2017-11-15T13:53:28-06:00 2016-12-31 410746749 CLIFTONLARSONALLEN LLP 4505 STEPHEN CIRCLE NW STE 200 CANTON OH 44718 990 2016-01-01 341445390 AULTMAN HEALTH FOUNDATION AULT 3303636352 2600 SIXTH STREET SW CANTON OH 44710 MARK D WRIGHT CHIEF FINANCIAL OFFICER 3303636352 2017-11-13 1 LISA HILLING P01624111 3304972000 67.137.57.251 2017-11-13 15:54:20 ES P D622ECA3460309134A8CB004E9BFE7369C27D6A9 BE93E25C38FEC74E798C9E46523CCDB5AE6503B0 2016 2021-01-29 14:40:06Z EDWARD J ROTH III 2600 SIXTH STREET SW CANTON OH 44710 67953539 0 X WWW.AULTMAN.ORG X 1975 OH THE MISSION OF AULTMAN HEALTH FOUNDATION IS TO "LEAD OUR COMMUNITY TO IMPROVED HEALTH." 44 37 403 40 0 0 0 0 43656563 42961630 5342266 2801848 431396 0 49430225 45763478 986437 726584 0 0 22903335 22063645 0 0 0 22402260 24791605 46292032 47581834 3138193 -1818356 309576992 304911105 27120685 27359347 282456307 277551758 X THE MISSION OF AULTMAN HEALTH FOUNDATION IS TO "LEAD OUR COMMUNITY TO IMPROVED HEALTH." THE VERTICALLY INTEGRATED HEALTH SYSTEM OF AULTMAN HOSPITAL AND AULTCARE HEALTH PLANS ENABLE AULTMAN TO BE ONE OF THE LOWEST-COST HEALTH CARE PROVIDERS IN NORTHEASTERN OHIO. LOWER COSTS HELP LOCAL BUSINESSES STAY FINANCIALLY HEALTHY AND MAINTAIN GOOD JOBS IN OUR COMMUNITY. IN ADDITION TO PROVIDING HIGH-QUALITY, LOW-COST HEALTH CARE, AULTMAN HEALTH FOUNDATION PROVIDES HEALTH EDUCATION FOR THE COMMUNITY. FOR EXAMPLE, THE WORKING ON WELLNESS (WOW) MOBILE HEALTH-FAIR UNIT PROVIDES HEALTH SCREENINGS AND WELLNESS EDUCATION FOR OUR COMMUNITY. SCREENINGS SUCH AS BLOOD PRESSURE CHECKS, HEIGHT, WEIGHT AND BODY MASS INDEX/PERCENTAGE OF BODY FAT ARE PROVIDED. IN 2016, THE WOW STAFF REACHED MORE THAN 20,000 PEOPLE. 0 0 18309064 0 0 WITH 111 EMPLOYEES, THE AULTMAN SYSTEMS AND TECHNOLOGY DEPARTMENT PROVIDES THE TECHNICAL INFRASTRUCTURE FOR BUSINESS AND CLINICAL SYSTEMS THROUGHOUT AULTMAN HOSPITAL, ITS SATELLITE FACILITIES AND SUBSIDIARIES. THE SYSTEMS AND TECHNOLOGY TEAM HANDLES EVERYTHING RELATED TO INFORMATION TECHNOLOGY AT AULTMAN HEALTH FOUNDATION - INCLUDING HARDWARE, SOFTWARE DATA SECURITY AND INTERNAL CUSTOMER SUPPORT. 6682905 0 6759398 THE AULTMAN SPECIALTY HOSPITAL, LOCATED ON THE MAIN AULTMAN CAMPUS, PROVIDES LONG-TERM ACUTE CARE FOR PATIENTS WITH MEDICALLY COMPLEX CONDITIONS. PATIENTS' AVERAGE LENGTH OF STAY IS 25 DAYS, AND THEY ARE TYPICALLY TRANSFERRED FROM AULTMAN ICU OR STEP-DOWN UNITS OR OTHER LOCAL HOSPITALS. IN 2016, 156 PATIENTS WERE CARED FOR AT THE AULTMAN SPECIALTY HOSPITAL. THE FACILITY'S QUALITY PROGRAM HAS BEEN ENHANCED IN THE AREAS OF IMPROVED PREVENTION OF SKIN BREAKDOWN, VENTILATOR-ASSOCIATED PNEUMONIA, LINE SEPSIS AND CLOSTRIDIUM DIFFICILE. 3497252 0 0 THE 25-MEMBER AULTMAN HEALTH FOUNDATION HUMAN RESOURCES DEPARTMENT PROVIDES SUPPORT SERVICES RELATIVE TO EMPLOYEE BENEFITS, COMPENSATION, EDUCATION AND DEVELOPMENT, EMPLOYEE RECRUITING, NEW-HIRE ORIENTATION, DIVERSITY AND INCLUSION, AND EMPLOYEE EVENTS. 10190115 726584 36202232 AULTMAN HEALTH FOUNDATION (AHF) WAS FORMED TO HANDLE THE OVERALL MANAGEMENT FOR AULTMAN HOSPITAL (AH) AND AHF'S SUBSIDIARIES. THIS STRUCTURE IS COMMON TO MANY HEALTH CARE SYSTEMS. AHF PERFORMS ACTIVITIES THAT DIRECTLY AND INDIRECTLY IMPACT AH. THERE IS A CLOSE WORKING RELATIONSHIP BETWEEN AHF AND AH AND SUBSTANTIAL RESOURCES OF AHF ARE COMMITTED TO FURTHERING THE AH MISSION. 10190115 726584 36202232 38679336 1 0 0 1 0 0 0 0 0 0 1 0 1 1 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 0 0 1 X 165 0 1 403 1 0 1 CJ EI 0 0 0 0 0 0 0 0 X 44 37 1 0 0 0 0 1 0 1 1 0 0 1 1 1 1 1 1 1 1 0 OH X MARK D WRIGHT 3303636192 2600 SIXTH STREET SW CANTON OH 44710 EDWARD J ROTH III PRESIDENT/CEO 50.00 5.00 X X 585821 0 23706 DOUGLAS J SIBILA CHAIR 6.00 2.00 X X 0 0 0 BARBARA HAMMONTREE BENNETT VICE CHAIR 5.00 5.00 X X 0 0 0 DARRYL J DILLENBACK 2ND VICE CHAIR & SECRETARY 7.00 6.00 X X 0 0 0 CHRISTOPHER E REMARK TREASURER/CEO-AH 5.00 50.00 X X 0 390700 24273 EMIL ALECUSAN DIRECTOR 6.00 0.00 X 0 0 0 DAVID W BARTLEY II DIRECTOR 3.00 1.00 X 0 0 0 BRIAN S BELDEN DIRECTOR 3.00 4.00 X 0 0 0 WILLIAM H BELDEN JR DIRECTOR 3.00 2.00 X 0 0 0 PAUL R BISHOP DIRECTOR 1.00 1.00 X 0 0 0 SHEILA MARKLEY BLACK DIRECTOR 1.00 0.00 X 0 0 0 THEODORE V BOYD DIRECTOR 3.00 1.00 X 0 0 0 PEGGY CLAYTOR DIRECTOR 1.00 1.00 X 0 0 0 NATE J COOKS DIRECTOR 1.00 3.00 X 0 0 0 ANTHONY DEGENHARD DIRECTOR 1.00 6.00 X 0 0 0 STEPHEN G DEUBLE DIRECTOR 2.00 0.00 X 0 0 0 MILAN R DOPIRAK MD DIRECTOR 1.00 54.00 X 0 430042 17061 LEO DOYLE DIRECTOR 5.00 5.00 X 0 0 0 DAVID M FINDLEY DIRECTOR 2.00 0.00 X 0 0 0 NORMAN J GAYNOR III DIRECTOR 1.00 0.00 X 0 0 0 T STEPHEN GREGORY DIRECTOR 5.00 4.00 X 0 0 0 PATRICIA A GRISCHOW DIRECTOR 2.00 2.00 X 0 0 0 RICK L HAINES DIRECTOR/CEO-AULTCARE 5.00 50.00 X 0 417085 17145 JOSEPH E HALTER JR DIRECTOR 3.00 1.00 X 0 0 0 MICHAEL E HANKE DIRECTOR 2.00 4.00 X 0 0 0 SUE HOSTETLER DIRECTOR 2.00 0.00 X 0 0 0 JOHN B HUMPHREY JR MD DIRECTOR 5.00 6.00 X 0 0 0 BECKY JEWELL DIRECTOR 1.00 1.00 X 0 0 0 GEOFF KARCHER DIRECTOR 3.00 0.00 X 0 0 0 JAMES E KNISLY DIRECTOR 1.00 0.00 X 0 0 0 GEORGE W LEMON DIRECTOR 2.00 3.00 X 0 0 0 GENE E LITTLE DIRECTOR 4.00 0.00 X 0 0 0 MICHAEL LYNCH DIRECTOR 2.00 53.00 X 0 428515 20619 RONALD R LYONS DIRECTOR 1.00 0.00 X 0 0 0 HARRY C C MACNEALY DIRECTOR 4.00 5.00 X 0 0 0 JEFFREY MILLER MD DIRECTOR 2.00 6.00 X 0 0 0 SUSHMIT PATEL DIRECTOR 1.00 0.00 X 0 0 0 MICHAEL RICH MD DIRECTOR 1.00 54.00 X 0 456870 23706 CHARLES B SCHEURER