2016-11-14T08:32:40-06:00 2015-12-31 410746749 CLIFTONLARSONALLEN LLP 388 S MAIN STREET SUITE 403 AKRON OH 44311 990 2015-01-01 340726081 ASHTABULA COUNTY MEDICAL CENTER ASHT 4409972262 2420 LAKE AVENUE ASHTABULA OH 44004 DON KEPNER VP FINANCE/CFO 4409972262 2016-11-10 1 LISA HILLING P01624111 3303760100 2015 2017-02-10 21:41:12Z MICHAEL HABOWSKI 2420 LAKE AVENUE ASHTABULA OH 44004 147447738 0 6026 X WWW.ACMCHEALTH.ORG X 1902 OH TO PROVIDE THE BEST POSSIBLE MEDICAL CARE THROUGH ALL PHASES OF LIFE TO THOSE SEEKING HELP. THE ASHTABULA COUNTY MEDICAL CENTER HEALTH CARE TEAM IS COMMITTED TO PRESERVING THE HUMAN RIGHTS AND DIGNITY OF THOSE WHO RECEIVE OUR CARE AND THOSE WHO PROVIDE IT. 15 10 1299 150 457117 0 132954 7076771 108128017 110488865 1644925 1243942 4505902 6034780 114411798 124844358 0 150000 0 0 63172461 67156156 0 0 0 45502513 49738916 108674974 117045072 5736824 7799286 115240737 113927164 63924729 61331440 51316008 52595724 TO PROVIDE THE BEST POSSIBLE MEDICAL CARE THROUGH ALL PHASES OF LIFE TO THOSE SEEKING HELP. THE ASHTABULA COUNTY MEDICAL CENTER HEALTH CARE TEAM IS COMMITTED TO PRESERVING THE HUMAN RIGHTS AND DIGNITY OF THOSE WHO RECEIVE OUR CARE AND THOSE WHO PROVIDE IT. 0 0 96003958 150000 116042703 ASHTABULA COUNTY MEDICAL CENTER (ACMC) IS A PRIVATE, NOT-FOR-PROFIT, COMMUNITY-ORIENTED MEDICAL CENTER THAT PROVIDES THE BEST POSSIBLE MEDICAL CARE THROUGH ALL PHASES OF LIFE TO THOSE SEEKING HELP. IN 2015 WE MET OUR MISSION OF MEETING OUR COMMUNITY'S HEALTH CARE NEEDS AS EVIDENCED BY APPROXIMATELY 33,605 EMERGENCY DEPARTMENT VISITS, 5,592 INPATIENT DISCHARGES, 1,271 INPATIENT SURGERIES, 7,070 OUTPATIENT SURGERIES, 378 BIRTHS, AND 73,052 RADIOLOGY PROCEDURES. 96003958 1 1 0 0 0 0 0 0 0 0 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 0 0 0 1 0 1 1 1 0 0 0 0 0 1 1 1 0 0 1 151 0 1299 1 1 1 0 0 0 0 0 0 0 0 0 X 15 10 0 1 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 OH X DON KEPNER VP FINANCECFO 4409972262 2420 LAKE AVENUE ASHTABULA OH 44004 X SUSAN STOCKER PHD CHAIRPERSON 0.30 0.30 X X 0 0 0 NANCY KISTER VICE-CHAIRPERSON 0.30 0.30 X X 0 0 0 JOE GIANGOLA SECRETARY/TREASURER 0.30 0.30 X X 0 0 0 MICHAEL HABOWSKI PRESIDENT/CEO 40.00 0.30 X X 0 0 0 PEG CARLO BOARD MEMBER 0.30 0.30 X 0 0 0 BILL DINGLEDINE BOARD MEMBER 0.30 0.30 X 0 0 0 ELENA MARQUETTI BOARD MEMBER 0.30 0.30 X 0 0 0 REV VERNON PALO BOARD MEMBER 0.30 0.30 X 0 0 0 MARLENE SARTINI BOARD MEMBER 0.30 0.30 X 0 0 0 JIM TIMONERE BOARD MEMBER 0.30 0.30 X 0 0 0 KELLY HANCOCK BOARD MEMBER/CCF REPRESENTIVE 0.30 0.30 X 0 0 0 JASON HERGENROEDER BOARD MEMBER/CCF REPRESENTIVE 0.30 0.30 X 0 0 0 JOSHUA MILLER BOARD MEMBER/CCF REPRESENTIVE 0.30 0.30 X 0 0 0 JUDE CAUWENBERGH DO BOARD MEMBER/CHIEF OF STAFF 60.00 0.30 X 224341 0 12414 DANIEL KEATON MD BOARD MEMBER/VICE-CHIEF OF STAFF 60.00 0.30 X 177360 0 10253 DON KEPNER VP FINANCE/CFO 40.00 0.30 X 0 0 0 KEN FRAME CHIEF NURSING OFFICER 40.00 0.00 X 0 0 0 ALEXANDER TAICH MD PHYSICIAN 60.00 0.00 X 925639 0 11307 ASHOK KONDRU MD PHYSICIAN 60.00 0.00 X 902062 0 14895 SUK K CHOI MD PHYSICIAN 60.00 0.00 X 628241 0 14594 MICHAEL J PAPSIDERO MD PHYSICIAN 60.00 0.00 X 585167 0 17053 LEE LANEY MD PHYSICIAN 60.00 0.00 X 809497 0 14895 4252307 0 95411 66 0 1 0 CLEVELAND CLINIC FOUNDATION PO BOX 931760 CLEVELAND OH 44193 ADMINISTRATIVE & CLINICAL SERVICES 5894852 ANESTHESIA CONSULTANTS EFT 5168 STANSBURG ROAD SOLON OH 44139 MEDICAL 2200584 ARAMARK CORP 24863 NETWORK PLACE CHICAGO IL 60673 CAFETERIA AND DIETARY SERVICES 1690080 AMICON MEDICAL GROUP INC 51 MEADOW LANE SUITE A NORTHFIELD OH 44067 MEDICAL 1097329 MEDIC MANAGEMENT GROUP INC 275 SPRINGSIDE DRIVE SUITE 100 AKRON OH 44333 PHYSICIAN BILLING 1092147 26 7000000 76771 7076771 NET PATIENT SERVICE REVENUE 624100 110488865 110488865 110488865 1115531 1115531 23825 0 23825 23825 23825 22730786 1005 22603380 0 127406 1005 128411 128411 MISC OPERATING REVENUE 624100 5263566 5263566 PREMIER FITNESS AND DAY SPA 713940 457117 457117 REBATES AND REFUNDS 624100 290272 290272 6010955 124844358 116042703 457117 1267767 150000 150000 1806137 1481032 325105 51926418 42579663 9346755 3086555 2530975 555580 6740369 5527102 1213267 3596677 2949275 