2016-11-15T12:20:43-06:00 2015-12-31 410746749 CLIFTONLARSONALLEN LLP PO BOX 35429 CANTON OH 447355429 990 2015-01-01 341445390 AULTMAN HEALTH FOUNDATION AULT 3303636352 2600 SIXTH STREET SW CANTON OH 44710 MARK D WRIGHT CHIEF FINANCIAL OFFICER 3303636352 2016-11-15 1 LISA HILLING P01624111 3304972000 2015 2017-02-10 21:41:12Z EDWARD J ROTH III 2600 SIXTH STREET SW CANTON OH 44710 76730223 0 X WWW.AULTMAN.ORG X 1975 OH THE MISSION OF AULTMAN HEALTH FOUNDATION IS TO "LEAD OUR COMMUNITY TO IMPROVED HEALTH." 43 37 400 37 0 0 0 0 40631107 43656563 4790460 5342266 953009 431396 46374576 49430225 926798 986437 0 0 20247097 22903335 0 0 0 20491327 22402260 41665222 46292032 4709354 3138193 325724316 309576992 28858272 27120685 296866044 282456307 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 MOBILE HEALTH-FAIR UNIT PROVIDES HEALTH SCREENINGS AND WELLNESS EDUCATION FOR OUR COMMUNITY. THE WOW TEAM PARTICIPATED IN 400 EVENTS IN 2015, RANGING FROM COMMUNITY GATHERINGS TO HEALTH FAIRS, AND WOW NURSES HAD PERSONAL INTERACTION WITH MORE THAN 26,000 COMMUNITY MEMBERS. 0 0 16576068 0 0 WITH 95 EMPLOYEES, THE AULTMAN SYSTEMS AND TECHNOLOGY DEPARTMENT PROVIDES THE TECHNICAL INFRASTRUCTURE FOR BUSINESS AND CLINICAL SYSTEMS THROUGHOUT THE AULTMAN HEALTH FOUNDATION, 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. 6562082 0 7655691 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 2015, 187 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. 4381862 0 2426 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. 10163957 986437 36429842 OTHER EXPENSES INCURRED ARE IN SUPPORT OF AULTMAN HEALTH FOUNDATION'S PURPOSE TO "LEAD OUR COMMUNITY TO IMPROVED HEALTH." 10163957 986437 36429842 37683969 1 0 0 1 0 0 0 0 0 0 1 0 1 0 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 67 0 1 400 1 0 1 CJ EI 0 0 0 0 0 0 0 0 X 43 37 1 0 0 0 0 0 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-AHF 50.00 5.00 X X 616011 0 23436 DOUGLAS J SIBILA CHAIR 1.00 1.00 X X 0 0 0 BARBARA HAMMONTREE BENNETT VICE CHAIR 1.00 1.00 X X 0 0 0 CHRISTOPHER E REMARK TREASURER/CEO-AH 5.00 50.00 X X 0 404894 24101 DARRYL J DILLENBACK 2ND VICE CHAIR & SECRETARY 1.00 0.00 X X 0 0 0 JOSEPH R HALTER JR DIRECTOR 1.00 0.00 X 0 0 0 PATRICIA A GRISCHOW DIRECTOR 1.00 0.00 X 0 0 0 RICK L HAINES DIRECTOR/CEO-AULTCARE 5.00 50.00 X 0 430887 17515 MILAN R DOPIRAK MD DIRECTOR 1.00 54.00 X 0 426826 17125 EMIL ALECUSAN DIRECTOR 1.00 0.00 X 0 0 0 LEO DOYLE DIRECTOR 1.00 1.00 X 0 0 0 DAVID W BARTLEY II DIRECTOR 1.00 1.00 X 0 0 0 BRIAN S BELDEN DIRECTOR 1.00 1.00 X 0 0 0 WILLIAM H BELDEN JR DIRECTOR 1.00 0.00 X 0 0 0 PAUL R BISHOP DIRECTOR 1.00 0.00 X 0 0 0 SHEILA MARKLEY BLACK DIRECTOR 1.00 1.00 X 0 0 0 THEODORE V BOYD DIRECTOR 1.00 0.00 X 0 0 0 PEGGY CLAYTOR DIRECTOR 1.00 1.00 X 0 0 0 NATE J COOKS DIRECTOR 1.00 1.00 X 0 0 0 STEPHEN G DEUBLE DIRECTOR 1.00 0.00 X 0 0 0 DAVID M FINDLEY DIRECTOR 1.00 0.00 X 0 0 0 NORMAN J GAYNOR III DIRECTOR 1.00 0.00 X 0 0 0 T STEPHEN GREGORY DIRECTOR 2.00 1.00 X 0 0 0 MICHAEL E HANKE DIRECTOR 1.00 0.00 X 0 0 0 SUE HOSTETLER DIRECTOR 1.00 0.00 X 0 0 0 JOHN B HUMPHREY JR MD DIRECTOR 1.00 1.00 X 0 0 0 JAMES E KNISELY DIRECTOR 1.00 0.00 X 0 0 0 GEORGE W LEMON DIRECTOR 1.00 1.00 X 0 0 0 GENE E LITTLE DIRECTOR 1.00 0.00 X 0 0 0 RONALD R LYONS DIRECTOR 1.00 0.00 X 0 0 0 HARRY CC MACNEALY DIRECTOR 1.00 1.00 X 0 0 0 JEFFREY MILLER MD DIRECTOR 1.00 2.00 X 0 0 0 TIMOTHY O'TOOLE MD DIRECTOR 1.00 2.00 X 0 47600 0 MICHAEL RICH MD DIRECTOR 1.00 54.00 X 0 371492 23307 ROBERT W SABOTA MD DIRECTOR 1.00 1.00 X 0 2550 0 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 1.00 0.00 X 0 0 0 TODD M SOMMER DIRECTOR 1.00 1.00 X 0 0 0 VICKY STERLING DIRECTOR 1.00 1.00 X 0 0 0 WILLIAM WALLACE MD DIRECTOR 1.00 4.00 X 0 5000 0 R CLINT ZOLLINGER ESQ DIRECTOR 1.00 0.00 X 0 0 0 GEOFF KARCHER DIRECTOR 1.00 0.00 X 0 0 0 MARK D WRIGHT CFO-AHF 50.00 5.00 X 358752 0 23675 ROBERT C MOLNAR VP - PHYSICIAN SERVICES 50.00 5.00 X 204907 0 20851 MARK N ROSE VP-LEGAL SERVICES 50.00 5.00 X 274196 0 24011 ELIZABETH A GETZ CHIEF INFORMATION OFFICER 50.00 5.00 X 256363 0 22406 SUSAN E OLIVERA VP-HUMAN RESOURCES 50.00 5.00 X 237686 0 22246 RONALD RUSNAK DIRECTOR OF CLINICAL INFORMATICS 50.00 5.00 X 321285 0 20043 TIMOTHY TEYNOR VP - PUBLIC POLICY 50.00 5.00 X 219714 0 21516 EILEEN GOOD SENIOR VP - CLINICAL ADVOCACY 50.00 5.00 X 215056 0 6126 KEVIN D PETE SENIOR VP - IHN 50.00 5.00 X 245831 0 22387 JASON A JUSTUS ASSOC VP - POMERENE FINANCE 50.00 5.00 X 214877 0 20655 3164678 1689249 309400 33 0 1 0 HURON CONSULTING GROUP INC 550 W VAN BUREN ST CHICAGO IL 60607 MANAGEMENT CONSULTING 555344 SOFT COMPUTER CONSULTANTS 5400 TECH DATA DR CLEARWATER FL 33760 TECHNOLOGY 411495 QCS CLEANING SOLUTIONS INC 1990 AUGUSTA DR SE MASSILLON OH 44646 CLEANING SERVICES 378912 BRUNER-COX LLP 4505 STEPHEN CIRCLE NW STE 200 CANTON OH 44735 ACCOUNTING 315803 INFOR 13560 MORRIS RD STE 4100 ALPHARETTA GA 30004 TECHNOLOGY 287722 38 HEALTH SYSTEM ADMINISTRATION 561000 34571853 34571853 PATIENT SERVICE REVENUE 624100 7744502 7744502 PROPERTY MANAGEMENT REVENUE 561000 1340208 1340208 43656563 1959203 1959203 30683061 27299998 3383063 3383063 3383063 OTHER INCOME 561000 431396 431396 431396 49430225 44087959 0 5342266 X 986437 986437 2084542 1688479 396063 16927936 13711628 3216308 585928 474602 111326 1828711 1481256 347455 1476218 1195737 280481 308961 250258 58703 208793 169122 39671 250700 203067 47633 46005 37264 8741 7745261 6273662 1471599 53955 43704 10251 414522 335763 78759 9070893 7347423 1723470 1274057 1031986 242071 284238 230233 54005 1148 930 