DIRECTOR 1.00 1.00 X 0 0 0 LOUIS G SHAHEEN MD DIRECTOR 1.00 1.00 X 0 0 0 JOHN A SIRPILLA DIRECTOR 4.00 1.00 X 0 0 0 TODD M SOMMER DIRECTOR 2.00 1.00 X 0 0 0 GAIL STERLING DIRECTOR 1.00 0.00 X 0 0 0 VICKY STERLING DIRECTOR 3.00 4.00 X 0 0 0 WILLIAM WALLACE MD DIRECTOR 1.00 4.00 X 0 0 0 R CLINT ZOLLINGER ESQ DIRECTOR 2.00 2.00 X 0 0 0 MARK D WRIGHT CFO 50.00 5.00 X 340298 0 24273 ELIZABETH A GETZ CIO 50.00 5.00 X 240539 0 23100 ROBERT C MOLNAR VP - PHYSICIAN SERVICES 50.00 5.00 X 189318 0 21235 SUSAN E OLIVERA VP - HUMAN RESOURCES 50.00 5.00 X 225683 0 22721 ALLISON M OPRANDI MD CEO - IHC 0.00 55.00 X 0 339379 23268 MARK N ROSE VP - LEGAL SERVICES 50.00 5.00 X 263737 0 24230 RONALD RUSNAK DIRECTOR OF CLINICAL INFORMATICS 50.00 5.00 X 309679 0 17016 KEVIN D PETE SENIOR VP - IHN 50.00 5.00 X 226663 0 22640 TIMOTHY TEYNOR VP - PUBLIC POLICY 50.00 5.00 X 195334 0 21406 JASON A JUSTUS ASSOC. VP - POMERENE FINANCE 55.00 0.00 X 195252 0 20912 FRANCIS SNYDER CEO - POMERENE 55.00 0.00 X 330597 0 15159 3102921 2462591 362470 30 0 1 0 CERNER CORP 2800 ROCKCREEK PKWY KANSAS CITY MO 64117 SOFTWARE SUPPORT 5885605 DELL FINANCIAL SERVICES ONE DELL WAY ROUND ROCK TX 78682 SOFTWARE SUPPORT 1403863 MICROSOFT CORPORATION ONE MICROSOFT WAY REDMOND WA 98052 SOFTWARE SUPPORT 1159284 CISCO SYSTEMS INC 170 W TASMAN DR SAN JOSE CA 95134 SOFTWARE SUPPORT 907275 HURON CONSULTING GROUP INC 550 WEST VAN BUREN STREET CHICAGO IL 60607 MANAGEMENT CONSULTING 698974 27 HEALTH SYSTEM ADMINISTRATION 561000 34368541 34368541 PATIENT SERVICE REVENUE 624100 6821514 6821514 PROPERTY MANAGEMENT REVENUE 561000 1294951 1294951 OTHER INCOME 561000 476624 476624 42961630 1231200 1231200 23760709 22190061 1570648 1570648 1570648 45763478 42961630 0 2801848 X 726584 726584 2796444 2265120 531324 15881649 12864136 3017513 614779 497971 116808 1203511 974844 228667 1567262 1269482 297780 99638 80707 18931 204292 165477 38815 24274 19662 4612 9577927 7758119 1819808 31477 25496 5981 508227 411664 96563 9964267 8071056 1893211 1243035 1006858 236177 197669 160112 37557 1181 957 224 592181 479667 112514 103969 84215 19754 MEDICAL SUPPLIES 894515 724557 169958 EDUCATION 767733 621864 145869 MISC EXPENSE 395398 320272 75126 RECRUITMENT 123706 100202 23504 62116 50314 11802 47581834 38679336 8902498 0 2355522 2066387 1325491 1629080 5450008 4284166 1796710 2159280 11080180 4599642 6573803 6480538 65566558 57888689 220744203 208522362 1080000 720000 4684697 21160603 309576992 304911105 3455992 2420062 5400000 5400000 18130000 19309857 134693 229428 27120685 27359347 X 282456307 277551758 282456307 277551758 309576992 304911105 X -1818356 -464789 -2621404 X 0 1 X 1 0 X X 1 AULTMAN HOSPITAL 340714538 3 1 10190115 0 1 10190115 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 PART I, LINE 12G, COLUMN V AULTMAN HEALTH FOUNDATION (AHF) WAS FORMED TO HANDLE THE OVERALL MANAGEMENT FOR AULTMAN HOSPITAL (AH) AND AHF'S SUBSIDIARIES. THIS STRUCTURE IS COMMON TO MANY HEALTH CARE SYSTEMS. AHF PERFORMS ACTIVITIES THAT DIRECTLY AND INDIRECTLY IMPACT AH. THERE IS A CLOSE WORKING RELATIONSHIP BETWEEN AHF AND AH AND SUBSTANTIAL RESOURCES OF AHF ARE COMMITTED TO FURTHERING THE AH MISSION. 0 0 0 0 0 0 1 0 1 183213 183213 0 PART II-B, LINE 1: THIS REPRESENTS PAYMENTS TO VARIOUS PROFESSIONAL ORGANIZATIONS FOR CONDUCTING FEDERAL AND STATE ADVOCACY, GOVERNMENT RELATIONS REPRESENTATION, AND GENERAL LEGISLATIVE COUNSELING AND BUSINESS REGULATIONS ON BEHALF OF THE ORGANIZATION. 4351851 4351851 3747868 2343614 1404254 2758551 2049495 709056 221910 206533 15377 6480538 INVESTMENT IN AFFILIATES 208522362 C 208522362 INTERCOMPANY RECEIVABLE 21154202 INTEREST RATE SWAP 6401 21160603 ESTIMATED THIRD-PARTY PAYOR SETTLEMENTS 229428 229428 X PART X, LINE 2: WHEN TAX RETURNS ARE FILED, IT IS HIGHLY CERTAIN THAT SOME POSITIONS TAKEN WOULD BE SUSTAINED UPON EXAMINATION BY THE TAXING AUTHORITIES, WHILE OTHERS ARE SUBJECT TO UNCERTAINTY ABOUT THE MERITS OF THE POSITION TAKEN OR THE AMOUNT OF THE POSITION THAT WOULD BE ULTIMATELY SUSTAINED. IN ACCORDANCE WITH THE INCOME TAXES TOPIC OF THE FINANCIAL ACCOUNTING STANDARDS BOARD (FASB) ACCOUNTING STANDARDS CODIFICATION, THE BENEFIT OF A TAX POSITION IS RECOGNIZED IN THE FINANCIAL STATEMENTS IN THE PERIOD DURING WHICH, BASED ON ALL AVAILABLE EVIDENCE, MANAGEMENT BELIEVES IT IS MORE LIKELY THAN NOT THAT THE POSITION WILL BE SUSTAINED UPON EXAMINATION, INCLUDING THE RESOLUTION OF APPEALS OR LITIGATION PROCESSES, IF ANY. TAX POSITIONS TAKEN ARE NOT OFFSET OR AGGREGATED WITH OTHER POSITIONS. TAX POSITIONS THAT MEET THE MORE-LIKELY-THAN-NOT RECOGNITION THRESHOLD ARE MEASURED AS THE LARGEST AMOUNT OF TAX BENEFIT THAT IS MORE THAN 50% LIKELY OF BEING REALIZED UPON SETTLEMENT WITH THE APPLICABLE TAXING AUTHORITY. THE PORTION OF THE BENEFITS ASSOCIATED WITH TAX POSITIONS TAKEN THAT EXCEEDS THE AMOUNT MEASURED AS DESCRIBED ABOVE IS RECORDED AS A LIABILITY FOR UNRECOGNIZED TAX BENEFITS ALONG WITH ANY ASSOCIATED INTEREST AND PENALTIES THAT WOULD BE PAYABLE TO THE TAXING AUTHORITIES UPON EXAMINATION. 