2018-11-07T08:37:27-06:00 2017-12-31 381357951 PLANTE & MORAN PLLC 250 S HIGH ST SUITE 100 COLUMBUS OH 43215 990 2017-01-01 341883284 LIMA MEMORIAL JOINT OPERATING COMPANY LIMA 4192283335 1001 BELLEFONTAINE AVENUE LIMA OH 45804 MICHAEL D SWICK PRESIDENT/CEO 4192283335 2018-11-01 1 BERNIE OSTROWSKI P00366367 6148493000 2018-11-01 67.59.56.33 2018-11-01 12:04:19 ED P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 4FC23CF2802050C71DEFF6D4463341DE789B9518 2017 2019-02-21 02:37:17Z LIMA MEMORIAL HEALTH SYSTEM MICHAEL D SWICK 1001 BELLEFONTAINE AVENUE LIMA OH 45804 202678726 0 X WWW.LIMAMEMORIAL.ORG X 1999 OH AS ONE OF THE LARGEST NOT-FOR-PROFIT HEALTH CARE ORGANIZATIONS IN WEST CENTRAL OHIO, LIMA MEMORIAL HEALTH SYSTEM IS COMMITTED TO IMPROVING THE QUALITY OF LIFE IN OUR COMMUNITIES THROUGH COMPREHENSIVE HEALTH SERVICES. LIMA MEMORIAL IS CONTINUALLY IMPROVING ITS SERVICES AND FACILITIES BY KEEPING UP WITH THE LATEST TECHNOLOGIES, PROVIDING CONTINUING EDUCATION TO OUR HEALTH CARE TEAM AND UPDATING OUR FACILITIES. OUR PATIENT SATISFACTION NUMBERS CONTINUE TO IMPROVE AND WE CONTINUALLY ACHIEVE QUALITY SCORES THAT ARE BETTER THEN THE STATE AND NATIONAL AVERAGES. 12 10 1690 300 429833 -106158 49868 3837 199112046 195929070 1550656 2880450 2630495 3694348 203343065 202507705 615563 653445 0 0 82649070 79206491 0 0 93964 100091616 102813970 183356249 182673906 19986816 19833799 328758731 352031914 102624152 102225447 226134579 249806467 X WE ARE HERE TO IMPROVE THE QUALITY OF LIFE IN OUR COMMUNITIES THROUGH COMPREHENSIVE HEALTH SERVICES. 0 0 151034025 653445 197294730 AS ONE OF THE LARGEST NOT-FOR-PROFIT HEALTHCARE ORGANIZATIONS IN WEST CENTRAL OHIO, LIMA MEMORIAL HEALTH SYSTEM IS COMMITTED TO IMPROVING THE QUALITY OF LIFE IN OUR COMMUNITIES THROUGH COMPREHENSIVE HEALTH SERVICES. LIMA MEMORIAL IS CONTINUALLY IMPROVING ITS SERVICES AND FACILITIES BY KEEPING UP WITH THE LATEST TECHNOLOGIES, PROVIDING CONTINUING EDUCATION TO OUR HEALTHCARE TEAM AND UPDATING OUR FACILITIES. OUR PATIENT SATISFACTION NUMBERS CONTINUE TO IMPROVE AND WE CONTINUALLY ACHIEVE QUALITY SCORES THAT ARE BETTER THAN STATE AND NATIONAL AVERAGES.THE HEALTH SYSTEM PROVIDES COMPREHENSIVE HEALTHCARE THAT ALLOWS US TO CARE FOR PATIENTS FROM BIRTH THROUGH ELDER YEARS. THESE SERVICES INCLUDE, BUT ARE NOT LIMITED TO:- 24-HOUR EMERGENCY SERVICES INCLUDING LEVEL II TRAUMA- ACCREDITED CHEST PAIN CENTER- THE HEART AND VASCULAR INSTITUTE- COMMISSION ON CANCER ACCREDITED CANCER INSTITUTE- ORTHOPEDICS- OBSTETRICS, LEVEL II NURSERY AND PEDIATRICS- WOMEN'S HEALTH CENTER- ROBOTIC SURGERY PROGRAM- DIAGNOSTIC & IMAGING- LABORATORY- INPATIENT AND OUTPATIENT REHABILITATION SERVICES- NEUROSCIENCE PROGRAM- UROLOGYIN 2017, LIMA MEMORIAL CONTRIBUTED AN ESTIMATED $33 MILLION IN COMMUNITY VALUE IN TERMS OF COMMUNITY BENEFIT EXPENDITURES, CHARITY CARE AND GOVERNMENT-SPONSORED HEALTH CARE. THIS NUMBER NOT ONLY INDICATES OUR COMMITMENT TO OUR COMMUNITIES, BUT ALSO FULFILLS OUR PURPOSE AS A NOT-FOR-PROFIT ORGANIZATION BY POSITIVELY IMPACTING THE MEMBERS OF THE COMMUNITIES THAT WE SERVE. THOUSANDS OF PEOPLE HAVE BENEFITED FROM THE COMPASSIONATE CARE AND EXPERTISE OF OUR PHYSICIANS, NURSES, ASSOCIATES AND VOLUNTEERS.EXAMPLES OF PROGRAMS BENEFITING THE BROADER COMMUNITY INCLUDE, BUT ARE NOT LIMITED TO:- EMS OUTREACH & EDUCATION- GO RED - HEART HEALTH AWARENESS CAMPAIGN- COLORECTAL AWARENESS CAMPAIGN- JOURNEY TO REMEMBER RAISED FUNDS FOR THE HEART PROGRAM- BREAST CANCER AWARENESS CAMPAIGN- KIDS CLINIC FOR CHILDREN WHO HAVE BEEN SEXUALLY ABUSED- CHILDREN'S DEVELOPMENTAL CENTER SUPPORT- BABY FAIR- CHEST PAIN CENTER- BONE DENSITY SCREENINGS- CARDIAC RISK ASSESSMENT SCREENINGS- PROSTATE CANCER AWARENESS CAMPAIGN & SCREENINGS- KIDNEY DISEASE SCREENINGS- SKIN CANCER SCREENINGS- CANCER RESOURCE CENTER- MEDICARE ELIGIBILITY PROGRAM- BREAST CANCER SURVIVOR SUPPORT GROUP- MENDED HEARTS SUPPORT GROUP- FAMILY BIRTH EDUCATION & CLINICS- DIABETIC EDUCATION- WOMEN'S RESOURCE CENTER- CONGESTIVE HEART FAILURE CLINIC- TV AND RADIO PSAS- BREASTFEEDING CLASS AND CLINIC- SMOKING CESSATION- COMMUNITY BLOOD DRIVESAS HEALTHCARE CONTINUES TO CHANGE, LIMA MEMORIAL WILL CONTINUE TO PROVIDE THE HIGHEST QUALITY OF CARE IN A FAMILY ATMOSPHERE TO OUR PATIENTS BY CONTINUALLY ADVANCING OUR SERVICES AND FACILITIES. IN ADDITION, THE HEALTH SYSTEM SUPPORTS OUR COMMUNITIES, NOT ONLY THROUGH COMPREHENSIVE HEALTHCARE, BUT THROUGH OUTREACH ACTIVITIES SUCH AS HEALTHCARE AWARENESS AND PREVENTION PROGRAMS, FREE PUBLIC HEALTH SCREENINGS, FINANCIAL SUPPORT FOR MANY COMMUNITY NON-PROFIT ORGANIZATIONS, AND OUTREACH TO THE UNDERSERVED.COMMUNITY BENEFIT DEFINITIONSLIMA MEMORIAL HEALTH SYSTEM'S 2017 COMMUNITY BENEFIT REPORT WAS PREPARED IN ACCORDANCE WITH THE REPORTING GUIDELINES PUBLISHED BY THE CATHOLIC HEALTH ASSOCIATION. COMMUNITY