218 595664 482488 113176 77714 62948 14766 MEDICAL SUPPLIES 965613 782147 183466 EDUCATION 740756 600012 140744 RECRUITMENT 160158 129728 30430 HOSPITAL FRANCHISE FEE 100024 81019 19005 103798 84076 19722 46292032 37683969 8608063 0 3350696 2355522 1398408 1325491 6562000 5450008 1651334 1796710 11207103 4633300 6809468 6573803 75752807 65566558 221284582 220744203 1440000 1080000 7475021 4684697 325724316 309576992 2847163 3455992 5400000 5400000 18130000 20611109 134693 28858272 27120685 X 296866044 282456307 296866044 282456307 325724316 309576992 X 3138193 -5553594 -11994336 X 0 1 X 1 0 X X 1 AULTMAN HOSPITAL 340714538 3 1 0 0 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 PART I 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. SPECIFICALLY IDENTIFYING THOSE EXPENSES RELATED TO AH WOULD BE DIFFICULT TO QUANTIFY. AS SUCH, AHF HAS NOT REPORTED ANY DIRECT EXPENSES ON SCHEDULE A PART I. 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 0 0 1 250700 250700 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. 4211313 4211313 3754689 2216043 1538646 2758551 1953087 805464 482550 464170 18380 6573803 INVESTMENT IN AFFILIATES 220744203 C 220744203 ESTIMATED THIRD-PARTY PAYOR SETTLEMENTS 114331 INTEREST RATE SWAP 20362 134693 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 STATEMENT 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 1 X 401.000000000000 1 1 0 1 1 35876 35876 0.00080 529899 598971 -69072 0.00000 565775 598971 -33196 0.00080 565775 598971 -33196 0.00080 1 88811 0 3402183 3142150 260033 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 13 1 1 1 1 X HTTPS://AULTMAN.ORG/HOME/ABOUT/AULTMAN-HOSPITAL/COMMUNITY-HEALTH-NEEDS-ASSE X 1 13 1 HTTPS://AULTMAN.ORG/HOME/ABOUT/AULTMAN-HOSPITAL/COMMUNITY-HEALTH-NEEDS-ASSE 0 0 1 X 100.000000000000 401.000000000000 X X X X 1 1 X X X X 1 X HTTPS://AULTMAN.ORG/HOME/PATIENTS-AND-VISITORS/INSURANCE-AND-BILLING/FINANC X HTTPS://AULTMAN.ORG/HOME/PATIENTS-AND-VISITORS/INSURANCE-AND-BILLING/FINANC X HTTPS://AULTMAN.ORG/HOME/PATIENTS-AND-VISITORS/INSURANCE-AND-BILLING/FINANC 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 ACUTE CARE SPECIALTY HOSPITAL USED THE STARK COUNTY COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) ADVISORY COMMITTEE. THE FOLLOWING AGENCIES HAVE BEEN INVOLVED IN THE COMMITTEE: ACCESS HEALTH STARK COUNTY; AFFINITY MEDICAL CENTER; ALLIANCE COMMUNITY HOSPITAL; ALLIANCE CITY HEALTH DEPARTMENT; AULTMAN HEALTH FOUNDATION; CANTON CITY HEALTH DEPARTMENT; CANTON COMMUNITY CLINIC; MERCY MEDICAL CENTER; PRESCRIPTION ASSISTANCE NETWORK OF STARK COUNTY; STARK COUNTY FAMILY COUNCIL; STARK COUNTY HEALTH DEPARTMENT; STARK COUNTY JOBS & FAMILY SERVICES; STARK COUNTY MEDICAL SOCIETY; STARK COUNTY MENTAL HEALTH & RECOVERY SERVICES BOARD; UNITED WAY OF GREATER STARK COUNTY AND WESTERN STARK CLINIC.TO COLLECT INFORMATION FROM THE CHNA ADVISORY COMMITTEE AULTMAN HOSPITAL PARTICIPATED IN TWO HEALTH IMPROVEMENT SUMMITS. DURING THE FIRST SUMMIT NEARLY 70 HEALTH AND SOCIAL SERVICE AGENCIES AND COMMUNITY VOLUNTEERS CAME TOGETHER TO REVIEW THE NEWLY RELEASED 2011 STARK COUNTY HEALTH NEEDS ASSESSMENT REPORT. THE REPORT INCLUDES SURVEY DATA COLLECTED FROM COMMUNITY RESIDENTS THROUGH A RANDOMIZED TELEPHONE POLL, SECONDARY HEALTH INDICATORS DATA AND YOUTH DATA OBTAINED FROM A SURVEY ADMINISTERED THROUGH STARK COUNTY SCHOOLS. THE DATA WAS ANALYZED AND FIVE LEADING HEALTH ISSUES WERE IDENTIFIED. PARTICIPANTS WERE ASKED TO DISCUSS THE RESULTS AND VOTE ON THREE HEALTH ISSUES FOR THE COMMUNITY TO ADDRESS. USING THE CONNECTING POINT VOTING SYSTEM, THE RESULTS WERE AVAILABLE IMMEDIATELY FOR VIEW. THE PARTICIPANTS WERE THEN ASKED TO BREAK INTO GROUPS AND BRAINSTORM IDEAS FOR ADDRESSING EACH HEALTH NEED. THESE IDEAS WERE USED TO CONSTRUCT A FRAMEWORK FOR A HEALTH IMPROVEMENT PLAN. PARTICIPANTS WERE ASKED TO CONTINUE THEIR COMMITMENT TO THIS PROCESS OVER THE NEXT FOUR MONTHS TO FURTHER DEVELOP THE PLAN. DURING THE SECOND SUMMIT OVER 60 COMMUNITY LEADERS FROM PUBLIC HEALTH, HEALTH CARE ORGANIZATIONS, FOUNDATIONS, AND OTHER GOVERNMENTAL AND SOCIAL SERVICES ORGANIZATION ATTENDED. THE SUMMIT WAS ORGANIZED TO BRING TOGETHER COMMUNITY ORGANIZATIONS THROUGHOUT STARK COUNTY WHOSE EFFORTS AND INITIATIVES ADDRESS ONE OR MORE OF THE THREE HEALTH PRIORITIES. THE ATTENDEES WERE ENCOURAGED TO COMMIT TO IMPLEMENTING GOALS AND STRATEGIES IN THE HEALTH IMPROVEMENT PLAN AND ASSIST IN EVALUATION EFFORTS. THE PURPOSE OF THE SUMMIT WAS ALSO TO MOTIVATE ATTENDEES TO MAKE SUSTAINABLE CHANGES AND TO SHOWCASE THE COUNTY'S COLLABORATION TO MAKE STARK COUNTY A HEALTHIER COMMUNITY.STARK COUNTY CHNA ADVISORY COMMITTEE ORIGINAL COMMITTEE MEMBERS: LES ABLE, COMMUNITY VOLUNTEER, RETIRED, STARK COUNTY MENTAL HEALTH BOARD JIM ADAMS, HEALTH COMMISSIONER, CANTON CITY HEALTH DEPARTMENT SHARON ANDREANI, DIRECTOR OF NURSING, ALLIANCE CITY HEALTH DEPARTMENT BARB BLEVINS, DIRECTOR, ACCESS HEALTH STARK COUNTY EMILY CANIFORD, DIRECTOR OF ADMINISTRATION AND SUPPORT SERVICES, STARK COUNTY HEALTH DEPARTMENT KAY CONLEY, COMMITTEE CHAIR, GRANTS COORDINATOR, STARK COUNTY HEALTH DEPARTMENT LYNNE DRAGOMIER, VP PUBLIC RELATIONS AND MARKETING, MERCY MEDICAL CENTER GARY FEAGLES, EXECUTIVE DIRECTOR, WESTERN STARK CLINIC BILL FRANKS, HEALTH COMMISSIONER, STARK COUNTY HEALTH DEPARTMENT DANA HALE, RN, BSN, CANTON CITY HEALTH DEPARTMENT WENDY HUNTER-VAUGHN, MANAGER OF PROGRAMS/EVALUATIONS, MENTAL HEALTH AND RECOVERY SERVICES BOARD OF STARK COUNTY BILL JAMES, DIRECTOR OF INDUSTRIAL ENGINEERING, ALLIANCE COMMUNITY HOSPITAL CAROL LICHTENWALTER, DIRECTOR, STARK