1 1 X 1 X 0 1 1 0 1 1 0 0 789027 793707 0 0.00000 789027 793707 0 0.00000 789027 793707 0 0.00000 1 62116 0 3259783 3041982 217801 X 1 1 1 1 AULTMAN SPECIALTY HOSPITAL 2600 SIXTH ST SW CANTON OH 44710 HTTP://WWW.AULTMAN.ORG 1454 AULTMAN SPECIALTY HOSPITAL 134246188 X LONG-TERM ACUTE CARE AULTMAN SPECIALTY HOSPITAL 1 0 0 1 X X X X X X X X X 16 1 1 1 1 X AULTMAN.ORG/HOME/ABOUT/AULTMAN-HOSPITAL/COMMUNITY-HEALTH-NEEDS-ASSESSMENT/ X X 1 16 1 AULTMAN.ORG/HOME/ABOUT/AULTMAN-HOSPITAL/COMMUNITY-HEALTH-NEEDS-ASSESSMENT/ 0 1 X 100.000000000000 X X X X 1 1 X X X X 1 X SEE PART V, PAGE 8 X SEE PART V, PAGE 8 X SEE PART V, PAGE 8 X X X X X 1 X 0 X X X X 1 X 0 0 AULTMAN SPECIALTY HOSPITAL PART V, SECTION B, LINE 5: IN CONDUCTING ITS MOST RECENT CHNA AULTMAN SPECIALTY HOSPITAL USED THE STARK COUNTY COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) ADVISORY COMMITTEE. THE CHNA ADVISORY COMMITTEE IS MADE UP OF A VARIETY OF HEALTH AND SOCIAL SERVICES AGENCIES AND VOLUNTEERS IN THE COMMUNITY. THE FOLLOWING AGENCIES HAVE BEEN INVOLVED IN THE COMMITTEE: STARK COUNTY HEALTH DEPARTMENT, CANTON CITY HEALTH DEPARTMENT, ALLIANCE COMMUNITY HOSPITAL, PEGASUS FARM, PRESCRIPTION ASSISTANCE NETWORK, MERCY MEDICAL CENTER, SISTERS OF CHARITY FOUNDATION OF CANTON, AUSTIN BAILEY HEALTH AND WELLNESS FOUNDATION, MENTAL HEALTH AND RECOVERY SERVICES BOARD OF STARK COUNTY, COMMUNITY ADVOCATES, STARK COUNTY FAMILY COUNCIL, HEALTH FOUNDATION OF GREATER MASSILLON, ACCESS HEALTH STARK COUNTY, STARK COUNTY MEDICAL SOCIETY, UNITED WAY OF GREATER STARK COUNTY, THE AULTMAN HEALTH FOUNDATION, STARK PARKS/LIVE WELL STARK COUNTY, STARK COUNTY COMMUNITY ACTION AGENCY, ALLIANCE CITY HEALTH DEPARTMENT, MASSILLON CITY HEALTH DEPARTMENT, AND THE OHIO STATE UNIVERSITY EXTENSION OFFICE. PERSONS REPRESENTING THE BROAD INTERESTS OF THE COMMUNITY, INCLUDING THOSE WITH KNOWLEDGE OF OR EXPERTISE IN PUBLIC HEALTH, PARTICIPATED IN THE CHNA PROCESS THROUGH THE COMMUNITY SURVEY AND COMMUNITY LEADER WEB SURVEY, AS MEMBERS OF THE ADVISORY COMMITTEE AND AS SUMMIT PARTICIPANTS. THE COMMUNITY SURVEY INCLUDED A RANDOM SAMPLE TELEPHONE SURVEY OF STARK COUNTY HOUSEHOLDS THAT INCLUDED A REPRESENTATIVE SAMPLE OF STARK COUNTY RESIDENTS AS WELL AS AN OVERSAMPLE OF AFRICAN-AMERICAN AND CANTON HOUSEHOLDS. TELEPHONE INTERVIEWS WERE UTILIZED TO ENSURE REPRESENTATIVENESS OF THE POPULATION. THE FINAL SAMPLE CONSISTED OF 800 RESPONDENTS. DATA COLLECTION FROM TELEPHONE INTERVIEWS BEGAN ON JUNE 1 AND ENDED ON JULY 10, 2015. THE OVERSAMPLE OF AFRICAN-AMERICAN AND CANTON HOUSEHOLDS BEGAN JULY 13 AND ENDED AUG. 25, 2015. THE COMMUNITY LEADER SURVEY WAS A WEB-BASED SURVEY WITH 72 SURVEYS COMPLETED FROM A TOTAL OF 476 INVITEES WITH VALID EMAIL ADDRESSES. INVITATIONS WERE SENT ON SEPT. 30, 2015 AND TWO REMINDER INVITATIONS WERE SENT ON OCT. 20 AND OCT. 28, 2015. THE ADVISORY COMMITTEE GUIDED THE DEVELOPMENT OF THE SURVEY AND APPROVED THE HEALTH INFORMATION PROVIDED.THE ADVISORY COMMITTEE HELD FIVE MEETINGS THROUGHOUT 2015 TO REVIEW INDICATORS, IDENTIFY SIGNIFICANT HEALTH NEEDS OF THE COMMUNITY AND IDENTIFY EXISTING HEALTH CARE FACILITIES AND RESOURCES WHICH ARE POTENTIALLY AVAILABLE TO ADDRESS THE SIGNIFICANT NEEDS IDENTIFIED. DURING THE EARLIER MEETINGS, THE ADVISORY COMMITTEE REVIEWED PRELIMINARY RESEARCH FINDINGS, DISCUSSED CONTENT FOR THE COMMUNITY LEADER WEB SURVEY, AND DISCUSSED THE NEED FOR ADDITIONAL DATA FOR THE ASSESSMENT, INCLUDING DATA ON CULTURAL COMPETENCY, GAPS IN SERVICE AND YOUTH. THE ADVISORY COMMITTEE AGREED TO USE THE COMMUNITY HEALTH IMPROVEMENT CYCLE PROCESS AS THE ASSESSMENT MODEL FOR THE CHNA. THE ADVISORY COMMITTEE DISCUSSED THE TIMING FOR UPDATING THE INDICATORS REPORT AND IDENTIFIED DATA SETS TO BE USED FOR COMPLETING THE STARK COUNTY HEALTH NEEDS ASSESSMENT. INDIVIDUAL HOSPITALS DISCUSSED THEIR PRIORITIES AND PROGRAMS THAT ARE ADDRESSING THOSE PRIORITIES. THE LATER MEETINGS INCLUDED DISCUSSIONS OF COMMUNITY HEALTH IMPROVEMENT PLANS AND PROGRAMS ADDRESSING COMMUNITY NEEDS.ON FEB. 24, 2016, DURING THE STARK COUNTY ANNUAL HEALTH IMPROVEMENT SUMMIT, THE FIVE SIGNIFICANT HEALTH NEEDS OF THE COMMUNITY WERE DISCUSSED AND PRIORITIZED FOLLOWED BY A DISCUSSION OF EXISTING RESOURCES AND ACTIVITIES WITHIN THE COMMUNITY ADDRESSING THOSE SIGNIFICANT HEALTH NEEDS. SUMMIT PARTICIPANTS, WHICH INCLUDED MORE THAN 50 HEALTH AND SOCIAL SERVICES AGENCIES AND VOLUNTEERS IN THE COMMUNITY, IDENTIFIED THE TOP THREE NEEDS AS THOSE NEEDS TO BE INCLUDED IN THE COMMUNITY HEALTH IMPROVEMENT PLAN. ALL REQUIRED SOURCES FROM THOSE REPRESENTING THE BROAD INTERESTS OF THE COMMUNITY PARTICIPATED IN THE CHNA PROCESS. AULTMAN SPECIALTY HOSPITAL PART V, SECTION B, LINE 6A: THE CHNA WAS CONDUCTED IN COLLABORATION WITH THE FOLLOWING HOSPITAL FACILITIES: AULTMAN HOSPITAL, AFFINITY MEDICAL CENTER, ALLIANCE COMMUNITY HOSPITAL, AND MERCY MEDICAL CENTER. AULTMAN SPECIALTY HOSPITAL PART V, SECTION B, LINE 6B: THE CHNA WAS CONDUCTED IN COLLABORATION WITH THE FOLLOWING NON-HOSPITAL FACILITIES: ACCESS HEALTH STARK COUNTY, ALLIANCE COMMUNITY GARDEN COMMITTEE, ALLIANCE CITY HEALTH DEPARTMENT, THE AULTMAN HEALTH FOUNDATION, AULTMAN MEDICAL GROUP, AUSTIN BAILEY HEALTH AND WELLNESS FOUNDATION, BUCKEYE HEALTH PLAN, CANTON CITY HEALTH DEPARTMENT, CANTON REGIONAL AREA HEALTH EDUCATION CENTER, CARROLL COUNTY GENERAL HEALTH DISTRICT, CIRV - COMMUNITY INITIATIVE TO REDUCE VIOLENCE, COMING TOGETHER STARK COUNTY, COMMUNITY ADVOCATES, CREATING HEALTHY COMMUNITIES, DELI OHIO LLC, GENTLEBROOK, GREYLEDGE CONSULTING, HEALTH FOUNDATION OF GREATER MASSILLON, HEALTH POLICY INSTITUTE OF OHIO, ICAN, LATINO BUSINESS LEAGUE, LIFECARE FAMILY HEALTH & DENTAL CENTER, LIGHTHOUSE VISIONS, INC., MASSILLON CITY HEALTH DEPARTMENT, MENTAL HEALTH AND RECOVERY SERVICES BOARD OF STARK COUNTY, MOLINA