2025-11-10T10:16:43-06:00 2024-12-31 410746749 CLIFTONLARSONALLEN LLP 4334 MUNSON STREET SUITE 200 CANTON OH 44718 990 2024-01-01 340726081 ASHTABULA COUNTY MEDICAL CENTER ASHT 4409972262 2420 LAKE AVENUE ASHTABULA OH 44004 LEONARD STEPP PRESIDENT & CEO 4409972262 2025-11-07 1 1 JENNIFER COLEMAN P00743188 3304972000 2025-11-07 2024 2025-03-06 01:10:19Z ASHTABULA REGIONAL MEDICAL CENTER LEONARD STEPP 2420 LAKE AVENUE ASHTABULA OH 44004 268217780 0 6026 X WWW.ARMCHEALTH.ORG X 1902 OH FULL-SERVICE ACUTE CARE HOSPITAL. 20 18 1146 18 214469 0 135790 3828575 177874277 176250170 6082350 7874793 751380 786063 184843797 188739601 0 0 0 0 83147240 87402874 0 0 0 90617700 100565755 173764940 187968629 11078857 770972 294705342 305203035 137533461 141314477 157171881 163888558 ASHTABULA COUNTY MEDICAL CENTER PROVIDES QUALITY HEALTHCARE TO POSITIVELY IMPACT THE HEALTH OF OUR COMMUNITY. 0 0 136773685 0 176250170 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 2024 WE MET OUR MISSION OF MEETING OUR COMMUNITY'S HEALTH CARE NEEDS AS EVIDENCED BY APPROXIMATELY 28,477 EMERGENCY DEPARTMENT VISITS, 4,958 INPATIENT DISCHARGES, 8,200 SURGICAL PROCEDURES (INCLUDING ENDOSCOPY), 0 BIRTHS, 77,296 RADIOLOGY PROCEDURES, AND 232,970 OUTPATIENT PROVIDER ENCOUNTERS. 136773685 1 1 0 0 0 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 1 1 0 0 0 0 0 0 0 1 0 0 0 0 0 0 1 1 1 0 0 1 121 0 1 1146 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 20 18 0 1 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 OH X LEONARD STEPP PRESIDENT & CEO 4409972262 2420 LAKE AVENUE ASHTABULA OH 44004 X DANIEL B KEATON MD CHIEF OF STAFF (END 12/31/24) 60.00 0.30 X 319175 0 32651 DAVID NOVAK MD VICE-CHIEF OF STAFF (END 12/31/24) 60.00 0.30 X 746739 0 82662 LEONARD STEPP JR PRESIDENT/CEO 40.00 0.60 X X 0 0 0 NANCY KISTER CHAIRPERSON 0.30 0.30 X X 0 0 0 CRAIG SERNIK VICE CHAIRPERSON 0.30 0.30 X X 0 0 0 ROGER CORLETT SECRETARY/TREASURER 0.30 0.30 X X 0 0 0 PEGGY CARLO BOARD MEMBER 0.30 0.30 X 0 0 0 DONALD CHAPLIN BOARD MEMBER 0.30 0.30 X 0 0 0 JOSEPH GIANGOLA BOARD MEMBER 0.30 0.30 X 0 0 0 KELLY HANCOCK BOARD MEMBER/CCF REPRESENTATIVE 0.30 0.30 X 0 0 0 JASON HERGENROEDER BOARD MEMBER/CCF REPRESENTATIVE 0.30 0.30 X 0 0 0 REV VERNON PALO BOARD MEMBER 0.30 0.30 X 0 0 0 RICHARD PARKER MD BOARD MEMBER/CCF REPRESENTATIVE 0.30 0.30 X 0 0 0 DAVID PONTIUS BOARD MEMBER 0.30 0.30 X 0 0 0 MARLENE SARTINI BOARD MEMBER 0.30 0.30 X 0 0 0 JAMES TIMONERE BOARD MEMBER 0.30 0.30 X 0 0 0 AMANDA CLARK CNO 40.00 0.60 X 0 0 0 ALANNA DAMES VP FINANCE/CFO 40.00 0.60 X 0 0 0 SHINOJ PATTALI MD PHYSICIAN 60.00 0.00 X 1338134 0 47506 ALEXANDER TAICH PHYSICIAN 60.00 0.00 X 1289264 0 57477 THEODORE G ECKMAN PHYSICIAN 60.00 0.00 X 