BENEFITS REPORTED BY THE HEALTH SYSTEM RESPOND TO AN IDENTIFIED COMMUNITY NEED AND MEET AT LEAST ONE OF THE FOLLOWING CRITERIA:- GENERATE A LOW OR NEGATIVE MARGIN;- RESPOND TO THE NEEDS OF SPECIAL POPULATIONS, SUCH AS MINORITIES, FRAIL, ELDERLY, POOR PERSONS WITH DISABILITIES, THE CHRONICALLY MENTALLY ILL, AND PERSONS WITH AIDS; AND-SUPPLY SERVICES OR PROGRAMS THAT WOULD LIKELY BE DISCONTINUED IF THE DECISION WERE MADE ON A PURELY FINANCIAL BASIS.THESE SERVICES INCLUDE:- COMMUNITY HEALTH SERVICES- HEALTH PROFESSIONS EDUCATION- SUBSIDIZED HEALTH SERVICES- RESEARCH ACTIVITIES- FINANCIAL CONTRIBUTIONS- COMMUNITY BUILDING ACTIVITIES- COMMUNITY BENEFIT OPERATIONS- COST OF CHARITY CARE- GOVERNMENT SPONSORED HEALTH CARE 151034025 1 0 0 1 0 0 0 0 0 0 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 1 1 1 0 0 1 165 0 1 1690 1 1 1 0 0 0 0 0 0 0 0 0 X 12 10 0 0 0 0 1 0 0 1 1 0 0 1 1 1 1 1 1 1 1 1 1 X MERI FOSTER 4192265197 1001 BELLEFONTAINE AVENUE LIMA OH 45804 JOHN H JOHNSON CHAIR 1.00 1.00 X X 0 0 0 KERMIT F STROH TREASURER 1.00 1.00 X X 0 0 0 BARRETT P RYDELL BOARD MEMBER 1.00 0.00 X 0 0 0 DEBRA MCCURDY BOARD MEMBER 1.00 0.00 X 0 0 0 ROBERT L THOMPSON BOARD MEMBER 1.00 0.00 X 0 0 0 PHILLIP R BUELL BOARD MEMBER 1.00 0.00 X 0 0 0 LORI A JOHNSTON BOARD MEMBER 1.00 0.00 X 0 0 0 JAMES F BLAIR BOARD MEMBER 1.00 0.00 X 0 0 0 PRAVEEN K MALHOTRA BOARD MEMBER 1.00 0.00 X 0 0 0 MICHAEL P BROWNING BOARD MEMBER 1.00 0.00 X 0 0 0 KEVIN C WEBB BOARD MEMBER 1.00 0.00 X 0 0 0 RUTH WALL BOARD MEMBER 1.00 1.00 X 11709 0 0 MICHAEL D SWICK PRESIDENT/CEO (SEE SCH J) 34.00 6.00 X 903103 0 255678 ROBERT E ARMSTRONG JR SENIOR VP/COO (SEE SCH J) 30.00 10.00 X 487869 0 123727 JOHN T FISCHBACH VP OF FINANCE/CFO (SEE SCH J) 34.00 6.50 X 306883 0 111975 KHA H TRAN MD THRU 917 VP OF MEDICAL AFFAIRS (SEE SCH J) 20.00 20.00 X 391383 0 93986 ANN-MARIE JEAN POHL VICE PRESIDENT/CNO (SEE SCH J) 40.00 0.00 X 323137 0 65841 LYNN C CARPENTER EXECUTIVE DIRECTOR 40.00 0.00 X 157476 0 31495 DENISE G KIRALY DIRECTOR - HUMAN RESOURCS 40.00 0.00 X 165666 0 32835 MARK W RECKER THRU 917 DIRECTOR - PHARMACY 40.00 0.00 X 157545 0 17238 DENNIS E MORRIS PHYSICIAN ADVISOR 40.00 0.00 X 153587 0 14662 JAMES J STRAUB MANAGER - OUTPATIENT PHARM 40.00 0.00 X 142617 0 14346 3200975 0 761783 51 0 1 0 LIMA ANESTHESIA & PAIN TREATMENT PC PO BOX 33058 PALM BEACH GARDENS FL 33420 MEDICAL SERVICES 1766675 OHIO CARDIOTHORACIC & VASCULAR 951 COMMERCE PARKWAY SUITE 201 LIMA OH 45804 MEDICAL SERVICES 1309363 MARSHALL & MELHORN LLC FOUR SEAGATE EIGHTH FLOOR TOLEDO OH 43604 LEGAL SERVICES 1079981 EMERGENCY PHYSICIANS OF NW OHIO INC PO BOX 638133 CINCINNATI OH 45263 MEDICAL SERVICES 899728 MAYO COLLABORATIVE SERVICES INC PO BOX 9146 MINNEAPOLIS MN 55480 MEDICAL SERVICES 809276 29 3837 3837 PATIENT SERVICE REV 621110 193625048 193625048 PHARMACY 900099 2178291 2178291 CLINIC REVENUE 621110 89591 89591 WELLNESS CENTER 900099 23903 23903 MEDICAL RECORDS 900099 7166 7166 5071 5071 195929070 2946840 2946840 1012242 12907 999335 999335 999335 91724 158114 -66390 -66390 -66390 INTEREST RATE SWAP 900099 875435 875435 UBI- REFERENCE LAB 621500 429833 429833 MEANINGFUL USE REVENUE 900099 42093 42093 1347652 1324232 23420 2695013 202507705 198294730 429833 3779305 X 653445 653445 1952125 1952125 60041790 50346406 9638177 57207 2045435 1715144 328342 1949 10251073 8595758 1645548 9767 4916068 4122235 789149 4684 1110619 1110619 110525 110525 26787214 15044387 11742827 6660492 6077943 571479 11070 2590505 2239233 349718 1554 234312 150511 83347 454 2375286 2375286 12454641 10765792 1688849 1084035 745207 338828 MEDICAL SUPPLIES 29982453 29982453 BAD DEBT EXPENSE 13867267 13867267 RECRUITING 678091 560974 117117 EDUCATION & REWARDS 505247 124887 379517 843 4373283 3667097 699750 6436 182673906 151034025 31545917 93964 21621649 21524375 6638147 6626566 22253560 23460174 3057587 6869326 4439507 4961826 8162469 5754345 270364500 167583858 105166649 102780642 49336094 57313158 3391601 3609013 104691468 119132489 328758731 352031914 17651334 17940847 132000 132000 48185514 47387344 9692539 7149085 26962765 29616171 102624152 102225447 X 225997775 249806467 136804 0 226134579 249806467 328758731 352031914 X 19833799 2700670 1137419 X X 0 1 X 1 0 X 0 0 0 0 0 0 0 0 1 10603 10603 0 PART II-B, LINE 1: LOBBYING EXPENSES ARE INCURRED IN CONNECTION WITH THE DUES PAID TO THE OHIO HOSPITAL ASSOCIATION AND THE AMERICAN HOSPITAL ASSOCIATION. 