HEALTHCARE OF OHIO, NORTH CANTON MEDICAL FOUNDATION, NORTH CANTON YMCA, NORTHEAST OHIO MEDICAL UNIVERSITY, THE OHIO STATE UNIVERSITY EXTENSION OFFICE, PATHWAY CARING FOR CHILDREN, PRESCRIPTION ASSISTANCE NETWORK, SCOTT'S TRAINING CENTER, STARK COMMUNITY FOUNDATION, STARK COUNTY COMMUNITY ACTION AGENCY, STARK COUNTY EDUCATIONAL SERVICES CENTER, STARK COUNTY FAMILY COUNCIL, STARK COUNTY HEALTH DEPARTMENT, STARK COUNTY JOB AND FAMILY SERVICE, CHILDREN SERVICES DIVISION, STARK COUNTY MEDICAL SOCIETY, STARK COUNTY URBAN MINORITY ALCOHOLISM DRUG ABUSE OUTREACH PROGRAM, STARK FRESH, STARK METROPOLITAN HOUSING AUTHORITY, STARK PARKS/LIVE WELL STARK COUNTY, SUMMA HEALTH, PEGASUS FARM, SISTERS OF CHARITY FOUNDATION OF CANTON, THRIVE - TOWARD HEALTH RESILIENCY FOR INFANT VITALITY & EQUITY, UNITED HEALTHCARE COMMUNITY PLAN, UNITED WAY OF GREATER STARK COUNTY, WALSH UNIVERSITY, AND YWCA CANTON.IN ADDITION, THE COLLABORATION CONTRACTED WITH CENTER FOR MARKETING & OPINION RESEARCH, LLC TO CONDUCT THE STARK COUNTY HEALTH NEEDS ASSESSMENT AND PREPARE THE 2015 STARK COUNTY HEALTH NEEDS ASSESSMENT. THE CENTER FOR MARKETING & OPINION RESEARCH PROVIDES PUBLIC OPINION RESEARCH SERVICES TO COLLEGES AND UNIVERSITIES, HOSPITALS AND HEALTH CARE ORGANIZATIONS, BUSINESSES, AND COMMUNITY-BASED ORGANIZATIONS AND GOVERNMENT AGENCIES. SERVICES INCLUDE TELEPHONE, WEB AND MAIL SURVEYS, FIELD, INTERCEPT AND KEY INFORMANT INTERVIEWS, FOCUS GROUP ADMINISTRATION, AS WELL AS A WIDE RANGE OF CONSULTING SERVICES. AULTMAN SPECIALTY HOSPITAL PART V, SECTION B, LINE 7D: THE CHNA AND CHNA IMPLEMENTATION PLAN CAN BE FOUND AT THE FOLLOWING URL:AULTMAN.ORG/HOME/ABOUT/AULTMAN-HOSPITAL/COMMUNITY-HEALTH-NEEDS-ASSESSMENT/ AULTMAN SPECIALTY HOSPITAL PART V, SECTION B, LINE 11: IN 2016, AULTMAN SPECIALTY HOSPITAL (ASH) CONDUCTED A CHNA THAT WAS COMPLETED IN OCTOBER 2016. WHILE THE MAJORITY OF 2016 WAS SPENT RESPONDING TO THE 2013 CHNA, ASH BEGAN RESPONDING TO THE NEEDS IDENTIFIED IN THE 2016 CHNA AS SOON AS IT WAS COMPLETED. THE 2013 CHNA IDENTIFIED ACCESS TO HEALTHCARE, OBESITY AND LACK OF HEALTHY LIFESTYLE CHOICES, AND ACCESS TO MENTAL HEALTH SERVICES AS THE SIGNIFICANT COMMUNITY HEALTH NEEDS. THE 2016 CHNA IDENTIFIED THOSE SAME NEEDS, AS WELL AS INFANT MORTALITY AND HEROIN/OPIATE USE AS THE FIVE SIGNIFICANT COMMUNITY HEALTH NEEDS. OF THESE FIVE SIGNIFICANT NEEDS, ASH CHOSE TO ADDRESS ACCESS TO HEALTH CARE IN THE 2016 IMPLEMENTATION STRATEGY. THE FOLLOWING IDENTIFIES THE NEED, ACTIONS TAKEN IN 2016 TO ADDRESS THE NEED, AND IMPACT OF THE ACTION IN ADDRESSING THE NEED.NEED: ACCESS TO HEALTH CAREAULTMAN HAS 554 PHYSICIANS ON ACTIVE STAFF IN MORE THAN 40 MEDICAL SPECIALTIES. REFERRAL LISTINGS ARE ALSO AVAILABLE TO PROVIDERS AND PATIENTS OF THE AULTMAN MEDICAL GROUP TO MAKE PATIENTS MORE AWARE OF PROVIDERS IN THEIR AREA. IN ADDITION TO PROVIDING CARE FOR PATIENTS WITH NO INSURANCE, AULTMAN ALSO SERVES THOUSANDS OF PATIENTS COVERED BY PROGRAMS SUCH AS MEDICAID. PAYMENTS FROM THESE FEDERALLY FUNDED PROGRAMS DO NOT ALWAYS COVER THE TOTAL COST OF SERVICE. FOR THE LOCAL AMISH COMMUNITY, AULTMAN OFFERS FREE TRANSPORTATION TO AND FROM DOCTOR APPOINTMENTS AND AULTMAN FACILITIES. AN AMISH HOUSE IS ALSO LOCATED ADJACENT TO THE AULTMAN CAMPUS, GIVING VISITORS A FREE PLACE TO STAY WHEN LOVED ONES ARE HOSPITALIZED. THE AULTMAN CANCER CENTER'S EVENTS PROVIDE A VARIETY OF FREE SCREENINGS TO HELP UNDERINSURED PEOPLE IN THE COMMUNITY. IN 2016, A TOTAL OF 388 SCREENINGS WERE PROVIDED AT 7 EVENTS TO MORE THAN 200 UNINSURED OR UNDERINSURED INDIVIDUALS. IN ADDITION, THE CANCER TEAM PARTICIPATED IN MORE THAN 20 COMMUNITY EVENTS THAT FOCUSED ON CANCER PREVENTION, EDUCATION, AND AWARENESS. THE HEALTHY U PROGRAM, A COLLABORATION BETWEEN AULTMAN CANCER CENTER AND STARK COUNTY SCHOOLS, EDUCATED 100 6TH GRADE STUDENTS ON CANCER BASICS AND HOW LIFETIME CANCER RISK CAN BE REDUCED THROUGH HEALTHY LIFESTYLE HABITS. A NEW PARTNERSHIP WITH STARK COUNTY FIREFIGHTERS WAS ESTABLISHED TO EDUCATE THE FIREFIGHTERS IN OUR COMMUNITY ON THEIR INCREASED RISK FOR CANCER AND HOW TO LOWER THOSE RISKS. THE AULTMAN INFUSION THERAPY DEPARTMENT OPERATES A MEDICATION REIMBURSEMENT PROGRAM FOR UNINSURED PATIENTS. LED BY AN ONCOLOGY-CERTIFIED REGISTERED NURSE, THE PROGRAM WAS SUCCESSFUL IN RECOVERING $949,400 IN DRUG COSTS AND $106,170 IN COPAY ASSISTANCE IN 2015 FROM VARIOUS ASSISTANCE PROGRAMS. AULTMAN HEALTH TALKS PROVIDES THE COMMUNITY WITH FREE HEALTH EDUCATION AND ACCESS TO A MEDICAL EXPERT ON A MONTHLY BASIS. PROVIDERS AND HEALTH CARE EXPERTS LEAD DISCUSSIONS ON A MULTITUDE OF HEALTH-RELATED TOPICS. AULTMAN HOSTED OVER 100 HEALTH TALKS IN 2016. AH HAS A PARTNERSHIP WITH ACCESS HEALTH STARK COUNTY (AHSC) TO COORDINATE FOLLOW-UP CARE FOR PATIENTS DISCHARGED FROM AH'S EMERGENCY DEPARTMENT. WHEN PATIENTS WITH MEDICAID OR THOSE WHO ARE UNINSURED AND DO NOT HAVE A PRIMARY CARE PROVIDER ARE DISCHARGED, THEY ARE REFERRED TO LIFECARE FAMILY HEALTH & DENTAL CENTER (LIFECARE). THE TEAMS FROM AULTMAN, AHSC, AND LIFECARE DEVELOPED A PROCESS FOR POST-EMERGENCY DEPARTMENT CARE COORDINATION FOR VULNERABLE POPULATIONS. AS OF THE PUBLICATION OF THE 2016 CHNA, AULTMAN WAS FOLLOWING 99 ACTIVE CLIENTS WHO ANSWERED A FOLLOW-UP CALL. EACH YEAR FOR THE GREAT AMERICAN SMOKE OUT, AULTMAN HEART, CANCER AND COMMUNITY TEAMS COLLABORATE TO PROVIDE FREE EDUCATION, CESSATION COUNSELING AND TO PROMOTE TOBACCO CESSATION