FAIRFIELD MEDICAL CENTER: Form 990, tax year 2016

View the entire original 990 at ProPublica ↗

Organization
FAIRFIELD MEDICAL CENTER (EIN 31-0645626)
Tax period
2016-01-01 to 2016-12-31
Filed
2017-11-03
IRS object ID
201703079349302100
Schema version
2016v3.0
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 ReturnHeader

FieldValueIRS element (for citing)
Return2017-11-03T04:27:32-00:00ReturnTs
Tax Period End2016-12-31TaxPeriodEndDt
Return Type990ReturnTypeCd
Tax Period Begin2016-01-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN310645626EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1Fairfield Medical CenterBusinessNameLine1Txt
FieldValueIRS element (for citing)
Business Name ControlFAIRBusinessNameControlTxt
Phone7406878000PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1401 North Ewing StreetAddressLine1Txt
CityLancasterCityNm
State AbbreviationOHStateAbbreviationCd
ZIP431303371ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonSky L GettysPersonNm
Person TitleCFO TreasurerPersonTitleTxt
Signature2017-11-03SignatureDt
Discuss With Paid PreparerfalseDiscussWithPaidPreparerInd

Filing Security Information FilingSecurityInformation

IP Address IPAddress

FieldValueIRS element (for citing)
I Pv4 Address127.0.0.1IPv4AddressTxt
FieldValueIRS element (for citing)
IP2017-11-03IPDt
IP Tm16:26:52IPTm
IP TimezoneEDIPTimezoneCd
Federal Original Submission Id3142862017307qw36qjmFederalOriginalSubmissionId
Federal Original Submission Id2017-11-03FederalOriginalSubmissionIdDt
Filing License TypePFilingLicenseTypeCd
At Submission Creation Device Id68198CF905BABD3D5EE838CAC143C831963E09EBAtSubmissionCreationDeviceId
At Submission Filing Device Id68198CF905BABD3D5EE838CAC143C831963E09EBAtSubmissionFilingDeviceId
FieldValueIRS element (for citing)
Tax2016TaxYr
Build TS2017-02-10 21:41:12ZBuildTS

Form 990 IRS990

Principal Ofcr Business Name PrincipalOfcrBusinessName

FieldValueIRS element (for citing)
Business Name Line1John R Janoso JrBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line1401 North Ewing StreetAddressLine1Txt
CityLancasterCityNm
State AbbreviationOHStateAbbreviationCd
ZIP43130ZIPCd
FieldValueIRS element (for citing)
Gross Receipts$303,614,356GrossReceiptsAmt
Group Return For AffiliatesfalseGroupReturnForAffiliatesInd
Organization501c3Yes (X)Organization501c3Ind
Website Addresswww.fmchealth.orgWebsiteAddressTxt
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Formation1982FormationYr
Legal Domicile StateOHLegalDomicileStateCd
Activity Or MissionFairfield Medical Center delivers outstanding healthcare for our patients, their families and our communities.ActivityOrMissionDesc
Voting Members Governing Body15VotingMembersGoverningBodyCnt
Voting Members Independent15VotingMembersIndependentCnt
Total Employee2540TotalEmployeeCnt
Total Volunteers264TotalVolunteersCnt
Total Gross UBI$356,542TotalGrossUBIAmt
PY Contributions Grants$23,777PYContributionsGrantsAmt
CY Contributions Grants$124,272CYContributionsGrantsAmt
PY Program Service Revenue$239,245,347PYProgramServiceRevenueAmt
CY Program Service Revenue$257,172,196CYProgramServiceRevenueAmt
PY Investment Income$4,870,552PYInvestmentIncomeAmt
CY Investment Income$1,553,117CYInvestmentIncomeAmt
PY Other Revenue$3,755,025PYOtherRevenueAmt
CY Other Revenue$2,697,047CYOtherRevenueAmt
PY Total Revenue$247,894,701PYTotalRevenueAmt
CY Total Revenue$261,546,632CYTotalRevenueAmt
CY Grants And Similar Paid$0CYGrantsAndSimilarPaidAmt
CY Benefits Paid To Members$0CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$110,986,165PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$117,628,354CYSalariesCompEmpBnftPaidAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$0CYTotalFundraisingExpenseAmt
PY Other Expenses$118,863,880PYOtherExpensesAmt
CY Other Expenses$125,650,665CYOtherExpensesAmt
PY Total Expenses$229,850,045PYTotalExpensesAmt
CY Total Expenses$243,279,019CYTotalExpensesAmt
PY Revenues Less Expenses$18,044,656PYRevenuesLessExpensesAmt
CY Revenues Less Expenses$18,267,613CYRevenuesLessExpensesAmt
Total Assets BOY$278,507,402TotalAssetsBOYAmt
Total Assets EOY$291,691,301TotalAssetsEOYAmt
Total Liabilities BOY$124,203,212TotalLiabilitiesBOYAmt
Total Liabilities EOY$128,102,514TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$154,304,190NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$163,588,787NetAssetsOrFundBalancesEOYAmt
MissionFairfield Medical Center delivers outstanding healthcare for our patients, their families and our communities.MissionDesc
Significant New Program SrvcfalseSignificantNewProgramSrvcInd
Significant ChangefalseSignificantChangeInd
Expense$87,997,958ExpenseAmt
Revenue$123,959,591RevenueAmt
DescPatient Care Inpatient Medical, Surgical, Emergency, Maternity, ICU, Psychiatry, and Nursing Services 79,477 admissions, procedures visitsDesc

Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp

FieldValueIRS element (for citing)
Expense$84,202,342ExpenseAmt
Revenue$120,489,820RevenueAmt
DescPatient Care Laboratory, Cardiovascular, Radiology, Therapy, Pharmacy, and Medical Supply Services 2,845,863 procedures dosagesDesc