647402 9395 7704 1691 102002 83642 18360 1803499 1478869 324630 92895 76174 16721 22855 18741 4114 4319987 3542389 777598 1468600 1204252 264348 SUPPLIES 19181744 15729030 3452714 MEDICAL SERVICES & FEES 8321361 6823516 1497845 EQUIPMENT RENTAL/MAINTE 4810977 3945001 865976 PURCHASED ADMINISTRATIV 3435617 2817206 618411 6169984 5059387 1110597 117045072 96003958 21041114 0 15458758 12773146 409104 1847539 16685910 20604042 96704 41358 977390 1079385 1201053 1525391 102616621 79513478 24191164 23103143 44859887 42846005 2916029 2741373 8444738 7365782 115240737 113927164 14263681 14178580 269027 211618 49392021 46941242 63924729 61331440 X 51301033 52580749 14975 14975 51316008 52595724 115240737 113927164 X 7799286 -2881275 -3638295 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1900567 1900567 29253586 21482757 7770829 3754115 2353144 1400971 66981745 55677577 11304168 726608 726608 23103143 SELF-INSURANCE INVESTMENTS 4769245 DEFERRED COMPENSATION 2449218 DUE FROM AFFLIATES 147319 7365782 RESERVE FOR SELF-INSURANCE LIABILITIES 9264223 DEFERRED COMPENSATION 2449218 ACCRUED PENSION LIABILITY 16803317 DISTRIBUTION PAYABLE TO THE CLEVELAND CLINIC FOUNDATION 1377500 INVESTMENT FROM CLEVELAND CLINIC FOUNDATION 15000000 THIRD-PARTY PAYABLES 1328800 CAPITAL LEASES 718184 46941242 X PART X, LINE 2: WHEN TAX RETURNS ARE FILED, IT IS HIGHLY CERTAIN THAT SOME POSITIONS TAKEN WOULD BE SUSTAINED UPON EXAMINATION BY THE TAXING AUTHORITIES, WHILE OTHERS ARE SUBJECT TO UNCERTAINTY ABOUT THE MERITS OF THE POSITION TAKEN OR THE AMOUNT OF THE POSITION THAT WOULD BE ULTIMATELY SUSTAINED. IN ACCORDANCE WITH THE INCOME TAXES TOPIC OF THE FINANCIAL ACCOUNTING STANDARDS BOARD (FASB) ACCOUNTING STANDARDS CODIFICATION, THE BENEFIT OF A TAX POSITION IS RECOGNIZED IN THE FINANCIAL STATEMENTS IN THE PERIOD DURING WHICH, BASED ON ALL AVAILABLE EVIDENCE, MANAGEMENT BELIEVES IT IS MORE LIKELY THAN NOT THAT THE POSITION WILL BE SUSTAINED UPON EXAMINATION, INCLUDING THE RESOLUTION OF APPEALS OR LITIGATION PROCESSES, IF ANY. TAX POSITIONS TAKEN ARE NOT OFFSET OR AGGREGATED WITH OTHER POSITIONS. TAX POSITIONS THAT MEET THE MORE-LIKELY-THAN-NOT RECOGNITION THRESHOLD ARE MEASURED AS THE LARGEST AMOUNT OF TAX BENEFIT THAT IS MORE THAN 50% LIKELY OF BEING REALIZED UPON SETTLEMENT WITH THE APPLICABLE TAXING AUTHORITY. THE PORTION OF THE BENEFITS ASSOCIATED WITH TAX POSITIONS TAKEN THAT EXCEEDS THE AMOUNT MEASURED AS DESCRIBED ABOVE IS RECORDED AS A LIABILITY FOR UNRECOGNIZED TAX BENEFITS ALONG WITH ANY ASSOCIATED INTEREST AND PENALTIES THAT WOULD BE PAYABLE TO THE TAXING AUTHORITIES UPON EXAMINATION. 1 1 X 1 X 0 1 1 0 0 368799 368799 0.00320 22152347 15921421 6230926 0.05320 24036 573529 -549493 0.00000 22545182 16494950 6050232 0.05640 4397318 4397318 0.03760 36826 36826 0.00030 51356 51356 0.00040 6400 6400 0.00010 4491900 4491900 0.03840 27037082 16494950 10542132 0.09480 1 10054968 0 29659193 30100296 -441103 X 1 1 1 1 ASHTABULA COUNTY MEDICAL CENTER 2420 LAKE AVENUE ASTHABULA OH 44004 WWW.ACMCHEALTH.ORG X X X ASHTABULA COUNTY MEDICAL CENTER 1 0 0 1 X X X X X X X X 13 1 0 0 1 X WWW.ACMCHEALTH.ORG/ABOUTUS.ASPX X 1 13 1 WWW.ACMCHEALTH.ORG/ABOUTUS.ASPX 0 0 1 X 200.000000000000 1 1 X X X X 1 X WWW.ACMCHEALTH.ORG/PATIENTVISITOR-FINANCIAL.ASPX X WWW.ACMCHEALTH.ORG/PATIENTVISITOR-FINANCIAL.ASPX X 1 X 0 X X X X 1 X 0 1 ASHTABULA COUNTY MEDICAL CENTER PART V, SECTION B, LINE 5: KEY INFORMANT SURVEYS WERE CONDUCTED WITH 12 PROFESSIONALS AND KEY CONTACTS FROM THROUGHOUT ASHTABULA COUNTY. WORKING WITH THE LEADERSHIP FROM ACMC, 21 PROSPECTIVE INDIVIDUALS WERE IDENTIFIED AND INVITED TO PARTICIPATE IN THE STUDY. THE KEY INFORMANTS INCLUDED ELECTED OFFICIALS, HEALTHCARE PROVIDERS, HEALTH AND HUMAN SERVICES EXPERTS, AND LEADERSHIP FROM VARIOUS AREA NON-PROFIT ORGANIZATIONS. THE CONTENT OF THE QUESTIONNAIRE FOCUSED ON KEY HEALTH CONCERNS, ACCESS TO CARE, AND EXISTING COMMUNITY ASSETS AND RESOURCES. QUESTIONS INCLUDED BOTH OPEN-ENDED ITEMS TO GATHER QUALITATIVE FEEDBACK, AS WELL AS, QUESTIONS TO WHICH RESPONDENTS PROVIDED RATINGS. IT SHOULD BE NOTED THAT WHILE THE KEY INFORMANT FEEDBACK IS INFORMATIVE AND HELPFUL WITH UNDERSTANDING COMMUNITY