THOMAS P JUBECK | |||||||||
| TRUSTEE (FORMER CHAIR-03/2017) | 2.00 | 0.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| I JAMES HACKENBERG ESQ | |||||||||
| TRUSTEE | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |||
| FRANK JEVNIKAR MD | |||||||||
| TRUSTEE | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |||
| JOHN F PLATZ | |||||||||
| TRUSTEE | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |||
| ROBERT G SCHIEBLI | |||||||||
| TRUSTEE | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |||
| STEPHEN C ELLIS | |||||||||
| TRUSTEE | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |||
| RODNEY HOWELL | |||||||||
| TRUSTEE | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |||
| RAYMOND SINES | |||||||||
| TRUSTEE | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |||
| PAUL SIRCKO | |||||||||
| TRUSTEE (UNTIL 03/17) | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |||
| SUSAN TULLAI-MCGUINNESS | |||||||||
| TRUSTEE (UNTIL 03/17) | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |||
| RICHARD MORRISON | |||||||||
| TRUSTEE (UNTIL 03/17) | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |||
| CYNTHIA MOORE-HARDY | |||||||||
| PRESIDENT AND CEO | 55.00 | 0.00 | Yes (X) | $813,575 | $0 | $25,243 | |||
| ROBERT TRACZ | |||||||||
| SR. VP/CFO | 50.00 | 5.00 | Yes (X) | $446,980 | $0 | $23,611 | |||
| JOHN BANIEWICZ MD | |||||||||
| SR VP, MEDICAL AFFAIRS | 45.00 | 10.00 | $483,014 | $0 | $24,421 | Yes (X) | |||
| STEVE R KARNS | |||||||||
| SR VP, ADMINISTRATIVE SERVICES | 55.00 | 0.00 | $751,595 | $0 | $21,363 | Yes (X) | |||
| RICHARD D CICERO | |||||||||
| SR VP, MARKETING & BUSINESS DEVELOPMENT | 45.00 | 10.00 | $467,733 | $0 | $20,584 | Yes (X) | |||
| MARY L OGRINC | |||||||||
| SR VP, PATIENT CARE SERVICES, CNO | 55.00 | 0.00 | $605,195 | $0 | $18,506 | Yes (X) | |||
| JOYCE A TAYLOR | |||||||||
| VP, QUALITY SERVICES, CQO | 40.00 | 0.00 | $205,191 | $0 | $9,398 | Yes (X) | |||
| CYNTHIA J RACER | |||||||||
| VP, CLINICAL SERVICES | 40.00 | 0.00 | $182,621 | $0 | $14,251 | Yes (X) | |||
| JERROLD M PETERS | |||||||||
| VP, INFORMATION TECH/CIO | 40.00 | 0.00 | $308,015 | $0 | $6,392 | Yes (X) | |||
| DAVID HERMAN | |||||||||
| VP, FINANCE | 40.00 | 0.00 | $186,817 | $0 | $16,443 | Yes (X) | |||
| ANDREA WASDOVICH | |||||||||
| VP, PERIOPERATIVE/CRITICAL CARE SERVICES (FORMER-1 | 40.00 | 0.00 | $153,932 | $0 | $5,054 | Yes (X) | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $4,604,668 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $185,266 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 63 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| CERNER HEALTH SERVICES INC | |||||
| PO BOX 959167 | ST LOUIS | MO | 631959167 | INFO TECH CONSULTING | $5,247,716 |
| CROTHALL HEALTHCARE INC | |||||
| 13028 COLLECTIONS CENTER DR | CHICAGO | IL | 60693 | HOUSEKEEPING | $4,295,999 |
| SODEXO INC AND AFFILIATES | |||||
| PO BOX 360170 | PITTSBURG | PA | 152516170 | NUTRITION SERVICES | $4,097,043 |
| COMMUNITY HOSPITALISTS LLC | |||||
| 30680 BAINBRIDGE ROAD | SOLON | OH | 44139 | MEDICAL PROVIDERS | $3,966,882 |
| CONVERGENT REVENUE CYCLE MANAGEMENT INC | |||||
| PO BOX 677688 | DALLAS | TX | 75267 | CONSULTING | $3,100,428 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 230 | CntrctRcvdGreaterThan100KCnt |
| Related Organizations | $1,670,424 | RelatedOrganizationsAmt |
| All Other Contributions | $576,000 | AllOtherContributionsAmt |
| Noncash Contributions | $1,012,329 | NoncashContributionsAmt |
| Total Contributions | $2,246,424 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | PATIENT CARE | Desc |
| Business | 621110 | BusinessCd |
| Total Revenue Column | $367,307,188 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $364,939,994 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $2,367,194 | UnrelatedBusinessRevenueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $367,307,188 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $6,543,434 | TotalRevenueColumnAmt |
| Exclusion | $6,543,434 | ExclusionAmt |
Incm From Invest Bond Proceeds IncmFromInvestBondProceedsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $8,669 | TotalRevenueColumnAmt |
| Exclusion | $8,669 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $2,433,547 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $0 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $2,433,547 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $2,433,547 | TotalRevenueColumnAmt |
| Unrelated Business Revenue | $436,021 | UnrelatedBusinessRevenueAmt |
| Exclusion | $1,997,526 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $65,513,710 | SecuritiesAmt |
| Other | $52,588,319 | OtherAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $66,101,745 | SecuritiesAmt |
| Other | $52,830,946 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | -$588,035 | SecuritiesAmt |
| Other | -$242,627 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$830,662 | TotalRevenueColumnAmt |
| Exclusion | -$830,662 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| RELATED SALES AND SERVICES | 621110 | $6,795,866 | $6,795,866 |
| CMS INCENTIVE PAYMENTS | 621110 | $3,188,743 | $3,188,743 |
| PURCHASE DISCOUNTS | 621110 | $2,398,564 | $2,398,564 |
Miscellaneous Revenue MiscellaneousRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $2,829,880 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $2,829,880 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $15,213,053 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $392,921,653 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $380,153,047 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $2,803,215 | UnrelatedBusinessRevenueAmt |
| Exclusion | $7,718,967 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,701,820 | TotalAmt |
| Management And General | $3,701,820 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $149,990,685 | TotalAmt |
| Program Services | $126,632,643 | ProgramServicesAmt |
| Management And General | $23,358,042 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,830,985 | TotalAmt |
| Program Services | $1,506,791 | ProgramServicesAmt |
| Management And General | $324,194 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $15,584,581 | TotalAmt |
| Program Services | $12,672,295 | ProgramServicesAmt |
| Management And General | $2,912,286 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $8,968,045 | TotalAmt |
| Program Services | $7,380,166 | ProgramServicesAmt |
| Management And General | $1,587,879 | ManagementAndGeneralAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,331,900 | TotalAmt |
| Program Services | $1,312,050 | ProgramServicesAmt |
| Management And General | $19,850 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $653,413 | TotalAmt |
| Program Services | $585,564 | ProgramServicesAmt |
| Management And General | $67,849 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $100,666 | TotalAmt |
| Management And General | $100,666 | ManagementAndGeneralAmt |
Fees For Services Lobbying FeesForServicesLobbyingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $20,926 | TotalAmt |
| Program Services | $4,894 | ProgramServicesAmt |
| Management And General | $16,032 | ManagementAndGeneralAmt |
Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $843,867 | TotalAmt |
| Management And General | $843,867 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $43,633,533 | TotalAmt |
| Program Services | $36,543,840 | ProgramServicesAmt |