4205111 4205111 155796915 100770321 55026594 107697154 64500477 43196677 2665320 2313060 352260 102780642 INVESTMENTS IN AFFILIATED ORG. 119132489 119132489 ACCRUED PENSION LIABILITY 3848430 PROFESSIONAL LIABILITY RESERVE 5200988 FIN 47 ASBESTOS LIABILITY 2987862 THIRD PARTY PAYOR SETTLEMENTS 4540500 FAIR VALUE OF INTEREST RATE SWAP AG 13038391 29616171 X PART X, LINE 2: THE HEALTH SYSTEM, LIMA MEMORIAL HOSPITAL, LIMA MEMORIAL PROFESSIONAL CORPORATION, LIMA MEMORIAL HOSPITAL FOUNDATION, AND LIMA MEMORIAL HOSPITAL AUXILIARY ARE NOT-FOR-PROFIT CORPORATIONS AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE (THE "CODE") AND ARE EXEMPT FROM FEDERAL INCOME TAXES PURSUANT TO SECTION 501(A) OF THE CODE. ELM TREE FOUNDATION, THE FOR-PROFIT SUBSIDIARY, IS A TAXABLE CORPORATION. ELM TREE FOUNDATION HAD NET OPERATING LOSS CARRYFORWARDS OF $853,131 AND $763,936 ON ITS FILED INCOME TAX RETURNS IN 2017 AND 2016, RESPECTIVELY. ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA REQUIRE MANAGEMENT TO EVALUATE TAX POSITIONS TAKEN BY THE HEALTH SYSTEM AND TO RECOGNIZE A TAX LIABILITY IF THE HEALTH SYSTEM HAS TAKEN AN UNCERTAIN POSITION THAT MORE LIKELY THAN NOT WOULD NOT BE SUSTAINED UPON EXAMINATION BY THE INTERNAL REVENUE SERVICE OR OTHER APPLICABLE TAXING AUTHORITIES. 1 1 X 1 X 1 X 1 1 0 0 2529515 3739947 0 0.00000 26821969 16917436 9904533 0.05900 29351484 20657383 9904533 0.05900 14460177 0 14460177 0.08610 14460177 14460177 0.08610 43811661 20657383 24364710 0.14510 1 13867267 1248054 45630049 54608944 -8978895 X 1 1 1 LMHS WOMEN'S HEALTH CO-MANAGEMENT COMPANY LLC CO-MANAGEMENT 0.50000 0.50000 1 1 LIMA MEMORIAL HEALTH SYSTEM 1001 BELLEFONTAINE AVE LIMA OH 45804 X X X LIMA MEMORIAL HEALTH SYSTEM 1 0 0 1 X X X X X X X X X 17 1 0 0 1 X WWW.LIMAMEMORIAL.ORG 1 17 1 WWW.LIMAMEMORIAL.ORG 0 1 X 200.000000000000 400.000000000000 X X X X X 1 1 X X X 1 X HTTP://WWW.LIMAMEMORIAL.ORG/PATIENT-RESOURCES/FINANCIAL-ASSISTANCE X HTTP://WWW.LIMAMEMORIAL.ORG/PATIENT-RESOURCES/FINANCIAL-ASSISTANCE X HTTP://WWW.LIMAMEMORIAL.ORG/PATIENT-RESOURCES/FINANCIAL-ASSISTANCE X X X X X 1 X 0 X X X X X 1 X 0 0 LIMA MEMORIAL HEALTH SYSTEM PART V, SECTION B, LINE 5: COMMUNITY MEMBERS FROM THE GROUPS, ORGANIZATIONS, AND SECTORS ESTABLISHED THE COMMUNITY SUSTAINABILITY ADVISORY COMMITTEE UNDER THE LIMA-ALLEN COUNTY REGIONAL PLANNING COMMISSION. THE COMMUNITY SUSTAINABILITY ADVISORY COMMITTEE WAS RESPONSIBLE FOR THE IMPLEMENTATION OF THE HEALTHY COMMUNITIES INSTITUTE SOFTWARE, WHICH HAS BEEN USED AS THE BASIS FOR THE COMMUNITY HEALTH NEEDS ASSESSMENT. THE HEALTHY COMMUNITIES INSTITUTE WEBSITE PROVIDED A LIST OF IDENTIFIED HEALTH CONDITIONS AND RELATED INDICATORS FOR ALLEN COUNTY. THE INFORMATION FOR AUGLAIZE AND PUTNAM COUNTIES WAS ANALYZED UNDER THE SAME QUARTILE SYSTEM.ORGANIZATION'S CONTACTED:ALLEN COUNTY ECONOMIC DEVELOPMENT GROUPALLEN COUNTY HEALTH DEPARTMENTLIMA/ALLEN COUNTY CHAMBER OF COMMERCESHAWNEE TOWNSHIP POLICEST. RITA'S MEDICAL CENTERUNITED WAY OF GREATER LIMAYMCAIN ADDITION, LEADERS, REPRESENTATIVES, OR MEMBERS OF MEDICALLY UNDERSERVED, LOW-INCOME AND MINORITY POPULATIONS AND POPULATIONS WITH CHRONIC DISEASE NEEDS WERE CONTACTED. THE HOSPITAL ALSO DERIVES ADDITIONAL INFORMATION FROM THE COMMUNITY HEALTH IMPROVEMENT PLAN COMMITTEE AND THE HEALTHY PEOPLE 2020 COMMITTEE. LIMA MEMORIAL HEALTH SYSTEM PART V, SECTION B, LINE 11: THE HOSPITAL HAS ADOPTED AN IMPLEMENTATION STRATEGY FOR 2016-2018 THAT ADDRESSES THE COMMUNITY HEALTH NEEDS IDENTIFIED IN THE COMMUNITY HEALTH NEEDS ASSESSMENT. THIS REPORT IS POSTED ON THE HOSPITAL'S WEBSITE WWW.LIMAMEMORIAL.ORG WHICH IS PAIRED WITH THE HEALTH SYSTEM'S STRATEGIC PLAN. LIMA MEMORIAL HEALTH SYSTEM PART V, SECTION B, LINE 20E: - CONSPICUOUS NOTICE ON BILLING STATEMENTS- PHONE CALLS 3 1 - MEDICAL PARK 525 EASTOWN RD LIMA OH 45807 MRI, CT 2 - YMCA - WELLNESS CENTER 345 S ELIZABETH ST LIMA OH 45801 WELLNESS CENTER 3 - HINO 951 COMMERCE PKWY LIMA OH 45804 CARDIAC TREATMENT PART I, LINE 7: COLUMN C, LINE 7A & 7B: THE HOSPITAL USED A COST-TO-CHARGE COSTING METHODOLOGY TO CALCULATE THE AMOUNTS REPORTED IN LINE 7. THE HOSPITAL DERIVED THE COST-TO-CHARGE RATIO FROM THE USE OF WORKSHEET 2.PART I, LINE 7E:IN ADDITION TO LIMA MEMORIAL JOINT OPERATING COMPANY'S COMMUNITY HEALTH IMPROVEMENT SERVICES AND COMMUNITY BENEFIT OPERATIONS, THIS LINE AMOUNT ALSO INCLUDES COMMUNITY BENEFIT PROVIDED BY LIMA MEMORIAL PROFESSIONAL CORPORATION, WHICH IS A RELATED ENTITY, IN AS MUCH AS LIMA MEMORIAL PROFESSIONAL CORPORATION'S ACTIVITY, ARE CARRIED ON IN A MANNER CONSISTENT WITH AND DIRECTLY IN CONNECTION WITH THE TAX EXEMPT PURPOSE OF LIMA MEMORIAL JOINT OPERATING COMPANY. PART I, LN 7 COL(F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 24B, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE OF THIS COLUMN IS $13,867,267. PART II, COMMUNITY BUILDING ACTIVITIES: LIMA MEMORIAL HEALTH SYSTEM PROMOTES THE HEALTH OF OUR COMMUNITIES BY PROVIDING SERVICE REGARDLESS OF ABILITY TO PAY, FUNDING THROUGH SPONSORSHIP, HEALTH SCREENINGS AND EDUCATION. WE WORK WITH A NUMBER OF ORGANIZATIONS THROUGHOUT THE REGION, INCLUDING THE CHAMBER OF COMMERCE, TO PROMOTE THE ECONOMIC GROWTH OF THE COMMUNITY. WE ARE ACTIVELY INVOLVED