NEEDS, THE SMALL NUMBER OF COMPLETED INTERVIEWS DOES NOT ALLOW FOR STATISTICAL GENERALIZATION TO THE POPULATION AS A WHOLE. THE KEY INFORMANT PARTICIPANTS WERE TANIA BURNETTE, CHILDREN'S SERVICES BOARD; DAN CLAYPOOL, ASHTABULA COUNTY COMMISSIONER; MIKE HABOWSKI, ACMC; IMRAAN HANIFF, MD, ACMC; ALICE HARDEN, SALVATION ARMY; CHRISTINE HILL, ASHTABULA CITY HEALTH DEPARTMENT; CHRIS KETTUNEN, ASHTABULA COUNTY HEALTH DEPARTMENT; DEB NEWCOMB, CONNEAUT HUMAN RESOURCE CENTER; DAVID PARKER, MD, ACMC; KATHY REGAL, COMMUNITY COUNSELING CENTER; RAYMOND SAPORITO, ASHTABULA COUNTY HEALTH DEPARTMENT; LYNN ZALEWSKI, CATHOLIC CHARITIES. ASHTABULA COUNTY MEDICAL CENTER PART V, SECTION B, LINE 11: ASHTABULA COUNTY MEDICAL CENTER HAS A 109-YEAR HISTORY OF PROVIDING SIGNIFICANT AMOUNTS OF COMMUNITY BENEFIT TO THE COMMUNITIES IT SERVES. ACMC WILL CONTINUE THIS COMMITMENT BY ALLOCATING APPROPRIATE HUMAN AND FINANCIAL RESOURCES TO MEET THOSE NEEDS THROUGH THE IMPLEMENTATION OF THE FOLLOWING STRATEGY:1. IMPROVE ACCESS TO CARE, INCLUDING BOTH PRIMARY AND SPECIALTY CARE BY:A. CONTINUING TO RECRUIT PRIMARY CARE (FAMILY MEDICINE, INTERNAL MEDICINE, PEDIATRICS, OBSTETRICS & GYNECOLOGY) PHYSICIANS TO THE COMMUNITY AND PLACING OFFICES IN SHORTAGE AREAS.B. CONTINUING TO RECRUIT SPECIALTY PHYSICIANS TO THE COMMUNITY TO ENSURE COMMUNITY RESIDENTS DO NOT HAVE TO LEAVE THE COMMUNITY TO RECEIVE CARE FROM A SPECIALIST.C. CONTINUING TO COLLABORATE WITH CLEVELAND CLINIC TO PROVIDE SPECIALTY CLINICS FOR SERVICES NOT AVAILABLE IN THE COMMUNITY.D. CONTINUING TO PROVIDE THE ACMC HEALTH EXPRESS FREE SHUTTLE SERVICE.E. EXPLORING COLLABORATION OPPORTUNITIES WITH ASHTABULA COUNTY DEPARTMENT OF JOB AND FAMILY SERVICES TO USE THE ASHTABULA COUNTY TRANSIT SYSTEM (ACTS) FOR MEDICAL APPOINTMENTS.F. COLLABORATING WITH ASHTABULA COUNTY DEPARTMENT OF JOB AND FAMILY SERVICES TO DEVELOP AND IMPLEMENT A PLAN TO ACCOMMODATE THE INCREASE IN MEDICAID RECIPIENTS IN MID-2014.G. CONTINUING TO OFFER FINANCIAL COUNSELING SERVICES TO ASSIST RESIDENTS IN QUALIFYING FOR PUBLIC ASSISTANCE AND ACMC'S CHARITY CARE PROGRAM.2. DECREASE THE PREVALENCE OF DIET AND EXERCISE-RELATED ISSUES, INCLUDING HIGH RATES OF OBESITY BY:A. COLLABORATING WITH SCHOOLS TO OFFER AFTER-SCHOOL PROGRAMMING TO INCLUDE NUTRITION EDUCATION AND PHYSICAL ACTIVITY.B. CONTINUING TO PARTICIPATE IN COMMUNITY-BASED PROGRAMS (INCLUDING LONGEST DAY OF PLAY, PARTNERSHIP FOR A REVOLUTION) WITH A FOCUS ON HEALTHY LIFESTYLE HABITS.C. CONTINUING TO OFFER HEALTHY FOOD OPTIONS IN THE ACMC CAFETERIA AND VENDING MACHINES.D. CONTINUING TO OFFER COMMUNITY MEMBERSHIPS AT THE ACMC-OWNED FITNESS FACILITY, INCLUDING EXPLORING A PLAN TO OPEN THE FACILITY FREE OF CHARGE ON A LIMITED BASIS.E. CONTINUING TO OFFER EXERCISE CLASSES FOR CHILDREN (KID FIT, ZUMBAKIDS, ZUMBATOMIC, MOMMY AND ME) AT THE ACMC-OWNED FITNESS FACILITY.F. CONTINUING TO PUBLISH DIET AND NUTRITION-FOCUSED EDUCATIONAL ARTICLES IN THE MEDIA AND IN ACMC-PRODUCED PUBLICATIONS.G. IMPLEMENTING AN INCENTIVE PROGRAM FOR ACMC EMPLOYEES TO RECEIVE DISCOUNT/REBATE ON HEALTH INSURANCE PREMIUMS FOR ATTAINING SPECIFIED HEALTH METRICS,AND CONTINUING THE SHAPE UP AND GO PROGRAM FOR EMPLOYEES.3. IMPROVE THE EFFECTIVENESS OF HEALTH EDUCATION INITIATIVES THAT EMPHASIZE THE RAMIFICATIONS OF HIGH-RISK HEALTH BEHAVIORS BY:A. LAUNCHING PROMOTION CAMPAIGNS TO TEACH CHILDREN AND ADULTS THE RISKS ASSOCIATED WITH SMOKING, DRINKING, AND OBESITY.4. DECREASE THE INCIDENCE OF WOMEN NOT RECEIVING FIRST TRIMESTER PRE-NATAL CARE AND THE INCIDENCE OF SMOKING IN PREGNANT WOMEN BY:A. COLLABORATING WITH HIGH SCHOOL GUIDANCE COUNSELORS AND NURSES TO PROVIDE EDUCATION REGARDING THE IMPORTANCE OF PRE-NATAL CARE.B. PROVIDING A FREE PREGNANCY TEST THROUGH SPLIT FLOW IN THE ACMC EMERGENCY DEPARTMENT, WITH REFERRAL AND APPOINTMENT SCHEDULING FOR OB/GYN FOLLOW UP.C. COLLABORATING WITH ASHTABULA DEPARTMENT OF JOB AND FAMILY SERVICES AND SOCIAL SERVICE AGENCIES (CATHOLIC CHARITIES, UNITED WAY) IN PROVIDING EDUCATION TO CLIENTS.D. OFFERING A SERIES OF SMOKING CESSATION CLASSES GEARED SPECIFICALLY TO PREGNANT WOMEN.E. PROVIDING FREE NICOTINE REPLACEMENT PATCHES TO PREGNANT WOMEN UNDER THE CARE