| Management And General | $7,089,693 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,695,748 | TotalAmt |
| Program Services | $985,231 | ProgramServicesAmt |
| Management And General | $710,517 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,294,166 | TotalAmt |
| Program Services | $4,543,086 | ProgramServicesAmt |
| Management And General | $751,080 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $11,357,806 | TotalAmt |
| Program Services | $10,584,457 | ProgramServicesAmt |
| Management And General | $773,349 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $12,426,896 | TotalAmt |
| Program Services | $10,910,735 | ProgramServicesAmt |
| Management And General | $1,516,161 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $153,284 | TotalAmt |
| Program Services | $153,284 | ProgramServicesAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $566,469 | TotalAmt |
| Program Services | $467,642 | ProgramServicesAmt |
| Management And General | $98,827 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $6,086,260 | TotalAmt |
| Program Services | $6,067,799 | ProgramServicesAmt |
| Management And General | $18,461 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $24,270,458 | TotalAmt |
| Program Services | $16,940,553 | ProgramServicesAmt |
| Management And General | $7,329,905 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,552,131 | TotalAmt |
| Program Services | $3,990,698 | ProgramServicesAmt |
| Management And General | $561,433 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| MEDICAL SUPPLIES | $62,081,223 | $62,081,223 | |
| BAD DEBT | $29,586,727 | $29,586,727 | |
| HOSPITAL FRANCHISE FEE | $5,100,630 | $5,100,630 | |
| MEMBERSHIP DUES | $786,512 | $223,673 | $562,839 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,118,127 | TotalAmt |
| Program Services | $1,118,127 | ProgramServicesAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $391,736,858 | TotalAmt |
| Program Services | $339,392,108 | ProgramServicesAmt |
| Management And General | $52,344,750 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,432,118 | BOYAmt |
| EOY | $790,747 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $40,623,321 | BOYAmt |
| EOY | $41,977,123 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,375,101 | BOYAmt |
| EOY | $4,372,097 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $12,188,352 | BOYAmt |
| EOY | $10,319,114 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $516,278,970 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $290,524,845 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $232,226,821 | BOYAmt |
| EOY | $225,754,125 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $235,256,235 | BOYAmt |
| EOY | $240,970,947 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $13,063,208 | BOYAmt |
| EOY | $25,031,783 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $539,165,156 | BOYAmt |
| EOY | $549,215,936 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $40,089,162 | BOYAmt |
| EOY | $39,241,076 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $474,809 | BOYAmt |
| EOY | $393,298 | EOYAmt |
Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $223,338,554 | BOYAmt |
| EOY | $219,712,975 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $56,681,332 | BOYAmt |
| EOY | $52,637,644 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $320,583,857 | BOYAmt |
| EOY | $311,984,993 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $218,581,299 | BOYAmt |
| EOY | $237,230,943 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $218,581,299 | BOYAmt |
| EOY | $237,230,943 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $539,165,156 | BOYAmt |
| EOY | $549,215,936 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | $1,184,795 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | $20,624,475 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | -$3,159,624 | OtherChangesInNetAssetsAmt |
| Info In Schedule O Part XII | Yes (X) | InfoInScheduleOPartXIIInd |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule B IRS990ScheduleB
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | 0 | VolunteersInd |
| Paid Staff Or Management | Yes (1) | PaidStaffOrManagementInd |
| Media Advertisements | 0 | MediaAdvertisementsInd |
| Mailings Members | 0 | MailingsMembersInd |
| Publications Or Broadcast | 0 | PublicationsOrBroadcastInd |
| Grants Other Organizations | 0 | GrantsOtherOrganizationsInd |
| Direct Contact Legislators | Yes (1) | DirectContactLegislatorsInd |
| Direct Contact Legislators | $4,894 | DirectContactLegislatorsAmt |
| Rallies Demonstrations | 0 | RalliesDemonstrationsInd |
| Other Activities | Yes (1) | OtherActivitiesInd |
| Other Activities | $16,032 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $20,926 | TotalLobbyingExpendituresAmt |
| Not Described Section501c3 | 0 | NotDescribedSection501c3Ind |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART II-B, LINE 1: | FormAndLineReferenceDesc |
| Explanation | LINE 1B: PAID WAGES OF VP, GOVERNMENTAL AFFAIRS AND PUBLIC RELATIONS, IN THE CONTEXT OF NETWORKING AND MAINTAINING RELATIONSHIPS WITH INDIVIDUALS, ORGANIZATIONS, AND ENTITIES THAT CREATE, INFLUENCE, VOTE, OR OTHERWISE DETERMINE POLICY FOR THE HEALTHCARE INDUSTRY AND HOSPITALS, SPECIFICALLY. LINE 1G: OCCURS IN THE ROUTINE COURSE OF BUSINESS FOR EDUCATIONAL, COMPLIANCE, AND POLICY ISSUES RELATIVE TO LAKE HEALTH FOR THE VP, GOVERNMENTAL AFFAIRS AND PUBLIC RELATIONS. LINE 1I: MEMBERSHIP DUES PAID TO HOSPITAL INDUSTRY ASSOCIATIONS AND ORGANIZATIONS, THE PERCENTAGE OF WHICH IS REPORTED UNDER IRS RULES AS LOBBYING EXPENSE. | ExplanationTxt |
Schedule D IRS990ScheduleD
CY Endwmt Fund CYEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $6,265,843 | BeginningYearBalanceAmt |
| Contributions | $1,432,011 | ContributionsAmt |
| Investment Earnings Or Losses | $434,510 | InvestmentEarningsOrLossesAmt |
| Grants Or Scholarships | $30,544 | GrantsOrScholarshipsAmt |
| Other Expenditures | $1,267,206 | OtherExpendituresAmt |
| End Year Balance | $6,834,614 | EndYearBalanceAmt |
CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $4,930,675 | BeginningYearBalanceAmt |
| Contributions | $1,469,849 | ContributionsAmt |
| Investment Earnings Or Losses | $235,080 | InvestmentEarningsOrLossesAmt |
| Grants Or Scholarships | $5,200 | GrantsOrScholarshipsAmt |
| Other Expenditures | $364,561 | OtherExpendituresAmt |
| End Year Balance | $6,265,843 | EndYearBalanceAmt |
CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $4,498,522 | BeginningYearBalanceAmt |
| Contributions | $848,337 | ContributionsAmt |
| Investment Earnings Or Losses | $98,143 | InvestmentEarningsOrLossesAmt |
| Grants Or Scholarships | $10,200 | GrantsOrScholarshipsAmt |
| Other Expenditures | $504,127 | OtherExpendituresAmt |
| End Year Balance | $4,930,675 | EndYearBalanceAmt |
CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $4,690,654 | BeginningYearBalanceAmt |
| Contributions | $318,956 | ContributionsAmt |
| Investment Earnings Or Losses | $123,314 | InvestmentEarningsOrLossesAmt |
| Grants Or Scholarships | $13,500 | GrantsOrScholarshipsAmt |
| Other Expenditures | $620,902 | OtherExpendituresAmt |
| End Year Balance | $4,498,522 | EndYearBalanceAmt |
CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $4,014,355 | BeginningYearBalanceAmt |
| Contributions | $919,340 | ContributionsAmt |
| Investment Earnings Or Losses | $479,684 | InvestmentEarningsOrLossesAmt |
| Grants Or Scholarships | $27,827 | GrantsOrScholarshipsAmt |
| Other Expenditures | $694,898 | OtherExpendituresAmt |