Prog Srvc Accom Acty3 ProgSrvcAccomActy3Grp

FieldValueIRS element (for citing)
Expense$23,916,211ExpenseAmt
Revenue$1,086,803RevenueAmt
DescPatient Care Nutritional Services 546,967 meals served Patient Care Laundry Services 1,577,382 pounds Patient Care Plant Engineering, Police, Housekeeping, Central Transport, Interest Depreciation 686,778 square feetDesc
FieldValueIRS element (for citing)
Total Program Service Expenses$196,116,511TotalProgramServiceExpensesAmt
Described In Section501c3Yes (true)DescribedInSection501c3Ind
Schedule B RequiredYes (true)ScheduleBRequiredInd
Political Campaign ActyfalsePoliticalCampaignActyInd
Lobbying ActivitiesfalseLobbyingActivitiesInd
Subject To Proxy TaxfalseSubjectToProxyTaxInd
Donor Advised FundfalseDonorAdvisedFundInd
Conservation EasementsfalseConservationEasementsInd
Collections Of ArtfalseCollectionsOfArtInd
Credit CounselingfalseCreditCounselingInd
Temp Or Permanent EndowmentsfalseTempOrPermanentEndowmentsInd
Report Land Building EquipmentYes (true)ReportLandBuildingEquipmentInd
Report Investments Other SecfalseReportInvestmentsOtherSecInd
Report Program Related InvstfalseReportProgramRelatedInvstInd
Report Other AssetsYes (true)ReportOtherAssetsInd
Report Other LiabilitiesYes (true)ReportOtherLiabilitiesInd
Include FIN48 FootnotefalseIncludeFIN48FootnoteInd
Independent Audit Fincl StmtfalseIndependentAuditFinclStmtInd
Consolidated Audit Fincl StmtYes (true)ConsolidatedAuditFinclStmtInd
School OperatingfalseSchoolOperatingInd
Foreign OfficefalseForeignOfficeInd
Foreign ActivitiesfalseForeignActivitiesInd
More Than5000 K To OrgfalseMoreThan5000KToOrgInd
More Than5000 K To IndividualsfalseMoreThan5000KToIndividualsInd
Professional FundraisingfalseProfessionalFundraisingInd
Fundraising ActivitiesfalseFundraisingActivitiesInd
Gaming ActivitiesfalseGamingActivitiesInd
Operate HospitalYes (true)OperateHospitalInd
Audited Financial Stmt AttYes (true)AuditedFinancialStmtAttInd
Grants To OrganizationsYes (true)GrantsToOrganizationsInd
Grants To IndividualsfalseGrantsToIndividualsInd
Schedule J RequiredYes (true)ScheduleJRequiredInd
Tax Exempt BondsYes (true)TaxExemptBondsInd
Invest Tax Exempt BondsfalseInvestTaxExemptBondsInd
Escrow AccountfalseEscrowAccountInd
On Behalf Of IssuerfalseOnBehalfOfIssuerInd
Engaged In Excess Benefit TransfalseEngagedInExcessBenefitTransInd
PY Excess Benefit TransfalsePYExcessBenefitTransInd
Loan OutstandingfalseLoanOutstandingInd
Grant To Related PersonfalseGrantToRelatedPersonInd
Business Rln With Org MemfalseBusinessRlnWithOrgMemInd
Business Rln With Fam MemfalseBusinessRlnWithFamMemInd
Business Rln With Officer EntfalseBusinessRlnWithOfficerEntInd
Deductible Non Cash ContrifalseDeductibleNonCashContriInd
Deductible Art ContributionfalseDeductibleArtContributionInd
Terminate OperationsfalseTerminateOperationsInd
Partial LiquidationfalsePartialLiquidationInd
Disregarded EntityYes (true)DisregardedEntityInd
Related EntityYes (true)RelatedEntityInd
Related Organization Ctrl EntYes (true)RelatedOrganizationCtrlEntInd
Transaction With Control EntYes (true)TransactionWithControlEntInd
Trnsfr Exmpt Non Chrtbl Rltd OrgYes (true)TrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted PrtshpfalseActivitiesConductedPrtshpInd
Schedule O RequiredYes (true)ScheduleORequiredInd
IRP Document198IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Backup Wthld ComplianceYes (true)BackupWthldComplianceInd
Employee2540EmployeeCnt
Employment Tax Returns FiledYes (true)EmploymentTaxReturnsFiledInd
Unrelated Bus Incm Over LimitYes (true)UnrelatedBusIncmOverLimitInd
Form990 T FiledYes (true)Form990TFiledInd
Foreign Financial AccountfalseForeignFinancialAccountInd
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTransInd
Taxable Party NotificationfalseTaxablePartyNotificationInd
Form8886 T FiledfalseForm8886TFiledInd
Nondeductible ContributionsfalseNondeductibleContributionsInd
Quid Pro Quo ContributionsfalseQuidProQuoContributionsInd
Form8282 Property Disposed OffalseForm8282PropertyDisposedOfInd
Rcv Fnds To Pay Prsnl Bnft CntrctfalseRcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft CntrctfalsePayPremiumsPrsnlBnftCntrctInd
Indoor Tanning ServicesfalseIndoorTanningServicesInd
Info In Schedule O Part VIYes (X)InfoInScheduleOPartVIInd
Governing Body Voting Members15GoverningBodyVotingMembersCnt
Independent Voting Member15IndependentVotingMemberCnt
Family Or Business RlnYes (true)FamilyOrBusinessRlnInd
Delegation Of Mgmt DutiesfalseDelegationOfMgmtDutiesInd
Change To Org DocumentsfalseChangeToOrgDocumentsInd
Material Diversion Or MisusefalseMaterialDiversionOrMisuseInd
Members Or StockholdersfalseMembersOrStockholdersInd
Election Of Board MembersfalseElectionOfBoardMembersInd
Decisions Subject To ApprovafalseDecisionsSubjectToApprovaInd
Minutes Of Governing BodyYes (true)MinutesOfGoverningBodyInd
Minutes Of CommitteesYes (true)MinutesOfCommitteesInd
Officer Mailing AddressfalseOfficerMailingAddressInd
Local ChaptersfalseLocalChaptersInd
Form990 Provided To Gvrn BodyfalseForm990ProvidedToGvrnBodyInd
Conflict Of Interest PolicyYes (true)ConflictOfInterestPolicyInd
Annual Disclosure Covered PrsnYes (true)AnnualDisclosureCoveredPrsnInd
Regular Monitoring EnfrcYes (true)RegularMonitoringEnfrcInd
Whistleblower PolicyYes (true)WhistleblowerPolicyInd
Document Retention PolicyYes (true)DocumentRetentionPolicyInd
Compensation Process CEOYes (true)CompensationProcessCEOInd
Compensation Process OtherYes (true)CompensationProcessOtherInd
Investment In Joint VentureYes (true)InvestmentInJointVentureInd
Written Policy Or ProcedureYes (true)WrittenPolicyOrProcedureInd
States Where Copy Of Return Is FldOHStatesWhereCopyOfReturnIsFldCd
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

FieldValueIRS element (for citing)
PersonSky L GettysPersonNm
Phone7406878011PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1401 North Ewing StreetAddressLine1Txt
CityLancasterCityNm
State AbbreviationOHStateAbbreviationCd
ZIP431303371ZIPCd

Form990 Part VII Section A Form990PartVIISectionAGrp (27 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndOfficerOfficerIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmtAverage Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRtKey EmployeeKeyEmployeeIndHighest Compensated EmployeeHighestCompensatedEmployeeIndFormer Ofcr Director TrusteeFormerOfcrDirectorTrusteeInd
Linda Sheridan
Chair003.00Yes (X)Yes (X)$0$0$0
Ron Burris
Vice Chair/Secretary003.00Yes (X)Yes (X)$0$0$0
Angela Krile
Director002.00Yes (X)$0$0$0
Adam Custer
Director002.00Yes (X)$0$0$0
Theresa Dyar DO
Director002.00Yes (X)$0$0$0
Dan Fruth
Director002.00Yes (X)$0$0$0
Barry Ritchey
Director002.00Yes (X)$0$0$0
Bradley Hedges PhD
Director002.00Yes (X)$0$0$0
Susan Nixon Stoughton
Director002.00Yes (X)$0$0$0
Milt Taylor Jr
Director002.00Yes (X)$0$0$0
Louis Varga
Director002.00Yes (X)$0$0$0
Renee Wagner
Director002.00Yes (X)$0$0$0
William Yaple
Director002.00Yes (X)$0$0$0
Jeffrey Yenchar MD
Director002.00Yes (X)$0$0$0
John R Janoso Jr
Director, President CEO055.00Yes (X)Yes (X)$458,804$0$64,655001.00
Sky L Gettys
CFO, Treasurer048.00Yes (X)$309,639$0$25,787002.00
Terrence B Welsh MD
Chief of Medical Affairs040.00$260,071$0$22,674Yes (X)
Helen F Harding
Chief Nursing Officer040.00$199,069$0$20,324Yes (X)
Martha Buckley MD
Chief Quality Officer040.00$327,525$0$19,521Yes (X)
Debra L Palmer
Chief HR Officer040.00$188,281$0$20,659Yes (X)
Alan F Greenslade
Chief Information Officer040.00$196,254$0$25,673Yes (X)
Randy L Brown
Staff Pharmacist041.00$165,409$0$16,971Yes (X)
Teresa R Ryan
Director, Patient Services040.00$151,987$0$17,221Yes (X)
Jeffrey M Ayers MD
Residency Prog. Dir.030.00$144,700$0$28,563Yes (X)
Pamela L Reed
Director OP Services034.00$142,674$0$12,087Yes (X)
Grant R Brame
Physicians Assistant040.00$152,552$0$22,865Yes (X)
Mina H Ubbing
Former President CEO$511,121$0$0Yes (X)
FieldValueIRS element (for citing)
Total Reportable Comp From Org$3,208,086TotalReportableCompFromOrgAmt
Total Other Compensation$297,000TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K44IndivRcvdGreaterThan100KCnt
Former Ofcr Employees ListedYes (true)FormerOfcrEmployeesListedInd
Total Comp Greater Than150 KYes (true)TotalCompGreaterThan150KInd
Compensation From Other SrcsfalseCompensationFromOtherSrcsInd