OF AN ACMC PHYSICIAN.5. IMPROVE HEALTH OUTCOMES, SPECIFICALLY MORBIDITY AND MORTALITY RATES, FOR HEART DISEASE AND CANCER BY:A. CONTINUING TO MAINTAIN CERTIFICATIONS IN STROKE, HEART FAILURE AND CHEST PAIN.B. EXPLORING EXPANDING ACCESS TO CARDIOLOGIST OFFICE VISITS BY PLACING A PHYSICIAN IN SATELLITE OFFICES IN VARIOUS PARTS OF THE COMMUNITY.C. CONTINUING TO OPERATE THE COMMUNITY'S ONLY DIAGNOSTIC CARDIAC CATHETERIZATION LABORATORY.D. RECRUITING A THIRD INVASIVE CARDIOLOGIST TO REDUCE WAIT TIME FOR INITIAL PHYSICIAN APPOINTMENT.E. EXPANDING HEART CARE SPECIALTY SERVICES TO INCLUDE A MONTHLY ELECTROPHYSIOLOGY SPECIALTY CLINIC.F. COLLABORATING WITH HIGH SCHOOLS TO OFFER SCREENING PROGRAMS FOR HIGH SCHOOL ATHLETES TO IDENTIFY HYPERTROPHIC CARDIOMYOPATHY.G. CONTINUING STAFF TRAINING IN THE USE OF ADVANCED TECHNOLOGY, INCLUDING CT, MRI AND PET CT, FOR EARLY DIAGNOSIS OF EARLY-STAGE HEART DISEASE AND CANCER.H. CONTINUING TO OFFER ANNUAL WOMEN'S HEART HEALTH AND WOMEN'S CANCER AWARENESS LUNCHEONS WITH A FOCUS ON PREVENTION AND TREATMENT TOPICS.I. EXPLORING TRANSPORTATION COLLABORATIONS WITH AMERICAN CANCER SOCIETY TO ASSIST COMMUNITY IN TRAVELING TO RADIATION ONCOLOGY APPOINTMENTS.J. EXPLORING COLLABORATION WITH CLEVELAND CLINIC TO ENROLL COMMUNITY RESIDENTS IN CLINICAL CANCER TRIALS.K. EXPLORING OPPORTUNITIES TO OFFER ADDITIONAL FREE SCREENINGS, INCLUDING HEMOCULT AND COLONOSCOPY.THE ADDITION OF THE NEW OR EXPANDED STRATEGIC INITIATIVES TO ADDRESS COMMUNITY HEALTH NEEDS WILL NOT DIMINISH ACMC'S COMMITMENT TO ITS CURRENT COMMUNITY BENEFIT PROGRAMS. THESE CURRENT PROGRAMS INCLUDE:A. CONTINUE TO OFFER DIABETES EDUCATION CLASSES AND SUPPORT GROUPS.B. CONTINUE TO PROVIDE LANGUAGE SUPPORT SERVICES TO NON-ENGLISH SPEAKING PATIENTS TO ENSURE EFFECTIVE COMMUNICATION AND APPROPRIATENESS OF CARE.C. CONTINUE TO SUPPORT A TOBACCO-FREE ENVIRONMENT THROUGH ACMC'S SMOKE FREE CAMPUS, HIRING POLICIES, AND SMOKING CESSATION PROGRAMS.D. CONTINUE TO PROVIDE INPATIENT AND OUTPATIENT MENTAL HEALTH SERVICES, AS WELL AS AN INTENSIVE OUTPATIENT PSYCHIATRY PROGRAM.E. CONTINUE TO PROVIDE FREE HEALTH SCREENINGS AND REFERRAL FOR TREATMENT.F. CONTINUE TO PROVIDE FINANCIAL COUNSELOR SERVICES TO ASSIST PATIENTS IN QUALIFYING FOR MEDICAL ASSISTANCE.G. CONTINUE TO OFFER A CHARITY CARE PROGRAM.ASHTABULA COUNTY MEDICAL CENTER CANNOT ADDRESS ALL OF THE HEALTH NEEDS PRESENT IN THE COMMUNITY. TO ENSURE ACMC REMAINS FINANCIALLY VIABLE AND IN A POSITION TO ENHANCE CURRENT SERVICES, DEVELOP NEW SERVICES AND CONTINUE TO PROVIDE A WIDE RANGE OF COMMUNITY BENEFITS, THE HOSPITAL'S IMPLEMENTATION STRATEGY FOCUS WILL NOT ADDRESS THE FOLLOWING NEEDS:DENTAL HEALTH: AS AN ACUTE CARE HOSPITAL, ACMC DOES NOT HAVE THE EXPERTISE TO ADDRESS BASIC DENTAL HEALTH.ACCIDENTS/UNINTENTIONAL INJURIES: THIS COMMUNITY HEALTH ISSUE IS BEYOND THE SCOPE OF ACMC, AND IS BEING ADDRESSED BY OTHERS.BIRTHS TO UNWED MOTHERS: THIS COMMUNITY HEALTH ISSUE IS BEYOND THE SCOPE OF ACMC, AND IS BEING ADDRESSED BY FAITH-BASED AND SOCIAL SERVICE AGENCIES.ALCOHOL ABUSE/EXCESSIVE BINGE DRINKING: THIS ISSUE IS BEYOND THE SCOPE OF ACMC AND IS BEING ADDRESSED BY OTHERS.SUICIDE: THIS COMMUNITY HEALTH ISSUE IS BEING ADDRESSED BY OTHERS, INCLUDING THE ASHTABULA COUNTY DEPARTMENT OF HEALTH AND A TASK FORCE FORMED FOLLOWING THE COMPLETION OF THE COUNTY'S COMMUNITY NEEDS ASSESSMENT.ACCESS TO HEALTHY FOODS: OTHER THAN WHAT IS OFFERED INSIDE THE WALLS OF OUR FACILITY, THIS ISSUE IS BEYOND THE SCOPE OF THE HOSPITAL AND THE HOSPITAL DOES NOT HAVE SUFFICIENT RESOURCES TO MAKE A MEANINGFUL IMPACT. ASHTABULA COUNTY MEDICAL CENTER PART V, SECTION B, LINE 22D: ALL PATIENTS ARE CHARGED THE SAME, STANDARD RATE, FOR A PARTICULAR SERVICE. ASHTABULA COUNTY MEDICAL CENTER PART V, SECTION B, LINE 24: ALL PATIENTS ARE CHARGED THE SAME, STANDARD RATE, FOR A PARTICULAR SERVICE. 