| End Year Balance | $4,690,654 | EndYearBalanceAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Board Designated Balance EOY | 0.01020 | BoardDesignatedBalanceEOYPct |
| Prmnnt Endowment Balance EOY | 0.46840 | PrmnntEndowmentBalanceEOYPct |
| Term Endowment Balance EOY | 0.52140 | TermEndowmentBalanceEOYPct |
| Endowments Held Unrelated Org | 0 | EndowmentsHeldUnrelatedOrgInd |
| Endowments Held Related Org | Yes (1) | EndowmentsHeldRelatedOrgInd |
| Related Org List Sch R | Yes (1) | RelatedOrgListSchRInd |
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $13,668,329 | OtherCostOrOtherBasisAmt |
| Book Value | $13,668,329 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $207,287,707 | OtherCostOrOtherBasisAmt |
| Depreciation | $72,423,381 | DepreciationAmt |
| Book Value | $134,864,326 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $5,306,281 | OtherCostOrOtherBasisAmt |
| Depreciation | $1,793,302 | DepreciationAmt |
| Book Value | $3,512,979 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $263,004,919 | OtherCostOrOtherBasisAmt |
| Depreciation | $206,682,765 | DepreciationAmt |
| Book Value | $56,322,154 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $27,011,734 | OtherCostOrOtherBasisAmt |
| Depreciation | $9,625,397 | DepreciationAmt |
| Book Value | $17,386,337 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $225,754,125 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (7 entries)
| DescDesc | AmtAmt |
|---|---|
| THIRD PARTY SETTLEMENTS | $3,265,084 |
| WORKERS COMPENSATION LIABILITY | $1,587,989 |
| DEFERRED COMPENSATION | $5,786,668 |
| LEASE OBLIGATION | $452,675 |
| ACCRUED SELF-INSURANCE | $962,191 |
| MARKETING LIABILITY | $20,000 |
| INTEREST RATE SWAP | $40,563,037 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $52,637,644 | TotalLiabilityAmt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART V, LINE 4: | FormAndLineReferenceDesc |
| Explanation | LAKE HEALTH'S PERMANENT ENDOWMENT AND TEMPORARILY RESTRICTED ENDOWMENT FUNDS 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 TO USE IN REALIZING LAKE HEALTH'S VISION OF PROVIDING HEALTH CARE FOR THE COMMUNITY. THE FOUNDATION'S SOLE MEMBER IS LAKE HEALTH. | ExplanationTxt |
Schedule F IRS990ScheduleF
Account Activities Outside US AccountActivitiesOutsideUSGrp (2 entries)
| RegionRegionTxt | Type Of Activities ConductedTypeOfActivitiesConductedTxt | Specific Services ProvidedSpecificServicesProvidedTxt | Region Total ExpendituresRegionTotalExpendituresAmt |
|---|---|---|---|
| CENTRAL AMERICA AND THE CARIBBEAN - ANTIGUA & BARBUDA, ARUBA, BAHAMAS, | PROGRAM SERVICES | PROGRAM-RELATED INVESTMENTS | $18,594,546 |
| CENTRAL AMERICA AND THE CARIBBEAN - ANTIGUA & BARBUDA, ARUBA, BAHAMAS, | PROGRAM SERVICES | MANAGEMENT FEES RELATED TO LHS ASSURANCE, LTD. | $165,477 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Subtotal Offices | 0 | SubtotalOfficesCnt |
| Subtotal Employees | 0 | SubtotalEmployeesCnt |
| Continuation Total Office | 0 | ContinuationTotalOfficeCnt |
| Continuation Total Employee | 0 | ContinuationTotalEmployeeCnt |
| Total Office | 0 | TotalOfficeCnt |
| Total Employee | 0 | TotalEmployeeCnt |
| Subtotal Spent | $18,760,023 | SubtotalSpentAmt |
| Continuation Spent | $0 | ContinuationSpentAmt |
| Total Spent | $18,760,023 | TotalSpentAmt |
| Transfer To Foreign Corp | 0 | TransferToForeignCorpInd |
| Interest In Foreign Trust | 0 | InterestInForeignTrustInd |
| Foreign Corp Ownership | Yes (1) | ForeignCorpOwnershipInd |
| Passive Foreign Investmest Co | 0 | PassiveForeignInvestmestCoInd |
| Foreign Partnership | 0 | ForeignPartnershipInd |
| Boycott Countries | 0 | BoycottCountriesInd |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (1) | FinancialAssistancePolicyInd |
| Written Policy | Yes (1) | WrittenPolicyInd |
| All Hospitals Policy | Yes (X) | AllHospitalsPolicyInd |
| FPG Reference Free Care | Yes (1) | FPGReferenceFreeCareInd |
Free Care Oth Percentage FreeCareOthPercentageGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | Yes (X) | OtherInd |
| Free Care Other | 250.000000000000 | FreeCareOtherPct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| FPG Reference Discounted Care | Yes (1) | FPGReferenceDiscountedCareInd |
| Percent400 | Yes (X) | Percent400Ind |
| Free Care Medically Indigent | Yes (1) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (1) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | 0 | ExpensesExceedBudgetInd |
| Annual Community Bnft Report | Yes (1) | AnnualCommunityBnftReportInd |
| Report Publically Available | Yes (1) | ReportPublicallyAvailableInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $3,932,073 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $7,825,072 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00000 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $53,482,314 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $29,456,543 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $24,025,771 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.06130 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $57,414,387 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $37,281,615 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $24,025,771 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.06130 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $432,908 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $432,908 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00110 | TotalExpensePct |
Subsidized Health Services SubsidizedHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $2,119,269 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $2,119,269 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00540 | TotalExpensePct |
Cash And In Kind Contributions CashAndInKindContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,024,753 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $1,024,753 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00260 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $3,576,930 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $3,576,930 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00910 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $60,991,317 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $37,281,615 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $27,602,701 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.07040 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (1) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $29,586,727 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $0 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $80,450,528 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $90,343,805 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$9,893,277 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | Yes (X) | CostToChargeRatioInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | Yes (1) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (1) | FinancialAssistancePrvsnInd |
Management Co And Jnt Ventures ManagementCoAndJntVenturesGrp (7 entries)
| Primary ActivitiesPrimaryActivitiesTxt | Org Profit Or OwnershipOrgProfitOrOwnershipPct | Ofcr Etc Profit Or OwnershipOfcrEtcProfitOrOwnershipPct | Physicians Profit Or OwnershipPhysiciansProfitOrOwnershipPct |
|---|---|---|---|
| 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 MANA CLG LLC | |||
| INVESTMENT IN FUTURE SITE | 0.51000 | 0.00000 | 0.49000 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital Facilities | 2 | HospitalFacilitiesCnt |