STRATEGIES, INCLUDING THE FREE "GIVE IT UP!" TOBACCO CESSATION PROGRAM. SNACKS, CAFETERIA DISCOUNT CARDS AND A RAFFLE ARE PROVIDED TO ATTRACT VISITORS. IN 2016, WE HAD 116 INTERACTIONS WITH VISITORS AND STAFF, GAVE OUT 10 GIFT BAGS TO THOSE WHO COMMITTED TO QUIT, AND SIGNED 4 PEOPLE UP FOR TOBACCO CESSATION CLASSES.NEEDS NOT ADDRESSEDASH CHOSE NOT TO ADDRESS THE NEED FOR MENTAL HEALTH SERVICES, INFANT MORTALITY, OBESITY AND LACK OF HEALTHY LIFESTYLE CHOICES, AND HEROIN/OPIATE USE BECAUSE ASH IS A LONG-TERM ACUTE CARE HOSPITAL AND DOES NOT POSSESS THE EXPERTISE TO ADDRESS THESE NEEDS. AULTMAN SPECIALTY HOSPITAL WILL RELY ON THE EXPERTISE OF OTHER ORGANIZATIONS, INCLUDING AULTMAN HOSPITAL, TO ADDRESS THESE NEEDS. THERE ARE SIGNIFICANT PROGRAMS, FACILITIES AND ORGANIZATIONS WITHIN THE COMMUNITY, AS IDENTIFIED IN THE 2016 CHNA REPORT AND IMPLEMENTATION STRATEGY, THAT ARE AVAILABLE TO ADDRESS THESE NEEDS. AULTMAN SPECIALTY HOSPITAL PART V, SECTION B, LINE 13H: AULTMAN HEALTH FOUNDATION IS THE PARENT COMPANY OF AULTMAN SPECIALTY HOSPITAL. ASH HAS A FINANCIAL ASSISTANCE POLICY (FAP) WHICH HAS THE SAME PROVISIONS AS THE POLICY FOR AULTMAN HOSPITAL AND OTHER FACILITIES WITHIN AULTMAN HEALTH FOUNDATION. ACCORDING TO AULTMAN HOSPITAL'S FINANCIAL ASSISTANCE POLICY (FAP), ALL MEDICALLY NECESSARY SELF-PAY PATIENTS ARE ELIGIBLE FOR FINANCIAL ASSISTANCE. ELIGIBILITY CRITERIA IS BASED ON THE UPDATES PUBLISHED BY THE UNITED STATES DEPARTMENT OF HEALTH AND HUMAN SERVICES. THE PERCENT OF ASSISTANCE PROVIDED IS DETERMINED ON A SLIDING SCALE AS FOLLOWS: 0% TO 100% OF FEDERAL POVERTY GUIDELINE (FPG) RECEIVES 100% DISCOUNT, 101% TO 150% OF FPG IS DISCOUNTED 90%, 151% TO 200% IS DISCOUNTED 80%, 201% TO 300% IS DISCOUNTED 65%, AND 301% AND ABOVE IS DISCOUNTED 54%. AULTMAN SPECIALTY HOSPITAL PART V, SECTION B, LINE 16J: THE FINANCIAL ASSISTANCE INFORMATION CAN BE FOUND AT THE FOLLOWING URL:AULTMAN.ORG/HOME/PATIENTS-AND-VISITORS/INSURANCE-AND-BILLING/ FINANCIAL-ASSISTANCE/ PART V, LINE 13A ALL MEDICALLY NECESSARY SELF-PAY PATIENTS ARE ELIGIBLE FOR FINANCIAL ASSISTANCE. ELIGIBILITY CRITERIA IS BASED ON THE UPDATES PUBLISHED BY THE UNITED STATES DEPARTMENT OF HEALTH AND HUMAN SERVICES. THE PERCENT OF ASSISTANCE PROVIDED IS DETERMINED ON A SLIDING SCALE AS FOLLOWS: 0% TO 100% OF FEDERAL POVERTY GUIDELINE (FPG) RECEIVES 100% DISCOUNT, 101% TO 150% OF FPG IS DISCOUNTED 90%, 151% TO 200% IS DISCOUNTED 80%, 201% TO 300% IS DISCOUNTED 65%, AND 301% AND ABOVE IS DISCOUNTED 54%. PART I, LINE 3C: AULTMAN HEALTH FOUNDATION IS THE PARENT COMPANY OF AULTMAN SPECIALTY HOSPITAL. ASH HAS A FINANCIAL ASSISTANCE POLICY (FAP) WHICH HAS THE SAME PROVISIONS AS THE POLICY FOR AULTMAN HOSPITAL AND OTHER FACILITIES WITHIN AULTMAN HEALTH FOUNDATION. ACCORDING TO AULTMAN HOSPITAL'S FINANCIAL ASSISTANCE POLICY (FAP), ALL MEDICALLY NECESSARY SELF-PAY PATIENTS ARE ELIGIBLE FOR FINANCIAL ASSISTANCE. ELIGIBILITY CRITERIA IS BASED ON THE UPDATES PUBLISHED BY THE UNITED STATES DEPARTMENT OF HEALTH AND HUMAN SERVICES. THE PERCENT OF ASSISTANCE PROVIDED IS DETERMINED ON A SLIDING SCALE AS FOLLOWS: 0% TO 100% OF FEDERAL POVERTY GUIDELINE (FPG) RECEIVES 100% DISCOUNT, 101% TO 150% OF FPG IS DISCOUNTED 90%, 151% TO 200% IS DISCOUNTED 80%, 201% TO 300% IS DISCOUNTED 65%, AND 301% AND ABOVE IS DISCOUNTED 54%. PART I, LINE 7: THE ORGANIZATION USED THE COST TO CHARGE RATIO CALCULATED IN WORKSHEET 2 OF SCHEDULE H. PART I, LINE 7, COLUMN (F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $ 62,116. PART I, LINE 6A AULTMAN HEALTH FOUNDATION, THE PARENT COMPANY, PUBLISHES AN ANNUAL REPORT WHICH INCLUDES ALL RELATED ORGANIZATIONS' PROGRAMS AND SERVICES DESIGNED TO LEAD THE COMMUNITY TO IMPROVED HEALTH AND PROMOTE HEALTHY LIFESTYLES. THIS REPORT IS AVAILABLE ON AULTMAN'S WEBSITE (SEE AULTMAN.ORG/HOME/ABOUT/AULTMAN-HOSPITAL/ANNUAL-REPORT/). PART III, LINE 2: BAD DEBT EXPENSE CONSISTS OF AMOUNTS DEEMED UNCOLLECTIBLE AND REFERRED TO COLLECTION AGENCY, PER THE ORGANIZATION'S WRITTEN DEBT COLLECTION POLICY. PART III, LINE 3: METHODOLOGY FOR BAD DEBT RELATED TO CHARITY CARE:PATIENTS REFERRED TO THE ASH ARE REFERRED HERE BECAUSE THEIR ILLNESSES ARE COMPLEX AND WILL REQUIRE LONG-TERM ACUTE CARE SERVICES. MOST OF THE PATIENTS WITH SUCH MEDICALLY COMPLEX ILLNESSES ARE ELDERLY AND HAVE CHRONIC AS WELL AS ACUTE ILLNESS AND ARE ABLE TO QUALIFY FOR MEDICARE OR MEDICAID. IF THE PATIENT MEETS THE HEALTH CRITERIA FOR ADMISSIONS INTO A LONG TERM ACUTE CARE FACILITY, ASH ACCEPTS THE PATIENT REGARDLESS OF THEIR ABILITY TO PAY. PATIENTS ARE OFTEN CONSIDERED SELF-PAY PATIENTS AT THE TIME OF ADMISSION AND THEN THROUGH OUR OUTREACH PROGRAM THESE PATIENTS ARE USUALLY ABLE TO QUALIFY FOR MEDICAID OR SOME OTHER FORM OF ASSISTANCE. BECAUSE OF THIS, ASH HAD $62,116 IN BAD DEBT EXPENSE IN 2016, A RELATIVELY SMALL AMOUNT. THE ORGANIZATION DOES HAVE A FINANCIAL ASSISTANCE POLICY WHICH HAS THE SAME PROVISIONS AS THE POLICY FOR ANY OTHER FACILITY WITHIN THE AULTMAN HEALTH FOUNDATION. PART III, LINE 4: SEE THE "RECEIVABLES AND PROVISION FOR BAD DEBTS" PARAGRAPHS IN NOTE 1 ON PAGE 9 OF THE ATTACHED AUDITED FINANCIAL STATEMENTS. PART III, LINE 8: ASH DOES NOT HAVE A SHORTFALL WITH ITS MEDICARE PATIENTS. THE COSTING METHODOLOGY USED IN DETERMINING THE AMOUNT REPORTED IN LINE 6 IS THE MEDICARE COST REPORT. PART III, LINE 9B: ASH FOLLOWS THE SAME COLLECTION PROCEDURES OUTLINED IN THE PARENT COMPANY'S COLLECTION