Contractor Compensation ContractorCompensationGrp (5 entries)

Address Line1ContractorAddress/USAddress/AddressLine1TxtCityContractorAddress/USAddress/CityNmState AbbreviationContractorAddress/USAddress/StateAbbreviationCdZIPContractorAddress/USAddress/ZIPCdServicesServicesDescCompensationCompensationAmt
McKesson
PO Box 98347ChicagoIL606930001Information Technology Services$3,650,724
Renovo Solutions
1801 E Parkcourt Place Bldg DSanta AnaCA92701Biomedical Services$3,272,738
East Main Shopping
123 S Broad StreetLancasterOH43130Real Estate$433,277
EMP Management Group Ltd
4535 Dressler Rd NWCantonOH44718Physician Services$686,000
Bricker & Eckler
100 South Third StreetColumbusOH43215Attorney Fees$584,738
FieldValueIRS element (for citing)
Cntrct Rcvd Greater Than100 K23CntrctRcvdGreaterThan100KCnt
All Other Contributions$124,272AllOtherContributionsAmt
Total Contributions$124,272TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp

FieldValueIRS element (for citing)
DescPatient Service Revenue NetDesc
Total Revenue Column$257,172,196TotalRevenueColumnAmt
FieldValueIRS element (for citing)
Total Program Service Revenue$257,172,196TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$1,528,926TotalRevenueColumnAmt

Gross Rents GrossRentsGrp

FieldValueIRS element (for citing)
Real$643,410RealAmt

Less Rental Expenses LessRentalExpensesGrp

FieldValueIRS element (for citing)
Real$496,040RealAmt

Rental Income Or Loss RentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Real$147,370RealAmt

Net Rental Income Or Loss NetRentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Total Revenue Column$147,370TotalRevenueColumnAmt

Gross Amount Sales Assets GrossAmountSalesAssetsGrp

FieldValueIRS element (for citing)
Securities$41,431,407SecuritiesAmt
Other$164,468OtherAmt

Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp

FieldValueIRS element (for citing)
Securities$41,389,675SecuritiesAmt
Other$182,009OtherAmt

Gain Or Loss GainOrLossGrp

FieldValueIRS element (for citing)
Securities$41,732SecuritiesAmt
Other-$17,541OtherAmt

Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp

FieldValueIRS element (for citing)
Total Revenue Column$24,191TotalRevenueColumnAmt

Other Revenue Misc OtherRevenueMiscGrp (3 entries)

DescDescTotal Revenue ColumnTotalRevenueColumnAmtExclusionExclusionAmtBusinessBusinessCdUnrelated Business RevenueUnrelatedBusinessRevenueAmt
Cafeteria Sales$1,004,487$1,004,487
Patronage Dividends$520,330$520,330900099
Outside Reference Lab$316,917621500$316,917

Miscellaneous Revenue MiscellaneousRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$707,943TotalRevenueColumnAmt
Related Or Exempt Func Income$668,318RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$39,625UnrelatedBusinessRevenueAmt
FieldValueIRS element (for citing)
Other Revenue Total$2,549,677OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$261,546,632TotalRevenueColumnAmt
Related Or Exempt Func Income$668,318RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$356,542UnrelatedBusinessRevenueAmt
Exclusion$1,524,817ExclusionAmt
FieldValueIRS element (for citing)
Info In Schedule O Part IXYes (X)InfoInScheduleOPartIXInd

Grants To Domestic Orgs GrantsToDomesticOrgsGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Grants To Domestic Individuals GrantsToDomesticIndividualsGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Foreign Grants ForeignGrantsGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Benefits To Members BenefitsToMembersGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

FieldValueIRS element (for citing)
Total$2,159,009TotalAmt
Program Services$850,304ProgramServicesAmt
Management And General$1,308,705ManagementAndGeneralAmt

Comp Disqual Persons CompDisqualPersonsGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

FieldValueIRS element (for citing)
Total$89,973,113TotalAmt
Program Services$78,724,814ProgramServicesAmt
Management And General$11,248,299ManagementAndGeneralAmt

Pension Plan Contributions PensionPlanContributionsGrp

FieldValueIRS element (for citing)
Total$4,818,459TotalAmt
Program Services$4,275,581ProgramServicesAmt
Management And General$542,878ManagementAndGeneralAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

FieldValueIRS element (for citing)
Total$14,027,728TotalAmt
Program Services$11,669,051ProgramServicesAmt
Management And General$2,358,677ManagementAndGeneralAmt

Payroll Taxes PayrollTaxesGrp

FieldValueIRS element (for citing)
Total$6,650,045TotalAmt
Program Services$5,681,758ProgramServicesAmt
Management And General$968,287ManagementAndGeneralAmt

Fees For Services Management FeesForServicesManagementGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Fees For Services Legal FeesForServicesLegalGrp

FieldValueIRS element (for citing)
Total$1,148,094TotalAmt
Management And General$1,148,094ManagementAndGeneralAmt

Fees For Services Accounting FeesForServicesAccountingGrp

FieldValueIRS element (for citing)
Total$102,700TotalAmt
Management And General$102,700ManagementAndGeneralAmt

Fees For Services Lobbying FeesForServicesLobbyingGrp

FieldValueIRS element (for citing)
Total$0TotalAmt
FieldValueIRS element (for citing)
Fees For Services Prof FundraisingFeesForServicesProfFundraising

Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Fees For Services Other FeesForServicesOtherGrp

FieldValueIRS element (for citing)
Total$24,417,738TotalAmt
Program Services$10,785,207ProgramServicesAmt
Management And General$13,632,531ManagementAndGeneralAmt

Advertising AdvertisingGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Information Technology InformationTechnologyGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Royalties RoyaltiesGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Occupancy OccupancyGrp

FieldValueIRS element (for citing)
Total$4,566,611TotalAmt
Program Services$4,125,265ProgramServicesAmt
Management And General$441,346ManagementAndGeneralAmt