COUNTY FAMILY COUNCIL KEVIN METZ, EXECUTIVE DIRECTOR, STARK COUNTY MEDICAL SOCIETY KRISTEN MIDAY, FINANCIAL ANALYST, AULTMAN HEALTH FOUNDATION MICHELLE MILLER, PROJECT LEADER OF RESEARCH AND DEVELOPMENT, ALLIANCE COMMUNITY HOSPITAL LIZ PRUITT, VP OF OPERATIONS, AFFINITY MEDICAL CENTER KELLY RICHENDOLLAR, HEALTH EDUCATOR, STARK COUNTY HEALTH DEPARTMENT CAROL RISALITI, EXECUTIVE DIRECTOR, PRESCRIPTION ASSISTANCE NETWORK OF STARK COUNTY LORIE TRAVAGLINO, DIRECTOR, UNITED WAY OF GREATER STARK COUNTY. AULTMAN SPECIALTY HOSPITAL PART V, SECTION B, LINE 6A: THE CHNA WAS CONDUCTED WITH THE FOLLOWING HOSPITAL FACILITIES:- AFFINITY MEDICAL CENTER- ALLIANCE COMMUNITY HOSPITAL- CANTON COMMUNITY HOSPITAL- MERCY MEDICAL CENTER- WESTERN STARK CLINIC AULTMAN SPECIALTY HOSPITAL PART V, SECTION B, LINE 7D: THE CHNA AND CHNA IMPLEMENTATION PLAN CAN BE FOUND AT THE FOLLOWING URL:HTTPS://AULTMAN.ORG/HOME/ABOUT/AULTMAN-HOSPITAL/COMMUNITY-HEALTH-NEEDS-ASSESSMENT/#/ AULTMAN SPECIALTY HOSPITAL PART V, SECTION B, LINE 11: AS A RESULT OF THE CHNA AND SUBSEQUENT ANALYSIS, THE FOLLOWING WERE IDENTIFIED AS THE PRIORITY AREAS IN WHICH THE HOSPITAL WILL FOCUS: ACCESS TO HEALTH CARE, OBESITY AND LACK OF HEALTHY LIFESTYLE CHOICES, LARGE NEED FOR MENTAL HEALTH SERVICESACCESS TO HEALTH CARE - CURRENT PROGRAMS AND SERVICES THAT ADDRESS THIS NEED: AH OFFERS SEVERAL SERVICES TO COMBAT LACK OF ACCESS TO HEALTH INSURANCE AND HEALTH CARE: THREE OUTPATIENT CENTERS, STAFFED BY RESIDENT PHYSICIANS AND TEACHING ATTENDING PHYSICIANS, THAT PROVIDE FAMILY MEDICINE, INTERNAL MEDICINE AND OBSTETRICS SERVICES TO UNDERINSURED AND UNINSURED MEMBERS OF THE COMMUNITY. MORE THAN 40,000 PATIENT VISITS ARE MADE TO THE OUTPATIENT CENTERS EACH YEAR. THE WOW PROGRAM, WHICH VISITS SCHOOLS, COMMUNITY CENTERS, CHURCHES, SENIOR CENTERS AND BLOCK PARTIES TO PROVIDE FREE SCREENINGS AND HEALTH EDUCATION. SCREENINGS SUCH AS BLOOD PRESSURE CHECKS, HEIGHT, WEIGHT AND BODY MASS INDEX/PERCENTAGE OF BODY FAT ARE PROVIDED. IN 2012, THE WOW VAN REACHED MORE THAN 20,000 PEOPLE. THE AULTMAN CANCER CENTER'S ANNUAL CANCER SCREENING DAY PROVIDES A VARIETY OF FREE SCREENINGS TO HELP UNDERINSURED PEOPLE IN OUR COMMUNITY. AT THE APRIL 2012 CANCER SCREENING DAY, 161 PATIENTS WERE SCREENED. MOST OF THE PARTICIPANTS RECEIVED MULTIPLE SCREENINGS, FOR A TOTAL OF 353 SCREENINGS THROUGHOUT THE EVENT. THE CENTER ALSO OFFERED A BREAST SCREENING DAY IN 2012 TO UNDERSERVED WOMEN IN THE CARROLLTON, OHIO AREA. THE AULTMAN INFUSION THERAPY DEPARTMENT BEGAN A MEDICATION REIMBURSEMENT PROGRAM FOR UNINSURED PATIENTS IN 2007. LED BY AN ONCOLOGY-CERTIFIED REGISTERED NURSE, THE PROGRAM WAS SUCCESSFUL IN RECOVERING $450,000 IN DRUG COSTS IN 2012 FROM VARIOUS ASSISTANCE PROGRAMS. FREE HEALTH TALK PRESENTATIONS PROVIDE COMMUNITY MEMBERS WITH GENERAL HEALTH INFORMATION AND THE OPPORTUNITY TO INTERACT WITH LOCAL HEALTH CARE PROFESSIONALS. TOPICS RANGE FROM MANAGING DIABETES TO HEART ATTACK SIGNS TO CANCER PREVENTION. THE AH PATIENT OUTREACH DEPARTMENT OFFERS CHARITY CARE ASSISTANCE TO THE UNINSURED OR UNDERINSURED, ALONG WITH PROVIDING PATIENT RIGHTS NOTIFICATION TO ALL MEDICARE BENEFICIARIES IN THE HOSPITAL. PATIENTS RECEIVE FINANCIAL COUNSELING, ASSISTANCE IN APPLYING FOR MEDICAID AND THE STATE-FUNDED HOSPITAL CARE ASSURANCE PROGRAM (HCAP) AS WELL AS GUIDANCE ON AULTMAN'S OWN FINANCIAL ASSISTANCE PROGRAM (FAP). THE DEPART. PROCESSED MORE THAN 15,000 CHARITY CARE APPLICATIONS IN 2012 AND DELIVERED NEARLY 17,000 PATIENTS' RIGHTS DOCUMENTS TO MEDICARE PATIENTS. AH PROVIDES HIGH-QUALITY HEALTH CARE PROGRAMS AND SERVICES TO ANYONE IN NEED, REGARDLESS OF THEIR ABILITY TO PAY. AH IS DEDICATED TO YOUR HEALTH, OFFERING EVERYTHING FROM MEDICAL CARE DISCOUNTS TO EDUCATIONAL PROGRAMS. AULTCARE OFFERS INDIVIDUAL AULTONE, EMPLOYER GROUP, AND PRIMETIME HEALTH PLAN MEDICARE ADVANTAGE PLANS. NETWORK PROVIDERS SPAN THE SPECTRUM OF HEALTH CARE SPECIALTIES TO MEET THE NEEDS OF ENROLLEES AND KEEP CARE LOCALLY BASED. CARE COORDINATION SERVICES ARE OFFERED WHEN IT IS NECESSARY FOR MEMBERS TO SEEK AND RECEIVE CARE OUTSIDE OF THE AULTCARE OR PRIMETIME HEALTH PLANS' NETWORK OF PROVIDERS. TELE-MONITORING SERVICES ARE OFFERED FOR HEART FAILURE AND DIABETES CHRONIC STATES. EMPLOYER GROUPS MAY CHOOSE TO ADD ON WELLNESS PROGRAMS DESIGNED SPECIFICALLY TO THE NEEDS OF THE GROUP WITH ONSITE HEALTH COACHING AND EDUCATION PROVIDED BY LICENSED PROFESSIONAL STAFF. TRANSITION PROGRAMS PROVIDE MEMBERS WHO ARE CONFINED IN AN ACUTE CARE SETTINGS EASE IN THEIR MOVING FROM THE ACUTE PHASE OF THEIR CARE TO THE NEXT LEVEL WITHIN THE HEALTH CARE CONTINUUM WITH THE GOAL OF REDUCING READMISSION. THE WEBSITE (WWW.AULTMAN.ORG) IS A COMMUNITY RESOURCE FOR HEALTH AND WELLNESS INFORMATION; HOSPITAL SERVICES AND A CALENDAR OF EVENTS; AN ONLINE PHYSICIAN DIRECTORY AND MORE. AH ALSO HAS A RELATIONSHIP WITH A HEALTH INFORMATION CONTENT PROVIDER CALLED EMMI. EMMI IS AN ANIMATED, WEB BASED EDUCATIONAL PRODUCT WITH AN EXTENSIVE LIBRARY OF SPECIFIC PROGRAMS DESIGNED TO HELP VIEWERS LEARN ABOUT THEIR MEDICAL CONDITION, WELLNESS, DIAGNOSTIC AND SURGICAL PROCEDURES. EMMI PROGRAMS CAN BE VIEWED IN THE HOME AT THE VIEWER'S OWN PACE. THE VIEWER MAY ALSO SHARE PROGRAMS WITH FRIENDS AND FAMILY. THESE PROGRAMS OFFER CURRENT, ACCURATE, SOUND AND UNBIASED MEDICAL INFORMATION. THEY ARE DESIGNED TO NOT ONLY EDUCATE THE VIEWER, BUT TO PROVIDE A BASE ON WHICH THE VIEWER CAN BUILD THEIR KNOWLEDGE AND BE AN INFORMED CONSUMER OF HEALTH CARE SERVICES.OBESITY AND LACK OF HEALTHY LIFESTYLE CHOICES - CURRENT PROGRAMS AND SERVICES THAT ADDRESS THIS