745527 0 23169 DAVID WEINERMAN PHYSICIAN 60.00 0.00 X 686604 0 57338 NATHANIEL S FRANLEY MD PHYSICIAN 60.00 0.00 X 694556 0 35928 5819999 0 336731 111 0 1 0 INDEPENDENCE CONSTRUCTION LLC 6400 E SCHAAF ROAD INDEPENDENCE OH 44131 CONSTRUCTION 31906906 AMERISOURCEBERGEN 25199 NETWORK PLACE CHICAGO IL 60673 MEDICAL SERVICES 25104370 CLEVELAND CLINIC FOUNDATION PO BOX 931760 CLEVELAND OH 44193 ADMINISTRATIVE AND CLINICAL SERVICES 20680673 RXBENEFITS 3700 COLONNADE PKWY 600 BIRMINGHAM IL 35243 MEDICAL SERVICES 4611978 ANESTHESIA CONSULTANTS 2420 LAKE AVE ASHTABULA OH 44004 MEDICAL SERVICES 3873551 149 3758454 70121 3828575 NET PATIENT SERVICE REVENUE 624100 165754471 165754471 MISC OPERATING REVENUE 624100 9578733 9578733 REBATES AND REFUNDS 624100 916966 916966 176250170 4477866 4477866 571594 0 571594 571594 571594 82857756 17350 79478179 0 3379577 17350 3396927 3396927 PREMIERE FITNESS 713940 214469 214469 214469 188739601 176250170 214469 8446387 X 1616650 1616650 67219125 52903075 14316050 2102248 2102248 11984470 11999702 -15232 4480381 4480381 735 735 190254 190254 192354 192354 59708 59708 26892816 19950130 6942686 359453 6982 352471 222533 155804 66729 2162462 38834 2123628 49083 25785 23298 1717167 1717167 6789221 5217791 1571430 1040702 200028 840674 SUPPLIES 39000486 38050774 949712 BAD DEBT EXPENSE 10306822 146884 10159938 EQUIPMENT REPAIRS AND M 5688224 2501668 3186556 LICENSES AND PERMITS 4315366 143236 4172130 1578369 952611 625758 187968629 136773685 51194944 0 10574324 5171176 23809828 0 19696510 30476438 2234338 2472263 5471384 3808834 258148812 91200335 100903782 166948477 113093318 86273482 4826479 4800268 14095379 5252097 294705342 305203035 23520171 31195121 19 0 72699371 71447805 41313900 38671551 137533461 141314477 X 157157579 163874256 14302 14302 157171881 163888558 294705342 305203035 X 770972 -660232 6605937 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1 12125 12125 0 PART II-B, LINE 1: TOTAL DUES OF $49,576 WERE PAID TO THE OHIO HOSPITAL ASSOCIATION BY ACMC, OF WHICH 5.5% WERE RELATED TO LOBBYING ACTIVITIES. TOTAL DUES OF $34,436 WERE PAID TO THE AMERICAN HOSPITAL ASSOCIATION BY ACMC, OF WHICH 27.29% WERE RELATED TO LOBBYING ACTIVITIES. 2905338 2905338 143326531 32910385 110416146 4683927 3803481 880446 100838243 54486469 46351774 6394773 6394773 166948477 DEFERRED COMPENSATION 4703580 INVESTMENT FROM CLEVELAND CLINIC FOUNDATION 15000000 THIRD-PARTY PAYABLES 3467351 SELF-INSURANCE 12991205 DISTRIBUTION PAYABLE TO CLEVELAND CLINIC 757500 CAPITAL LEASES 1751915 38671551 X PART X, LINE 2: ASHTABULA COUNTY MEDICAL CENTER IS A NONPROFIT CORPORATIONS AND IS RECOGNIZED AS TAX-EXEMPT PURSUANT TO SECTION 501 (C)(3) OF THE INTERNAL REVENUE CODE. 