Hospital Facilities HospitalFacilitiesGrp (2 entries)
| FacilityFacilityNum | Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | Website AddressWebsiteAddressTxt | Licensed HospitalLicensedHospitalInd | General Medical And SurgicalGeneralMedicalAndSurgicalInd | Emergency Room24 HrsEmergencyRoom24HrsInd |
|---|---|---|---|---|---|---|---|---|
| WEST MEDICAL CENTER | ||||||||
| 1 | 36000 EUCLID AVENUE | WILLOUGHBY | OH | 44094 | WWW.LAKEHEALTH.ORG | Yes (X) | Yes (X) | Yes (X) |
| TRIPOINT MEDICAL CENTER | ||||||||
| 2 | 7590 AUBURN ROAD | CONCORD | OH | 44077 | WWW.LAKEHEALTH.ORG | Yes (X) | Yes (X) | Yes (X) |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp (2 entries)
| FacilityFacilityNum | First Licensed CY Or PYFirstLicensedCYOrPYInd | Tax Exempt Hospital CY Or PYTaxExemptHospitalCYOrPYInd | CHNA ConductedCHNAConductedInd | Community DefinitionCommunityDefinitionInd | Community DemographicsCommunityDemographicsInd | Existing ResourcesExistingResourcesInd | How Data ObtainedHowDataObtainedInd | Community Health NeedsCommunityHealthNeedsInd | Other Health IssuesOtherHealthIssuesInd | Community Hlth Needs Id ProcessCommunityHlthNeedsIdProcessInd | Consulting ProcessConsultingProcessInd | Prior CHNA ImpactPriorCHNAImpactInd | CHNA ConductedCHNAConductedYr | Take Into Account Others InputTakeIntoAccountOthersInputInd | CHNA Conducted With Other FcltsCHNAConductedWithOtherFcltsInd | CHNA Conducted With Non FcltsCHNAConductedWithNonFcltsInd | CHNA Report Widely AvailableCHNAReportWidelyAvailableInd | Rpt Available On Own WebsiteRptAvailableOnOwnWebsiteInd | Own Website URLOwnWebsiteURLTxt | Paper Copy Public InspectionPaperCopyPublicInspectionInd | Implementation Strategy AdoptImplementationStrategyAdoptInd | Implementation Strategy AdptImplementationStrategyAdptYr | Strategy Posted WebsiteStrategyPostedWebsiteInd | Strategy Website URLStrategyWebsiteURLTxt | Organization Incur Excise TaxOrganizationIncurExciseTaxInd | Elig Criteria ExplainedEligCriteriaExplainedInd | FPG Family Incm Lmt Free DscntFPGFamilyIncmLmtFreeDscntInd | FPG Family Incm Lmt Free CareFPGFamilyIncmLmtFreeCarePct | FPG Family Incm Lmt Dscnt CareFPGFamilyIncmLmtDscntCarePct | Income Level CriteriaIncomeLevelCriteriaInd | Asset Level CriteriaAssetLevelCriteriaInd | Medical Indigency CriteriaMedicalIndigencyCriteriaInd | Insurance Status CriteriaInsuranceStatusCriteriaInd | Underinsurance Stat CriteriaUnderinsuranceStatCriteriaInd | Residency CriteriaResidencyCriteriaInd | Explained BasisExplainedBasisInd | App Financial Asst ExplnAppFinancialAsstExplnInd | Described InfoDescribedInfoInd | Described Suprt DocDescribedSuprtDocInd | Provided Hospital ContactProvidedHospitalContactInd | Other MethodOtherMethodInd | Includes Publicity MeasuresIncludesPublicityMeasuresInd | FAP Available On WebsiteFAPAvailableOnWebsiteInd | FAP Available On Website URLFAPAvailableOnWebsiteURLTxt | FAP App Available On WebsiteFAPAppAvailableOnWebsiteInd | FAP App Available On Website URLFAPAppAvailableOnWebsiteURLTxt | FAP Summary On WebsiteFAPSummaryOnWebsiteInd | FAP Summary On Website URLFAPSummaryOnWebsiteURLTxt | FAP Avlbl On Request No ChargeFAPAvlblOnRequestNoChargeInd | FAP App Avlbl On Request No ChrgFAPAppAvlblOnRequestNoChrgInd | FAP Sum Avlbl On Request No ChrgFAPSumAvlblOnRequestNoChrgInd | Notified FAP Copy Bill DisplayNotifiedFAPCopyBillDisplayInd | Communtity Notified FAPCommuntityNotifiedFAPInd | FAP Actions On NonpaymentFAPActionsOnNonpaymentInd | Permit No ActionsPermitNoActionsInd | Collection ActivitiesCollectionActivitiesInd | Provided Written NoticeProvidedWrittenNoticeInd | Made Effort Orally NotifyMadeEffortOrallyNotifyInd | Processed FAP ApplicationProcessedFAPApplicationInd | Made Presumptive Elig DetermMadePresumptiveEligDetermInd | Nondis Emergency Care PolicyNondisEmergencyCarePolicyInd | Prospective Medicare MedicaidProspectiveMedicareMedicaidInd | Amounts Generally BilledAmountsGenerallyBilledInd | Gross ChargesGrossChargesInd |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| WEST MEDICAL CENTER | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| 1 | 0 | 0 | Yes (1) | Yes (X) | Yes (X) | Yes (X) | Yes (X) | Yes (X) | Yes (X) | Yes (X) | Yes (X) | Yes (X) | 16 | Yes (1) | Yes (1) | 0 | Yes (1) | Yes (X) | HTTPS://LAKEHEALTH.ORG/ABOUT/HEALTH-NEEDS-ASSESSMENT | Yes (X) | Yes (1) | 16 | Yes (1) | HTTPS://LAKEHEALTH.ORG/ABOUT/HEALTH-NEEDS-ASSESSMENT | 0 | Yes (1) | Yes (X) | 250.000000000000 | 400.000000000000 | Yes (X) | Yes (X) | Yes (X) | Yes (X) | Yes (X) | Yes (X) | Yes (1) | Yes (1) | Yes (X) | Yes (X) | Yes (X) | Yes (X) | Yes (1) | Yes (X) | HTTPS://LAKEHEALTH.ORG/PATIENTS/FINANCIAL-INFORMATION/FINANCIAL-AID | Yes (X) | HTTPS://LAKEHEALTH.ORG/PATIENTS/FINANCIAL-INFORMATION/FINANCIAL-AID | Yes (X) | HTTPS://LAKEHEALTH.ORG/PATIENTS/FINANCIAL-INFORMATION | Yes (X) | Yes (X) | Yes (X) | Yes (X) | Yes (X) | Yes (1) | Yes (X) | 0 | Yes (X) | Yes (X) | Yes (X) | Yes (X) | Yes (1) | Yes (X) | 0 | 0 |
| TRIPOINT MEDICAL CENTER | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| 2 | 0 | 0 | Yes (1) | Yes (X) | Yes (X) | Yes (X) | Yes (X) | Yes (X) | Yes (X) | Yes (X) | Yes (X) | Yes (X) | 16 | Yes (1) | Yes (1) | 0 | Yes (1) | Yes (X) | HTTPS://LAKEHEALTH.ORG/ABOUT/HEALTH-NEEDS-ASSESSMENT | Yes (X) | Yes (1) | 16 | Yes (1) | HTTPS://LAKEHEALTH.ORG/ABOUT/HEALTH-NEEDS-ASSESSMENT | 0 | Yes (1) | Yes (X) | 250.000000000000 | 400.000000000000 | Yes (X) | Yes (X) | Yes (X) | Yes (X) | Yes (X) | Yes (X) | Yes (1) | Yes (1) | Yes (X) | Yes (X) | Yes (X) | Yes (X) | Yes (1) | Yes (X) | HTTPS://LAKEHEALTH.ORG/PATIENTS/FINANCIAL-INFORMATION/FINANCIAL-AID | Yes (X) | HTTPS://LAKEHEALTH.ORG/PATIENTS/FINANCIAL-INFORMATION/FINANCIAL-AID | Yes (X) | Yes (X) | Yes (X) | Yes (X) | Yes (X) | Yes (1) | Yes (X) | 0 | Yes (X) | Yes (X) | Yes (X) | Yes (X) | Yes (1) | Yes (X) | 0 | 0 | ||
Supplemental Information SupplementalInformationGrp (9 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| 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 FAP 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 FAP 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. |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 58 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp (58 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | FacilityFacilityTxt |
|---|---|---|---|---|
| 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 - TYLER URGENT CARE | ||||
| 7956 TYLER BLVD | MENTOR | OH | 44060 | URGENT CARE CENTER |
| 6 - LHPG OBGYN WOMEN'S HEALTH SPECIALIST | ||||
| 35040 CHARDON RD BLDG VII SUITE 205 | WILLOUGHBY HILLS | OH | 44094 | PHYSICIAN OFFICE |
| 7 - WILLOUGHBY HILLS | ||||
| 34600 CHARDON RD UNIT H | WILLOUGHBY HILLS | OH | 44094 | DIAGNOSTIC CENTER |
| 8 - LHPG MENTOR IMED | ||||
| 9485 MENTOR AVENUE SUITE 210 | MENTOR | OH | 44060 | PHYSICIAN OFFICE |
| 9 - LHPG MENTOR PEDIATRICS | ||||
| 9485 MENTOR AVENUE SUITE 101 | MENTOR | OH | 44060 | PHYSICIAN OFFICE |
| 10 - LHPG NORTH COAST FAMILY PRACTICE | ||||
| 7580 AUBURN RD SUITE 202 | CONCORD | OH | 44077 | PHYSICIAN OFFICE |
| 11 - CHARDON URGENT CARE | ||||
| 510 FIFTH AVENUE | CHARDON | OH | 44024 | URGENT CARE CENTER |
| 12 - LHPG MADISON FAMILY PRACTICE | ||||
| 6270 NORTH RIDGE RD | MADISON | OH | 44057 | PHYSICIAN OFFICE |
| 13 - LHPG OBGYN - WILLOW MEDICAL | ||||
| 36001 EUCLID AVENUE SUITE C-10 | WILLOUGHBY | OH | 44094 | PHYSICIAN OFFICE |
| 14 - LHPG WILLOUGHBY IMED | ||||
| 36001 EUCLID AVENUE SUITE C 240 260 | WILLOUGHBY | OH | 44094 | PHYSICIAN OFFICE |