NEED: AH SERVICES AND INITIATIVES TO TARGET OBESITY AND UNHEALTHY LIFESTYLE CHOICES INCLUDED: THE HEALTH VISION 2020 INITIATIVE, AIMED AT MAKING STARK COUNTY HEALTHIER BY THE YEAR 2020. THE AULTMAN HEALTH VISION 2020 COMMITTEE TARGETED TOBACCO USE AND OBESITY 2012, OFFERING FREE EDUCATIONAL PROGRAMS, HEALTH SCREENINGS AND THE "GIVE IT UP!" TOBACCO CESSATION PROGRAM TO EQUIP LOCAL RESIDENTS WITH THE TOOLS THEY NEED TO MAKE HEALTHIER LIFESTYLE CHOICES. AULTMAN WEIGHT MANAGEMENT (AWM) PROGRAMS TO HELP CLIENTS LOSE WEIGHT AND IMPROVE THEIR HEALTH. AH OFFERS THREE MEDICALLY SUPERVISED WEIGHT-LOSS PROGRAMS FOR ADULTS; ALONG WITH THE FUN 2B FIT FAMILY-CENTERED PROGRAM FOR CHILDREN 8-15 AND THEIR PARENTS. AWM RELOCATED IN 2012 FROM AN OFFICE BUILDING TO AN AH FACILITY PACKED WITH FITNESS EQUIPMENT, TO MAKE THE EXERCISE COMPONENT OF THE PROGRAM MORE CONVENIENT FOR CLIENTS. NOW, CLIENTS CAN ATTEND THEIR WEEKLY MEETINGS AND EXERCISE AT THE SAME FACILITY. FREE COMMUNITY HEALTH TALK PRESENTATIONS THAT PROVIDE ATTENDEES WITH INFORMATION ON HOW TO EAT HEALTHIER, EXERCISE AND IMPROVE THEIR HEALTH. PRIMETIME PROGRAM THAT HELPS COMMUNITY MEMBERS 50 AND OLDER STAY ACTIVE BY OFFERING A VARIETY OF EXERCISE CLASSES, ALONG WITH GOLF AND BOWLING LEAGUES. THE PRIMETIME PROGRAM EXPANDED TO THE AULTMAN ORRVILLE HOSPITAL LOCATION IN 2012, TO MEET THE NEEDS OF ORRVILLE AND WAYNE COUNTY RESIDENTS. THE CANTON PROJECT, A VEGAN DIET SUPPORT GROUP, LED BY AN AULTMAN CARDIAC REHAB NURSE AND CARDIOLOGIST. THE MONTHLY SUPPORT GROUP IS FREE TO ATTEND, AND ABOUT 100 PEOPLE ARE ON THE SUPPORT GROUP ROSTER. THE GROUP OFFERS INFORMATION AND ENCOURAGEMENT TO PEOPLE ON VEGAN OR PLANT-BASED DIETS. ACTIVITIES RANGE FROM FOOD LABEL-READING SESSIONS TO POT-LUCK SUPPERS TO TIPS ON HOW TO ORDER AT RESTAURANTS. THE CARDIOLOGIST ALSO ATTENDS REGULARLY TO SHARE THE LATEST MEDICAL RESEARCH WITH THE GROUP. THE SHARON LANE HEALTH INFORMATION CENTER, LOCATED AT AH, WHICH OFFERS MANY RESOURCES FOR HEALTHY LIFESTYLES INCLUDING A FULL LENDING LIBRARY, VIDEOS, COOKBOOKS, LITERATURE AND ANATOMICAL MODELS. HEALTH EDUCATION SPECIALISTS ARE ON HAND TO HELP VISITORS WITH CUSTOMIZED RESEARCH. THE WORKING ON WELLNESS (WOW) VAN, WHICH PROVIDES FREE HEALTH SCREENINGS AND EDUCATION THROUGHOUT THE COMMUNITY. THE WOW VAN VISITS AREA SCHOOLS, COMMUNITY/OUTREACH CENTERS, CHURCHES, SENIOR CENTERS; BLOCK PARTIES, ETC. TO PROVIDE AGE-APPROPRIATE HEALTH INFORMATION. IN 2012, THE WOW PROGRAM PROMOTED HEALTHY EATING TO LOCAL SCHOOL CHILDREN BY PROVIDING COLORFUL MYPLATE PLACEMATS TO TEACH KIDS ABOUT FOOD GROUPS AND CREATING "SMART" PLATES OF FOOD. THE WOW VAN ALSO PROVIDES NONINVASIVE HEALTH SCREENINGS INCLUDING BLOOD PRESSURE CHECKS, HEIGHT, WEIGHT AND BODY MASS INDEX/PERCENTAGE OF BODY FAT ARE PROVIDED. EDUCATIONAL PROGRAMS INCLUDING OUTPATIENT COUNSELING WITH A DIETITIAN AND A DIABETES MANAGEMENT PROGRAM, LED BY CERTIFIED DIABETES EDUCATORS. THE AULTMAN AMBASSADOR PROGRAM IS AN INITIATIVE TO REDUCE OBESITY AMONG HIGH SCHOOL STUDENTS, BY WORKING INTENSIVELY WITH A SPECIFIC HIGH SCHOOL OVER SEVERAL YEARS. IN OUR MODEL, AH PARTNERS WITH CARDIOVASCULAR CONSULTANTS (HEART SURGEONS), AN AREA COLLEGE/ UNIVERSITY AND A LOCAL HIGH SCHOOL. OBESITY IS REDUCED THROUGH ACTIVITIES IN BOTH THE SCHOOL AND COMMUNITY. RIGHT NOW, WE ARE ACTIVE IN LOUISVILLE HIGH SCHOOL WITH MALONE UNIVERSITY AS OUR COLLEGIATE PARTNER. A COLLABORATIVE WELLNESS COUNCIL CONSISTING OF AH EMPLOYEES; MALONE FACULTY; AND LOUISVILLE HIGH SCHOOL ADMINISTRATORS, TEACHERS, PARENTS AND STUDENTS HELPS TO DECIDE THE SPECIFIC ACTIONS THAT WE TAKE. THE WELLNESS COUNCIL MEETS MONTHLY DURING THE SCHOOL YEAR.NEED FOR ADDITIONAL MENTAL HEALTH SERVICES - CURRENT PROGRAMS AND SERVICES THAT ADDRESS THIS NEED: AH OFFERS A VARIETY OF SERVICES TO HELP PATIENTS WITH MENTAL HEALTH ISSUES INCLUDING: AN INPATIENT PSYCHIATRIC UNIT THAT PROVIDES GROUP AND FAMILY THERAPY, MEDICATION ADJUSTMENTS, ART THERAPY, SOCIAL SERVICES AND DISCHARGE PLANNING. THE UNIT FEATURES 24/7 NURSING CARE AND SECURITY COVERAGE. THE OUTPATIENT PARTIAL HOSPITALIZATION PROGRAM AND INTENSIVE OUTPATIENT PROGRAM THAT PROVIDE SHORT-TERM, DAILY PROGRAMMING FOR PATIENTS WITHOUT HAVING TO STAY OVERNIGHT IN THE HOSPITAL. THE AULTMAN BEHAVIORAL HEALTH CENTER, WHICH OPENED IN 2012, OFFERS OUTPATIENT GROUP THERAPY, INDIVIDUAL MENTAL HEALTH ASSESSMENTS, MEDICATION MANAGEMENT AND MORE.SEE IMPLEMENTATION PLAN FOR FURTHER AULTMAN SPECIALTY HOSPITAL PART V, SECTION B, LINE 16I: THE FINANCIAL ASSISTANCE INFORMATION CAN BE FOUND AT THE FOLLOWING URL:HTTPS://AULTMAN.ORG/HOME/PATIENTS-AND-VISITORS/INSURANCE-AND-BILLING/FINANCIAL-ASSISTANCE/#/ AULTMAN SPECIALTY HOSPITAL PART V, SECTION B, LINE 22D: THE AMOUNTS GENERALLY BILLED (AGB) IS CALCULATED BY THE LOOK BACK METHOD. UNDER THE LOOK BACK METHOD THE AGB PERCENTAGE IS CALCULATED BY DIVIDING THE SUM OF ALL CLAIMS OVER A PRIOR 12-MONTH PERIOD FOR EMERGENCY AND OTHER MEDICALLY NECESSARY CARE THAT HAVE BEEN ALLOWED BY THE HEALTH INSURERS (PERMITTED TO BE USED IN THE AGB CALCULATION) BY THE SUM OF THE HOSPITAL'S GROSS CHARGES FOR THOSE CLAIMS. THE RESULTING AGB PERCENTAGE IS THEN MULTIPLIED BY THE GROSS CHARGES FOR THE CARE PROVIDED TO AN INDIVIDUAL THAT QUALIFIES FOR ASSISTANCE UNDER THE FINANCIAL ASSISTANCE POLICY (FAP) TO DETERMINE THE MAXIMUM AMOUNT THAT INDIVIDUAL MAY BE "CHARGED" FOR THAT CARE. FOR THE PURPOSE OF DETERMINING WHAT A FAP-ELIGIBLE INDIVIDUAL MAY BE "CHARGED" FOR EMERGENCY OR MEDICALLY NECESSARY CARE, ONLY THE AMOUNT HE OR SHE IS PERSONALLY RESPONSIBLE FOR PAYING AFTER ALL DEDUCTIONS, DISCOUNTS (INCLUDING DISCOUNTS AVAILABLE UNDER THE FAP) AND INSURANCE REIMBURSEMENTS HAVE BEEN APPLIED IS CONSIDERED. PART I, LINE 3C: AULTMAN HEALTH FOUNDATION IS THE PARENT COMPANY OF AULTMAN SPECIALTY HOSPITAL, FORMERLY THE ACUTE CARE SPECIALTY HOSPITAL (ASH THEREAFTER). 