Travel TravelGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Pymt Travel Entrtnmnt Pub Ofcl PymtTravelEntrtnmntPubOfclGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Conferences Meetings ConferencesMeetingsGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Interest InterestGrp

FieldValueIRS element (for citing)
Total$4,646,458TotalAmt
Program Services$4,228,277ProgramServicesAmt
Management And General$418,181ManagementAndGeneralAmt

Payments To Affiliates PaymentsToAffiliatesGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Depreciation Depletion DepreciationDepletionGrp

FieldValueIRS element (for citing)
Total$13,561,509TotalAmt
Program Services$9,378,547ProgramServicesAmt
Management And General$4,182,962ManagementAndGeneralAmt

Insurance InsuranceGrp

FieldValueIRS element (for citing)
Total$1,585,698TotalAmt
Management And General$1,585,698ManagementAndGeneralAmt

Other Expenses OtherExpensesGrp (3 entries)

DescDescTotalTotalAmtProgram ServicesProgramServicesAmtManagement And GeneralManagementAndGeneralAmt
Supplies$55,316,485$55,283,470$33,015
Physician Fees$9,280,891$8,580,194$700,697
Other Expenses$11,024,481$2,534,043$8,490,438

All Other Expenses AllOtherExpensesGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$243,279,019TotalAmt
Program Services$196,116,511ProgramServicesAmt
Management And General$47,162,508ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$19,266,404BOYAmt
EOY$17,387,885EOYAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

FieldValueIRS element (for citing)
BOY$15,900,345BOYAmt
EOY$16,620,644EOYAmt

Accounts Receivable AccountsReceivableGrp

FieldValueIRS element (for citing)
BOY$23,951,652BOYAmt
EOY$30,651,368EOYAmt

Inventories For Sale Or Use InventoriesForSaleOrUseGrp

FieldValueIRS element (for citing)
BOY$4,313,915BOYAmt
EOY$5,462,149EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

FieldValueIRS element (for citing)
BOY$4,765,919BOYAmt
EOY$4,763,905EOYAmt
FieldValueIRS element (for citing)
Land Bldg Equip Cost Or Other Bss$293,991,856LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec$171,249,679LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
BOY$118,110,827BOYAmt
EOY$122,742,177EOYAmt

Investments Pub Traded Sec InvestmentsPubTradedSecGrp

FieldValueIRS element (for citing)
BOY$59,984,010BOYAmt
EOY$62,476,167EOYAmt

Intangible Assets IntangibleAssetsGrp

FieldValueIRS element (for citing)
BOY$4,515,499BOYAmt
EOY$4,597,273EOYAmt

Other Assets Total OtherAssetsTotalGrp

FieldValueIRS element (for citing)
BOY$27,698,831BOYAmt
EOY$26,989,733EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$278,507,402BOYAmt
EOY$291,691,301EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$6,501,672BOYAmt
EOY$7,720,995EOYAmt

Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$95,307,216BOYAmt
EOY$92,791,917EOYAmt

Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp

FieldValueIRS element (for citing)
BOY$1,348,089BOYAmt
EOY$900,364EOYAmt

Other Liabilities OtherLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$21,046,235BOYAmt
EOY$26,689,238EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$124,203,212BOYAmt
EOY$128,102,514EOYAmt
FieldValueIRS element (for citing)
Organization Follows SFAS117Yes (X)OrganizationFollowsSFAS117Ind

Unrestricted Net Assets UnrestrictedNetAssetsGrp

FieldValueIRS element (for citing)
BOY$154,304,190BOYAmt
EOY$163,588,787EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$154,304,190BOYAmt
EOY$163,588,787EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$278,507,402BOYAmt
EOY$291,691,301EOYAmt
FieldValueIRS element (for citing)
Info In Schedule O Part XIYes (X)InfoInScheduleOPartXIInd
Reconcilation Revenue Expnss$18,267,613ReconcilationRevenueExpnssAmt
Net Unrlzd Gains Losses Invst$1,852,554NetUnrlzdGainsLossesInvstAmt
Other Changes In Net Assets-$10,835,570OtherChangesInNetAssetsAmt
Method Of Accounting AccrualYes (X)MethodOfAccountingAccrualInd
Accountant Compile Or ReviewfalseAccountantCompileOrReviewInd
FS AuditedYes (true)FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

FieldValueIRS element (for citing)
Consolidated Basis Fincl StmtYes (X)ConsolidatedBasisFinclStmtInd
FieldValueIRS element (for citing)
Audit CommitteeYes (true)AuditCommitteeInd
Federal Grant Audit RequiredfalseFederalGrantAuditRequiredInd

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
HospitalYes (X)HospitalInd
Public Support CY1700.00000PublicSupportCY170Pct
Public Support CY5090.00000PublicSupportCY509Pct
Investment Income CY0.00000InvestmentIncomeCYPct

Schedule B IRS990ScheduleB

Contributor Information ContributorInformationGrp

FieldValueIRS element (for citing)
ContributorRESTRICTEDContributorNum

Contributor Business Name ContributorBusinessName

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor US Address ContributorUSAddress

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Total ContributionsRESTRICTEDTotalContributionsAmt

Schedule D IRS990ScheduleD

FieldValueIRS element (for citing)
Incl Escrow Custodial Acct LiabfalseInclEscrowCustodialAcctLiabInd

Land LandGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$6,251,052OtherCostOrOtherBasisAmt
Book Value$6,251,041BookValueAmt

Buildings BuildingsGrp

FieldValueIRS element (for citing)
Investment Cost Or Other Basis$87,455InvestmentCostOrOtherBasisAmt
Other Cost Or Other Basis$115,431,971OtherCostOrOtherBasisAmt
Depreciation$59,511,397DepreciationAmt
Book Value$56,008,029BookValueAmt

Leasehold Improvements LeaseholdImprovementsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$3,206,339OtherCostOrOtherBasisAmt
Depreciation$2,913,755DepreciationAmt
Book Value$292,584BookValueAmt

Equipment EquipmentGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$153,764,869OtherCostOrOtherBasisAmt
Depreciation$106,084,495DepreciationAmt
Book Value$47,680,374BookValueAmt

Other Land Buildings OtherLandBuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$15,250,170OtherCostOrOtherBasisAmt
Depreciation$2,740,021DepreciationAmt
Book Value$12,510,149BookValueAmt
FieldValueIRS element (for citing)
Total Book Value Land Buildings$122,742,177TotalBookValueLandBuildingsAmt

Other Securities OtherSecuritiesGrp (2 entries)

DescDesc
Financial derivatives and other financial products
Closely-held equity interests

Other Assets Org OtherAssetsOrgGrp (6 entries)

DescDescBook ValueBookValueAmt
Unamortized bond financing expense
Due from related organizations$6,280,174
Notes receivable/income guarantee$1,112,376
Investment in subsidiary$14,590,476
Other receivables$5,006,707
Third party settlements
FieldValueIRS element (for citing)
Total Book Value Other Assets$26,989,733TotalBookValueOtherAssetsAmt

Other Liabilities Org OtherLiabilitiesOrgGrp (4 entries)

DescDescAmtAmt
Federal income taxes
Accrued payroll and benefits$18,787,810
Other Liabilities$6,402,619
Third Party Settlements$1,498,809
FieldValueIRS element (for citing)
Total Liability$26,689,238TotalLiabilityAmt