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 (FASS) ACCOUNTING STANDARDS CODIFICATION, THE BENEFIT OF A TAX POSITION IS RECOGNIZED IN THE CONSOLIDATED 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. 1 1 X 1 X 0 1 1 0 0 533526 533526 0.00280 25409698 18607301 6802397 0.03620 245223 930862 0 0.00000 26188447 19538163 7335923 0.03900 15389966 15389966 0.08190 31035 31035 0.00020 103880 103880 0.00060 15524881 15524881 0.08270 41713328 19538163 22860804 0.12170 1 10306822 0 24816214 25224687 -408473 X 1 1 1 1 ASHTABULA COUNTY MEDICAL CENTER 2420 LAKE AVENUE ASTHABULA OH 44004 WWW.ARMCHEALTH.ORG 360125 X X X ASHTABULA COUNTY MEDICAL CENTER 1 0 0 1 X X X X X X X X X 22 1 0 0 1 X WWW.ARMCHEALTH.ORG/ABOUT-US/COMMUNITY-HEALTH-NEEDS-ASSESSMENT/ X 1 23 1 WWW.ARMCHEALTH.ORG/ABOUT-US/COMMUNITY-HEALTH-NEEDS-ASSESSMENT/ 0 1 X 200.000000000000 X X 1 1 X X X X 1 X WWW.ARMCHEALTH.ORG/PATIENTS-VISITORS/FINANCIAL-SERVICES/ X WWW.ARMCHEALTH.ORG/PATIENTS-VISITORS/FINANCIAL-SERVICES/ X WWW.ARMCHEALTH.ORG/PATIENTS-VISITORS/FINANCIAL-SERVICES/ X X X X X 1 X 0 X X X X X 1 X 0 1 ASHTABULA COUNTY MEDICAL CENTER PART V, SECTION B, LINE 5: ASHTABULA COUNTY MEDICAL CENTER (ACMC), IN COLLABORATION WITH HEALTHY ASHTABULA COUNTY, CONDUCTED A COMPREHENSIVE COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) IN 2022 TO IDENTIFY SIGNIFICANT HEALTH NEEDS IN THE COMMUNITY SERVED BY THE HOSPITAL. HEALTHY ASHTABULA COUNTY ENGAGED AN EXTERNAL CONSULTANT, ILLUMINOLOGY, TO GUIDE THE DEVELOPMENT OF THE CHNA. INDIVIDUALS FROM HEALTHY ASHTABULA COUNTY MET ON OCTOBER 21, 2021 TO BEGIN THE PROCESS OF DEVELOPING THE CHNA. DURING THAT MEETING, PARTICIPANTS WERE ASSIGNED TO ONE OF FIVE SMALL GROUPS. DISCUSSION IN EACH SMALL GROUP FOCUSED ON: - IDENTIFYING WHAT A HEALTHY COUNTY LOOKS LIKE- IDENTIFYING THE BARRIERS TO REACHING THAT HEALTHY IDEAL- IDENTIFYING THE MOST IMPORTANT ISSUES THAT SHOULD BE CONSIDERED FOR THE 2022 CHNAFOLLOWING THE SMALL GROUP DISCUSSIONS, THE FULL GROUP RECONVENED AND REACHED CONSENSUS ON ASHTABULA COUNTY'S PRIORITY HEALTH NEEDS. THE ASSESSMENT WAS CONDUCTED TO COMPLY WITH REQUIREMENTS SET FORTH IN THE AFFORDABLE CARE ACT, IN ACCORDANCE WITH THE TIMELINE ESTABLISHED BY IRS REGULATIONS, AND TO COMPLEMENT OHIO'S STATE HEALTH ASSESSMENT. THE CHNA INCLUDES BOTH PRIMARY AND SECONDARY DATA THAT WAS COLLECTED AND ANALYZED TO FORMULATE KEY FINDINGS. PRIMARY DATA INCLUDED SURVEYS OF ASHTABULA COUNTY ADULTS AND YOUTH, AS WELL AS FEEDBACK FROM KEY STAKEHOLDER INTERVIEWS. SECONDARY DATA WAS COLLECTED FROM VARIOUS STATE AND FEDERAL SOURCES. THE GOAL OF THE CHNA IS TO ENHANCE THE HOSPITAL'S COMMITMENT TO THE HEALTH AND WELL-BEING OF THE COMMUNITY IT SERVES. ASHTABULA COUNTY