5 1 - JEFFERSON FAMILY HEALTH CENTER 234 NORTH CHESTNUT ST JEFFERSON OH 44047 FAMILY HEALTH CENTER 2 - CONNEAUT FAMILY HEALTH CENTER 354 W MAIN ROAD CONNEAUT OH 44030 FAMILY HEALTH CENTER 3 - NORTH KINGSVILLE FAMILY HEALTH CENTER 6441 S MAIN ST NORTH KINGSVILLE OH 44068 FAMILY HEALTH CENTER 4 - ASHTABULA WOMEN'S HEALTH CENTER 524 W 24TH STREET ASHTABULA OH 44004 WOMEN'S HEALTH CENTER 5 - GASTROENTEROLOGY HEALTH CENTER 2112 LAKE AVENUE ASHTABULA OH 44004 GASTROENTEROLOGY HEALTH CENTER PART I, LINE 3C: N/A PART I, LINE 6A: N/A PART I, LINE 7: ACMC ESTIMATED CHARITY CARE COSTS BY CALCULATING A RATIO OF COST TO GROSS CHARGES AND THEN MULTIPLYING THAT RATIO BY THE GROSS UNCOMPENSATED CHARGES ASSOCIATED WITH PROVIDING CARE TO CHARITY PATIENTS.ACMC IS PAID A PROSPECTIVELY DETERMINED RATE FOR THE MAJORITY OF INPATIENT ACUTE CARE AND OUTPATIENT, SKILLED NURSING, AND REHABILITATION SERVICES PROVIDED FOR MEDICAID. THESE RATES VARY ACCORDING TO A PATIENT CLASSIFICATION SYSTEM THAT IS BASED ON CLINICAL, DIAGNOSTIC, AND OTHER FACTORS. MEDICAID PAYMENTS FOR CAPITAL ARE RECEIVED ON A COST REIMBURSEMENT METHODOLOGY. PAYMENTS ARE RECEIVED ON A PROSPECTIVE BASIS FOR ACMC'S MEDICAL EDUCATION COSTS, SUBJECT TO CERTAIN LIMITS. PROVISION FOR ESTIMATED RETROACTIVE ADJUSTMENTS, IF ANY, RESULTING FROM REGULATORY MATTERS OR OTHER ADJUSTMENTS UNDER PAYMENT AGREEMENTS ARE ESTIMATED IN THE PERIOD THE RELATED SERVICES ARE PROVIDED. PART I, LINE 7G: ACMC PROVIDES AN ATHLETIC TRAINER TO THREE HIGH SCHOOLS AT NO COST TO THE SCHOOL DISTRICTS FOR THIS SERVICE. PART I, LINE 7C ACMC PARTICIPATES IN THE HOSPITAL CARE ASSURANCE PROGRAM (HCAP) TO FINANCIALLY SUPPORT THOSE HOSPITALS THAT SERVICE A DISPROPORTIONATE SHARE OF LOW-INCOME PATIENTS UNABLE TO PAY FOR CARE. HCAP FUNDS BASIC, MEDICALLY NECESSARY HOSPITAL SERVICES FOR PATIENTS WHOSE FAMILY INCOME IS AT OR BELOW THE FEDERAL POVERTY LEVEL, WHICH INCLUDES MEDICAID PATIENTS AND PATIENTS WITHOUT HEALTH INSURANCE. PART I, LINE 7E ACMC PROVIDES A SIGNIFICANT RECRUITING SUBSIDY AND GUARANTEE FOR ALL NEW PHYSICIANS THE HOSPITAL RECRUITS. IN ADDITION, THE HOSPITAL PROVIDES A GUARANTEE AFTER THE INITIAL RECRUITMENT FOR SOME PHYSICIANS DUE TO THE PRESSING NEED FOR THE PHYSICIAN'S SPECIALTY. WITHOUT THE HOSPITAL DOING THIS, ACMC WOULD NOT BE ABLE TO PROVIDE MANY OF THESE SERVICES LOCALLY. THE RECRUITMENT AND GUARANTEE COSTS ACMC INCURS REDUCES GEOGRAPHIC AND FINANCIAL BARRIERS TO ACCESSING HEALTH CARE AND IMPROVES THE AVAILABILITY OF HEALTH SERVICES IN THE AREA ACMC SERVES. PART III, LINE 2: TOTAL BAD DEBT EXPENSE FOR THE ENTIRE HOSPITAL COMPLEX IS EQUAL TO THE TOTAL GROSS CHARGES WRITTEN OFF AS REPORTED ON THE 2015 MEDICARE COST REPORT. PART II N/A PART III, LINE 4: PATIENT RECEIVABLES ARE REDUCED BY AN ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS. THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS IS BASED UPON MANAGEMENT'S ASSESSMENT OF HISTORICAL AND EXPECTED NET COLLECTIONS CONSIDERING HISTORICAL BUSINESS AND ECONOMIC CONDITIONS, TRENDS IN HEALTHCARE COVERAGE, MAJOR PAYOR SOURCES AND OTHER COLLECTION INDICATORS. PERIODICALLY THROUGH THE YEAR, MANAGEMENT ASSESSES THE ADEQUACY OF THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS BASED UPON HISTORICAL WRITE-OFF EXPERIENCE BY PAYOR CATEGORY. THE RESULTS OF THIS REVIEW ARE THEN USED TO MAKE MODIFICATIONS TO THE PROVISION FOR UNCOLLECTIBLE ACCOUNTS TO ESTABLISH AN APPROPRIATE ALLOWANCE FOR UNCOLLECTIBLE RECEIVABLES. AFTER SATISFACTION OF AMOUNTS DUE FROM INSURANCE, ACMC FOLLOWS ESTABLISHED GUIDELINES FOR PLACING CERTAIN PAST-DUE PATIENT BALANCES WITH COLLECTION AGENCIES, SUBJECT TO THE TERMS OF CERTAIN RESTRICTIONS ON COLLECTION EFFORTS AS DETERMINED BY ACMC. ACMC MAINTAINS ALLOWANCES FOR LOSSES BASED ON THE EXPECTED COLLECTIBILITY OF PATIENT ACCOUNTS RECEIVABLE (BAD DEBTS) AND TO REFLECT NET AMOUNTS DUE FROM PATIENTS AND THIRD-PARTY PAYERS (CONTRACTUAL ADJUSTMENTS).ACMC PROVIDES CARE TO PATIENTS WHO DO NOT HAVE THE ABILITY TO PAY AND WHO QUALIFY FOR CHARITY SERVICES PURSUANT TO ESTABLISHED POLICIES OF ACMC. CHARITY SERVICES ARE DEFINED AS THOSE FOR WHICH PATIENTS HAVE THE OBLIGATION AND WILLINGNESS TO PAY BUT DO NOT HAVE THE ABILITY TO DO SO. ACMC DOES NOT INCLUDE CHARITY CARE IN NET PATIENT SERVICE REVENUE. PART III, LINE 8: MEDICARE SURPLUS IS NOT TREATED AS COMMUNITY BENEFIT. THE AMOUNTS REPORTED WERE GENERATED FROM THE MEDICARE COST REPORT FILED FOR 2015. ACMC IS PAID A PROSPECTIVELY DETERMINED RATE FOR THE MAJORITY OF INPATIENT ACUTE