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Financial Assistance PolicyYes (true)FinancialAssistancePolicyInd
Written PolicyYes (true)WrittenPolicyInd
FPG Reference Free CareYes (true)FPGReferenceFreeCareInd
Percent100Yes (X)Percent100Ind
FPG Reference Discounted CareYes (true)FPGReferenceDiscountedCareInd
Percent300Yes (X)Percent300Ind
Free Care Medically IndigentYes (true)FreeCareMedicallyIndigentInd
Financial Assistance BudgetYes (true)FinancialAssistanceBudgetInd
Expenses Exceed BudgetfalseExpensesExceedBudgetInd
Annual Community Bnft ReportYes (true)AnnualCommunityBnftReportInd
Report Publically AvailableYes (true)ReportPublicallyAvailableInd

Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp

FieldValueIRS element (for citing)
Total Community Benefit Expns$2,256,115TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$2,617,619DirectOffsettingRevenueAmt

Unreimbursed Medicaid UnreimbursedMedicaidGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$40,179,367TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$29,320,533DirectOffsettingRevenueAmt
Net Community Benefit Expns$10,858,834NetCommunityBenefitExpnsAmt
Total Expense0.04460TotalExpensePct

Total Financial Assistance Typ TotalFinancialAssistanceTyp

FieldValueIRS element (for citing)
Total Community Benefit Expns$42,435,482TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$31,938,152DirectOffsettingRevenueAmt
Net Community Benefit Expns$10,858,834NetCommunityBenefitExpnsAmt
Total Expense0.04460TotalExpensePct

Community Health Services CommunityHealthServicesGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$2,047,305TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$124,732DirectOffsettingRevenueAmt
Net Community Benefit Expns$1,922,573NetCommunityBenefitExpnsAmt
Total Expense0.00790TotalExpensePct

Health Professions Education HealthProfessionsEducationGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$5,974,209TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$4,322,696DirectOffsettingRevenueAmt
Net Community Benefit Expns$1,651,513NetCommunityBenefitExpnsAmt
Total Expense0.00680TotalExpensePct

Subsidized Health Services SubsidizedHealthServicesGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$17,289,620TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$10,649,749DirectOffsettingRevenueAmt
Net Community Benefit Expns$6,639,871NetCommunityBenefitExpnsAmt
Total Expense0.02730TotalExpensePct

Research ResearchGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$131,353TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$131,353NetCommunityBenefitExpnsAmt
Total Expense0.00050TotalExpensePct

Cash And In Kind Contributions CashAndInKindContributionsGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$148,390TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$148,390NetCommunityBenefitExpnsAmt
Total Expense0.00060TotalExpensePct

Total Other Benefits TotalOtherBenefitsGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$25,590,877TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$15,097,177DirectOffsettingRevenueAmt
Net Community Benefit Expns$10,493,700NetCommunityBenefitExpnsAmt
Total Expense0.04310TotalExpensePct

Total Community Benefits TotalCommunityBenefitsGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$68,026,359TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$47,035,329DirectOffsettingRevenueAmt
Net Community Benefit Expns$21,352,534NetCommunityBenefitExpnsAmt
Total Expense0.08770TotalExpensePct

Economic Development EconomicDevelopmentGrp

FieldValueIRS element (for citing)
Net Community Benefit Expns$16,444NetCommunityBenefitExpnsAmt
Total Expense0.00010TotalExpensePct

Community Support CommunitySupportGrp

FieldValueIRS element (for citing)
Net Community Benefit Expns$13,769NetCommunityBenefitExpnsAmt
Total Expense0.00010TotalExpensePct

Environmental Improvements EnvironmentalImprovementsGrp

FieldValueIRS element (for citing)
Net Community Benefit Expns$10,497NetCommunityBenefitExpnsAmt

Leadership Development LeadershipDevelopmentGrp

FieldValueIRS element (for citing)
Net Community Benefit Expns$79,733NetCommunityBenefitExpnsAmt
Total Expense0.00030TotalExpensePct

Coalition Building CoalitionBuildingGrp

FieldValueIRS element (for citing)
Net Community Benefit Expns$10,429NetCommunityBenefitExpnsAmt

Workforce Development WorkforceDevelopmentGrp

FieldValueIRS element (for citing)
Net Community Benefit Expns$1,468NetCommunityBenefitExpnsAmt

Total Communtity Building Acty TotalCommuntityBuildingActyGrp

FieldValueIRS element (for citing)
Net Community Benefit Expns$132,340NetCommunityBenefitExpnsAmt
Total Expense0.00050TotalExpensePct
FieldValueIRS element (for citing)
Bad Debt Expense ReportedYes (true)BadDebtExpenseReportedInd
Bad Debt Expense$8,954,145BadDebtExpenseAmt
Bad Debt Expense Attributable$1,045,128BadDebtExpenseAttributableAmt
Reimbursed By Medicare$65,773,340ReimbursedByMedicareAmt
Cost Of Care Reimbursed By Medcr$65,401,989CostOfCareReimbursedByMedcrAmt
Medicare Surplus Or Shortfall$371,351MedicareSurplusOrShortfallAmt

Costing Methodology Used CostingMethodologyUsedGrp

FieldValueIRS element (for citing)
Cost Accounting SystemYes (X)CostAccountingSystemInd
FieldValueIRS element (for citing)
Written Debt Collection PolicyYes (true)WrittenDebtCollectionPolicyInd
Financial Assistance PrvsnYes (true)FinancialAssistancePrvsnInd

Management Co And Jnt Ventures ManagementCoAndJntVenturesGrp

Entity Name EntityName

FieldValueIRS element (for citing)
Business Name Line1Southeast Ohio Sleep DisordersBusinessNameLine1Txt
FieldValueIRS element (for citing)
Primary ActivitiesSleep LabPrimaryActivitiesTxt
Org Profit Or Ownership0.51000OrgProfitOrOwnershipPct
Physicians Profit Or Ownership0.49000PhysiciansProfitOrOwnershipPct
FieldValueIRS element (for citing)
Hospital Facilities1HospitalFacilitiesCnt

Hospital Facilities HospitalFacilitiesGrp

FieldValueIRS element (for citing)
Facility1FacilityNum

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1Fairfield Medical CenterBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line1401 North Ewing StreetAddressLine1Txt
CityLancasterCityNm
State AbbreviationOHStateAbbreviationCd
ZIP43130ZIPCd
FieldValueIRS element (for citing)
Website Addresswww.fmchealth.orgWebsiteAddressTxt
Licensed HospitalYes (X)LicensedHospitalInd
General Medical And SurgicalYes (X)GeneralMedicalAndSurgicalInd
Emergency Room24 HrsYes (X)EmergencyRoom24HrsInd
Facility Reporting Group1FacilityReportingGroupCd

Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp

Hospital Facility Name HospitalFacilityName

FieldValueIRS element (for citing)
Business Name Line11BusinessNameLine1Txt
FieldValueIRS element (for citing)
Facility1FacilityNum
First Licensed CY Or PYfalseFirstLicensedCYOrPYInd
Tax Exempt Hospital CY Or PYfalseTaxExemptHospitalCYOrPYInd
CHNA ConductedYes (true)CHNAConductedInd
Community DefinitionYes (X)CommunityDefinitionInd
Community DemographicsYes (X)CommunityDemographicsInd
Existing ResourcesYes (X)ExistingResourcesInd
How Data ObtainedYes (X)HowDataObtainedInd
Community Health NeedsYes (X)CommunityHealthNeedsInd
Other Health IssuesYes (X)OtherHealthIssuesInd
Community Hlth Needs Id ProcessYes (X)CommunityHlthNeedsIdProcessInd
Consulting ProcessYes (X)ConsultingProcessInd
CHNA Conducted16CHNAConductedYr
Take Into Account Others InputYes (true)TakeIntoAccountOthersInputInd
CHNA Conducted With Other FcltsYes (true)CHNAConductedWithOtherFcltsInd
CHNA Conducted With Non FcltsYes (true)CHNAConductedWithNonFcltsInd
CHNA Report Widely AvailableYes (true)CHNAReportWidelyAvailableInd
Rpt Available On Own WebsiteYes (X)RptAvailableOnOwnWebsiteInd
Own Website URLfmchealth.orgOwnWebsiteURLTxt
Other WebsiteYes (X)OtherWebsiteInd
Other Website URLmyfdh.org/pdf/2016-Fairfield-County-Community-Health-Assessment.pdfOtherWebsiteURLTxt
Paper Copy Public InspectionYes (X)PaperCopyPublicInspectionInd
Rpt Available Thru Other MethodYes (X)RptAvailableThruOtherMethodInd
Implementation Strategy AdoptYes (true)ImplementationStrategyAdoptInd
Implementation Strategy Adpt16ImplementationStrategyAdptYr
Strategy Posted WebsiteYes (true)StrategyPostedWebsiteInd
Strategy Website URLfmchealth.orgStrategyWebsiteURLTxt
Organization Incur Excise TaxfalseOrganizationIncurExciseTaxInd
Elig Criteria ExplainedYes (true)EligCriteriaExplainedInd
FPG Family Incm Lmt Free DscntYes (X)FPGFamilyIncmLmtFreeDscntInd
FPG Family Incm Lmt Free Care0000000100.000000000000FPGFamilyIncmLmtFreeCarePct
FPG Family Incm Lmt Dscnt Care0000000300.000000000000FPGFamilyIncmLmtDscntCarePct
Medical Indigency CriteriaYes (X)MedicalIndigencyCriteriaInd
Insurance Status CriteriaYes (X)InsuranceStatusCriteriaInd
Underinsurance Stat CriteriaYes (X)UnderinsuranceStatCriteriaInd
Explained BasisYes (true)ExplainedBasisInd
App Financial Asst ExplnYes (true)AppFinancialAsstExplnInd
Described InfoYes (X)DescribedInfoInd
Described Suprt DocYes (X)DescribedSuprtDocInd
Provided Hospital ContactYes (X)ProvidedHospitalContactInd
Provided Nonprofit ContactYes (X)ProvidedNonprofitContactInd
Includes Publicity MeasuresYes (true)IncludesPublicityMeasuresInd
FAP Available On WebsiteYes (X)FAPAvailableOnWebsiteInd
FAP Available On Website URLfmchealth.orgFAPAvailableOnWebsiteURLTxt
FAP App Available On WebsiteYes (X)FAPAppAvailableOnWebsiteInd
FAP App Available On Website URLfmchealth.orgFAPAppAvailableOnWebsiteURLTxt
FAP Summary On WebsiteYes (X)FAPSummaryOnWebsiteInd
FAP Summary On Website URLfmchealth.orgFAPSummaryOnWebsiteURLTxt
FAP Avlbl On Request No ChargeYes (X)FAPAvlblOnRequestNoChargeInd
FAP App Avlbl On Request No ChrgYes (X)FAPAppAvlblOnRequestNoChrgInd
FAP Sum Avlbl On Request No ChrgYes (X)FAPSumAvlblOnRequestNoChrgInd
Notified FAP Copy Bill DisplayYes (X)NotifiedFAPCopyBillDisplayInd
Communtity Notified FAPYes (X)CommuntityNotifiedFAPInd
FAP Actions On NonpaymentYes (true)FAPActionsOnNonpaymentInd
Permit No ActionsYes (X)PermitNoActionsInd
Collection ActivitiesfalseCollectionActivitiesInd
Provided Written NoticeYes (X)ProvidedWrittenNoticeInd
Made Effort Orally NotifyYes (X)MadeEffortOrallyNotifyInd
Processed FAP ApplicationYes (X)ProcessedFAPApplicationInd
Made Presumptive Elig DetermYes (X)MadePresumptiveEligDetermInd
Nondis Emergency Care PolicyYes (true)NondisEmergencyCarePolicyInd
Look Back Medicaid Medcr PrvtYes (X)LookBackMedicaidMedcrPrvtInd
Amounts Generally BilledfalseAmountsGenerallyBilledInd
Gross ChargesfalseGrossChargesInd

Supplemental Information SupplementalInformationGrp (5 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
Group Fairfield Medical Center Line Part V, Section B, Line 5Fairfield County contracted with the Hospital Council of Northwest Ohio, a non-profit hospital association, to coordinate and manage the health assessment process. During planning meetings, banks of potential survey questions were reviewed and discussed. Based on input from the Fairfield County planning committee, the Project Coordinator composed drafts of surveys containing 116 items for the adult survey and a draft youth survey containing 76 items. The needs of the population, especially those who are medically underserved, low-income, minority populations and populations with chronic disease needs, were taken into account through the sample methodology that surveyed these populations and over-sampled minority populations.
Group Fairfield Medical Center Line Part V, Section B, Line 6bThe CHNA was conducted in association with Bloom Carroll District Schools, The Fairfield Department of Health, Fairfield Community Health Center, Fairfield County ADAMH Board, Fairfield County Injury Prevention Program, United Way of Fairfield County, Fairfield County Family, Adult and Children First Council, Fairfield County Commissioners Office, Head Start/Fairfield County Community Action and Southeastern Ohio Center for Independent Living.
Group Fairfield Medical Center Line Part V, Section B, Line 11An initial meeting was held in October 2016, to review the process and timeline, as well as choosing priorities based on quantitative and qualitative data to prioritize target impact areas. The health problems were ranked on the basis of magnitude, seriousness of consequences and feasiblity of correcting. To assess resource need, the committee determined existing programs, services and activities in the community that address the priority target impact areas and looked at the number of programs that address each outcome, geographic area served, and prevention programs already in place. It was determined that there would not be sufficient resources to address every outcome in the needs assessment. In addition, Fairfield Medical Center held meetings individually to determine strengths of the hospital to complement what is being done in the community. For instance, we have an in-depth drug prevention/treatment program in place, which is a key area of need. The Hospital Implementation Plan was finalized and approved by the Board in December of 2016.
Group Fairfield Medical Center Line Part V, Section B, Line 6aDiley Ridge Medical Center
Group Fairfield Medical Center Line Part V, Section B, Line 7dA copy of the full report was given to key leaders at a community event