POLICY. FOR THOSE PATIENTS KNOWN TO QUALIFY FOR CHARITY CARE OR FINANCIAL ASSISTANCE, THE ORGANIZATION REPEATEDLY OFFERS PATIENTS ACCESS TO FINANCIAL HELP DURING THEIR HOSPITAL STAY AND AFTER AS WELL AS WITH EACH BILLING NOTICE. BILLS ARE SENT TO A COLLECTION AGENCY AS A LAST RESORT AND ONLY: WHEN PATIENTS HAVE THE ABILITY TO PAY SOME PORTION OF THEIR HEALTHCARE EXPENSES BUT DECLINE TO DO SO; WHEN PATIENTS DECLINE TO WORK WITH THE ORGANIZATION TO DETERMINE IF THEY QUALIFY FOR FREE OR DISCOUNTED CARE VIA FEDERAL, STATE, LOCAL OR HOSPITAL ASSISTANCE PROGRAMS; OR WHEN THE ORGANIZATION IS UNABLE TO LOCATE THE PATIENT OR PERSON RESPONSIBLE FOR THE BILL. PART VI, LINE 2: NEEDS ASSESSMENT:AULTMAN SPECIALTY HOSPITAL (ASH) ASSESSES THE COMMUNITY'S HEALTH CARENEEDS IN A VARIETY OF WAYS. IT STUDIES PROTOCOL VOLUME AND PATIENTSATISFACTION SURVEYS. IT DOCUMENTS MEDICAL CONDITIONS THAT THOUSANDS OFCOMMUNITY MEMBERS AND MEDICAL STAFF MEMBERS CAN INQUIRE ABOUT IN THESHARON LANE HEALTH CENTER HEALTH LIBRARY. IT TRACKS ATTENDANCE AT THE MORETHAN 100 "HEALTH TALK" PRESENTATIONS HELD EACH YEAR TO DETERMINE WHAT TOPICS ARE OF MOST INTEREST TO THE COMMUNITY.IN 2016, ASH COLLABORATED WITH AREA HOSPITALS AND HEALTH CARE FACILITIESTO CONDUCT A COMMUNITY HEALTH SURVEY. THE GOAL WAS TO GAUGE THE HEALTHSTATUS AND HEALTH HABITS OF STARK COUNTY RESIDENTS - AND IDENTIFY AREASWHERE ASH CAN IMPROVE THE HEALTH OF OUR COMMUNITY. FIFTEEN QUESTIONS WEREINCLUDED ON THE POLL OF 1,276 STARK COUNTY HOUSEHOLDS. THE SURVEY SHOWED ACCESS TO HEALTH INSURANCE COVERAGE AND HEALTH CARE AS THE TOP PRIORITY;ALONG WITH OBESITY AND LACK OF HEALTHY LIFESTYLE CHOICE; OTHER AREAS OFCONCERN WERE PRESCRIPTION DRUG MISUSE, LARGER NEED FOR MENTAL HEALTHSERVICES, AND GREATER ACCESS TO DENTAL CARE. THE HOSPITAL IS CURRENTLY INTHE PROCESS OF DEVELOPING ITS IMPLEMENTATION PLAN. PART VI, LINE 3: PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE:IF ABLE, AT THE TIME OF REGISTRATION PATIENTS ARE ASKED TO FILL OUT THE HOSPITAL CARE ASSURANCE PROGRAM APPLICATION WHICH INCLUDES CONTACT INFORMATION FOR QUESTIONS AND ASSISTANCE IN COMPLETING THE FORMS. SIGNS AND APPLICATIONS ARE POSTED AT ALL POINTS OF ADMISSIONS INFORMING PATIENTS OF THE FREE CARE PROGRAMS WHICH ARE AVAILABLE. IN 2010, THE APPLICATION WAS ADDED TO THE INTERNET FOR EASY PATIENT ACCESS. ASH STAFF ASSISTS SELF-PAY INPATIENTS WITH THE MEDICAID PROCESS AND OTHER PROGRAMS UNDER WHICH THEY ARE ELIGIBLE FOR ASSISTANCE. PATIENTS WHO ARE UNABLE TO BE SCREENED DURING THEIR STAY RECEIVE FOLLOW UP ASSISTANCE WITH QUALIFYING FOR THE ASSISTANCE PROGRAM THAT MOST APPROPRIATELY FITS THEIR FINANCIAL NEEDS. THE APPLICATION AND CONTACT INFORMATION FOR THE OUTREACH DEPARTMENT IS PRINTED ON THE BACK OF EVERY STATEMENT. PART VI, LINE 4: COMMUNITY INFORMATION:ASH ENCOURAGES ITS EMPLOYEES AND BOARD MEMBERS TO BE ACTIVELY INVOLVED IN THE COMMUNITY.THE ORGANIZATION HAS ELEVEN BOARD MEMBERS WHO ARE ACTIVELY INVOLVED IN THE COMMUNITY TO BE REPRESENTATIVES OF THE COMMUNITY'S INTERESTS IN HEALTH CARE SERVICES.THE MEDICAL STAFF IS COMPRISED OF 224 PHYSICIANS. ANY PHYSICIAN IN GOOD STANDING WITHIN AULTMAN HOSPITAL'S MEDICAL STAFF AND WITH AN APPROPRIATE SPECIALTY TO CARE FOR MEDICALLY COMPLEX PATIENTS MAY APPLY FOR PRIVILEGES AT ASH.ASH'S SERVICE AREA INCLUDES STARK, WAYNE, HOLMES, CARROLL AND TUSCARAWAS COUNTIES. THE CORE SERVICE AREA FOR THE HOSPITAL IS STARK COUNTY. THE OHIO DEPARTMENT OF DEVELOPMENT ESTIMATED THE 2016 POPULATION OF OUR FIVE COUNTY AREAS TO BE OVER 654,107. THE ORGANIZATION IS ONE OF ONLY 2 FACILITIES WITHIN THE 5 COUNTY AREAS WHO ARE CONSIDERED LONG-TERM ACUTE CARE FACILITIES AND WHO PROVIDE THE SPECIALIZATION NEEDED TO CARE FOR PATIENTS WITH SUCH COMPLEX MEDICAL CONDITIONS. PART VI, LINE 5: ASH IS A WHOLLY OWNED SUBSIDIARY OF AULTMAN HEALTH FOUNDATION. AULTMANHEALTH FOUNDATION SUPPORTS AND PROMOTES THE HEALTH OF ITS COMMUNITYMEMBERS IN A VARIETY OF WAYS.FROM EDUCATIONAL PROGRAMS TO HEALTH SCREENINGS, AULTMAN ACTIVELY PROMOTESHEALTH AND WELLNESS IN THE COMMUNITY. EDUCATIONAL PROGRAMS INCLUDE MORETHAN 100 FREE HEALTH TALK PRESENTATIONS EACH YEAR, FEATURING LOCALPHYSICIANS AND HEALTH CARE PROFESSIONALS. THE AULTMAN WEBSITE HASADDITIONAL HEALTH CARE RESOURCES, INCLUDING A HEALTH LIBRARY, SYMPTOMCHECKER, VIDEOS AND RISK ASSESSMENTS.AULTMAN'S WORKING ON WELLNESS (WOW) MOBILE HEALTH-FAIR UNIT DEBUTED INFEBRUARY 2009. STAFFED BY MEDICAL PROFESSIONALS, THE WOW VAN VISITSSCHOOLS, COMMUNITY CENTERS, CHURCHES, SENIOR CENTERS AND BLOCK PARTIES TOPROVIDE FREE SCREENINGS AND HEALTH EDUCATION. SCREENINGS SUCH AS BLOODPRESSURE CHECKS, HEIGHT, WEIGHT AND BODY MASS INDEX/PERCENTAGE OF BODY FATARE PROVIDED. IN 2016, THE WOW STAFF REACHED MORE THAN 20,000 PEOPLE.ADDITIONAL OUTREACH EFFORTS INCLUDED AULTMAN REPRESENTATIVES ATTENDINGHEALTH FAIRS THROUGHOUT THE YEAR. THESE EVENTS INCLUDE SENIOR DAY AT THEPRO FOOTBALL HALL OF FAME, THE CANTON FARMERS' MARKET AND HEALTH FAIRS ATLOCAL SCHOOLS.2016 MARKED THE NINTH YEAR AULTMAN HOSTED THE CAREERS IN HEALTH CARESUMMER PROGRAM FOR HIGH SCHOOL SENIORS AND COLLEGE STUDENTS INTERESTED INHEALTH CARE CAREERS. SYMPOSIUM PRESENTERS INCLUDED AULTMAN DOCTORS,NURSES, STAFF AND ADMINISTRATORS WHO SHARED INSIGHT ON THE CHALLENGES ANDOPPORTUNITIES OF WORKING IN HEALTH CARE. THE EVENT ALSO INCLUDED A HEALTH PART VI, LINE 6: AULTMAN'S BOARD OF DIRECTORS HAS 37 NON-EMPLOYED MEMBERS. A TOTAL OF 43 OF THE 44 VOTING BOARD MEMBERS RESIDE IN THE CORE SERVICE AREA. THE REMAINING PORTION RESIDES IN THE TERTIARY MARKET. COMMUNITY PHYSICIANS REQUESTING AND ULTIMATELY QUALIFYING FOR MEDICAL STAFF PRIVILEGES WOULD BE GRANTED PRIVILEGES IN THEIR RESPECTIVE MEDICAL DEPARTMENTS. 