| 15 - LAKE WELLNESS AND REHABILITATION | ||||
| 9170 MENTOR AVENUE | MENTOR | OH | 44060 | REHABILITATION CLINIC |
| 16 - LHPG WILLOUGHBY PEDIATRICS | ||||
| 36100 EUCLID AVENUE SUITE 300 | WILLOUGHBY | OH | 44094 | PHYSICIAN OFFICE |
| 17 - LHPG MADISON PEDIATRICS | ||||
| 6270 NORTH RIDGE RD | MADISON | OH | 44057 | PHYSICIAN OFFICE |
| 18 - LHPG WILLOUGHBY HILLS IMED | ||||
| 2747 SOM CENTER RD UNIT D | WILLOUGHBY HILLS | OH | 44094 | PHYSICIAN OFFICE |
| 19 - LHPG CHARDON FAMILY PRACTICE | ||||
| 510 FIFTH AVENUE SUITE 130 | CHARDON | OH | 44024 | PHYSICIAN OFFICE |
| 20 - LHPG MENTOR FAMILY PRACTICE | ||||
| 6990 LINDSAY DRIVE 3 | MENTOR | OH | 44060 | PHYSICIAN OFFICE |
| 21 - LHPG MENTOR GENERAL SURGERY | ||||
| 9500 MENTOR AVENUE SUITE 300 | MENTOR | OH | 44060 | PHYSICIAN OFFICE |
| 22 - LHPG WILLOWICK FAMILY PRACTICE | ||||
| 29804 LAKESHORE BLVD | WILLOWICK | OH | 44095 | PHYSICIAN OFFICE |
| 23 - LHPG PLASTIC SURGERY | ||||
| 9500 MENTOR AVENUE SUITE 200 | MENTOR | OH | 44060 | PHYSICIAN OFFICE |
| 24 - LHPG GENERAL SURGERY | ||||
| 36060 EUCLID AVENUE SUITE 204 | WILLOUGHBY | OH | 44094 | PHYSICIAN OFFICE |
| 26 - LHPG CHARDON PEDIATRICS | ||||
| 510 FIFTH AVENUE | CHARDON | OH | 44024 | PHYSICIAN OFFICE |
| 27 - LAKE WELLNESS AND REHABILITATION | ||||
| 34881 EUCLID AVE | WILLOUGHBY | OH | 44060 | REHABILITATION CLINIC |
| 28 - LHPG ORTHOPEDIC SURGERY | ||||
| 36060 EUCLID AVENUE SUITE 203 | WILLOUGHBY | OH | 44094 | PHYSICIAN OFFICE |
| 29 - PAINESVILLE QUICK CLINIC | ||||
| 74 S PARK PLACE | PAINESVILLE | OH | 44077 | QUICK CLINIC |
| 31 - LHPG WEST CARDIO ELECTROPHYSIOLOGY | ||||
| 36100 EUCLID AVENUE SUITE 400 | WILLOUGHBY | OH | 44094 | PHYSICIAN OFFICE |
| 32 - LHPG WEST IMED | ||||
| 36100 EUCLID AVENUE SUITE 210 | WILLOUGHBY | OH | 44094 | PHYSICIAN OFFICE |
| 33 - LHPG MENTOR OBGYN | ||||
| 9485 MENTOR AVENUE SUITE 202 | MENTOR | OH | 44060 | PHYSICIAN OFFICE |
| 34 - PAINESVILLE IMED | ||||
| 1223 MENTOR AVE | PAINESVILLE | OH | 44077 | PHYSICIAN OFFICE |
| 35 - LHPG SPORTS MEDICINE & REHAB | ||||
| 36060 EUCLID AVENUE SUITE 105 | WILLOUGHBY | OH | 44094 | PHYSICIAN OFFICE |
| 36 - LHPG INTEGRATIVE MEDICINE | ||||
| 9500 MENTOR AVENUE SUITE 360 | MENTOR | OH | 44060 | PHYSICIAN OFFICE |
| 37 - MENTOR MEDICAL PHYSICIAN BUILDING | ||||
| 9485 MENTOR AVENUE SUITES 200 203 | MENTOR | OH | 44060 | PHYSICIAN OFFICE |
| 38 - HACKETT MEDICAL BUILDING | ||||
| 8300 TYLER RD | MENTOR | OH | 44060 | PHYSICIAN OFFICE |
| 39 - LHPG OBGYN | ||||
| 36001 EUCLID SUITE C-7 | WILLOUGHBY | OH | 44094 | PHYSICIAN OFFICE |
| 40 - LHPG BARIATRIC SURGERY | ||||
| 36100 EUCLID AVENUE SUITE 170 | WILLOUGHBY | OH | 44094 | PHYSICIAN OFFICE |
| 41 - LHPG VASCULAR SURGERY | ||||
| 36001 EUCLID AVENUE SUITE B-1 B-3 | WILLOUGHBY HILLS | OH | 44094 | PHYSICIAN OFFICE |
| 42 - BARIATRIC SURGERY | ||||
| 34600 CHARDON RD UNIT G | WILLOUGHBY HILLS | OH | 44094 | PHYSICIAN OFFICE |
| 43 - CHARDON RADIOLOGY | ||||
| 510 FIFTH AVE SUITE 110 | CHARDON | OH | 44024 | PHYSICIAN OFFICE |
| 44 - LAKE AMBULATORY BLDG REFERENCE LAB | ||||
| 9500 MENTOR AVE SUITE 120 | MENTOR | OH | 44060 | DIAGNOSTIC CENTER |
| 45 - LAKE AMBULATORY BLDG PHLEBOTOMIST | ||||
| 9500 MENTOR AVE SUITE 220 | MENTOR | OH | 44060 | DIAGNOSTIC CENTER |
| 46 - LHPG NEWBURY FAMILY PRACTICE | ||||
| 10780 KINSMAN RD | NEWBURY | OH | 44065 | PHYSICIAN OFFICE |
| 47 - PERRY HEALTH AND WELLNESS CENTER | ||||
| 2 SUCCESS BLVD | PERRY | OH | 44081 | PHYSICIAN OFFICE |
| 48 - LAKE WEST MEDICAL CENTER REFERENCE LAB | ||||
| 36100 EUCLID AVE SUITE 190 | WILLOUGHBY | OH | 44094 | DIAGNOSTIC CENTER |
| 49 - EASTSIDE IMAGING | ||||
| 2785 SOM CENTER RD | WILLOUGHBY HILLS | OH | 44094 | DIAGNOSTIC CENTER |
| 50 - LAKE WELLNESS & REHAB PT (WILLOUGHBY FI | ||||
| 37100 EUCLID AVE | WILLOUGHBY | OH | 44094 | REHABILITATION CLINIC |
| 51 - LHPG NORTHEAST OHIO HEART ASSOCIATES | ||||
| 36100 EUCLID AVENUE SUITE 120 | WILLOUGHBY | OH | 44077 | PHYSICIAN OFFICE |
| 52 - LHPG NORTHEAST OHIO HEART ASSOCIATES | ||||
| 7580 AUBURN ROAD SUITE 106 | CONCORD | OH | 44077 | PHYSICIAN OFFICE |
| 53 - LHPG SPORTS MEDICINE | ||||
| 7580 AUBURN ROAD SUITE 214 | CONCORD | OH | 44077 | PHYSICIAN OFFICE |
| 54 - BEACON HEALTH | ||||
| 36100 EUCLID AVENUE SUITE 120 | WILLOUGHBY | OH | 44094 | PHYSICIAN OFFICE |
| 55 - OPHTHALMOLOGY ASSOCIATES | ||||
| 36100 EUCLID AVE SUITE 450 | WILLOUGHBY | OH | 44094 | PHYSICIAN OFFICE |
| 56 - MENTOR MEDICAL PHYSICAL FITNESS CENTER | ||||
| 8655 MARKET STREET MENTOR | MENTOR | OH | 44060 | MEDICAL FITNESS CENTER |
| 57 - PERRICO HEALTH CENTER | ||||
| 4176 STATE ROUTE 306 | WILLOUGHBY | OH | 44060 | PHYSICIAN OFFICE |
| 58 - ARTHRITIS ASSOCIATES | ||||
| 34500 CHARDON ROAD SUITE 2 | WILLOUGHBY HILLS | OH | 44094 | PHYSICIAN OFFICE |
| 59 - NORTH SHORE RESPIRATORY AND SLEEP SERVIC | ||||
| 4212 CHILLICOTHE ROAD SUITE 110 | WILLOUGHBY | OH | 44094 | PHYSICIAN OFFICE |
| 60 - PULMONARY CARE | ||||
| 4212 CHILLICOTHE ROAD SUITE 110 | WILLOUGHBY | OH | 44094 | PHYSICIAN OFFICE |
Supplemental Information Detail SupplementalInformationDetail (15 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| 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 $29,586,727 FROM PART IX. |
| PART II, COMMUNITY BUILDING ACTIVITIES: | COMMUNITY BUILDING ACTIVITIESCOMMUNITY ADVISORY GROUPS HAVE BEEN IN PLACE FOR 12 YEARS. THESE DISTINCT GROUPS REPRESENT WOMEN, SENIORS AND PAST PATIENTS OF THE SYSTEM. EACH GROUP IS MADE UP OF APPROXIMATELY 20 MEMBERS. QUARTERLY MEETINGS ARE HELD IN WHICH EDUCATION IS FOLLOWED BY INPUT ON SPECIFIC PROGRAMS OR IMPROVEMENTS BEING CONSIDERED. THE GROUPS ARE MODERATED BY A THIRD-PARTY FACILITATOR TO AVOID BIASING THE GROUPS. THE INFORMATION FROM THESE GROUPS HAS BEEN USED TO INFORM LAKE HEALTH MANAGEMENT ON ISSUES RANGING FROM WAY-FINDING TO PROGRAM NEEDS. COALITION BUILDING LAKE HEALTH 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. |
| 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 2017 WAS $90,343,805. THE PAYMENTS RELATED TO THESE SERVICES WERE $80,450,528 LEAVING A MEDICARE SHORTFALL OF $9,893,277 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 ARE EMBARKING ON A TRANSFORMATIONAL STRATEGIC PLAN INCLUDING 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 DIABETES, CONGESTIVE HEART FAILURE, HEART DISEASE, ACCESS TO PREVENTIVE SCREENINGS, AND HIGH BLOOD PRESSURE. PROGRAMS DESIGNED TO ADDRESS WEIGHT MANAGEMENT SPAN FROM EARLY CHILDHOOD THROUGH MATURE ADULTS. BE FIT FOR LIFE (FORMERLY GET HEALTHY LAKE COUNTY) IS NOW IN ITS ELEVENTH YEAR OF OPERATION AND HAS NEARLY 3,900 MEMBERS.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. THAT'S WHY WE 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 ALSO 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 230,000) AND SELECTED ZIP CODES IN ITS SECONDARY SERVICE AREAS (CUYAHOGA, ASHTABULA AND GEAUGA COUNTIES WITH A POPULATION IN THE DEFINED ZIP CODES) OF 268,113. (POPULATION FIGURES ARE AS OF 2015.) |