MEDICAL CENTER WILL USE THE FINDINGS FROM THE ASSESSMENT TO GUIDE ITS COMMUNITY BENEFIT INITIATIVES, PRIORITIZE RESOURCES, AND DEVELOP COLLABORATIONS TO IMPROVE THE HEALTH OF ASHTABULA COUNTY. THE CHNA WILL BE USED TO DEVELOP AND IMPLEMENT STRATEGIES TO ADDRESS, IN COLLABORATION WITH HEALTHY ASHTABULA COUNTY, THE SIGNIFICANT HEALTH NEEDS OF ASHTABULA COUNTY. ASHTABULA COUNTY MEDICAL CENTER PART V, SECTION B, LINE 11: ASHTABULA COUNTY MEDICAL CENTER PROVIDES NUMEROUS SERVICES AND PROGRAMS IN AN EFFORT TO ADDRESS THE HEALTH NEEDS OF ITS COMMUNITY. STRATEGIES AND INITIATIVES WITHIN THIS IMPLEMENTATION STRATEGY ARE INCLUDED ACCORDING TO THE PRIORITIZED LIST IDENTIFIED IN THE 2022 COMMUNITY HEALTH NEEDS ASSESSMENT AND IN COLLABORATION WITH HEALTHY ASHTABULA COUNTY IN DEVELOPING THE COMMUNITY HEALTH IMPROVEMENT PLAN.ADULT DEPRESSION/ANXIETY PREVENTION AND TREATMENTDURING THE MONTHS BETWEEN THE PUBLICATION OF THE COMMUNITY HEALTH NEEDS ASSESSMENT AND THE COMPLETION OF THE IMPLEMENTATION STRATEGY (COMMUNITY HEALTH IMPROVEMENT PLAN), MEMBERS OF HEALTHY ASHTABULA COUNTY DETERMINED THAT CONCENTRATING ONLY ON THE ADULT POPULATION WOULD NOT BE IN THE BEST SERVICE TO THE COMMUNITY. IT WAS AGREED TO BROADEN THE STRATEGY TO INCLUDE ALL AGES THE REVISED STRATEGY IS: PREVENT AND PROMOTE TREATMENT OF DEPRESSION AND ANXIETY ACROSS THE LIFESPANHEALTHY ASHTABULA COUNTY OBJECTIVES:-BY 2026, IMPLEMENT AN ANTI-STIGMA MENTAL HEALTH AWARENESS, INFORMATIONAL AND EDUCATIONAL CAMPAIGN.-BY 2026, RAISE AWARENESS AMONG HEALTH AND SOCIAL SERVICE PROVIDERS ABOUT MENTAL HEALTH TO FOCUS ON MEETING THE NEEDS OF THE WHOLE PERSON BY IMPLEMENTING AT LEAST FOUR STRATEGIES. -BY 2026, ENHANCE LINKAGE TO TREATMENT FOR ENGAGEMENT AND RETENTION FROM HOSPITALS TO TREATMENT PROVIDERS. IN ADDITION TO THE INITIATIVES IDENTIFIED THROUGH HEALTHY ASHTABULA COUNTY, ASHTABULA COUNTY MEDICAL CENTER WILL PURSUE SEVERAL INITIATIVES THAT ARE SPECIFIC TO THE HOSPITAL.ACMC-SPECIFIC INITIATIVES:-CONTINUE TO COLLABORATE WITH COMMUNITY COUNSELING CENTER AND THE ASHTABULA COUNTY MENTAL HEALTH RECOVERY SERVICES BOARD TO PROVIDE A HEALTHCARE ACCESS NAVIGATOR TO CONNECT PATIENTS OF ACMC PRIMARY CARE PROVIDERS WITH BEHAVIORAL HEALTH AND/OR SUBSTANCE USE DISORDER RECOURSES IN THE COMMUNITY.-CONTINUE TO OFFER INPATIENT AND OUTPATIENT BEHAVIORAL HEALTH SERVICES.ACCESS TO CAREHEALTHY ASHTABULA COUNTY OBJECTIVES:-BY 2026, CONDUCT ONE COLLABORATIVE ASSESSMENT OF ACCESS TO HEALTHCARE.-BY 2026, INCREASE THE PERCENT OF ASHTABULA COUNTY RESIDENTS WHO HAVE HEALTH INSURANCE BY 2% (TARGET RESIDENTS AGE 18-65).-BY 2026, IMPLEMENT AT LEAST TWO MULTI-SECTOR STRATEGIES TO EXPAND ACCESS AND COORDINATION OF COMMUNITY SERVICES AVAILABLE TO SUPPORT THE NEEDS OF THE 'WHOLE PERSON' (TO INCLUDE PHYSICAL, MENTAL, SOCIAL, AND BEHAVIORAL CARE OR SUPPORT).