CARE AND OUTPATIENT, SKILLED NURSING, AND REHABILITATION SERVICES PROVIDED FOR MEDICARE. THESE RATES VARY ACCORDING TO A PATIENT CLASSIFICATION SYSTEM THAT IS BASED ON CLINICAL, DIAGNOSTIC, AND OTHER FACTORS. MEDICARE PAYMENTS FOR CAPITAL ARE RECEIVED ON A PROSPECTIVE BASIS. PAYMENTS ARE RECEIVED ON A PROSPECTIVE BASIS FOR ACMC'S MEDICAL EDUCATION COSTS, SUBJECT TO CERTAIN LIMITS. ACMC IS PAID FOR COST REIMBURSABLE ITEMS AT A TENTATIVE RATE, WITH FINAL SETTLEMENT DETERMINED AFTER SUBMISSION OF ANNUAL COST REPORTS BY ACMC AND AUDITS THEREOF BY THE MEDICARE FISCAL INTERMEDIARY. PROVISION FOR ESTIMATED RETROACTIVE ADJUSTMENTS, IF ANY, RESULTING FROM REGULATORY MATTERS OR OTHER ADJUSTMENTS UNDER PAYMENT AGREEMENTS ARE ESTIMATED IN THE PERIOD THE RELATED SERVICES ARE PROVIDED.LAWS AND REGULATIONS GOVERNING MEDICARE ARE COMPLEX AND SUBJECT TO INTERPRETATION AS WELL AS SIGNIFICANT REGULATORY ACTION, AND, IN THE NORMAL COURSE OF BUSINESS, ACMC IS SUBJECT TO CONTRACTUAL REVIEWS AND AUDITS. AS A RESULT, THERE IS AT LEAST A REASONABLE POSSIBILITY THAT RECORDED ESTIMATES WILL CHANGE IN THE NEAR TERM. ACMC BELIEVES IT IS IN COMPLIANCE WITH APPLICABLE LAWS AND REGULATIONS GOVERNING THE MEDICARE PROGRAM AND THAT ADEQUATE PROVISIONS HAVE BEEN MADE FOR ANY ADJUSTMENTS THAT MAY RESULT FROM FINAL SETTLEMENTS. PART III, LINE 9B: REASONABLE EFFORTS ARE PERFORMED TO DETERMINE THE PATIENT'S ELIGIBILITY UNDER THE HOSPITAL'S FAP AND THE HOSPITAL DOES NOT PERFORM DEBT COLLECTION PROCEDURES BEFORE MAKING THESE REASONABLE EFFORTS. THIS IS ACHIEVED THROUGH THE HCAP APPLICATION. DOCUMENTATION OF THE PATIENT OR FAMILY INCOME FOR HCAP ELIGIBILITY WILL BE BASED UPON A BEST EVIDENCE METHODOLOGY. HOSPITAL EMPLOYEES WILL PROCEED THROUGH THE FOLLOWING IN AN EFFORT TO SECURE THE BEST EVIDENCE AVAILABLE FOR THE PATIENT OR GUARANTOR AT THE TIME OF THEIR ENCOUNTER. 1. A COMPLETED HCAP APPLICATION INCLUSIVE OF THE PATIENT OR GUARANTOR'S SIGNATURE. 2. A COMPLETED HCAP APPLICATION, WHICH INCLUDES THE SIGNATURE OF THE PATIENT REPRESENTATIVE SECURING THE INFORMATION FROM THE RESPONSIBLE PARTY. IF THE APPLICATION CANNOT BE SECURED AT THE TIME OF THE ENCOUNTER, THE RESPONSIBLE PARTY WILL BE PROVIDED WITH A RETURN ENVELOPE. THEY WILL BE ASKED TO PROVIDE THIS INFORMATION UPON THEIR RETURN TO THEIR HOME. IN THE EVENT THAT THE INFORMATION IS RECEIVED, IT IS TO BE REVIEWED AND CONSIDERED AGAINST THE ABOVE-DEFINED ELIGIBILITY DETERMINATION CRITERIA. IF IT IS NOT RETURNED WITHIN 14 DAYS OF DISCHARGE, ACMC CONTACTS THE PATIENT VIA TELEPHONE TO COMPLETE THE APPLICATION. FOR OUTPATIENT HOSPITAL SERVICES, THE ELIGIBILITY DETERMINATION IS EFFECTIVE FOR NINETY DAYS FROM THE INITIAL SERVICE DATE. DURING THIS PERIOD A NEW ELIGIBILITY DETERMINATION NEED NOT BE COMPLETED. ELIGIBILITY FOR INPATIENT HOSPITAL SERVICES MUST BE DETERMINED SEPARATELY FOR EACH ADMISSION , UNLESS THE PATIENT IS READMITTED WITHIN FORTY-FIVE DAYS OF DISCHARGE FOR THE SAME UNDERLYING CONDITION. ELIGIBILITY FOR RECIPIENTS OF THE DISABILITY ASSISTANCE PROGRAM MUST BE VERIFIED ON A MONTHLY BASIS. IN THE EVENT THE PATIENT DOES NOT COMPLETE AN APPLICATION DURING THE ENCOUNTER, AND AS A RESULT OF THE HCAP COMMUNICATION, PATIENT STATEMENTS, OR RESULT OF COLLECTION EFFORTS, HOSPITAL STAFF WILL COMPLETE THE HCAP APPLICATION, OVER THE TELEPHONE OR IN-PERSON, ON BEHALF OF THE RESPONSIBLE PARTY. PART VI, LINE 2: ACMC USES MARKET DATA THAT REFLECTS ACTUAL PATIENT VISITS (DATA THAT IS SUBMITTED TO THE OHIO HOSPITAL ASSOCIATION BY ALL HOSPITALS IN THE STATE). MANAGEMENT REVIEWS THE NUMBER OF PATIENTS FROM THE MARKET WHO LEAVE ASHTABULA COUNTY FOR HEALTHCARE, AND WHAT SERVICES THEY LEAVE FOR. ACMC CONDUCTS A PHYSICIAN SATISFACTION SURVEY EVERY OTHER YEAR; ONE COMPONENT OF THE SURVEY IS TO OBTAIN PHYSICIAN INPUT INTO WHAT SERVICES/SPECIALTIES ARE NEEDED. ACMC CONDUCTS A MEDICAL STAFF DEVELOPMENT PLAN (APPROXIMATELY EVERY THREE YEARS) IN WHICH COMMUNITY PHYSICIANS ARE ASKED ABOUT THEIR PRACTICE PLANS (PLANNING TO RETIRE, BECOME EMPLOYED, GO INDEPENDENT, EXPAND) AND WHAT SPECIALISTS ARE NEEDED IN THE COMMUNITY TO BETTER SERVE THEIR PATIENTS. THIS HELPS GUIDE THE PHYSICIAN RECRUITMENT EFFORTS TO ENSURE