WITH THE RHODES STATE SCHOOL OF NURSING, THE UNIVERSITY OF NORTHWEST OHIO, APOLLO CAREER CENTER, AS WELL AS CONTINUING EDUCATION AND TRAINING FOR EMTS AND PARAMEDICS. PART III, LINE 2: BASED ON GROSS AS PRESENTED IN THE FINANCIAL STATEMENTS. PART III, LINE 3: BAD DEBT IS ATTRIBUTABLE TO PATIENTS IDENTIFIED UNDER CHARITY CARE WAS ESTIMATED BY A THIRD PARTY THROUGH SCREENING OF BAD DEBT PATIENTS AT POVERTY LEVEL. THE HOSPITAL APPLIES ANY DISCOUNTS/PAYMENTS RECEIVED AGAINST PATIENTS ACCOUNTS BEFORE DETERMINING BAD DEBT EXPENSE. PART III, LINE 4: ACCOUNTS RECEIVABLE FOR PATIENTS, INSURANCE COMPANIES AND GOVERNMENTAL AGENCIES ARE BASED ON GROSS CHARGES. AN ALLOWANCE FOR CONTRACTUAL ADJUSTMENTS AND INTERIM PAYMENT ADVANCES IS BASED ON EXPECTED PAYMENT RATES FROM PAYORS BASED ON CURRENT REIMBURSEMENT METHODOLOGIES. THIS AMOUNT ALSO INCLUDES AMOUNTS RECEIVED AS INTERIM PAYMENTS AGAINST UNPAID CLAIMS BY CERTAIN PAYORS. THE ALLOWANCE FOR CONTRACTUAL ADJUSTMENTS IS REPORTED AS PART OF THE PATIENT ACOUNTS RECEIVABLE AMOUNT ON THE CONSOLIDATED BALANCE SHEET. AN ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS IS ESTABLISHED ON AN AGGREGATE BASIS BY USING HISTORICAL WRITE-OFF RATE FACTORS APPLIED TO UNPAID ACCOUNTS BASED ON AGING. LOSS RATE FACTORS ARE BASED ON HISTORICAL LOSS EXPERIENCE AND ADJUSTED FOR ECONOMIC CONDITIONS AND OTHER TRENDS AFFECTING THE HOSPITAL'S ABILITY TO COLLECT OUTSTANDING AMOUNTS. UNCOLLECTIBLE AMOUNTS ARE WRITTEN OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS IN THE PERIOD THEY ARE DETERMINED TO BE UNCOLLECTIBLE. PART III, LINE 8: SECTION B: BASED ON A COST-TO-CHARGE RATIO DETERMINED IN ACCORDANCE WITH THE MEDICARE COST REPORT REQUIREMENTS, THE COSTS OF PROVIDING CARE TO THE MEDICARE POPULATION IN 2017 WAS $54,608,944. THE PAYMENTS RELATED TO THESE SERVICES WERE $45,630,049. LEAVING A MEDICARE SHORTFALL OF $8,978,895 FOR THE YEAR. THE MEDICARE SHORTFALL IS A COMMUNITY BENEFIT BECAUSE PROVIDING SERVICES TO THE ELDERLY IS A TAX EXEMPT PURPOSE CONSISTENT WITH LIMA MEMORIAL JOINT OPERATING COMPANY'S OVERALL EXEMPT STATUS, AND THE HOSPITAL ACCEPTS THESE PATIENTS REGARDLESS OF ITS IMPACT ON OVERALL PROFITABILITY. PART III, LINE 9B: PATIENTS DO NOT RECEIVE ANY NOTICE FROM LMH UNTIL BALANCES ARE DETERMINED TO BE THE PATIENT'S RESPONSIBILITY. ONCE A FAP APPLICATION IS RECEIVED THE COLLECTION PROCESS IS PUT ON HOLD UNTIL ELIGIBILITY IS DETERMINED. PRIMARY SELF-PAY ACCOUNTS ARE REFERRED TO AN OUTSIDE AGENCY AS AN EXTENSION OF THE BUSINESS OFFICE AT DAY 45. ACCOUNTS REMAIN WITH THE AGENCY UNTIL IT IS AT A ZERO BALANCE OR 150 DAYS. AT 150 DAYS THE ACCOUNT IS CLOSED BACK AND GIVEN TO THE SUBSEQUENT AGENCY FOR REGULAR COLLECTION FOLLOW UP. BALANCE AFTER INSURANCE ACCOUNTS ARE REFERRED TO AN OUTSIDE AGENCY ONCE ANY MONEY IS MOVED INTO SELF-PAY. THE ACCOUNT IS KEPT FOR A MINIMUM OF 90 DAYS AND THEN REFERRED TO A COLLECTION AGENCY. PART VI, LINE 2: LIMA MEMORIAL HEALTH SYSTEM (LMHS) REGULARLY PARTICIPATES IN COMPREHENSIVE COMMUNITY HEALTH NEEDS ASSESSMENTS TO IDENTIFY FAR-REACHING HEALTH NEEDS FACED BY PEOPLE IN THE COMMUNITIES SERVED BY THE HEALTH SYSTEM. ASSESSMENT RESULTS ARE EVALUATED OVER TIME AND SERVE AS THE BASIS TO DEVELOP NEW OR EXPANDED PLANS TO ADDRESS SERVICES IN RESPONSE TO NEEDS.LMHS JOINED OTHER AREA ORGANIZATIONS TO DEVELOP, IMPLEMENT AND UTILIZE THE 2016 ALLEN COUNTY COMMUNITY HEALTH NEEDS ASSESSMENT. THE NEEDS ASSESSMENT COLLECTED DATA FOR ALLEN COUNTY ADULTS (AGES 19 YEARS OF AGE AND OLDER) AND YOUTH (AGES 12 THROUGH 18) WHO PARTICIPATED IN A COUNTY-WIDE ASSESSMENT SURVEY DURING 2016-17. THE FINDINGS ARE BASED ON SELF-ADMINISTERED SURVEYS USING A STRUCTURED QUESTIONNAIRE. THE QUESTIONS WERE MODELED AFTER SURVEY INSTRUMENTS USED BY THE CENTERS FOR DISEASE CONTROL AND PREVENTION FOR THEIR NATIONAL AND STATE BEHAVIORAL RISK FACTOR SURVEILLANCE SYSTEM AND YOUTH RISK BEHAVIOR SURVEILLANCE SYSTEM.THE SURVEY ASSESSED THE FOLLOWING AREAS: COMMUNITY CONCERNS AND SERVICES, PHYSICAL HEALTH ISSUES AND BEHAVIORAL HEALTH ISSUES. FOR AREAS OUTSIDE OF ALLEN COUNTY, LIMA MEMORIAL UTILIZES DATA FROM ADDITIONAL COUNTY-BASED NEEDS ASSESSMENT WHEN AVAILABLE. SURVEY RESULTS ARE BEING USED TO SHAPE COMMUNITY OUTREACH EFFORTS.IN 2017, LIMA MEMORIAL WAS INVOLVED WITH THE COMMUNITY HEALTH IMPROVEMENT PLANNING COMMITTEE THROUGH PARTICIPATION AND FUNDING IN CONJUNCTION WITH THE CITY OF LIMA AND THE ALLEN COUNTY YMCA. A PORTION OF THIS PROGRAM IS DEDICATED TO REVIEWING THE NEEDS AND RISKS OF ALLEN COUNTY. OBESITY, ESPECIALLY CHILDHOOD OBESITY, WAS DETERMINED TO BE A SIGNIFICANT HEALTH RISK.LIMA MEMORIAL HEALTH SYSTEM IS PART OF THE ACTIVATE ALLEN COUNTY LEADERSHIP COMMITTEE, WHICH ADDRESSES A VARIETY OF HEALTH-RELATED NEEDS IN THE COMMUNITIES WE SERVE. THIS COMMITTEE IS COMMITTED TO REDUCING OBESITY AND SMOKING