1 AMERICAN CANCER SOCIETY 5555 FRANTZ RD DUBLIN OH 43017 240726080 501(C)(3) 9000 RELAY FOR LIFE SPONSOR AMERICAN HEART ASSOCIATION 4916 HILLS DALES RD NW CANTON OH 44708 135613797 501(C)(3) 17000 CANTON GO RED SPONSOR; HEART BALL TICKETS ARTS IN STARK 1001 MARKET AVE N CANTON OH 44702 346609771 501(C)(3) 80750 SUPPORT LOCAL ART PROGRAMS CANTON REGIONAL CHAMBER OF COMMERCE 222 MARKET AVE N CANTON OH 44702 340129930 501(C)(6) 53618 SUPPORT LOCAL COMMUNITY EVENTS CITY OF MASSILLON ONE JAMES DUNCAN PLAZA MASSILLON OH 44646 346001829 CITY OF MASSILLON 50000 MASSILLON DOWNTOWN IMPROVEMENT PROJECT MASSILLON CHAMBER OF COMMERCE 137 LINCOLN WAY E MASSILLON OH 44646 340383260 501(C)(6) 9102 MEMBERSHIP INVESTMENT THE AULTMAN FOUNDATION 2600 SIXTH ST SW CANTON OH 44710 208090459 501(C)(3) 75000 TO SUPPORT VARIOUS ORGANIZATIONS IN THE COMMUNITY UNITED WAY GREATER STARK COUNTY 4825 HIGBEE AVE NW STE 101 CANTON OH 44718 134254191 501(C)(3) 251875 COMMUNITY INVOLVEMENT WALSH UNIVERSITY 2020 EAST MAPLE NORTH CANTON OH 44720 340868798 501(C)(3) 155000 TO SUPPORT CONSTRUCTION AND EQUIPEMENT OF LEARNING SPACE FOR MASTER'S DEGREE IN OCCUPATIONAL THERAPY. 7 2 PART I, LINE 2: AULTMAN HEALTH FOUNDATION'S (AHF) COMMUNITY SUPPORT POLICY/PROCEDURE PROVIDES GUIDANCE IN RESPONSE TO COMMUNITY ORGANIZATION REQUESTS FOR SUPPORT. AHF DEEMS IT BENEFICIAL AND NECESSARY TO BE A GOOD CORPORATE CITIZEN AND WILL CONSIDER SUPPORT OF COMMUNITY ENDEAVORS AND PROJECTS THAT WILL IMPROVE THE LIVES AND LIVELIHOOD OF THE COMMUNITY IT SERVES. A SPONSORSHIP COMMITTEE MEETS REGULARLY TO REVIEW REQUESTS FOR SUPPORT FROM VARIOUS COMMUNITY ORGANIZATIONS. X 1 1 X X X X X 0 1 0 0 0 0 0 0 0 EDWARD J ROTH III PRESIDENT/CEO 573752 0 100 0 11969 0 7950 0 15756 0 609527 0 0 0 CHRISTOPHER E REMARK TREASURER/CEO-AH 0 389476 0 100 0 1124 0 7950 0 16323 0 414973 0 0 MILAN R DOPIRAK MD DIRECTOR 0 298414 0 117642 0 13986 0 7950 0 9111 0 447103 0 0 RICK L HAINES DIRECTOR/CEO-AULTCARE 0 411828 0 600 0 4657 0 7950 0 9195 0 434230 0 0 MICHAEL LYNCH DIRECTOR 0 413423 0 13453 0 1639 0 7950 0 12669 0 449134 0 0 MICHAEL RICH MD DIRECTOR 0 227452 0 185621 0 43797 0 7950 0 15756 0 480576 0 0 MARK D WRIGHT CFO 339206 0 100 0 992 0 7950 0 16323 0 364571 0 0 0 ELIZABETH A GETZ CIO 237077 0 2753 0 709 0 7344 0 15756 0 263639 0 0 0 ROBERT C MOLNAR VP - PHYSICIAN SERVICES 186164 0 2751 0 403 0 5817 0 15418 0 210553 0 0 0 SUSAN E OLIVERA VP - HUMAN RESOURCES 224902 0 100 0 681 0 6965 0 15756 0 248404 0 0 0 ALLISON M OPRANDI MD CEO - IHC 0 331686 0 5180 0 2513 0 7950 0 15318 0 362647 0 0 MARK N ROSE VP - LEGAL SERVICES 261448 0 100 0 2189 0 7950 0 16280 0 287967 0 0 0 RONALD RUSNAK DIRECTOR OF CLINICAL INFORMATICS 308262 0 100 0 1317 0 7950 0 9066 0 326695 0 0 0 KEVIN D PETE SENIOR VP - IHN 225611 0 100 0 952 0 6884 0 15756 0 249303 0 0 0 TIMOTHY TEYNOR VP - PUBLIC POLICY 191438 0 100 0 3796 0 5988 0 15418 0 216740 0 0 0 JASON A JUSTUS ASSOC. VP - POMERENE FINANCE 164062 0 30700 0 490 0 5910 0 15002 0 216164 0 0 0 FRANCIS SNYDER CEO - POMERENE 275544 0 52100 0 2953 0 7950 0 7209 0 345756 0 0 0 PART I, LINE 1A ALL EMPLOYEES ARE ELIGIBLE TO RECEIVE REIMBURSEMENT FOR HEALTH CLUB COSTS UP TO $120 ANNUALLY AS PART OF THE ORGANIZATION'S EFFORT TO PROMOTE HEALTHY LIFESTYLES. THIS AMOUNT WAS INCLUDED AS TAXABLE COMPENSATION FOR ALL EMPLOYEES THAT RECEIVED THE BENEFIT. PART I, LINE 3 SEE SCHEDULE O FOR THE NARRATIVE RELATED TO FORM 990, PART VI, LINE 15 FOR AN EXPLANATION OF EXECUTIVE COMPENSATION REVIEW. PART I, LINE 4B MARK ROSE, EILEEN GOOD, RICK HAINES, ED ROTH, CHRIS REMARK, MARK WRIGHT, FRANCIS SNYDER, AND TIM TEYNOR ARE PARTICIPANTS IN THE ORGANIZATION'S 457(F) PLAN. THERE WERE NO CONTRIBUTIONS TO OR DISTRIBUTIONS FROM THE PLAN IN 2016. FORM 990, PART V, LINE 2B: AULTMAN HEALTH FOUNDATION'S EMPLOYEES ARE PAID BY A COMMON PAYMASTER. AULTMAN HEALTH FOUNDATION IS THE PARENT COMPANY OF THE AULTMAN HEALTH SYSTEM. SEE SCHEDULE R FOR INFORMATION ON SUBSIDIARIES. FORM 990, PART VI, SECTION A, LINE 1 THE BOARD OF DIRECTORS HAS AN EXECUTIVE COMMITTEE THAT CONSISTS OF THE CHAIR, VICE CHAIR, PRESIDENT/CEO, SECRETARY, TREASURER, PRESIDENT OF THE MEDICAL STAFF AT AULTMAN HOSPITAL, AND THE PAST CHAIR. THE EXECUTIVE COMMITTEE MEETS ONLY AS NECESSARY BETWEEN MEETINGS OF THE BOARD OF DIRECTORS AND HAS AND EXERCISES THE AUTHORITY OF THE BOARD IN THE MANAGEMENT OF THE ORGANIZATION, EXCEPT IN MATTERS IN WHICH THE BOARD IS REQUIRED TO ACT BY LAW, BY THE ARTICLES OF INCORPORATION, OR BY THE CODE OF REGULATIONS. FORM 990, PART VI, SECTION A, LINE 2 JOHN SIRPILLA AND THEODORE BOYD ARE BOARD MEMBERS OF THE AULTMAN HEALTH FOUNDATION AND AULTMAN HOSPITAL AND HAVE A BUSINESS RELATIONSHIP. BRIAN BELDEN AND WILLIAM BELDEN ARE BOARD MEMBERS OF THE AULTMAN HEALTH FOUNDATION AND AULTMAN HOSPITAL AND HAVE A FAMILY RELATIONSHIP. GEOFF KARCHER AND BRYAN RICE ARE BOARD MEMBERS OF THE AULTMAN HEALTH FOUNDATION AND AULTMAN HOSPITAL AND HAVE A BUSINESS RELATIONSHIP. JOSEPH HALTER AND GEOFF KARCHER ARE BOARD MEMBERS OF THE AULTMAN HEALTH FOUNDATION AND AULTMAN HOSPITAL AND HAVE A BUSINESS RELATIONSHIP. GENE LITTLE AND HARRY MACNEALY ARE BOARD MEMBERS OF