THE HOSPITAL IS MEETING THE HEALTH NEEDS OF THE MARKET. EVERYONE ON THE ADMINISTRATIVE TEAM IS ASSIGNED TO 8-12 PHYSICIANS WITH WHOM THEY HAVE REGULAR CONVERSATIONS ABOUT THEIR PRACTICE NEEDS, COMMUNITY NEEDS, ETC. MEMBERS OF THE MANAGEMENT TEAM ACTIVELY SERVE ON THE BOARDS OF COMMUNITY ORGANIZATIONS, MANY OF WHICH HAVE A MISSION TO ADDRESS COMMUNITY NEED; HEALTHCARE BEING ONE OF THOSE NEEDS (COMMUNITY ACTION, SALVATION ARMY, UNITED WAY, CATHOLIC CHARITIES, SENIOR ADVOCACY AND PROTECTIVE NETWORK, ETC.). PART VI, LINE 3: INFORMATION ABOUT ELIGIBILITY FOR ASSISTANCE UNDER FEDERAL, STATE OR LOCAL GOVERNMENT PROGRAMS IS DESCRIBED ON THE PATIENT'S BILL, THE POLICY IS POSTED ON THE HOSPITAL'S WEBSITE AND IS ALSO AVAILABLE UPON REQUEST. THE NOTICE, BOTH IN ENGLISH AND SPANISH, IS POSTED AT THE FOLLOWING LOCATIONS: EMERGENCY DEPARTMENT, ALL ADMISSIONS/REGISTRATION AREAS, PATIENT FINANCIAL SERVICES DEPARTMENT. ACMC FINANCIAL COUNSELORS MEET WITH ANY PATIENT THAT MAY NEED ANY FORM OF FINANCIAL AID PRIOR TO DISCHARGE AND EDUCATE THEM ON FINANCIAL ASSISTANCE. PART VI, LINE 4: AFFILIATED WITH THE CLEVELAND CLINIC, ACMC IS THE LARGEST AND MOST ADVANCED HOSPITAL IN ASHTABULA COUNTY. ACMC OPENS THE DOOR TO THE WORLD'S BEST HEALTHCARE BY APPLYING CLEVELAND CLINIC'S CLINICAL INFORMATION AND STATE-OF-THE-ART STANDARDS OF CARE. THE PRIMARY MARKET IS COMPRISED OF THE FOLLOWING ZIP CODES: 44004, 44005, 44010, 44030, 44032, 44041, 44048, 44068, 44082. THE SECONDARY MARKET IS COMPRISED OF THE FOLLOWING ZIP CODES: 44003, 44076, 44084, 44085, 44093, 44099. THE PAYER MIX IS 50.8% MEDICARE, 26.90% MEDICAID, 18.9% COMMERCIAL, 2.7% SELF PAY, 0.8% OTHER. 80% OF THE MARKET HAS ONLY A HIGH SCHOOL DIPLOMA; 11% HAVE A COLLEGE DEGREE. THE MEDIAN HOUSEHOLD INCOME IS APPROXIMATELY $40,000; WITH PER CAPITA INCOME AT APPROXIMATELY $19,000. PART VI, LINE 5: ACMC IS AN ACTIVE PARTICIPANT AND SPONSOR OF EVENTS LIKE RELAY FOR LIFE AND AMERICAN HEART WALK AND SPONSOR OF HEALTH-RELATED EVENTS OF COMMUNITY ORGANIZATIONS (EXAMPLE: ZONTA WOMEN'S HEALTH DAY). ACMC PUBLISHES A COMMUNITY MAGAZINE 2X/YEAR WITH HEALTHCARE INFORMATION AND TIPS FOR HEALTHY LIVING. THE WEBSITE CONTAINS HEALTH INFORMATION AND DOWNLOADABLE RESOURCES. THE HOSPITAL HOLDS TWO WOMEN'S HEALTH LUNCHEONS EACH YEAR (HEART AND CANCER). ACMC PARTICIPATES IN NUMEROUS HEALTH FAIRS AND COMMUNITY EVENTS AT WHICH THE HOSPITAL PROVIDES FREE SCREENINGS (BLOOD PRESSURE, BLOOD SUGAR, BODY MASS INDEX, BACK STRENGTH, CHOLESTEROL). THE HOSPITAL HOLDS MONTHLY DINNER EVENTS FOR THE COMMUNITY AT WHICH A PHYSICIAN DISCUSSES SPECIFIC HEALTH ISSUES. STAFF (PHYSICIANS, CLINICIANS, ETC.) APPEAR ON LOCAL CABLE TV SHOW 2X/MONTH TO SHARE HEALTH INFORMATION. ACMC OFFERS SUPPORT GROUPS (EXAMPLES DIABETES AND COPD). THE HOSPITAL IS WORKING WITH AMERICAN CANCER SOCIETY TO OFFER REACH TO RECOVERY, LOOK GOOD FEEL BETTER AND OTHER PROGRAMS IN ASHTABULA COUNTY. ACMC ALSO PROVIDES AN ATHLETIC TRAINER TO THREE HIGH SCHOOLS (NO COST TO THE SCHOOL DISTRICTS FOR THIS SERVICE). PART VI, LINE 6: ACMC IS AN AFFILIATE OF THE CLEVELAND CLINIC. THE CLEVELAND CLINIC HEALTH SYSTEM ENGAGES IN MANY COMMUNITY OUTREACH PROGRAMS, INCLUDING INITIATIVES DESIGNED TO SERVE THE VULNERABLE AND AT-RISK POPULATIONS IN OUR COMMUNITIES. CLEVELAND CLINIC'S OUTREACH PROGRAMS RANGE FROM FREE HEALTH SCREENINGS AND CLINICAL SERVICES TO ENROLLMENT ASSISTANCE FOR GOVERNMENT-FUNDED HEALTH PROGRAMS. COMMUNITY OUTREACH PROGRAMS ARE ALSO THOSE PROGRAMS THAT IMPROVE ACCESS TO HEALTH SERVICES. CLEVELAND CLINIC CAREGIVERS COLLABORATE WITH COMMUNITY ORGANIZATIONS TO PROVIDE A CONTINUUM OF CARE THAT SUPPORTS ECONOMICALLY AND MEDICALLY UNDERSERVED AREAS. THE 2014 COMMUNITY BENEFIT REPORT PUBLISHED BY THE CLEVELAND CLINIC STATED $681.8 MILLION WAS SPENT BY THE CLEVELAND CLINIC IN 2014 ON COMMUNITY OUTREACH PROGRAMS. PART VI, LINE 7 N/A 0 ASHTABULA REGIONAL HOME HEALTH SERVICES 3949 JEFFERSON ROAD ASHTABULA OH 44004 341143158 501(C)(3) 150000 TO SUPPORT THE MISSION OF THE ASHTABULA REGIONAL HOME HEALTH SERVICES 1 0 X X X 0 0 0 0 0 0 0 0 0 JUDE CAUWENBERGH DO BOARD MEMBER/CHIEF OF STAFF 224071 0 0 0 270 0 7730 0 4684 0 236755 0 0 0 DANIEL KEATON