IN LIMA AND ALLEN COUNTY BY PROMOTING HEALTHY EATING, ACTIVE LIVING AND A TOBACCO-FREE LIFESTYLE.ASSESSMENT SUMMARYDESIRED OUTCOMES FOR ALLEN COUNTY RESIDENTS: REDUCE RISK FOR CHRONIC DISEASE, REDUCE POOR BIRTH OUTCOMES (E.G. LOW BIRTHWEIGHT AND PRETERM DELIVERIES), REDUCE INFANT MORTALITY, REDUCE SUICIDE RATE, REDUCE SUBSTANCE ABUSE, AND INCREASE ACCESS TO HEALTH CARE. PART VI, LINE 3: ALL PATIENTS OF LIMA MEMORIAL HOSPITAL ARE EDUCATED ON THE HOSPITAL'S CHARITY CARE PROGRAM DURING THE REGISTRATION PROCESS VIA WALL-POSTED STATEMENTS, HOSPTIAL PERSONNEL INQUIRIES, ETC. INFORMATION REGARDING THE HOSPITIAL'S CHARITY CARE IS ALSO FOUND ON LIMA MEMORIAL'S WEBSITE. STATEMENTS GOING TO PATIENTS ALSO IDENTIFY THIS PROGRAM. PART VI, LINE 4: AS OF THE CENSUS OF 2000, THERE WERE 108,473 PEOPLE, 40,066 HOUSEHOLDS, AND 28,208 FAMILIES RESIDING IN THE COUNTY. THE POPULATION DENSITY WAS 268 PEOPLE PER SQUARE MILE. THERE WERE 44,245 HOUSING UNITS AT AN AVERAGE DENSITY OF 109 PER SQUARE MILE. THE RACIAL MAKEUP OF THE COUNTY WAS 84.95% CAUCASIAN, 12.19% AFRICAN AMERICAN, 0.21% NATIVE AMERICAN, 0.55% ASIAN, 0.01% PACIFIC ISLANDER, 0.63% FROM OTHER RACES, AND 1.45% FROM TWO OR MORE RACES. 1.42% OF THE POPULATION WERE HISPANIC/LATINO, 33.8% WERE GERMAN, 14.2% AMERICAN, 8.8% IRISH AND 6.6% ENGLISH ANCESTRY ACCORDING TO THE CENSUS 2000. THERE ARE 40,646 HOUSEHOLDS OUT OF WHICH 32.9% HAD CHILDREN UNDER THE AGE OF 18 LIVING WITH THEM, 53% WERE MARRIED COUPLES LIVING TOGETHER, 12.4% HAD A FEMALE HOUSEHOLDER WITH NO HUSBAND PRESENT AND 30.6% WERE NON-FAMILIES. 26.3% OF ALL HOUSEHOLDS WERE MADE UP OF INDIVIDUALS AND 11.2% HAD SOMEONE LIVING ALONE WHO WAS 65 YEARS OF AGE OR OLDER. THE AVERAGE HOUSEHOLD SIZE WAS 2.52 AND THE AVERAGE FAMILY SIZE WAS 3.05. IN THE COUNTY THE POPULATION WAS SPREAD OUT WITH 25.9% UNDER THE AGE OF 18, 9.9% FROM 18 TO 24, 27.6% FROM 25 TO 44, 22.4% FROM 45 TO 64, AND 14.2% WHO WERE 65 YEARS OF AGE OR OLDER. THE MEDIAN AGE WAS 36 YEARS. FOR EVERY 100 FEMALES THERE WERE 100 MALES. FOR EVERY 100 FEMALES AGE 18 AND OVER THERE WERE 98 MALES. THE MEDIAN INCOME FOR A HOUSEHOLD IN THE COUNTY WAS $37,408 AND THE MEDIAN INCOME FOR A FAMILY WAS $44,723. MALES HAD A MEDIAN INCOME OF $35,546 VERSUS $23,537 FOR FEMALES. THE PER CAPITA INCOME FOR THE COUNTY WAS $17,511. ABOUT 9.6% OF FAMILIES AND 12.1% OF THE POPULATION WERE BELOW THE POVERTY LINE, INCLUDING 17% OF THOSE UNDER AGE 18 AND 9.6% OF THOSE AGE 65 OR OVER. LIMA MEMORIAL HEALTH SYSTEM SERVES A 10 COUNTY AREA THAT INCLUDES MORE THAN 475,000 PEOPLE. THE COUNTIES INCLUDE ALLEN, AUGLAIZE, PUTNAM, HANCOCK, MERCER, HARDIN, LOGAN, SHELBY, PAULDING AND VAN WERT. THE MEDIAN HOUSEHOLD INCOME FOR THE REGION IS $44,300. 24% OF RESIDENTS ARE UNDER 18 YEARS OLD, WHILE 14.5% OF RESIDENTS ARE 65 YEARS OLD OR OLDER. 95.4% OF OUR ENTIRE SERVICE AREA IS CAUCASIAN, WHILE 2.75% ARE AFRICAN AMERICAN. IN OUR PRIMARY SERVICE AREA OF ALLEN COUNTY 85.6% ARE CAUCASIAN, WHILE 11.7% ARE AFRICAN AMERICAN. THE REGION IS PRIMARILY RURAL WITH SMALL COMMUNITIES. THE LARGEST CITY IN THE REGION IS LIMA WITH A POPULATION OF 38,771. PART VI, LINE 5: LIMA MEMORIAL HEALTH SYSTEM CONTINUES TO INCREASE OUR COMMUNITY INVESTMENT THROUGH PARTICIPATION AND SPONSORSHIP OF LOCAL AND REGIONAL EVENTS THAT PROMOTE HEALTHY LIFESTYLE CHOICES, PREVENTATIVE CARE AND CHRONIC DISEASE MANAGEMENT.BEYOND THE NUMBERS: KEY COMMUNITY BENEFIT ACTIVITIES OF 2017LIMA MEMORIAL HEALTH SYSTEM DEVELOPS PROGRAMS AND SERVICES TO ADDRESS COMMUNITY HEALTH NEEDS AND MAKES INVESTMENTS IN INTIATIVES THAT ALIGN WITH OUR MISSION, VISION AND VALUES. MUCH OF LIMA MEMORIAL HEALTH SYSTEM'S COMMUNITY BENEFIT INVESTMENT FOR 2017 WAS IN THE AREA OF CHARITABLE CARE AND WELLNESS. THIS ENABLED THOSE WITHOUT INSURANCE OR WITH LIMITED INSURANCE TO ACCESS MEDICAL CARE AND SCREENING HEALTH TESTS.BEYOND THAT FOCUS ARE PROGRAMS AND SERVICES THAT BENEFIT EVERY RESIDENT AND SUPPORT THE FAR REACHING GOAL OF A HEALTHIER WEST CENTRAL OHIO. LIMA MEMORIAL HEALTH SYSTEM CANNOT MEET ALL OF THE HEALTHCARE NEEDS WITHOUT THE ENGAGEMENT AND SUPPORT OF KEY STAKEHOLDERS INCLUDING OUR MEDICAL STAFF AND OTHER COMMUNITY ORGANIZATIONS.COMMUNITY HEALTH SERVICESIN 2017, LIMA MEMORIAL HEALTH SYSTEM PROVIDED AND/OR PARTICIPATED IN NUMEROUS COMMUNITY HEALTH SERVICE PROGRAMS. INCLUDED IN THIS CATEGORY ARE HEALTH AND WELLNESS EDUCATION, HEALTH SCREENINGS, COMMUNITY DEVELOPMENT AND SERVICES TO HELP PEOPLE ADOPT HEALTHY LIFESTYLE CHANGES. ALSO INCLUDED ARE THE MYRIAD OF SUPPORT GROUP ACTIVITIES THAT HELP PATIENTS AND THEIR FAMILIES MANAGE CHRONIC HEALTH CONDITIONS.KEY INIATIVES THE PAST YEAR INCLUDE DIAGNOSTIC HEART AND VASCULAR SCREENINGS FOR AT-RISK ADULTS, CHILDHOOD DIABETES EDUCATION IN AREA SCHOOLS, INJURY PREVENTION AND AWARENESS, BREAST AND LUNG SCREENINGS AND HEALTHY EATING EVENTS.A