Supplemental Information Detail SupplementalInformationDetail (9 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
Part IIKnowing that a strong economy can help build strong people, we have dedicated ourselves to helping our local economy through donations to organizations helping to draw more business to the area and by participating in local Chambers of Commerce. We also recognize the importance of recycling as a way to improve the health of our planet, and therefore our people, with environmental improvements. Participation with other community entities by Coalition Building also helps us to keep our pulse on the health of the community through grassroots involvement.
Part III Line 4An allowance for uncollectible accounts is established on an aggregate basis by using historical write-off 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 Centers 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. The information can be found on page 8 of the financial statements.
Part III Line 8The total for Medicare Cost is taken directly from the Medicare Cost Report.
Part III Line 9bIn all instances of debt collection, patients are given information regarding financial assistance available. In addition, patients are made aware of the availability of financial assistance with an acknowledgement letter of services rendered, regardless of ability to pay or payment source. FMC will do everything possible to help those who qualify for charity care to be made aware of the assistance available. We also provide financial counselors to assist patients in filling out the necessary forms for assistance. The following options are available A. Payment in the form of cash, credit card or checks. A discount is offered with payment at the time of service and within 10 days of receiving the hospital bill. B. H.E.L.P. Bank Financial Program C. Hospital Payment Program D. Assistance with application to Medicare or Medicaid E. Hospital Care Assurance Program HCAP F. Hospital Assistance Program summary defining Fairfield Medical Centers financial opportunities. G. Assistance for the uninsured patient.
Part VI Line 2Fairfield Medical Center participates in a Community Health Needs Assessment every three years, as required, and it also stays in constant contact with other health organizations in the community to keep abreast of the health needs that we might not yet be aware of.
Part VI Line 3There are prominent signs at Registration and Collections stating our Financial Assistance Policy. It is also printed on the back of bills that are sent out. The FAP is also posted at the Fairfield County Health Center so that all are aware of our policy.
Part VI Line 4Fairfield Medical Center serves Fairfield County and surrounding counties. We have labs and health centers in outlying areas to better serve those who find it difficult to drive to Lancaster for health needs.
Part VI Line 5We know that a strong economy builds strong people and strong families, so we encourage economic development through donations and service organization participation. We also partner with many organizations in the community to help us keep our pulse on the health of the community, as well as the needs of the community that we may be able to help to meet. We help to build other organizations by helping them to raise funds and by lending valuable skills through Board participation. We also lend expertise by teaching valuable skills to other community organizations.
Part VI, Line 7OH

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Grant Records MaintainedYes (true)GrantRecordsMaintainedInd

Recipient Table RecipientTable

Recipient Business Name RecipientBusinessName

FieldValueIRS element (for citing)
Business Name Line1Fairfield Medical Center FoundationBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line1401 North Ewing StreetAddressLine1Txt
CityLancasterCityNm
State AbbreviationOHStateAbbreviationCd
ZIP43130ZIPCd
FieldValueIRS element (for citing)
Recipient EIN208952945RecipientEIN
IRC Section501c3IRCSectionDesc
Cash Grant$402,637CashGrantAmt
FieldValueIRS element (for citing)
Total501c3 Org1Total501c3OrgCnt

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Severance PaymentYes (true)SeverancePaymentInd
Supplemental Nonqual Rtr PlanYes (true)SupplementalNonqualRtrPlanInd
Equity Based Comp ArrngmfalseEquityBasedCompArrngmInd
Comp Based On Revenue Of Flng OrgfalseCompBasedOnRevenueOfFlngOrgInd
Comp Bsd On Rev Related OrgsfalseCompBsdOnRevRelatedOrgsInd
Comp Bsd Net Earns Flng OrgfalseCompBsdNetEarnsFlngOrgInd
Comp Bsd Net Earns Rltd OrgsfalseCompBsdNetEarnsRltdOrgsInd
Any Non Fixed PaymentsYes (true)AnyNonFixedPaymentsInd
Initial Contract ExceptionfalseInitialContractExceptionInd

Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (13 entries)

TitleTitleTxtOther Compensation Filing OrgOtherCompensationFilingOrgAmtTotal Compensation Filing OrgTotalCompensationFilingOrgAmtBase Compensation Filing OrgBaseCompensationFilingOrgAmtDeferred Compensation Flng OrgDeferredCompensationFlngOrgAmtNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmtBonus Filing OrganizationBonusFilingOrganizationAmount
Mina H Ubbing
Former President CEO$511,121$511,121
Sky L Gettys
CFO, Treasurer$1,300$335,361$308,274$18,550$7,237
Terrence B Welsh MD
Chief of Medical Affairs$1,508$282,745$258,563$17,347$5,327
Helen F Harding
Chief Nursing Officer$2,123$219,393$196,946$14,149$6,175
Randy L Brown
Staff Pharmacist$550$182,380$164,859$11,901$5,070
Teresa R Ryan
Director, Patient Services$900$169,208$151,087$11,147$6,074
Jeffrey M Ayers MD
Residency Prog. Dir.$1,162$173,263$143,538$10,185$18,378
Pamela L Reed
Director OP Services$1,225$154,761$141,449$8,701$3,386
John R Janoso Jr
Director, President CEO$523,459$433,804$36,550$28,105$25,000
Martha Buckley MD
Chief Quality Officer$3,000$347,046$324,525$18,550$971
Debra L Palmer
Chief HR Officer$1,662$208,940$186,619$13,532$7,127
Alan F Greenslade
Chief Information Officer$1,200$221,927$195,054$13,774$11,899
Grant R Brame
Physicians Assistant$923$175,417$147,226$9,530$13,335$4,403

Schedule K IRS990ScheduleK

Tax Exempt Bonds Issues TaxExemptBondsIssuesGrp

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd

Issuer Name IssuerName

FieldValueIRS element (for citing)
Business Name Line1County of Fairfield OhioBusinessNameLine1Txt
FieldValueIRS element (for citing)
Bond Issuer EIN316400066BondIssuerEIN
CUSIP304286AM9CUSIPNum
Bond Issued2013-06-27BondIssuedDt
Issue Price$98,511,516IssuePriceAmt
PurposeTo refund prior issue and to fund new surgical unit.PurposeDesc

Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd
Retired$56,264,480RetiredAmt
In Reserve Fund$6,320,525InReserveFundAmt
Issuance Costs From Proceeds$926,511IssuanceCostsFromProceedsAmt
Capital Expenditures$35,000,000CapitalExpendituresAmt
Current RefundingYes (true)CurrentRefundingInd
Advance RefundingfalseAdvanceRefundingInd
Final Allocation MadefalseFinalAllocationMadeInd
Adequate Books And Rec MaintYes (true)AdequateBooksAndRecMaintInd

Tax Exempt Bonds Private Bus Use TaxExemptBondsPrivateBusUseGrp

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd
Owning Bond Financed PropertyfalseOwningBondFinancedPropertyInd
Any Lease ArrangementsfalseAnyLeaseArrangementsInd
Mgmt Contract Bond Fincd PropfalseMgmtContractBondFincdPropInd
Any Research AgreementsfalseAnyResearchAgreementsInd

Tax Exempt Bonds Arbitrage TaxExemptBondsArbitrageGrp

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd
Form8038 T FiledfalseForm8038TFiledInd
Rebate Not Due YetfalseRebateNotDueYetInd
Exception To RebatefalseExceptionToRebateInd
No Rebate DuefalseNoRebateDueInd
Variable Rate IssuefalseVariableRateIssueInd
Hedge Identified In Bks And RecfalseHedgeIdentifiedInBksAndRecInd
Gross Proceeds Invested In GICfalseGrossProceedsInvestedInGICInd
Gross Proceeds InvestedfalseGrossProceedsInvestedInd
Written Proc To Monitor ReqsfalseWrittenProcToMonitorReqsInd