| 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 550 PHYSICIANS 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. IN 2017, WE PROVIDED OVER $450,000 IN COMMUNITY BENEFIT THROUGH HEALTH EDUCATION PROGRAMS, EXCLUDING BLOOD DRIVES. DURING THESE COMMUNITY EVENTS AND HEALTH FAIRS, WE PERFORMED OVER 11,600 BLOOD PRESSURE CHECKS, CHOLESTEROL SCREENINGS, GLUCOSE, HEEL SCREENINGS, SKIN CANCER SCREENINGS AND PROSTATE CANCER SCREENINGS FOR FREE OR AT LOW COST. 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 THE BEST OF HEALTH MAGAZINE, MAILED QUARTERLY TO ABOUT 150,000 HOUSEHOLDS CALENDAR OF EVENTS IN THE NEWS-HERALD, TEN TIMES PER YEAR MONTHLY E-NEWSLETTER REGARDING IMPORTANT HEALTH ISSUES AND UPCOMING HEALTH AND WELLNESS EVENTSB. EDUCATION ON SPECIFIC DISEASE CONDITIONS SENIOR CONNECTION LUNCH AND LEARNS COMMUNITY HEALTH LECTURE SERIES ARTHRITIS EXPO STRESS MANAGEMENT BREAST HEALTH FOR HISPANIC WOMENC. HEALTH PROMOTION AND WELLNESS PROGRAMS BE FIT FOR LIFEE. EDUCATION TO THE PUBLIC ABOUT HEALTH ISSUES INFORMATION THROUGH MEDIA RELEASES WEBSITE SOCIAL MEDIA (FACEBOOK, TWITTER, GOOGLE+)F. SCHOOL HEALTH EDUCATION PROGRAMS HEART SMART KIDS ASSEMBLYG. DIGITAL CONSUMER HEALTH INFORMATION CONSTANT CONTACT E-BLASTS SOCIAL MEDIA (FACEBOOK, TWITTER, GOOGLE+) WEBSITE VIDEOSH. SOCIAL MEDIA CONSUMER HEALTH INFORMATION FACEBOOK POSTS AND REMINDERS TWITTER POSTS AND REMINDERS GOOGLE+ VIDEOSI. SELF-HELP WELLNESS WORKSHOP MINDFULNESS RETREATONE OF THE MANY WAYS LAKE HEALTH IS BUILDING THE COMMUNITY IS THROUGH STRONG PARTNERSHIPS WITH OTHERS WHO SHARE OUR COMMITMENT TO LOCAL ACCESS, HEALING WITH COMPASSION AND SUPERIOR QUALITY. LAKE HEALTH JOINED FORCES WITH LAKE METROPARKS, LAKE COUNTY YMCA AND THE LAKE COUNTY HEALTH DISTRICT TO LAUNCH BE FIT FOR LIFE. THE ANNUAL MINDFULNESS RETREAT PROVIDES A DAYLONG EVENT THAT PROVIDES RELAXATION AND THE OPPORTUNITY TO PAUSE, REFLECT AND HEAL. |
| PART VI, LINE 6: | LAKE HOSPITAL SYSTEM, INC. DBA LAKE HEALTH IS THE PRIMARY HEALTHCARE-PROVIDING ENTITY WHICH OPERATES TWO HOSPITAL FACILITIES 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. |
| PART VI, LINE 7, REPORTS FILED WITH STATES | OH |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Club Dues Or Fees | Yes (X) | ClubDuesOrFeesInd |
| Written Policy Ref T And E Expnss | Yes (1) | WrittenPolicyRefTAndEExpnssInd |
| Substantiation Required | Yes (1) | SubstantiationRequiredInd |
| Compensation Committee | Yes (X) | CompensationCommitteeInd |
| Independent Consultant | Yes (X) | IndependentConsultantInd |
| Form990 Of Other Organizations | Yes (X) | Form990OfOtherOrganizationsInd |
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | 0 | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | Yes (1) | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (11 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| CYNTHIA MOORE-HARDY | ||||||||||||||
| PRESIDENT AND CEO | $790,255 | $0 | $0 | $0 | $23,320 | $0 | $13,950 | $0 | $11,293 | $0 | $838,818 | $0 | $0 | $0 |
| ROBERT TRACZ | ||||||||||||||
| SR. VP/CFO | $436,075 | $0 | $0 | $0 | $10,905 | $0 | $13,744 | $0 | $9,867 | $0 | $470,591 | $0 | $0 | $0 |
| JOHN BANIEWICZ MD | ||||||||||||||
| SR VP, MEDICAL AFFAIRS | $472,906 | $0 | $0 | $0 | $10,108 | $0 | $13,950 | $0 | $10,471 | $0 | $507,435 | $0 | $0 | $0 |
| STEVE R KARNS | ||||||||||||||
| SR VP, ADMINISTRATIVE SERVICES | $358,059 | $0 | $0 | $0 | $393,536 | $0 | $13,898 | $0 | $7,465 | $0 | $772,958 | $0 | $0 | $0 |
| RICHARD D CICERO | ||||||||||||||
| SR VP, MARKETING & BUSINESS DEVELOPM | $297,484 | $0 | $0 | $0 | $170,249 | $0 | $13,711 | $0 | $6,873 | $0 | $488,317 | $0 | $0 | $0 |
| MARY L OGRINC | ||||||||||||||
| SR VP, PATIENT CARE SERVICES, CNO | $324,954 | $0 | $0 | $0 | $280,241 | $0 | $13,295 | $0 | $5,211 | $0 | $623,701 | $0 | $0 | $0 |
| JOYCE A TAYLOR | ||||||||||||||
| VP, QUALITY SERVICES, CQO | $198,009 | $0 | $0 | $0 | $7,182 | $0 | $4,024 | $0 | $5,374 | $0 | $214,589 | $0 | $0 | $0 |
| CYNTHIA J RACER | ||||||||||||||
| VP, CLINICAL SERVICES | $176,798 | $0 | $0 | $0 | $5,823 | $0 | $5,654 | $0 | $8,597 | $0 | $196,872 | $0 | $0 | $0 |
| JERROLD M PETERS | ||||||||||||||
| VP, INFORMATION TECH/CIO | $166,271 | $0 | $0 | $0 | $141,744 | $0 | $1,309 | $0 | $5,083 | $0 | $314,407 | $0 | $0 | $0 |
| DAVID HERMAN | ||||||||||||||
| VP, FINANCE | $181,670 | $0 | $0 | $0 | $5,147 | $0 | $5,017 | $0 | $11,426 | $0 | $203,260 | $0 | $0 | $0 |
| ANDREA WASDOVICH | ||||||||||||||
| VP, PERIOPERATIVE/CRITICAL CARE SERV | $76,413 | $0 | $0 | $0 | $77,519 | $0 | $2,064 | $0 | $2,990 | $0 | $158,986 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 1A | LAKE HOSPITAL SYSTEM, INC.'S CEO, CYNTHIA MOORE-HARDY, RECEIVED THE FOLLOWING TAXABLE BENEFIT IN 2017: -SOCIAL CLUB DUES OF $8,380 |
| 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: - RICHARD CICERO: $160,080 - STEVE KARNS: $382,260 - LESLI MANZO: $68,000 - MARY OGRINC: $269,100 - JERRY PETERS: $136,000 |
Schedule K IRS990ScheduleK
Tax Exempt Bonds Issues TaxExemptBondsIssuesGrp (3 entries)
| Bond ReferenceBondReferenceCd | Bond Issuer EINBondIssuerEIN | CUSIPCUSIPNum | Bond IssuedBondIssuedDt | Issue PriceIssuePriceAmt | PurposePurposeDesc | DefeasedDefeasedInd | On Behalf Of IssuerOnBehalfOfIssuerInd | Pool FinancingPoolFinancingInd |
|---|---|---|---|---|---|---|---|---|
| COUNTY OF LAKE OHIO SERIES 2008 | ||||||||
| A | 346001618 | 50943PBL2 | 2008-06-26 | $187,820,719 | SEE PART VI | Yes (1) | 0 | 0 |
| COUNTY OF LAKE OHIO SERIES 2015 | ||||||||
| B | 346001618 | 50943PCC1 | 2015-08-03 | $69,960,181 | SEE PART VI | 0 | 0 | 0 |
| COUNTY OF LAKE OHIO SERIES 2017 | ||||||||
| C | 346001618 | 2017-12-19 | $83,380,000 | SEE PART VI | 0 | 0 | 0 | |
Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp (3 entries)
| Bond ReferenceBondReferenceCd | RetiredRetiredAmt | Bond DefeasedBondDefeasedAmt | Total ProceedsTotalProceedsAmt | In Reserve FundInReserveFundAmt | Refunding EscrowRefundingEscrowAmt | Issuance Costs From ProceedsIssuanceCostsFromProceedsAmt | Credit EnhancementCreditEnhancementAmt | Other Spent ProceedsOtherSpentProceedsAmt | Substantial CompletionSubstantialCompletionYr | Current RefundingCurrentRefundingInd | Advance RefundingAdvanceRefundingInd | Final Allocation MadeFinalAllocationMadeInd | Adequate Books And Rec MaintAdequateBooksAndRecMaintInd | Capital ExpendituresCapitalExpendituresAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| A | $128,990,000 | $60,245,000 | $193,719,535 | $1,098,595 | $294,854 | $1,808,396 | $57,940 | $190,459,750 | 2009 | Yes (1) | 0 | Yes (1) | Yes (1) | |
| B | $69,989,101 | $50,530,191 | $268,650 | 2016 | 0 | Yes (1) | Yes (1) | Yes (1) | $19,190,260 | |||||
| C | $138,445,000 | $138,445,000 | 2017 | Yes (1) | 0 | Yes (1) | Yes (1) |
Tax Exempt Bonds Private Bus Use TaxExemptBondsPrivateBusUseGrp (3 entries)
| Bond ReferenceBondReferenceCd | Owning Bond Financed PropertyOwningBondFinancedPropertyInd | Any Lease ArrangementsAnyLeaseArrangementsInd | Mgmt Contract Bond Fincd PropMgmtContractBondFincdPropInd | Engage Bond Counsel ContractsEngageBondCounselContractsInd | Any Research AgreementsAnyResearchAgreementsInd | Private Bus Use By OthersPrivateBusUseByOthersPct | Private Bus Concerning UBIPrivateBusConcerningUBIPct | Total Private Business UseTotalPrivateBusinessUsePct | Bond Iss Meet Prvt Sec Pymt TestBondIssMeetPrvtSecPymtTestInd | Change In Use Bond Financed PropChangeInUseBondFinancedPropInd | Procs Nonqualified Bond RemdtdProcsNonqualifiedBondRemdtdInd |
|---|---|---|---|---|---|---|---|---|---|---|---|
| A | 0 | 0 | Yes (1) | Yes (1) | 0 | 0.00000 | 0.00000 | 0.00000 | 0 | 0 | Yes (1) |
| B | 0 | 0 | Yes (1) | Yes (1) | 0 | 0.00000 | 0.00000 | 0.00000 | 0 | 0 | 0 |
| C | 0 | 0 | Yes (1) | Yes (1) | 0 | 0.00000 | 0.00000 | 0.00000 | 0 | 0 | 0 |
Tax Exempt Bonds Arbitrage TaxExemptBondsArbitrageGrp (3 entries)
| Bond ReferenceBondReferenceCd | Form8038 T FiledForm8038TFiledInd | Rebate Not Due YetRebateNotDueYetInd | Exception To RebateExceptionToRebateInd | No Rebate DueNoRebateDueInd | Variable Rate IssueVariableRateIssueInd | Hedge Identified In Bks And RecHedgeIdentifiedInBksAndRecInd | Gross Proceeds Invested In GICGrossProceedsInvestedInGICInd | Gross Proceeds InvestedGrossProceedsInvestedInd | Written Proc To Monitor ReqsWrittenProcToMonitorReqsInd | Superintegrated HedgeSuperintegratedHedgeInd | Hedge TerminatedHedgeTerminatedInd |