THIRD SUBSET OF THIS CATEGORY INCLUDES HEALTH CARE SUPPORT SERVICES, OR THOSE SERVICES THAT ARE PROVIDED TO ASSIST COMMUNITY MEMBERS IN ACCESSING BOTH INFORMATION AND THE MEDICAL CARE THAT THEY NEED. CHIEF AMONG THE HEALTH SYSTEM'S SUPPORT INITIATIVES ARE THE FINANCIAL COUNSELORS THAT ENSURE THAT PATIENTS WHO ARE STRUGGLING FINANCIALLY AND/OR LACK MEDICAL INSURANCE ARE AFFORDED THE CARE THAT THEY NEED.HEALTH PROFESSIONS EDUCATIONLIMA MEMORIAL HEALTH SYSTEM BELIEVES THAT HAVING HIGHLY TRAINED MEDICAL PERSONNEL BENEFITS EVERYONE IN THE COMMUNITY. BEYOND ONGOING EDUCATION FOR PHYSICIANS, NURSES, TECHNICIANS, AND OTHER CLINICIANS, THE HEALTH SYSTEM SUPPORTED NUMEROUS SPECIAL INITIATIVES IN 2017 TO FURTHER CAPABILITIES OF AREA MEDICAL PERSONNEL.OUR SCHOOLS OF NURSING PROGRAM PROVIDED A TRAINING SITE FOR OVER 450 NURSING STUDENTS IN 2017. LIMA MEMORIAL HEALTH SYSTEM ALSO PROVIDES EDUCATIONAL SUPPORT IN THE MEDICAL COMMUNITY BY PROVIDING HUNDREDS OF HOURS OF TRAINING FOR AREA EMT'S AND PARAMEDICS.FINANCIAL CONTRIBUTIONSLIMA MEMORIAL PROVIDES BOTH CASH AND IN-KIND SUPPORT TO INDIVIDUALS AND OTHER COMMUNITY ORGANIZATIONS. THE SPONSORSHIP FUND PROVIDES FUNDING SUPPORT TO WEST CENTRAL OHIO PROGRAMS THAT ADDRESS IDENTIFIED COMMUNITY NEEDS AND SERVE VULNERABLE POPULATIONS. IN 2017, LIMA MEMORIAL CONTRIBUTED TO MORE THAN 55 ORGANIZATIONS INCLUDING YMCA OF LIMA, , THE UNITED WAY, COMMUNITY HEALTH SERVICES,, AND THE GREATER LIMA REGION.COMMUNITY BENEFIT OPERATIONSFOR 2017, COMMUNITY BENEFITS EXPENSES RECORDED INCLUDES THE REPORT ON THE HEALTH SYSTEM'S COMMUNITY BENEFIT INVESTMENT. THE APPLICABLE COSTS FOR STAFF ENGAGING IN ACTUAL COMMUNITY BENEFIT SERVICES AND PROGRAMMING ARE REPORTED WITHIN SPECIFIC INITIATIVES AND ACTIVITIES. CHARITY CARE.IN ACCORDANCE WITH REPORTING REQUIREMENTS, LIMA MEMORIAL'S CHARITY CARE EXPENSE IS BASED UPON COSTS VERSUS CHARGES. CHARITY CARE INCLUDES LIMA MEMORIAL'S TRADITIONAL INPATIENT AND EMERGENCY SERVICES. UPON APPROVAL FOR FINANCIAL ASSISTANCE, ALL HOSPITAL CARE IN THE ENSUING SIX MONTH PERIOD IS INCLUDED. THIS APPROACH ENSURES THAT ASSISTANCE IS PORTABLE AND THAT PATIENTS HAVE ACCESS TO NEEDED MEDICAL SERVICES BY MAKING A SINGLE APPLICATION.A KEY GOAL IS TO IDENTIFY COMMUNITY MEMBERS IN NEED SOONER. THE RESULT IS MORE CHARITY CARE AND FEWER BAD DEBTS.GOVERNMENT SPONSORED HEALTHCAREPAYMENT SHORTFALLS FOR PUBLIC INSURANCE PROGRAMS, INCLUDING MEDICAID AND MEDICARE, WERE $33,381,227 IN 2017. PART VI, LINE 6: LIMA MEMORIAL HEALTH SYSTEM DEVELOPS PROGRAMS AND SERVICES TO ADDRESS COMMUNITY HEALTH NEEDS TO SUPPORT THE GOAL OF A HEALTHIER WEST CENTRAL OHIO. PART VI, LINE 7, REPORTS FILED WITH STATES OH 1 LIMA MEMORIAL FOUNDATION 1001 BELLEFONTAINE AVE LIMA OH 45804 341707570 501(C)3 12500 HEALTH INITIATIVE AUGLAIZE COUNTY AGRICULTURAL SOCIETY 101 FAIRVIEW DR WAPAKONETA OH 45895 344427752 501(C)3 14625 COMMUNITY DEVELOPMENT RHODES STATE COLLEGE 4240 CAMPUS DRIVE LIMA OH 45804 341266573 501(C)3 5000 COMMUNITY DEVELOPMENT/HEALTH AND WELLNESS ALLEN COUNTY AGRICULTURAL SOCIETY 2750 HARDING HWY LIMA OH 45804 346570403 501(C)3 10175 COMMUNITY DEVELOPMENT LIMA AREA FAMILY YMCA 345 S ELIZABETH ST LIMA OH 45801 344431173 501(C)3 267994 COMMUNITY DEVELOPMENT/HEALTH AND WELLNESS UNITED WAY 616 S COLLETT ST SUITE 101 LIMA OH 45805 344466356 501(C)3 10000 COMMUNITY DEVELOPMENT GREATER LIMA REGION 144 S MAIN STREET LIMA OH 45801 815315417 501(C)3 101000 COMMUNITY DEVELOPMENT AMERICAN HEART ASSOCIATION 7272 GREENVILLE AVE DALLAS TX 75231 135613797 501(C)3 5000 COMMUNITY DEVELOPMENT/HEALTH AND WELLNESS LIMA AREA CHAMBER FOUNDATION 144 S MAIN STREET LIMA OH 45801 344179070 501(C)3 22500 COMMUNITY DEVELOPMENT LIMA SYMPHONY ORCHESTRA 67 TOWN SQUARE PO BOX 1651 LIMA OH 45802 344465022 501(C)3 10800 COMMUNITY DEVELOPMENT COMMUNITY HEALTH SERVICES 410 BIRCHARD AVENUE FREMONT OH 43420 341120194 501(C)3 151683 COMMUNITY DEVELOPMENT/HEALTH AND WELLNESS MENTAL HEALTH & RECOVERY SERVICES BOARD 529 S ELIZABETH STREET LIMA OH 45804 346400019 GOV'T 5000 COMMUNITY DEVELOPMENT/HEALTH AND WELLNESS 12 0 PART I, LINE 2: IN MOST CASES THE EFFECTIVE USE OF FUNDS IS EVIDENT THROUGH THE POSITIVE RESULTS OF THE PROGRAMS WE FUND. IN ADDITION, LIMA MEMORIAL HAS BOARD REPRESENTATION ON MOST OF THE ORGANIZATIONS WE SUPPORT. IF THIS IS NOT THE CASE WE DO ASK FOR THEIR BUSINESS PLAN AND A LIST OF EXPENDITURES. X 1 1 X X X X X 1 1 0 0 0 0 0 0 0 MICHAEL D SWICK PRESIDENT/CEO (SEE SCH J) 359360 0 239399 0 304344 0 232478 0 23200 0 1158781 0 293973 0 ROBERT E ARMSTRONG JR SENIOR VP/COO (SEE SCH J) 240588 0 118987 0 128294 0 98243 0 25484 0 611596 0 121178 0 JOHN T FISCHBACH VP OF FINANCE/CFO (SEE SCH J) 209058 0 91217 0 6608 0 92602 0 19373 0 418858 0 0 0 KHA H TRAN MD THRU 917 VP OF MEDICAL AFFAIRS (SEE SCH J) 242532 0 89257 0 59594 0 68754 0 25232 0 485369 