Procedures Corrective Action ProceduresCorrectiveActionGrp

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd
Procedures Corrective ActionfalseProceduresCorrectiveActionInd

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (7 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
Form 990, Part VI, Section A, Line 2Various members of the Board of Directors are key employees and/or officers of organizations that may conduct normal, arms length transactions with one another.
Form 990, Part VI, Section B, Line 11bThe 990 is reviewed by the President and Treasurer of the organization after review by the Controller. Then it is made available for Board Member review prior to filing.
Form 990, Part VI, Section B, Line 12cDirectors, President, Vice President, Managers, Case Management employees, Contracts Collections employees, employees with direct purchasing responsibilities, employed physicians, and employees who are contracted or shared with other organizations are required to complete an annual questionnaire disclosing potential conflicts of interest. If a known or perceived conflict of interest arises, the Compliance Officer investigates, documents, and works to resolve the conflict of interest.
Form 990, Part VI, Section B, Line 15 a bAnnually, the Compensation Committee compares officer and key employee compensation to regional industry averages. This committee consists of independent members of the Board of Directors. Compensation adjustment recommendations are submitted, to be included in the budget, to the Finance and Audit Committee. Compensation adjustments are taken to the Board of Directors for final approval, and if approved are then implemented.
Form 990, Part VI, Section C, Line 19The governing documents, conflict of interest, and financials are made available to the public by requests made to FMC management.
Form 990, Part IX, Line 11gOther fees for services include lab testing, administrative consulting, outsourced biomedical services, outsourced collection services, outsourced IT services and other general purchased services.
Form 990, Part XI, Line 9The other change in net assets reported represents intercompany transfers between Fairfield Medical Center and related organizations see Schedule R for fixed asset purchases, shared employees, expenses and other intercompany transactions.

Schedule R IRS990ScheduleR

Id Disregarded Entities IdDisregardedEntitiesGrp

Disregarded Entity Name DisregardedEntityName

FieldValueIRS element (for citing)
Business Name Line1Home Health ResourcesBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line1401 North Ewing StreetAddressLine1Txt
CityLancasterCityNm
State AbbreviationOHStateAbbreviationCd
ZIP43130ZIPCd
FieldValueIRS element (for citing)
EIN311159707EIN
Primary ActivitiesDurable Med. Equip.PrimaryActivitiesTxt
Legal Domicile StateOHLegalDomicileStateCd

Direct Controlling Entity Name DirectControllingEntityName

FieldValueIRS element (for citing)
Business Name Line1Zane Properties CorporationBusinessNameLine1Txt

Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (2 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdExempt Code SectionExemptCodeSectionTxtPublic Charity StatusPublicCharityStatusTxtBusiness Name Line1DirectControllingEntityName/BusinessNameLine1TxtControlled OrganizationControlledOrganizationIndDirect Controlling NADirectControllingNACd
Fairfield Healthcare Professionals Inc
401 North Ewing StreetLancasterOH43130311425884Physician PracticesOH501c311aFairfield Medical Centerfalse
Fairfield Medical Center Foundation
401 North Ewing StreetLancasterOH43130208952945FundraisingOH501c37falseN/A

Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp

Related Organization Name RelatedOrganizationName

FieldValueIRS element (for citing)
Business Name Line1Southeast Ohio Sleep Disorders Center LLCBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line1135 North Ewing Street FL 3AddressLine1Txt
CityLancasterCityNm
State AbbreviationOHStateAbbreviationCd
ZIP43130ZIPCd
FieldValueIRS element (for citing)
EIN311639116EIN
Primary ActivitiesSleep disorder trmtPrimaryActivitiesTxt
Legal Domicile StateOHLegalDomicileStateCd

Direct Controlling Entity Name DirectControllingEntityName

FieldValueIRS element (for citing)
Business Name Line1Fairfield Medical CenterBusinessNameLine1Txt
FieldValueIRS element (for citing)
Predominant Income TypeRelatedPredominantIncomeTypeTxt
Disproportionate AllocationsfalseDisproportionateAllocationsInd
General Or Managing PartnerYes (true)GeneralOrManagingPartnerInd
Ownership0.51000OwnershipPct

Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp

Related Organization Name RelatedOrganizationName

FieldValueIRS element (for citing)
Business Name Line1Zane Properties CorporationBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line1401 North Ewing StreetAddressLine1Txt
CityLancasterCityNm
State AbbreviationOHStateAbbreviationCd
ZIP43130ZIPCd
FieldValueIRS element (for citing)
EIN311202009EIN
Primary ActivitiesHolding CompanyPrimaryActivitiesTxt
Legal Domicile StateOHLegalDomicileStateCd

Direct Controlling Entity Name DirectControllingEntityName

FieldValueIRS element (for citing)
Business Name Line1Fairfield Medical CenterBusinessNameLine1Txt
FieldValueIRS element (for citing)
Entity TypeC CorpEntityTypeTxt
Ownership1.00000OwnershipPct
Controlled OrganizationfalseControlledOrganizationInd
FieldValueIRS element (for citing)
Receipt Of Int Annts Rnts RyltsYes (true)ReceiptOfIntAnntsRntsRyltsInd
Gift Grnt Or Cap Contri To Oth OrgfalseGiftGrntOrCapContriToOthOrgInd
Gift Grnt Cap Contri From Oth OrgfalseGiftGrntCapContriFromOthOrgInd
Loans Or Guarantees To Other OrgfalseLoansOrGuaranteesToOtherOrgInd
Loans Or Guarantees From Oth OrgfalseLoansOrGuaranteesFromOthOrgInd
Div Related OrganizationfalseDivRelatedOrganizationInd
Asset Sale To Other OrgYes (true)AssetSaleToOtherOrgInd
Asset Purchase From Other OrgfalseAssetPurchaseFromOtherOrgInd
Asset ExchangefalseAssetExchangeInd
Rental Of Facilities To Oth OrgfalseRentalOfFacilitiesToOthOrgInd
Rental Of Fclts From Oth OrgYes (true)RentalOfFcltsFromOthOrgInd
Perform Of Services For Oth OrgfalsePerformOfServicesForOthOrgInd
Perform Of Services By Other OrgfalsePerformOfServicesByOtherOrgInd
Sharing Of FacilitiesfalseSharingOfFacilitiesInd
Paid Employees SharingYes (true)PaidEmployeesSharingInd
Reimbursement Paid To Other OrgYes (true)ReimbursementPaidToOtherOrgInd
Reimbursement Paid By Other OrgYes (true)ReimbursementPaidByOtherOrgInd
Transfer To Other OrgYes (true)TransferToOtherOrgInd
Transfer From Other OrgfalseTransferFromOtherOrgInd

Transactions Related Org TransactionsRelatedOrgGrp (10 entries)

Transaction TypeTransactionTypeTxtInvolvedInvolvedAmt
Southeast Ohio Sleep Disorders Center LLC
a$42,525
Fairfield Healthcare Professionals Inc
a$41,208
Fairfield Healthcare Professionals Inc
g$376,192
Zane Properties Corporation
k$192,540
Fairfield Healthcare Professionals Inc
o$8,397,171
Zane Properties Corporation
p$85,577
Fairfield Healthcare Professionals Inc
q$4,760,000
Fairfield Healthcare Professionals Inc
r$2,182,244
Zane Properties Corporation
q$76,235
Zane Properies Corporation
r$440,014

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