|---|---|---|---|---|---|---|---|---|---|---|---|
| A | 0 | 0 | 0 | Yes (1) | Yes (1) | 0 | 0 | 0 | Yes (1) | ||
| B | 0 | Yes (1) | 0 | 0 | 0 | 0 | 0 | 0 | Yes (1) | ||
| C | 0 | Yes (1) | 0 | 0 | Yes (1) | Yes (1) | 0 | 0 | Yes (1) | 0 | 0 |
Procedures Corrective Action ProceduresCorrectiveActionGrp (3 entries)
| Bond ReferenceBondReferenceCd | Procedures Corrective ActionProceduresCorrectiveActionInd |
|---|---|
| A | Yes (1) |
| B | Yes (1) |
| C | Yes (1) |
Supplemental Information Detail SupplementalInformationDetail (12 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| DATE REBATE COMPUTATION PERFORMED | ISSUER NAME: COUNTY OF LAKE, OHIO SERIES 2008 DATE THE REBATE COMPUTATION WAS PERFORMED: 06/26/2013 |
| 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). |
| SCHEDULE K, PART I, 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). |
| SCHEDULE K, PART I, 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 II, COLUMN A, LINE 6: PROCEEDS IN REFUNDING ESCROWS | A PORTION OF THE AMOUNT SHOWN CONSISTS OF REPLACEMENT PROCEEDS OF THE 2008 BONDS. |
| SCHEDULE K, PART II, COLUMN B LINE 10 - CAPITAL EXPENDITURES FROM PROCEEDS: | LINE INCLUDES $24,000 OF INTEREST ON THE 2015 BONDS, AND INVESTMENT EARNINGS IN THE AMOUNT OF $242. |
| SCHEDULE K, PART II, COLUMN A, LINE 11 - OTHER SPENT PROCEEDS: | THESE BOND PROCEEDS WERE USED TO REFUND PRIOR DEBT, AS NOTED IN THE NOTES FOR PART I. |
| SCHEDULE K, PART II, COLUMN B, LINE 11 - OTHER SPENT PROCEEDS: | THESE BOND PROCEEDS WERE USED TO REFUND PRIOR DEBT, AS NOTED IN THE NOTES FOR PART I. |
| SCHEDULE K, PART II, COLUMN B, 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. |
| SCHEDULE K, PART IV, COLUMM C, LINES 4B AND 4C | SERIES 2017 PROVIDER JPMORGAN CHASE, TERM 20.48 YEARS; SERIES 2017 PROVIDER PNC BANK, TERM 28.81 YEARS; AND SERIES 2017 PROVIDER PNC BANK, TERM 29.15 YEARS. |
Schedule L IRS990ScheduleL
Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp
Name Of Interested NameOfInterested
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | MATT J CICERO | PersonNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Relationship Description | FAMILY MEMBER OF KEY EMPLOYEE, RICHARD D. CICERO | RelationshipDescriptionTxt |
| Transaction | $57,624 | TransactionAmt |
| Transaction | SEE PART V | TransactionDesc |
| Sharing Of Revenues | 0 | SharingOfRevenuesInd |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART IV, COLUMN D | FormAndLineReferenceDesc |
| Explanation | MATT J. CICERO, WHO HAS A FAMILY RELATIONSHIP WITH RICHARD D. CICERO, SERVED AS A HOSPITAL EMPLOYEE DURING 2017 AND RECEIVED COMPENSATION. | ExplanationTxt |
Schedule M IRS990ScheduleM
Other Non Cash Contri Table OtherNonCashContriTableGrp (2 entries)
| Non Cash CheckboxNonCashCheckboxInd | DescDesc | ContributionContributionCnt | Noncash Contributions Rpt F990NoncashContributionsRptF990Amt | Method Of Determining RevenuesMethodOfDeterminingRevenuesTxt |
|---|---|---|---|---|
| Yes (X) | MEDICAL EQUIPMENT | 1 | $905,100 | RETAIL VALUE |
| Yes (X) | MISC WALKWAY ITEMS | 20 | $107,229 | RETAIL VALUE |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Any Property That Must Be Held | 0 | AnyPropertyThatMustBeHeldInd |
| Review Process Unusual NC Gifts | Yes (1) | ReviewProcessUnusualNCGiftsInd |
| Third Parties Used | Yes (1) | ThirdPartiesUsedInd |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 32B: | ALL GIFT DONATIONS ARE RECEIVED BY THE RELATED ORGANIZATION LAKE HEALTH FOUNDATION AND FOLLOW THE GIFT POLICY OF THAT RELATED ENTITY. |
| PART I, LINE 33: | PART I, COLUMN (B) IS THE NUMBER OF CONTRIBUTIONS. |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (7 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION B, LINE 11B | THE PROCESS FOLLOWED BEFORE FILING THE LAKE HOSPITAL SYSTEMS, INC. FORM 990 INCLUDES A DETAILED REVIEW COMPLETED BY AN INDEPENDENT OUTSIDE CPA FIRM, PRESENTATION TO AND REVIEW BY THE LHS CFO AND CEO, PRESENTATION AND REVIEW BY THE LHS FINANCE COMMITTEE, AND PRESENTATION TO THE LHS 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 MAY 2016. |
| 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). LAKE HOSPITAL SYSTEM, INC. MAKES AVAILABLE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS 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 NATIONALLY RECOGNIZED MUNICIPAL SECURITIES INFORMATION REPOSITORIES FOR COMPLIANCE WITH BOND ISSUES AND ANNUAL FINANCIAL INFORMATION WITH THE ATTORNEY GENERAL OF THE STATE OF OHIO. GOVERNING DOCUMENTS FOR LHS ARE AVAILABLE THROUGH THE WEBSITE OF THE OHIO SECRETARY OF STATE. |
| FORM 990, PART IX, LINE 11G | ANSW SVC/ LANG INTERP: PROGRAM SERVICE EXPENSES 192,539. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 192,539. BLOOD: PROGRAM SERVICE EXPENSES 1,048,518. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,048,518. CASUAL LABOR: PROGRAM SERVICE EXPENSES 1,605,878. MANAGEMENT AND GENERAL EXPENSES -19,547. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,586,331. CLINICAL SVCS: PROGRAM SERVICE EXPENSES 19,762. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 19,762. COLLECTIONS: PROGRAM SERVICE EXPENSES 3,015,579. MANAGEMENT AND GENERAL EXPENSES 14,125. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,029,704. CONSULTING: PROGRAM SERVICE EXPENSES 687,773. MANAGEMENT AND GENERAL EXPENSES 1,684,290. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,372,063. COURIER: PROGRAM SERVICE EXPENSES 238,949. MANAGEMENT AND GENERAL EXPENSES 255,430. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 494,379. DATA PROC: PROGRAM SERVICE EXPENSES 739,859. MANAGEMENT AND GENERAL EXPENSES 625,148. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,365,007. EQUIP MAINT: PROGRAM SERVICE EXPENSES 4,094,297. MANAGEMENT AND GENERAL EXPENSES 136,805. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 4,231,102. EQUIPMENT LEASE: PROGRAM SERVICE EXPENSES 706,986. MANAGEMENT AND GENERAL EXPENSES 31,919. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 738,905. FOOD: PROGRAM SERVICE EXPENSES 174,851. MANAGEMENT AND GENERAL EXPENSES 2,976,252. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,151,103. HOUSEKEEPING: PROGRAM SERVICE EXPENSES 342,253. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 342,253. LAB: PROGRAM SERVICE EXPENSES 2,158,654. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,158,654. LABOR: PROGRAM SERVICE EXPENSES 2,580,057. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,580,057. LINEN: PROGRAM SERVICE EXPENSES 13,807. MANAGEMENT AND GENERAL EXPENSES 263,931. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 277,738. MARKETING: PROGRAM SERVICE EXPENSES 368,315. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 368,315. MINOR EQUIPMENT: PROGRAM SERVICE EXPENSES 6,945. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 6,945. OTHER EXPENSES: PROGRAM SERVICE EXPENSES 299,461. MANAGEMENT AND GENERAL EXPENSES 191,085. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 490,546. PROFESSIONAL FEE BENEFITS: PROGRAM SERVICE EXPENSES 2,522,827. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,522,827. PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 4,385,455. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 4,385,455. PURCH SVC: PROGRAM SERVICE EXPENSES 10,754,564. MANAGEMENT AND GENERAL EXPENSES 638,910. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 11,393,474. RECORDS STORAGE: PROGRAM SERVICE EXPENSES 88,981. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 88,981. RECRUITMENT: PROGRAM SERVICE EXPENSES 90,677. MANAGEMENT AND GENERAL EXPENSES 272,882. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 363,559. REPAIRS: PROGRAM SERVICE EXPENSES 400,670. MANAGEMENT AND GENERAL EXPENSES 18,463. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 419,133. SVC RECOV: PROGRAM SERVICE EXPENSES 6,183. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 6,183. |