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 THE POLICY ALL MEDICALLY NECESSARY SELF-PAY PATIENTS ARE ELIGIBLE FOR FINANCIAL ASSISTANCE. ELIGIBILITY CRITERIA IS BASED ON THE FEDERAL POVERTY GUIDELINES (FPG) AND ARE UPDATED ANNUALLY 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% - 100% OF FPG RECEIVES A 100% DISCOUNT, 101% - 150% OF FPG RECEIVES A 90% DISCOUNT, 151% - 200% OF FPG RECEIVES A 80% DISCOUNT, 201% - 250% OF FPG RECEIVES A 65% DISCOUNT, 251% - 300% OF FPG RECEIVES A 55% DISCOUNT, 301% - 350% OF FPG RECEIVES A 45% DISCOUNT, 351% - 400% OF FPG RECEIVES A 35% DISCOUNT, 401% AND ABOVE IS DISCOUNTED AT 30%. 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 $ 88,811. PART I, LINE 6A AULTMAN HEALTH FOUNDATION, THE PARENT COMPANY, PUBLISHES ANNUALLY ITS 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. 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 CRITICAL CARE. MOST OF THE PATIENTS WITH SUCH 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. 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. THE BAD DEBT EXPENSE RELATED TO CHARITY CARE IS CALCULATED BY TAKING THE SELF-PAY PAY WRITE-OFFS FROM THE BAD DEBT EXPENSE TIMES 30%, WHICH WOULD BE THE LOWEST PERCENTAGE DISCOUNT ON THE ASSISTANCE SLIDING SCALE. PART III, LINE 4: PATIENT ACCOUNTS RECEIVABLE ARE REDUCED BY AN ALLOWANCE FOR AMOUNTS THAT COULD BECOME UNCOLLECTIBLE IN THE FUTURE. PREMIUMS RECEIVABLE ARE CARRIED AT ORIGINAL BILLED AMOUNTS LESS AN ESTIMATE FOR DOUBTFUL RECEIVABLES BASED ON A REVIEW OF ALL OUTSTANDING AMOUNTS ON A MONTHLY BASIS. PREMIUMS RECEIVABLE ARE CONSIDERED PAST DUE TO THE EXTENT THAT THERE IS NO RELATED UNEARNED PREMIUM.ADDITIONS TO THE ALLOWANCE FOR DOUBTFUL ACCOUNTS ARE MADE BY MEANS OF THE PROVISION FOR DOUBTFUL ACCOUNTS. ACCOUNTS WRITTEN OFF AS UNCOLLECTIBLE ARE DEDUCTED FROM THE ALLOWANCE AND SUBSEQUENT RECOVERIES ARE ADDED. THE FOUNDATION HAS DETERMINED, BASED ON AN ASSESSMENT AT THE CONSOLIDATED ENTITY LEVEL, THAT PATIENT SERVICE REVENUE IS PRIMARILY RECORDED PRIOR TO ASSESSING THE PATIENT'S ABILITY TO PAY AND AS SUCH, THE ENTIRE PROVISION FOR DOUBTFUL ACCOUNTS RELATED TO PATIENT REVENUE IS RECORDED AS A DEDUCTION FROM PATIENT SERVICE REVENUE IN THE ACCOMPANYING CONSOLIDATED STATEMENTS OF OPERATIONS. 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:ASH ASSESSES THE COMMUNITY'S HEALTH CARE NEEDS IN A VARIETY OF WAYS. IT STUDIES PROTOCOL VOLUME AND PATIENT SATISFACTION SURVEYS. IT DOCUMENTS MEDICAL CONDITIONS THAT THOUSANDS OF COMMUNITY MEMBERS AND MEDICAL STAFF MEMBERS CAN INQUIRE ABOUT IN THE SHARON LANE HEALTH CENTER HEALTH LIBRARY. IT TRACKS ATTENDANCE AT THE MORE THAN 100 "HEALTH TALK" PRESENTATIONS HELD EACH YEAR TO DETERMINE WHAT TOPICS ARE OF MOST INTEREST TO THE COMMUNITY. BETWEEN 2011 - 2013, AULTMAN COLLABORATED WITH AREA HOSPITALS AND HEALTH CARE FACILITIES TO CONDUCT A COMMUNITY HEALTH SURVEY. THE GOAL WAS TO GAUGE THE HEALTH STATUS AND HEALTH HABITS OF STARK COUNTY RESIDENTS - AND IDENTIFY AREAS WHERE AULTMAN CAN IMPROVE THE HEALTH OF OUR COMMUNITY. FIFTEEN QUESTIONS WERE INCLUDED ON THE POLL OF 1,067 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 OF CONCERN WERE PRESCRIPTION DRUG MISUSE, LARGER NEED FOR MENTAL HEALTH SERVICES, AND GREATER ACCESS TO DENTAL CARE. THE HOSPITAL IS CURRENTLY IN THE 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 INFORMATIONASH 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 635 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 MARKET FOR THE HOSPITAL IS STARK COUNTY. THE OHIO DEPARTMENT OF DEVELOPMENT ESTIMATED THE 2015 POPULATION OF OUR FIVE COUNTY AREAS TO BE OVER 655,864. 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: PROMOTION OF COMMUNITY HEALTH:ASH IS A WHOLLY OWNED SUBSIDIARY OF AULTMAN HEALTH FOUNDATION. AULTMAN HEALTH FOUNDATION SUPPORTS AND PROMOTES THE HEALTH OF ITS COMMUNITY MEMBERS IN A VARIETY OF WAYS. FROM EDUCATIONAL PROGRAMS TO HEALTH SCREENINGS, AULTMAN ACTIVELY PROMOTES HEALTH AND WELLNESS IN THE COMMUNITY. EDUCATIONAL PROGRAMS INCLUDE MORE THAN 100 FREE HEALTH TALK PRESENTATIONS EACH YEAR, FEATURING LOCAL PHYSICIANS AND HEALTH CARE PROFESSIONALS. THE SHARON LANE COMMUNITY CENTER OFFERS A COMPREHENSIVE COLLECTION OF HEALTH CARE AND CONSUMER-HEALTH MATERIALS RANGING FROM BOOKS AND DVDS AVAILABLE FOR LENDING TO ANATOMICAL MODELS. THE CENTER IS OPEN TO PATIENTS AND THEIR FAMILY MEMBERS, STUDENTS, PHYSICIANS AND THE GENERAL PUBLIC. ADDITIONAL HEALTH RESOURCES INCLUDE AN ILLUSTRATED HEALTH ENCYCLOPEDIA, SYMPTOM CHECKER AND WELLNESS TOOLS ON THE AULTMAN WEBSITE.AULTMAN'S WORKING ON WELLNESS (WOW) MOBILE HEALTH-FAIR UNIT DEBUTED IN FEBRUARY 2009. STAFFED BY MEDICAL PROFESSIONALS, THE WOW VAN VISITS SCHOOLS, COMMUNITY CENTERS, CHURCHES, SENIOR CENTERS AND BLOCK PARTIES TO PROVIDE FREE SCREENINGS AND HEALTH EDUCATION. SCREENINGS SUCH AS BLOOD PRESSURE CHECKS, HEIGHT, WEIGHT AND BODY MASS INDEX/PERCENTAGE OF BODY FAT ARE PROVIDED. IN 2015, THE WOW STAFF REACHED MORE THAN 26,000 PEOPLE.IN 2015, THE AULTMAN HEART CENTER TEAM TOOK ITS "MEET THE TEAM WITH MORE HEART" MESSAGE IN THE COMMUNITY BY SHARING EDUCATIONAL MATERIALS ON EVERYTHING FROM SMOKING CESSATION TO HEART-HEALTHY EATING. ADDITIONAL OUTREACH EFFORTS INCLUDED A "WEAR RED" EVENT TO PROMOTE WOMEN'S HEART HEALTH AND VARIOUS CANCER SCREENING EVENTS FOR UNDERSERVED MEMBERS OF THE COMMUNITY. AULTMAN REPRESENTATIVES ALSO ATTENDED HEALTH FAIRS THROUGHOUT THE YEAR, INCLUDING SENIOR CELEBRATION DAY AT THE PRO FOOTBALL HALL OF FAME, THE CANTON FARMERS' MARKET, THE SENIOR EXPO AND HEALTH FAIRS AT LOCAL SCHOOLS. 