MD BOARD MEMBER/VICE-CHIEF OF STAFF 159180 0 0 0 18180 0 6933 0 3320 0 187613 0 0 0 ALEXANDER TAICH MD PHYSICIAN 925477 0 0 0 162 0 10600 0 707 0 936946 0 0 0 ASHOK KONDRU MD PHYSICIAN 900874 0 0 0 1188 0 10600 0 4295 0 916957 0 0 0 SUK K CHOI MD PHYSICIAN 627022 0 0 0 1219 0 10600 0 3994 0 642835 0 0 0 MICHAEL J PAPSIDERO MD PHYSICIAN 583979 0 0 0 1188 0 10600 0 6453 0 602220 0 0 0 LEE LANEY MD PHYSICIAN 582722 0 4348 0 222427 0 10600 0 4295 0 824392 0 0 0 PART I, LINE 3 SALARIES ARE REVIEWED APPROXIMATELY EVERY TWO YEARS. SALARIES ARE COMPARED TO LOCAL, REGIONAL, AND NATIONAL MARKET RATES AND IN CONJUNCTION WITH THE CEO AND CFO TO DETERMINE COMPENSATION. WHEN OPENINGS FOR KEY POSITIONS BECOME AVAILABLE, THE HR DEPARTMENT EXAMINES THE MARKET RATES TO DETERMINE A STARTING SALARY. EVERY YEAR THE TYPICAL SALARY HAS A 2% MERIT RATE INCREASE. ASHOK KONDRU MD EMPLOYEE OF ACMC PART OF EMPLOYMENT AGREEMENT. REPAYMENT BEGAN IN 2014. X 150000 41358 0 1 1 41358 KIMBERLY GIANGOLA FAMILY MEMBER OF JOSEPH GIANGOLA, ACMC TRUSTEE 24771 EMPLOYMENT AGREEMENT WITH ACMC 0 JENINE ENGLISH FAMILY MEMBER OF PEG CARLO, ACMC TRUSTEE 80748 EMPLOYMENT AGREEMENT WITH ACMC 0 BRITTANY COACH FAMILY MEMBER OF PEG CARLO, ACMC TRUSTEE 65354 EMPLOYMENT AGREEMENT WITH ACMC 0 JENNIFER CAUWENBERGH FAMILY MEMBER OF JUDE CAUWENBERGH, D.O., ACMC TRUSTEE 31499 EMPLOYMENT AGREEMENT WITH ACMC 0 PENNY PALFY FAMILY MEMBER OF SUSAN STOCKER, PH.D., ACMC TRUSTEE 53189 EMPLOYMENT AGREEMENT WITH ACMC 0 FORM 990, PART VI, SECTION A, LINE 3 THE CLEVELAND CLINIC FOUNDATION HOLDS AND EXERCISES A MANAGEMENT AGREEMENT WITH ACMC. FORM 990, PART VI, SECTION B, LINE 11 THE FORM 990 REPORT IS PUBLISHED TO THE BOARD OF DIRECTORS' WEBSITE. FORM 990, PART VI, SECTION B, LINE 12C ALL OFFICERS, TRUSTEES, AND KEY EMPLOYEES ARE REQUIRED TO ANNUALLY REVIEW AND SIGN A CONFLICT OF INTEREST POLICY ACKNOWLEDGEMENT FORM. FORM 990, PART VI, SECTION B, LINE 15 SALARIES ARE REVIEWED APPROXIMATELY EVERY TWO YEARS. SALARIES ARE COMPARED TO LOCAL, REGIONAL, AND NATIONAL MARKET RATES AND IN CONJUNCTION WITH THE CEO AND CFO TO DETERMINE COMPENSATION. WHEN OPENINGS FOR KEY POSITIONS BECOME AVAILABLE, THE HR DEPARTMENT EXAMINES THE MARKET RATES TO DETERMINE A STARTING SALARY. EVERY YEAR THE TYPICAL SALARY HAS A 2% MERIT RATE INCREASE. FORM 990, PART VI, SECTION C, LINE 19 ALL REQUESTS ARE SENT TO THE CEO FOR DISTRIBUTION. FORM 990, PART VII, SECTION A THE FOLLOWING OFFICERS WORKING FULL-TIME FOR ACMC ARE EMPLOYED BY THE CLEVELAND CLINIC AND ARE COMPENSATED THROUGH EMPLOYMENT AGREEMENTS WITH THE CLEVELAND CLINIC: MICHAEL HABOWSKI, PRESIDENT/CEO; DON KEPNER, VP FINANCE/CFO; KEN FRAME, CHIEF NURSING OFFICER. FORM 990, PART XI, LINE 9: EQUITY INCOME IN AFFLIATE -174,656. DISTRIBUTION TO CLEVELAND CLINIC FOUNDATION -1,377,500. EFFECT OF RECOGNITION PROVISION AT MEASUREMENT DATE OF PENSION OBLIGATION -2,086,139. FEDERAL ELECTIONS SECTION 1.263(A)-1(F) DE MINIMIS SAFE HARBOR ELECTION ASHTABULA COUNTY MEDICAL CENTER 2420 LAKE AVENUE ASHTABULA, OH 44004 EMPLOYER IDENTIFICATION NUMBER: 34-0726081 FOR THE YEAR ENDING DECEMBER 31, 2015 ASHTABULA COUNTY MEDICAL CENTER IS MAKING THE DE MINIMIS SAFE HARBOR ELECTION UNDER REG. SEC. 1.263(A)-1(F). ASHTABULA COUNTY MEDICAL CENTER FOUNDATION 2420 LAKE AVENUE ASHTABULA OH 44004 341392784 SUPPORT THE ASHTABULA COUNTY MEDICAL CENTER OH 501(C)(3) LINE 11A, I ASHTABULA COUNTY MEDICAL CENTER 1 ROCK CREEK MEDICAL CENTER DBA GLENBEIGH HEALTH SOURCES 2863 STATE ROUTE 45 ROCK CREEK OH 44084 341789783 OPERATE AND MAINTAIN A HOSPITAL AND OUTPATIENT CENTERS OH 501(C)(3) LINE 3 ASHTABULA COUNTY MEDICAL CENTER 1 ASHTABULA REGIONAL HOME HEALTH SERVICES 3949 JEFFERSON ROAD ASHTABULA OH 44004 341143158 HOME HEALTH SERVICES OH 501(C)(3) LINE 9 ASHTABULA COUNTY MEDICAL CENTER 1 0 1 1 0 0 0 0 0 0 0 0 0 0 1 1 0 1 1 1 ASHTABULA COUNTY MEDICAL CENTER FOUNDATION Q 136576 CASH RECEIVED ASHTABULA REGIONAL HOME HEALTH SERVICES Q 125741 CASH RECEIVED ROCK CREEK MEDICAL CENTER DBA GLENBEIGH HEALTH SERVICES Q 798183 CASH RECEIVED ASHTABULA REGIONAL HOME HEALTH SERVICES B 150000 CASH DISBURSED ROCK CREEK MEDICAL CENTER DBA GLENBEIGH HEALTH SERVICES C 7000000 CASH RECEIVED