| FORM 990, PART XI, LINE 9: | NET GAIN FROM AFFILIATED ENTITIES 555,029. DERIVATIVE INSTRUMENTS LOSS -2,534,520. NET CHANGE IN UNREALIZED GAIN/LOSS ON TRADING INVESTMENTS 165,508. UNDERWRITING SUPPORT OF FOUNDATION -334,711. GAIN/LOSS ON DISPOSAL OF ASSETS -619,290. OTHER CHANGES -394,890. REVERSAL OF ACCRUAL 3,250. |
| 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. |
Schedule R IRS990ScheduleR
Id Disregarded Entities IdDisregardedEntitiesGrp
Disregarded Entity Name DisregardedEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | LAKE HEALTH IPHE | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 7590 AUBURN RD | AddressLine1Txt |
| City | CONCORD | CityNm |
| State Abbreviation | OH | StateAbbreviationCd |
| ZIP | 44077 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Primary Activities | PHYSICIAN SERVICES | PrimaryActivitiesTxt |
| Legal Domicile State | OH | LegalDomicileStateCd |
| Total Income | $0 | TotalIncomeAmt |
| End Of Year Assets | $0 | EndOfYearAssetsAmt |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | LAKE HOSPITAL SYSTEM INC | BusinessNameLine1Txt |
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (3 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Direct Controlling NADirectControllingNACd | Controlled OrganizationControlledOrganizationInd | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt |
|---|---|---|---|---|---|---|---|---|---|---|---|
| LAKE HEALTH UNIVERSITY HOSPITALS SEIDMAN CANCER CENTER | |||||||||||
| 9485 MENTOR AVENUE | MENTOR | OH | 44060 | 311565964 | TREATMENT OF CANCER PATIENTS | OH | 501(C)(3) | LINE 3 | N/A | 0 | |
| LAKE HOSPITAL FOUNDATION | |||||||||||
| 7590 AUBURN RD | CONCORD | OH | 44077 | 341425872 | FUNDRAISING FOR BENEFIT OF LAKE HOSPITAL SYSTEM, INC. | OH | 501(C)(3) | LINE 12A, I | Yes (1) | LAKE HOSPITAL SYSTEM INC DBA LAKE HEALTH | |
| PRIMEHEALTH INC | |||||||||||
| 7590 AUBURN RD | CONCORD | OH | 44077 | 341778204 | PHYSICIAN CORPORATION | OH | 501(C)(3) | LINE 3 | Yes (1) | LAKE HOSPITAL SYSTEM INC DBA LAKE HEALTH | |
Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp (6 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Direct Controlling NADirectControllingNACd | Predominant Income TypePredominantIncomeTypeTxt | Share Of Total IncomeShareOfTotalIncomeAmt | Share Of EOY AssetsShareOfEOYAssetsAmt | Disproportionate AllocationsDisproportionateAllocationsInd | General Or Managing PartnerGeneralOrManagingPartnerInd | OwnershipOwnershipPct | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| CONCORD MEDICAL CAMPUS PHYSICIAN BUILDING LLC | ||||||||||||||
| 7580 AUBURN ROAD | CONCORD | OH | 44077 | 260550261 | OFFICE SPACE | OH | N/A | EXCLUDED | $287,649 | $7,836,867 | 0 | 0 | 0.51470 | |
| LAKE WEST MEDICAL SPECIALISTS LLC | ||||||||||||||
| 36000 EUCLID AVENUE | WILLOUGHBY | OH | 44094 | 341964657 | OFFICE SPACE | OH | N/A | EXCLUDED | $38,336 | $415,731 | 0 | Yes (1) | 0.12000 | |
| MENTOR MEDICAL CAMPUS PHYSICIAN BUILDING LLC | ||||||||||||||
| 9485 MENTOR AVENUE | MENTOR | OH | 44060 | 341958475 | OFFICE SPACE | OH | N/A | UBI | $110,036 | $1,810,607 | 0 | 0 | 0.40390 | |
| MENTOR SURGERY CENTER LLC | ||||||||||||||
| 9485 MENTOR AVENUE | MENTOR | OH | 44060 | 341863257 | OUTPATIENT SURGERY | OH | N/A | RELATED | $1,172,180 | $3,551,784 | 0 | Yes (1) | 0.42210 | |
| LAKE WILLOUGHBY PROPERTIES LLC | ||||||||||||||
| 4166 CHILLICOTHE ROAD | WILLOUGHBY | OH | 44094 | 364837155 | OFFICE SPACE | OH | N/A | UBI | -$168,224 | $7,868,790 | 0 | 0 | 0.35000 | |
| NEW MANNA CLG LLC | ||||||||||||||
| 24651 CENTER RIDGE ROAD SUITE 350 | WESTLAKE | OH | 44145 | 371848577 | INVESTMENT IN FUTURE SITE | OH | UBI | $11,250,000 | 0 | 0 | 0.51000 | YES | ||
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (3 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Entity TypeEntityTypeTxt | OwnershipOwnershipPct | Controlled OrganizationControlledOrganizationInd | Address Line1ForeignAddress/AddressLine1Txt | CityForeignAddress/CityNm | CountryForeignAddress/CountryCd | Legal Domicile Foreign CountryLegalDomicileForeignCountryCd | Share Of EOY AssetsShareOfEOYAssetsAmt | Direct Controlling NADirectControllingNACd | Share Of Total IncomeShareOfTotalIncomeAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| INTERLAKE HEALTH CORPORATION - DISSOLVED 2017 | |||||||||||||||||
| 7590 AUBURN ROAD | CONCORD | OH | 44077 | 341540475 | HEALTHCARE | OH | LAKE HOSPITAL SYSTEM INC DBA LAKE HEALTH | C | 1.00000 | Yes (1) | |||||||
| LHS ASSURANCE | |||||||||||||||||
| 980456229 | INSURANCE COMPANY | LAKE HOSPITAL SYSTEM INC DBA LAKE HEALTH | C | 1.00000 | Yes (1) | 23 LIME TREE BAY AVENUE | GRAND CAYMAN | CJ | CJ | $23,597,633 | |||||||
| LAKE PHO INC | |||||||||||||||||
| 7590 AUBURN ROAD | CONCORD | OH | 44077 | 341696001 | PHYSICIAN SERVICES | OH | C | 0.50000 | 0 | $3,004,730 | N/A | -$122,206 | |||||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | Yes (1) | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | Yes (1) | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | 0 | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | Yes (1) | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | Yes (1) | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | Yes (1) | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | 0 | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | Yes (1) | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | 0 | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (1) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | Yes (1) | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | Yes (1) | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | Yes (1) | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |
Transactions Related Org TransactionsRelatedOrgGrp (16 entries)
| Transaction TypeTransactionTypeTxt | InvolvedInvolvedAmt | Method Of Amount DeterminationMethodOfAmountDeterminationTxt |
|---|---|---|
| PRIMEHEALTH INC | ||
| P | $27,258,353 | BOOK VALUE |
| LHS ASSURANCE LTD | ||
| C | $250,000 | BOOK VALUE |
| LAKE HEALTH FOUNDATION | ||
| C | $1,420,424 | BOOK VALUE |
| LAKE HEALTH FOUNDATION | ||
| M | $334,711 | BOOK VALUE |
| LAKE WEST MEDICAL SPECIALISTS LLC | ||
| K | $353,970 | BOOK VALUE |
| LHUH SEIDMAN CANCER CENTER | ||
| J | $799,392 | BOOK VALUE |
| MENTOR SURGERY CENTER LLC | ||
| F | $444,291 | BOOK VALUE |
| MENTOR SURGERY CENTER LLC | ||
| J | $481,936 | BOOK VALUE |
| MENTOR MEDICAL CAMPUS PHYSICIAN BUILDING LLC | ||
| F | $124,615 | BOOK VALUE |
| MENTOR MEDICAL CAMPUS PHYSICIAN BUILDING LLC | ||
| J | $81,188 | BOOK VALUE |
| MENTOR MEDICAL CAMPUS PHYSICIAN BUILDING LLC | ||
| K | $612,825 | BOOK VALUE |
| CONCORD MEDICAL CAMPUS PHYSICIAN BUILDING LLC | ||
| J | $101,235 | BOOK VALUE |
| CONCORD MEDICAL CAMPUS PHYSICIAN BUILDING LLC | ||
| K | $1,371,257 | BOOK VALUE |
| LAKE WILLOUGHBY PROPERTIES LLC | ||
| R | $617,284 | BOOK VALUE |
| LAKE WILLOUGHBY PROPERTIES LLC | ||
| K | $58,772 | BOOK VALUE |
| NEW MANNA CLG LLC | ||
| R | $12,500,000 | BOOK VALUE |