2015 MARKED THE EIGHTH YEAR AULTMAN HOSTED THE CAREERS IN HEALTH CARE SUMMER PROGRAM FOR HIGH SCHOOL SENIORS AND COLLEGE STUDENTS INTERESTED IN HEALTH CARE CAREERS. SYMPOSIUM PRESENTERS INCLUDED AULTMAN DOCTORS, NURSES, STAFF AND ADMINISTRATORS WHO SHARED INSIGHT ON THE CHALLENGES AND OPPORTUNITIES OF WORKING IN HEALTH CARE. THE EVENT ALSO INCLUDED A HEALTH CARE CAREER FAIR WITH MORE THAN A DOZEN DEPARTMENTS AND SERVICES REPRESENTED. JOB SHADOWING EXPERIENCES WITH DOCTORS, NURSES AND OTHER HEALTH CARE PROFESSIONALS WERE AVAILABLE. AULTMAN'S LEVEL III NEONATAL INTENSIVE CARE UNIT, DESIGNATED BY THE OHIO DEPARTMENT OF HEALTH, IS A TRANSFER HOSPITAL FOR SMALLER FACILITIES IN COUNTIES INCLUDING TUSCARAWAS, HOLMES, COSHOCTON AND COLUMBIANA. AULTMAN PROVIDES SPECIALIZED CARE FOR MOTHERS WITH HIGH-RISK PREGNANCIES AND PREMATURE BABIES, UNDER ONE ROOF. CRITICALLY INJURED PATIENTS WHO NEED SPECIALIZED CARE ARE BROUGHT TO AULTMAN'S LEVEL II TRAUMA CENTER. AULTMAN HOSPITAL HAS THE ONLY LEVEL II TRAUMA CENTER FOR ADULT AND PEDIATRIC PATIENTS IN ITS FIVE-COUNTY SERVICE AREA. THE LEVEL II DESIGNATION FROM THE AMERICAN COLLEGE OF SURGEONS CERTIFIES AULTMAN HAS THE FACILITIES, TECHNOLOGY AND SPECIALLY TRAINED CLINICAL STAFF TO TREAT TRAUMA PATIENTS.IN 2015, AULTMAN HEALTH FOUNDATION CONTRIBUTED TO THE BETTERMENT OF THE STARK COUNTY COMMUNITY WITH THE FOLLOWING ACTIVITIES:SAFETY FIRST AULTMAN'S SAFETY FIRST PROGRAM BRINGS A MESSAGE OF BIKE SAFETY TO ALL STARK COUNTY FIRST-GRADE CLASSES, ALONG WITH SOME LOCATIONS IN WAYNE AND CARROLL COUNTIES. NEARLY 450 AULTMAN EMPLOYEES VOLUNTEERED IN 2015 TO SHARE THE BIKE SAFETY LESSON AND GIVE FREE HELMETS TO APPROXIMATELY 5,000 FIRST-GRADERS.WORKING ON WELLNESS (WOW)THE WOW TEAM VISITED MORE THAN 400 SITES IN 2015, RANGING FROM COMMUNITY EVENTS TO SENIOR CITIZEN CENTERS. WOW NURSES HAD PERSONAL INTERACTION WITH MORE THAN 26,000 COMMUNITY MEMBERS. CANCER OUTREACHCOMMUNITY OUTREACH EFFORTS EXPANDED IN 2015 WITH PARTICIPATION IN 17 HEALTH FAIRS AND COMMUNITY EVENTS. THE TEAM ORGANIZED FREE BREAST SCREENING EVENTS IN CARROLLTON AND MASSILLON THAT REACHED 80 UNDERSERVED WOMEN. THE ANNUAL CANCER SCREENING DAY AT AULTMAN HOSPITAL PROVIDED 80 UNDERINSURED PATIENTS WITH A TOTAL OF 195 FREE SCREENINGS FOR BREAST, CERVICAL, COLON, LUNG, PROSTATE, SKIN AND ORAL CANCERS. THE CANCER PROGRAM BEGAN WORKING ON THE HEALTHY U PROGRAM IN 2015, A PARTNERSHIP WITH LOCAL SCHOOLS TO TEACH STUDENTS AND FAMILIES ABOUT HEALTHY LIFESTYLES THAT REDUCE CANCER RISK.HARVEST FOR HUNGERFOOD INSECURITY IS A CRITICAL ISSUE IN NORTHEASTERN OHIO, AND AULTMAN TEAM MEMBERS GIVE GENEROUSLY TO THE ANNUAL HARVEST FOR HUNGER CAMPAIGN. IN 2015, AULTMAN EMPLOYEES PROVIDED 9,673 POUNDS OF NONPERISHABLE FOOD DONATIONS AND $15,217 IN MONETARY GIFTS THAT HELPED THOUSANDS OF FAMILIES AND INDIVIDUALS IN NEED.CAREERS IN HEALTH CARE SUMMER LEARNING PROGRAMAULTMAN MEDICAL EDUCATION HOSTED THE EIGHTH ANNUAL CAREERS IN HEALTH CARE PROGRAM, DESIGNED FOR STUDENTS 18 AND OLDER WITH INTERESTS IN HEALTH CARE CAREERS. THE PROGRAM INCLUDED PRESENTATIONS FROM DOCTORS, NURSES AND HOSPITAL ADMINISTRATORS, PROVIDING A GLIMPSE AT HOW A HOSPITAL RUNS. THE SYMPOSIUM ALSO FEATURED A CAREER FAIR THAT ENABLE THE STUDENTS TO TALK WITH EMPLOYEES FROM MORE THAN A DOZEN AULTMAN DEPARTMENTS. SUMMER JOB SHADOWING EXPERIENCES WERE ALSO AVAILABLE FOR SYMPOSIUM PARTICIPANTS. NATIONAL WALKING DAY FOR NATIONAL WALKING DAY IN APRIL, AULTMAN ENCOURAGED THE COMMUNITY TO "GET OUT AND MOVING." THE EVENT STARTED WITH AN EMPLOYEE WALK AROUND THE MAIN AULTMAN HOSPITAL CAMPUS. WALKERS THROUGHOUT THE COMMUNITY COULD PARTICIPATE IN AULTMAN'S SOCIAL MEDIA PHOTO CONTEST TO WIN AN IPAD MINI AND OTHER PRIZES. THE FESTIVITIES CONCLUDED WITH A COMMUNITY WALK HELD IN CONJUNCTION WITH STARK PARKS THAT INCLUDED FREE HEALTH SCREENINGS, GIVEAWAYS, PHOTO OPPORTUNITIES WITH LOCAL MASCOTS AND VENDOR DISCOUNTS.BREAST OASISFOR WOMEN WHO CANNOT AFFORD BASIC CLOTHING ITEMS SUCH AS BRAS, EACH DAY PRESENTS EMOTIONAL AND UNCOMFORTABLE SITUATIONS. IN 2015, AULTMAN TEAM MEMBERS HELPED LOCAL WOMEN IN NEED BY DONATING 2,018 NEW AND GENTLY USED BRAS - ALONG WITH $220 IN CASH AND GIFT CARDS.WALKING TO RAISE FUNDS AND IMPROVE THE COMMUNITY'S HEALTHAULTMAN HEALTH FOUNDATION TEAM MEMBERS AND THEIR LOVED ONES SUPPORT ANNUAL FUNDRAISING WALKS FOR ORGANIZATIONS INCLUDING THE MARCH OF DIMES AND JUVENILE DIABETES RESEARCH FOUNDATION. AULTMAN NOT ONLY PARTICIPATES IN THE AMERICAN CANCER SOCIETY'S RELAY FOR LIFE AND MAKING STRIDES AGAINST BREAST CANCER WALK - ALONG WITH THE AMERICAN HEART ASSOCIATION'S HEART WALK - BUT CLINICIANS ARE ON HAND TO PROVIDE EDUCATIONAL INFORMATION ABOUT REDUCING RISKS OF CANCER AND HEART DISEASE. UNITED WAYEVERY YEAR, AULTMAN ORGANIZES A FUNDRAISING CAMPAIGN TO BENEFIT UNITED WAY. IN 2015, AULTMAN EMPLOYEES AND PHYSICIANS GENEROUSLY DONATED $477,272 TO FUND PROGRAMS TO BENEFIT COMMUNITY MEMBERS OF ALL AGES AND FROM ALL WALKS OF LIFE.AULTMAN AMBASSADOR PROGRAM THE AULTMAN AMBASSADOR PROGRAM ARMS LOCAL HIGH SCHOOL STUDENTS WITH THE INFORMATION AND CONFIDENCE THEY NEED TO PROMOTE HEALTHY HABITS IN THEIR SCHOOLS SUCH AS ENCOURAGING CLASSMATES TO DRINK WATER INSTEAD OF SODA AND SUGARY DRINKS. THE PROGRAM IS A COLLABORATIVE EFFORT AMONG AULTMAN HEALTH FOUNDATION, AULTMAN