0 54910 0 ANN-MARIE JEAN POHL VICE PRESIDENT/CNO (SEE SCH J) 168832 0 78540 0 75765 0 65841 0 0 0 388978 0 70892 0 LYNN C CARPENTER EXECUTIVE DIRECTOR 138039 0 14900 0 4537 0 4984 0 26511 0 188971 0 0 0 DENISE G KIRALY DIRECTOR - HUMAN RESOURCS 150466 0 15200 0 0 0 5202 0 27633 0 198501 0 0 0 MARK W RECKER THRU 917 DIRECTOR - PHARMACY 142684 0 14200 0 661 0 3422 0 13816 0 174783 0 0 0 DENNIS E MORRIS PHYSICIAN ADVISOR 153587 0 0 0 0 0 4658 0 10004 0 168249 0 0 0 JAMES J STRAUB MANAGER - OUTPATIENT PHARM 130017 0 12600 0 0 0 4342 0 10004 0 156963 0 0 0 PART I, LINE 1A LIMA MEMORIAL JOINT OPERATING COMPANY PROVIDES SOCIAL CLUB DUES TO THE CEO; THEY ARE TREATED AS TAXABLE COMPENSATION. PART I, LINES 4A-B THE FOLLOWING INDIVIDUALS PARTICIPATED IN AN IRC 457(F) NON-QUALIFIED DEFERRED COMPENSATION PLAN. THIS PLAN IS FUNDED BY THE HOSPITAL AND VESTS WITH SERVICE THEREFORE IS SUBJECT TO RISK OF FORFEITURE. ROBERT E. ARMSTRONG, JR.: $55,943 MICHAEL D. SWICK: $190,178 KHA H. TRAN, MD: $27,534 JOHN FISCHBACH: $40,597 ANN-MARIE JEAN POHL: $23,631 THE FOLLOWING INDIVIDUALS RECEIVED SEVERANCE PAYMENTS DURING THE YEAR: MARK RECKER: $45,734 KHA H. TRAN: $9,443 A OHIO HIGHER EDUCATION FACILITY COMM 346849674 2014-02-20 50215000 SEE PART VI 0 0 0 A 2330000 50215000 1385653 7183784 41645563 2014 1 0 0 1 A 0 1 1 0 0 0.01900 0.01900 0 0 1 A 0 0 1 0 1 1 PNC BANK NATIONAL ASSOCIATION 30.400000000000 0 0 0 0 0 A 1 PART 1. ROW A COLUMN (F) CONSTRUCT HOSPITAL FACILITIES, AND REFUND IN A CURRENT REFUNDING ISSUE THE FOLLOWING ISSUES OF OBLIGATIONS: (1) CITY OF LIMA, OHIO ADJUSTABLE RATE HOSPITAL FACILITIES REFUNDING BONDS SERIES 2003 (LIMA MEMORIAL HOSPITAL PROJECT), ISSUED ON APRIL 10, 2003; (2) CITY OF LIMA, OHIO VARIABLE RATE DEMAND HOSPITAL FACILITIES REVENUE BONDS, SERIES 2007 (LIMA MEMORIAL HOSPITAL PROJECT), ISSUED ON JULY 18, 2007; (3) VILLAGE OF ELIDA, OHIO, HOSPITALS FACILITIES REVENUE BONDS, SERIES 2000 (LIMA MEMORIAL PROJECT), AS REISSUED ON MAY 22, 2007; AND (4) THE THEN OUTSTANDING PRINCIPAL AMOUNT OF A TAXABLE BANK LOAN FROM J.P. MORGAN CHASE, BANK. N.A., PURSUANT TO A CONSTRUCTION LOAN AGREEMENT DATED NOVEMBER 23, 2004. PART II. ROW 5, COLUMN A INCLUDES AMOUNTS EXCEPTED FROM THE "PROCEEDS-SPENT-LAST" RULE UNDER TREASURY REGULATIONS 1.148-6(D)(3)(II)(3). JJ JOHNSON J.J. JOHNSON IS THE SON OF BOARD MEMBER JOHN JOHNSON 67259 EMPLOYMENT 0 GINA M FISCHBACH GINA M. FISCHBACH IS THE WIFE OF VP/CFO JOHN T. FISCHBACH 33632 EMPLOYMENT 0 RONALD L POHL - PRESIDENT OF OHIO RONALD L. POHL IS THE HUSBAND OF VP/CNO ANN-MARIE JEAN POHL 750000 MANAGEMENT AGREEMENT WITH OHIO CARDIOTHORACIC & VASCULAR SURGEONS 0 FORM 990, PART VI, SECTION A, LINE 6 THE MEMBERS ARE LIMA MEMORIAL HOSPITAL AND PH VENTURES, INC., WHOSE SOLE MEMBER IS PROMEDICA HEALTH SYSTEM, BOTH OHIO NONPROFIT CORPORATIONS. FORM 990, PART VI, SECTION B, LINE 11B THE AUDIT COMMITTEE OF THE BOARD REVIEWS AND APPROVES THE FORM 990, AND A COPY OF THE FORM 990 IS PROVIDED TO THE BOARD, PRIOR TO FILING. THIS PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. FORM 990, PART VI, SECTION B, LINE 12C EACH TRUSTEE, PRINCIPAL OFFICER, AND MEMBER OF A COMMITTEE WITH BOARD-DELEGATED POWERS SHALL ANNUALLY SIGN A STATEMENT WHICH AFFIRMS THAT SUCH PERSON: 1) HAS RECEIVED A COPY OF THE CONFLICTS OF INTEREST POLICY; 2) HAS READ AND UNDERSTANDS THE POLICY; 3) HAS AGREED TO COMPLY WITH THE POLICY; AND 4) UNDERSTANDS THAT THE CORPORATION IS A CHARITABLE ORGANIZATION AND THAT IN ORDER TO MAINTAIN ITS FEDERAL TAX EXEMPTION, IT MUST ENGAGE PRIMARILY IN ACTIVITIES WHICH ACCOMPLISH ONE OR MORE OF ITS TAX-EXEMPT PURPOSES. IF THE BOARD OR COMMITTEE HAS REASONABLE CAUSE TO BELIEVE THAT A MEMBER HAS FAILED TO DISCLOSE ACTUAL OR POSSIBLE CONFLICTS OF INTEREST, IT SHALL INFORM THE MEMBER OF THE BASIS FOR SUCH BELIEF AND AFFORD THE MEMBER AN OPPORTUNITY TO EXPLAIN THE ALLEGED FAILURE TO DISCLOSE. IF, AFTER HEARING THE RESPONSE OF THE MEMBER AND MAKING SUCH FURTHER INVESTIGATION AS MAY BE WARRANTED IN THE CIRCUMSTANCES, THE BOARD OR COMMITTEE DETERMINES THAT THE MEMBER HAS IN FACT FAILED TO DISCLOSE AN ACTUAL OR POSSIBLE CONFLICT OF INTEREST, IT SHALL TAKE APPROPRIATE DISCIPLINARY AND CORRECTIVE ACTION. FORM 990, PART VI, SECTION B, LINE 15 THE PROCESS FOR DETERMINING THE ORGANIZATION'S CEO, OTHER OFFICERS AND KEY EMPLOYEES' COMPENSATION INCLUDES: 1) REVIEW AND APPROVAL BY THE COMPENSATION COMMITTEE; 2) THE UTILIZATION OF AN INDEPENDENT COMPENSATION CONSULTANT; 3) COMPARABLE DATA; AND 4) CONTEMPORANEOUS DOCUMENTATION. THIS PROCESS WAS LAST COMPLETED IN 2017. FORM 990, PART VI, SECTION C, LINE 19 THE GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE CURRENTLY NOT AVAILABLE TO THE PUBLIC. THE FINANCIAL STATEMENTS ARE FILED WITH THE RETURN AS REQUIRED. FORM 990, PART IX, LINE 11G PURCHASE SERVICE: PROGRAM SERVICE EXPENSES 2,492,395. MANAGEMENT AND GENERAL EXPENSES 3,887,885. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 6,380,280. HEARING AID REPAIR: PROGRAM SERVICE EXPENSES 4,141. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 4,141. PROF PURCHASE SERVICE: PROGRAM SERVICE EXPENSES 4,475,198. MANAGEMENT AND GENERAL EXPENSES 2,165. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 4,477,363. CONSULTING: PROGRAM SERVICE EXPENSES 37,368. MANAGEMENT AND GENERAL EXPENSES 69,467. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 106,835. COLLECTION: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 665,510. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 665,510. RENTAL: PROGRAM SERVICE EXPENSES 988,133. MANAGEMENT AND GENERAL EXPENSES 550,814. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,538,947. COPIER RENTAL: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 94,235. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 94,235. CELL PHONE RENTAL: PROGRAM SERVICE EXPENSES 32,191. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 32,191. SERVICE CONTRACTS: PROGRAM SERVICE EXPENSES 1,472,141. MANAGEMENT AND GENERAL EXPENSES 6,108,715. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 7,580,856. FREIGHT: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 290,008. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 290,008. WASTE: PROGRAM SERVICE EXPENSES 12,437. MANAGEMENT AND GENERAL EXPENSES 9,949. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 22,386. COURTESY TRANSPORT-PARKING: PROGRAM SERVICE EXPENSES 150,806. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 150,806. CLEANING: PROGRAM SERVICE EXPENSES 43,113. MANAGEMENT AND GENERAL EXPENSES 64,079. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 107,192. PHYSICIAN FEES: PROGRAM SERVICE EXPENSES 5,166,105. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 5,166,105. CORPORATE FEE: PROGRAM SERVICE EXPENSES 170,359. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 170,359. FORM 990, PART XI, LINE 9: IMPLEMENTATION OF NEW ACCOUNTING PRONOUNCEMENT 32,269. INVESTMENT IN LMHS WOMEN'S HEALTH CO-MANAGEMENT K-1 -3,838. INTERCOMPANY ALLOCATIONS -779. TRANSFER FROM AFFILIATE - UNRESTRICTED 1,109,767. FORM 990, PART XI, LINE 2C EXPLANATION: THE AUDIT COMMITTEE ASSUMES RESPONSIBILITY FOR THE OVERSIGHT OF THE AUDIT AND THE SELECTION OF THE INDEPENDENT ACCOUNTANT. THIS PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. FORM 990, SUPPLEMENTAL FINANCIAL INFORMATION THE CALCULATION RECONCILES THE ORGANIZATION'S OPERATIONS TO THE LIMA MEMORIAL HEALTH SYSTEM'S CONSOLIDATED FINANCIAL STATEMENTS. GAIN (LOSS) FROM OPERATIONS LMH $ 16,302,923 LMP $ (13,718,887) ELM TREE $ 50,750 FOUNDATION $ 154,714 TOTAL GAIN (LOSS) FROM OPERATIONS $ 2,789,500 NON-OPERATING REVENUES, NET* $ 6,049,275 INTEREST RATE SWAP $ 875,435 AUDITED EXCESS REVENUE $ 9,714,210 NET ASSETS RELEASED FROM RESTRICTION $ - PPA $ - NET $ 9,714,210 OTHER 990 ADJUSTMENTS WOMEN'S HEALTH K-1 $ 3,838 UNREALIZED GAIN/LOSS $( 3,377,802) CARDINAL HEALTH K-1 $( 62,584) TOTAL OTHER 990 ADJUSTMENTS $(3,436,548) NET $ 6,277,662 LMJOC 990 $ 19,833,799 LMPC 990 $(13,718,203) ELM TREE 1120 $ 49,006 LMH 990EZ $( 62,584) LM FOUNDATION 990 $200,931 LM AUXILIARY 990 $(25,287) NET TAX RETURNS $ 6,277,662 DIFFERENCE: FINANCIAL STATEMENTS VS TAX RETURN $ 0 * INCLUDES UNREALIZED GAIN/LOSS OF $3,377,802 LIMA MEMORIAL HOSPITAL 1001 BELLEFONTAINE AVENUE LIMA OH 45804 344434676 HEALTHCARE OH 501(C)(3) 170(B)(1)(A)(III) LIMA MEMORIAL JOINT OPERATING COMPANY 1 LIMA MEMORIAL HOSPITAL FOUNDATION 1001 BELLEFONTAINE AVENUE LIMA OH 45804 341707570 SUPPORTING ORGANIZATION FOR LIMA MEMORIAL HOSPITAL OH 501(C)(3) 509(A)(3) LIMA MEMORIAL JOINT OPERATING COMPANY 1 LIMA MEMORIAL HOSPITAL AUXILIARY 1001 BELLEFONTAINE AVENUE LIMA OH 45804 341694632 SUPPORTING ORGANIZATION FOR LIMA MEMORIAL HOSPITAL OH 501(C)(3) 509(A)(3) LIMA MEMORIAL JOINT OPERATING COMPANY 1 LIMA MEMORIAL PROFESSIONAL CORPORATION 1001 BELLEFONTAINE AVENUE LIMA OH 45804 341935236 HEALTHCARE OH 501(C)(3) 170(B)(1)(A)(III) LIMA MEMORIAL JOINT OPERATING COMPANY 1 LMHS WOMEN'S HEALTH CO-MANAGEMENT COMPANY LLC 1001 BELLEFONTAINE AVE LIMA OH 45804 271023520 WOMEN'S HEALTH CO-MANAGEMENT OH LIMA MEMORIAL JOINT OPERATING COMPANY RELATED 3838 90633 0 1 0.50000 ELM TREE FOUNDATION 1220 EAST ELM STREET LIMA OH 45804 341417720 RENTAL REAL ESTATE OH LIMA MEMORIAL JOINT OPERATING COMPANY C 1023235 6748129 1.00000 1 0 1 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 LIMA MEMORIAL HOSPITAL FOUNDATION S 1109767 EQUITY TRANSFER LIMA MEMORIAL PROFESSIONAL CORPORATION R 14282825 EQUITY TRANSFER LIMA MEMORIAL PROFESSIONAL CORPORATION J 828198 LEASE CONTRACT ELM TREE FOUNDATION K 450999 LEASE CONTRACT ELM TREE FOUNDATION Q 150000 CASH TRANSACTION