THE AULTMAN HEALTH FOUNDATION AND AULTMAN HOSPITAL AND HAVE A BUSINESS RELATIONSHIP. EDWARD ROTH AND HARRY MACNEALY ARE BOARD MEMBERS OF THE AULTMAN HEALTH FOUNDATION AND AULTMAN HOSPITAL AND HAVE A BUSINESS RELATIONSHIP. FORM 990, PART VI, SECTION A, LINE 7A THE AULTMAN HOSPITAL MEDICAL STAFF PRESIDENT AND PRESIDENT-ELECT, AS WELL AS THE PHYSICIAN CHAIRMAN OF THE BOARD OF AULTCARE CORPORATION, ARE EX-OFFICIO VOTING MEMBERS OF THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 WAS PREPARED BY AN INDEPENDENT CPA FIRM BASED ON INFORMATION PROVIDED BY AULTMAN HEALTH FOUNDATION'S FINANCE DEPARTMENT. AHF'S FINANCE DEPARTMENT CAREFULLY REVIEWED AND ANALYZED THE TAX RETURN. THE DEPARTMENT RECONCILED THE GENERAL LEDGER AMOUNTS TO THE APPROPRIATE SCHEDULES ON THE FORM 990 AND COMPARED THOSE AMOUNTS TO THE AUDITED FINANCIAL STATEMENTS. IN ADDITION, THE FINANCE DEPARTMENT DID A COMPARATIVE ANALYSIS TO THE PRIOR YEAR RETURN. THE ANALYSIS AND RECONCILIATION SCHEDULES, ALONG WITH A COMPLETE COPY OF THE 990, WERE PROVIDED TO THE CHIEF FINANCIAL OFFICER FOR REVIEW AND APPROVAL. A COMPLETE COPY OF THE 990 WAS THEN MADE AVAILABLE TO THE BOARD OF DIRECTORS THROUGH A SECURED INTERNET PORTAL PRIOR TO THE FILING DATE. FORM 990, PART VI, SECTION B, LINE 12C THE AULTMAN HEALTH FOUNDATION'S BOARD OF DIRECTORS HAS A CONFLICT OF INTEREST POLICY. AS A RESULT OF THIS POLICY, EACH YEAR BOARD MEMEBERS, OFFICERS, AND SENIOR STAFF COMPLETE A FORM DISCLOSING ANY CONFLICTS OF INTEREST THEY MAY HAVE. THE COMPLIANCE OFFICE REVIEWS THESE DISCLOSURE FORMS AND INFORMS THE BOARD CHAIRMAN, AND OTHER APPROPRIATE OFFICERS, OF NOTABLE CONFLICTS, IF ANY. THOSE WITH CONFLICTS ARE ASKED TO RECUSE THEMSELVES FROM DISCUSSIONS RELATING TO THE CONFLICT. FORM 990, PART VI, SECTION B, LINE 15 THE AULTMAN HEALTH FOUNDATION AND ITS AFFILIATED ENTITIES USE THE FOLLOWING REFERENCE MATERIALS FOR THE DEVELOPMENT OF EXECUTIVE COMPENSATION: OHIO HOSPITAL ASSOCIATION (OHA), MERCER INTEGRATED HEALTH NETWORK, INCLUDING SURVEY DATA FOR BOTH HOSPITALS AND HEALTH PLANS, AND SULLIVAN COTTER AND ASSOCIATES (SCA). ADDITIONAL SOURCES OF SALARY SURVEY DATA ARE AVAILABLE FOR USE WHERE APPROPRIATE INCLUDING COMPDATASURVEYS.COM, SALARY.COM, AND CHAMPS. IN THESE CASES, THE SURVEY IS REFERENCED WHERE APPLICABLE. EXECUTIVE PERFORMANCE, WAGE RECOMMENDATIONS AND BONUS PAYMENTS ARE REVIEWED BY THE CEO PRIOR TO REVIEW AND APPROVAL BY THE COMPENSATION COMMITTEE OF THE AULTMAN HEALTH FOUNDATION BOARD OF DIRECTORS. THE CEO'S COMPENSATION IS ALSO REVIEWED AND APPROVED BY THE COMPENSATION COMMITTEE. THE COMPENSATION COMMITTEE OF THE AULTMAN HEALTH FOUNDATION BOARD OF DIRECTORS HAS ENGAGED SULLIVAN COTTER & ASSOCIATES, INC., AN INDEPENDENT COMPENSATION CONSULTING FIRM, FOR REVIEW OF EXECUTIVE COMPENSATION PRACTICES. THE AULTMAN HEALTH FOUNDATION AND ITS AFFILIATED ENTITIES USE THE FOLLOWING REFERENCE MATERIALS FOR THE DEVELOPMENT OF PHYSICIAN COMPENSATION: MEDICAL GROUP MANAGEMENT ASSOCIATES (MGMA), AMERICAN MEDICAL GROUP ASSOCIATION (AMGA), HOSPITAL AND HEALTHCARE COMPENSATION SERVICE (HHCS) AND SULLIVAN COTTER AND ASSOCIATES (SCA). IN ADDITION TO SALARY SURVEYS, AULTMAN HOSPITAL ALSO RETAINS AN INDEPENDENT CONSULTING FIRM FOR PHYSICIANS COMPENSATION SERVICES. ALL PHYSICIAN COMPENSATION RECOMMENDATIONS ARE SENT TO THE CEO, VP OF PHYSICIAN SERVICES, COO, AND CNO FOR FINAL APPROVAL. FORM 990, PART VI, SECTION C, LINE 19 AULTMAN HEALTH FOUNDATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. PART VI, SECTION A, LINE 1B EDWARD J ROTH III AND CHRISTOPHER E REMARK ARE PAID EMPLOYEES OF THE ORGANIZATION. RICK L HAINES, MILAN R DOPIRAK MD, MICHAEL LYNCH MD AND MICHAEL RICH MD ARE PAID EMPLOYEES OF A RELATED ORGANIZATION. FORM 990, PART IX, LINE 11G CONSULTING FEES: PROGRAM SERVICE EXPENSES 2,436,961. MANAGEMENT AND GENERAL EXPENSES 571,633. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,008,594. PURCHASED MAINTENANCE: PROGRAM SERVICE EXPENSES 2,313,303. MANAGEMENT AND GENERAL EXPENSES 542,627. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,855,930. LTACH PATIENT SERVICES: PROGRAM SERVICE EXPENSES 1,358,419. MANAGEMENT AND GENERAL EXPENSES 318,642. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,677,061. OTHER CONTRACTED SERVICES: PROGRAM SERVICE EXPENSES 1,345,512. MANAGEMENT AND GENERAL EXPENSES 315,614. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,661,126. PROFESSIONAL FEES - PHYSICIAN: PROGRAM SERVICE EXPENSES 183,740. MANAGEMENT AND GENERAL EXPENSES 43,100. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 226,840. PROFESSIONAL FEES - NONPHYSICIAN: PROGRAM SERVICE EXPENSES 44,911. MANAGEMENT AND GENERAL EXPENSES 10,535. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 55,446. HOSPITAL FRANCHISE FEE: PROGRAM SERVICE EXPENSES 75,273. MANAGEMENT AND GENERAL EXPENSES 17,657. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 92,930. FORM 990, PART XI, LINE 9: INTERFUND TRANSFERS -2,648,167. INTEREST RATE SWAP 26,763. FEDERAL ELECTIONS SECTION 1.263(A)-1(F) DE MINIMIS SAFE HARBOR ELECTION AULTMAN HEALTH FOUNDATION 2600 SIXTH STREET SW CANTON, OH 44710 EMPLOYER IDENTIFICATION NUMBER: 34-1445390 FOR THE YEAR ENDING DECEMBER 31, 2016 AULTMAN HEALTH FOUNDATION IS MAKING THE DE MINIMIS SAFE HARBOR ELECTION UNDER REG. SEC. 1.263(A)-1(F). 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PROVIDER ORG. 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