COLLEGE, MALONE UNIVERSITY, LOUISVILLE HIGH SCHOOL AND CANTON SOUTH HIGH SCHOOL. LOUISVILLE HAS PARTICIPATED IN THE PROGRAM FOR FIVE YEARS, WHILE CANTON SOUTH HAS BEEN ON BOARD FOR THREE YEARS. A TOTAL OF 15 STUDENT AMBASSADORS PARTICIPATED IN THE PROGRAM FOR THE 2015-16 SCHOOL YEAR.SENIOR CELEBRATION DAYTHE 2015 SENIOR CELEBRATION DAY AT THE PRO FOOTBALL HALL OF FAME DREW MORE THAN 1,300 ATTENDEES WHO ENJOYED A DAY OF HEALTH INFORMATION AND DEMONSTRATIONS, GIVEAWAYS AND REFRESHMENTS, AND FREE ADMISSION TO THE HALL. A TOTAL OF 20 AULTMAN DEPARTMENTS PARTICIPATED, INCLUDING DIABETES EDUCATION, THERAPY SERVICES, PAIN MANAGEMENT AND HOME CARE.ADDITIONAL COMMUNITY BENEFITIN 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. IN 2014, AULTMAN PROVIDED SERVICES TO MEDICAID PATIENTS RESULTING IN MORE THAN $2.8 MILLION IN UNREIMBURSED COST.THROUGH ITS RESIDENT TEACHING PROGRAMS, AULTMAN DELIVERS A SIGNIFICANT LEVEL OF QUALITY OUTPATIENT AND INPATIENT HEALTH CARE TO INSURED, UNDERINSURED AND UNINSURED INDIVIDUALS IN OUR MARKET. FOR MEMBERS OF THE AMISH COMMUNITY, AULTMAN OFFERS FREE TRANSPORTATION TO AND FROM DOCTORS' APPOINTMENTS AND AULTMAN HOSPITAL. AN AMISH HOUSE IS ALSO LOCATED ADJACENT TO THE AULTMAN CAMPUS, GIVING VISITORS A FREE PLACE TO STAY WHEN LOVED ONES ARE HOSPITALIZED. PART VI, LINE 6: AULTMAN'S BOARD OF DIRECTORS HAS 37 NON-EMPLOYED MEMBERS. A TOTAL OF 41 OF THE 43 VOTING BOARD MEMBERS RESIDE IN THE CORE MARKET 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 SUPPORT AMERICAN HEART ASSOCIATION 4916 HILLS DALES RD NW CANTON OH 44708 135613797 501(C)(3) 31500 SUPPORT ARTS IN STARK 1001 MARKET AVE N CANTON OH 44702 346609771 501(C)(3) 130000 SUPPORT CANTON REGIONAL CHAMBER OF COMMERCE 222 MARKET AVE N CANTON OH 44702 340129930 501(C)(6) 67149 SUPPORT DEPT OF SURGERY SCHOOL OF MEDICINE PO BOX 365067 SAN JUAN RQ 936 660433762 27481 SUPPORT JACKSON-BELDEN CHAMBER OF COMMERCE 5735 WALES AVE NW MASSILLON OH 44646 341384716 501(C)(6) 5650 SUPPORT TEAM NEO FOUNDATION 737 BOLIVAR RD CLEVELAND OH 44115 341885407 501(C)(3) 20000 SUPPORT THE AULTMAN FOUNDATION 2600 SIXTH ST SW CANTON OH 44710 208090459 501(C)(3) 125000 SUPPORT UNITED WAY GREATR STARK COUNTY 4825 HIGBEE AVE NW STE 101 CANTON OH 44718 134254191 501(C)(3) 274007 SUPPORT 7 2 PART I, LINE 2: AULTMAN HEALTH FOUNDATION RECEIVES MYRAID REQUESTS FOR SUPPORT FROM COMMUNITY ORGANIZATIONS EACH YEAR. A MULTIDISCIPLINARY COMMITTEE MEETS REGUARLY TO REVIEW SPONSORSHIP REQUESTS. AULTMAN HEALTH FOUNDATION PARTNERS WITH LOCAL NONPROFIT ORGANIZATIONS TO SUPPORT PROJECTS THAT PROMOTE WELLNESS, HEALTH EDUCATION AND HUMAN SERVICES IN OUR COMMUNITY. SINCE 2007, MORE THAN 150 DIFFERENT AGENCIES HAVE RECEIVED GRANT FUNDING FROM AULTMAN HEALTH FOUNDATION IN EXCESS OF $1.65 MILLION. X 1 1 X X X X X 0 1 0 0 0 0 0 0 0 EDWARD J ROTH III PRESIDENT/CEO-AHF 588234 0 2100 0 25677 0 7950 0 15486 0 639447 0 0 0 CHRISTOPHER E REMARK TREASURER/CEO-AH 0 383604 0 2100 0 19190 0 7950 0 16151 0 428995 0 0 RICK L HAINES DIRECTOR/CEO-AULTCARE 0 408144 0 100 0 22643 0 7950 0 9565 0 448402 0 0 MILAN R DOPIRAK MD DIRECTOR 0 311038 0 88958 0 26830 0 7950 0 9175 0 443951 0 0 MICHAEL RICH MD DIRECTOR 0 237066 0 133330 0 1096 0 7950 0 15357 0 394799 0 0 MARK D WRIGHT CFO-AHF 337840 0 2100 0 18812 0 7950 0 15725 0 382427 0 0 0 ROBERT C MOLNAR VP - PHYSICIAN SERVICES 184412 0 2100 0 18395 0 5706 0 15145 0 225758 0 0 0 MARK N ROSE VP-LEGAL SERVICES 252728 0 1100 0 20368 0 7860 0 16151 0 298207 0 0 0 ELIZABETH A GETZ CHIEF INFORMATION OFFICER 235346 0 2100 0 18917 0 7236 0 15170 0 278769 0 0 0 SUSAN E OLIVERA VP-HUMAN RESOURCES 217715 0 1100 0 18871 0 6760 0 15486 0 259932 0 0 0 RONALD RUSNAK DIRECTOR OF CLINICAL INFORMATICS 319731 0 100 0 1454 0 7950 0 12093 0 341328 0 0 0 TIMOTHY TEYNOR VP - PUBLIC POLICY 196735 0 1100 0 21879 0 6155 0 15361 0 241230 0 0 0 EILEEN GOOD SENIOR VP - CLINICAL ADVOCACY 188460 0 1100 0 25496 0 5697 0 429 0 221182 0 0 0 KEVIN D PETE SENIOR VP - IHN 225681 0 1100 0 19050 0 6901 0 15486 0 268218 0 0 0 JASON A JUSTUS ASSOC VP - POMERENE FINANCE 163306 0 32990 0 18581 0 5940 0 14715 0 235532 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 EDWARD J. ROTH III, CHRISTOPHER E. REMARK, RICK L. HAINES, EILEEN F. GOOD, MARK N. ROSE, AND MARK D. WRIGHT ARE PARTICIPANTS IN THE ORGANIZATION'S 457(B) PLAN. THERE WERE NO PAYOUTS IN 2015. AHF CONTRIBUTED $18,000 FOR EACH PERSON. 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 2 JOHN SIRPILLA AND THEODORE BOYD HAVE A BUSINESS RELATIONSHIP. R CLINT ZOLLINGER ESQ AND SHEILA MARKLEY BLACK ESQ HAVE A BUSINESS RELATIONSHIP. BRIAN BELDEN AND WILLIAM BELDEN HAVE A FAMILY RELATIONSHIP. GEOFF KARCHER AND BRYAN RICE HAVE A BUSINESS RELATIONSHIP. JOSEPH R. HALTER, JR. AND GEOFF KARCHER HAVE A BUSINESS RELATIONSHIP. GENE LITTLE AND HARRY C.C. MACNEALY HAVE A BUSINESS RELATIONSHIP. EDWARD J. ROTH III AND HARRY C.C. MACNEALY HAVE A BUSINESS RELATIONSHIP. FORM 990, PART VI, SECTION B, LINE 11 A DETAIL REVIEW OF THE FORM 990 IS PERFORMED BY AN INDEPENDENT CPA FIRM. AULTMAN HEALTH FOUNDATION'S FINANCE DEPARTMENT CAREFULLY REVIEWS AND ANALYZES THE TAX RETURN. THE DEPARTMENT RECONCILES THE GENERAL LEDGER AMOUNTS TO THE APPROPRIATE SCHEDULES ON THE FORM 990 AND COMPARES THOSE AMOUNTS TO THE AUDITED FINANCIAL STATEMENTS. IN ADDITION, THE FINANCE DEPARTMENT DOES A COMPARATIVE ANALYSIS TO THE PRIOR YEAR RETURN. THE ANALYSIS AND RECONCILIATION SCHEDULES ALONG WITH A COMPLETE COPY OF THE 990 ARE PROVIDED TO THE CHIEF FINANCIAL OFFICER FOR REVIEW AND APPROVAL. A COMPLETE COPY OF THE 990 IS 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 USES 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 CODER 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 CODER & 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 CODER 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, CHRISTOPHER E. REMARK, RICK L. HAINES, MILAN R. DOPIRAK, M.D. AND MICHAEL RICH, M.D. ARE PAID EMPLOYEES OF AHF OR A RELATED ORGANIZATION. TIMOTHY O' TOOLE PERFORMS MEDICAL DIRECTORSHIP DUTIES FOR THE ORGANIZATION AND RECEIVES COMPENSATION. FORM 990, PART IX, LINE 11G CONSULTING FEES: PROGRAM SERVICE EXPENSES 2,073,821. MANAGEMENT AND GENERAL EXPENSES 486,452. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,560,273. LTACH PATIENT SERVICES: PROGRAM SERVICE EXPENSES 1,290,362. MANAGEMENT AND GENERAL EXPENSES 302,677. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,593,039. OTHER CONTRACTED SERVICES: PROGRAM SERVICE EXPENSES 1,079,583. MANAGEMENT AND GENERAL EXPENSES 253,235. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,332,818. PROFESSIONAL FEES - NONPHYSICIAN: PROGRAM SERVICE EXPENSES 46,968. MANAGEMENT AND GENERAL EXPENSES 11,017. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 57,985. PROFESSIONAL FEES - PHYSICIAN: PROGRAM SERVICE EXPENSES 249,528. MANAGEMENT AND GENERAL EXPENSES 58,531. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 308,059. PURCHASED MAINTENANCE: PROGRAM SERVICE EXPENSES 1,533,400. MANAGEMENT AND GENERAL EXPENSES 359,687. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,893,087. FORM 990, PART XI, LINE 9: INTERFUND TRANSFERS -11,973,974. INTEREST RATE SWAP -20,362. 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, 2015 AULTMAN HEALTH FOUNDATION IS MAKING THE DE MINIMIS SAFE HARBOR ELECTION UNDER REG. SEC. 1.263(A)-1(F). AULTMAN SPECIALTY HOSPITAL 2600 SIXTH ST SW CANTON OH 44710 134246188 LONG-TERM ACUTE CARE OH 7655691 3508773 AULTMAN HEALTH FOUNDATION INTEGRATED HEALTH COLLABORATIVE LLC 2600 SIXTH ST SW CANTON OH 44710 454325320 HEALTH COLLABORATIVE OH 306190 56410 AULTMAN HEALTH FOUNDATION AULTMAN HOSPITAL 2600 SIXTH ST SW CANTON OH 44710 340714538 HOSPITAL OH 501(C)(3) LINE 3 AULTMAN HEALTH FOUNDATION 1 THE AULTMAN FOUNDATION 2600 SIXTH ST SW CANTON OH 44710 208090459 FUNDRAISING OH 501(C)(3) LINE 7 AULTMAN HEALTH FOUNDATION 1 ORRVILLE HOSPITAL FOUNDATION 832 S MAIN ST ORRVILLE OH 44667 340733138 HOSPITAL OH 501(C)(3) LINE 3 AULTMAN HEALTH FOUNDATION 1 AULTMAN COLLEGE OF NURSING AND HEALTH 2600 SIXTH ST SW CANTON OH 44710 201359433 COLLEGE OH 501(C)(3) LINE 2 AULTMAN HOSPITAL 1 AULTMAN NORTH CANTON MEDICAL GROUP 2600 SIXTH ST SW CANTON OH 44710 341088530 HEALTHCARE OH 501(C)(3) LINE 9 AULTMAN HEALTH FOUNDATION 1 TUSCARAWAS VALLEY REGIONAL CANCER CENTER 300 MEDICAL PARK DRIVE DOVER OH 44622 311689698 MEDICAL SERVICE OH 501(C)(3) LINE 3 N/A 0 WEST TUSCARAWAS PROPERTY MANAGEMENT LLC 2600 SIXTH ST SW CANTON OH 44710 200090246 PROPERTY MGMT OH AULTCARE INSURANCE COMPANY EXCLUDED -316525 10729242 0 0 1.00000 AULTMAN ONCOLOGY CENTER OF EXCELLENCE LLC 2600 SIXTH ST SW CANTON OH 44710 454215510 HEALTHCARE OH AULTMAN HOSPITAL RELATED 93952 46084 0 0 0.72900 MCKINLEY ASSURANCE SPC PO BOX 1051 GEORGE TOWN GRAND CAYMANS CJ 980468384 PORTFOLIO CJ AULTMAN HEALTH FOUNDATION C 5079863 17191426 1.00000 1 AULTCARE CORPORATION 2600 SIXTH ST SW CANTON OH 44710 341488123 PREF. PROVIDER ORG. OH AULTMAN HEALTH FOUNDATION C 5631668 6111119 0.50000 1 AULTCARE HOLDING COMPANY 2600 SIXTH ST SW CANTON OH 44710 471165287 HOLDING COMPANY OH AULTMAN HEALTH FOUNDATION C 1.00000 1 NORTH CENTRAL MEDICAL RESOURCES INC 2600 SIXTH ST SW CANTON OH 44710 341610344 MEDICAL EQUIPMENT RENTAL OH AULTCARE HOLDING COMPANY C 3699952 161341053 1.00000 1 OHIO SPECIALTY PHYSICIANS CORPORATION 2600 SIXTH ST SW CANTON OH 44710 341853300 HEALTH SERVICES OH AULTCARE HOLDING COMPANY C 3245995 447926 1.00000 1 OHIO HOSPITAL BASED PHYSICIANS CORP 2600 SIXTH ST SW CANTON OH 44710 341871647 HEALTH SERVICES OH AULTCARE HOLDING COMPANY C 10681965 1115950 1.00000 1 OHIO PHYSICIANS PROFESSIONAL CORP 2600 SIXTH ST SW CANTON OH 44710 311509897 HEALTH SERVICES OH AULTCARE HOLDING COMPANY C 18354381 2417822 1.00000 1 AULTMAN MSO 2600 SIXTH ST SW CANTON OH 44710 311509904 ADMIN SERVICES OH AULTCARE HOLDING COMPANY C 7154703 1435310 1.00000 1 AULTCARE HEALTH INSURING CORPORATION 2600 SIXTH ST SW CANTON OH 44710 463305099 INSURANCE OH AULTCARE HOLDING COMPANY C 227508743 76169293 1.00000 1 AULTCARE INSURANCE COMPANY 2600 SIXTH ST SW CANTON OH 44710 341624818 INSURANCE OH AULTCARE HOLDING COMPANY C 252583371 79034952 1.00000 1 AULTRA ADMINISTRATIVE GROUP 2600 SIXTH ST SW CANTON OH 44710 204951704 ADMIN SERVICE OH AULTCARE HOLDING COMPANY C 2460773 66915 1.00000 1 AULTCOMP MCO INC 2600 SIXTH ST SW CANTON OH 44710 274379962 HEALTH SERVICES OH AULTCARE HOLDING COMPANY C 3094918 89051 1.00000 1 WAYNE HEALTH SERVICES & SUPPLIES 2600 SIXTH ST SW CANTON OH 44710 341501390 MEDICAL SUPPLIES OH AULTCARE HOLDING COMPANY C 1825823 2567688 1.00000 1 AULTMAN MEDICAL GROUP 2600 SIXTH ST SW CANTON OH 44710 453166014 HEALTH SERVICES OH AULTCARE HOLDING COMPANY C 13219149 2942337 1.00000 1 MAINSIGHT ASO LLC 2600 SIXTH ST SW CANTON OH 44710 473587655 HEALTH SERVICES OH AULTCARE HOLDING COMPANY C 1.00000 1 0 1 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 0 THE AULTMAN FOUNDATION B 125000 FMV AULTMAN HOSPITAL K 312342 FMV AULTMAN HOSPITAL P 1629541 FMV AULTCARE INSURANCE COMPANY Q 1195998 FMV AULTMAN HOSPITAL Q 32522364 FMV AULTMAN ORRVILLE HOSPITAL Q 223452 FMV AULTMAN HOSPITAL R 750000 FMV