-BY 2026, INCREASE UTILIZATION OF TELEHEALTH SERVICES BY 15% TO PROMOTE PREVENTATIVE CARE.IN ADDITION TO THE INITIATIVES IDENTIFIED THROUGH HEALTHY ASHTABULA COUNTY, ASHTABULA COUNTY MEDICAL CENTER WILL PURSUE SEVERAL INITIATIVES THAT ARE SPECIFIC TO THE HOSPITAL. ACMC-SPECIFIC INITIATIVES:-CONTINUE TO PROVIDE FINANCIAL COUNSELORS TO ASSIST PATIENTS IN EVALUATING ELIGIBILITY FOR FINANCIAL ASSISTANCE OR PUBLIC HEALTH INSURANCE PROGRAMS.-CONTINUE TO OFFER A WALK-IN EXPRESS CARE CLINIC WITH EVENING AND WEEKEND HOURS.-CONTINUE TO PROVIDE FREE TRANSPORTATION ON THE HEALTH EXPRESS SHUTTLE FOR PATIENTS SEEKING CARE AT ACMC OR WITH ACMC PROVIDER.- CONTINUE TO PROVIDE INFORMATION ABOUT PROVIDERS AND SERVICES TO RESIDENTS AT COMMUNITY EVENTS AND THROUGH THE WORKPLACE WELLNESS PROGRAM.-CONTINUE TO RECRUIT PRIMARY CARE AND SPECIALTY CARE PROVIDERS TO ASHTABULA COUNTY.-CONTINUE TO COLLABORATE WITH CLEVELAND CLINIC TO PROVIDE SPECIALISTS AND SPECIALTY CLINICS FOR SERVICES NOT AVAILABLE IN THE COMMUNITY.-CONTINUE TO COLLABORATE WITH COMMUNITY COUNSELING CENTER AND THE ASHTABULA COUNTY MENTAL HEALTH RECOVERY SERVICES BOARD TO PROVIDE A HEALTHCARE ACCESS NAVIGATOR TO CONNECT CLIENTS OF COMMUNITY COUNSELING CENTER WITH AN ACMC PRIMARY CARE PROVIDER. OBESITY PREVENTIONDURING THE MONTHS BETWEEN THE PUBLICATION OF THE COMMUNITY HEALTH NEEDS ASSESSMENT AND THE COMPLETION OF THE IMPLEMENTATION STRATEGY (COMMUNITY HEALTH IMPROVEMENT PLAN), MEMBERS OF HEALTHY ASHTABULA COUNTY RECOGNIZED THE STRONG CONNECTION BETWEEN OBESITY AND CHRONIC CONDITIONS. IT WAS AGREED TO BROADEN THE STRATEGY TO INCLUDE BOTH OBESITY AND CHRONIC CONDITIONS. THE REVISED STRATEGY IS:PREVENT OBESITY AND CHRONIC CONDITIONS BY PROMOTING NUTRITION AND PHYSICAL ACTIVITYHEALTHY ASHTABULA COUNTY OBJECTIVES:-BY 2026, INCREASE THE PERCENT OF CHILDREN AGES 3-17 WHO EAT 5 OR MORE SERVINGS OF FRUITS AND VEGETABLES PER DAY BY 2%.-BY 2026, INCREASE CHILD PHYSICAL ACTIVITY OF 5 OR MORE DAYS PER WEEK BY 2%.-BY 2026, REDUCE THE OVERALL ADULT OBESITY RATE OF THE COUNTY BY 3%.IN ADDITION TO THE INITIATIVES IDENTIFIED THROUGH HEALTHY ASHTABULA COUNTY, ASHTABULA COUNTY MEDICAL CENTER WILL PURSUE SEVERAL INITIATIVES THAT ARE SPECIFIC TO THE HOSPITAL.ACMC-SPECIFIC INITIATIVES:-CONTINUE TO OFFER A FREE EXERCISE PRESCRIPTION PROGRAM AT ACMC-OWNED FITNESS CENTER.-CONTINUE TO OFFER INPATIENT AND OUTPATIENT DIABETES EDUCATION.-CONTINUE TO PROVIDE FREE HYPERTENSION SCREENING AT COMMUNITY OUTREACH EVENTS.-CONTINUE TO PROVIDE EDUCATIONAL MATERIALS FOCUSED ON OBESITY AND CHRONIC CONDITIONS AT COMMUNITY OUTREACH EVENTS. ASHTABULA COUNTY MEDICAL CENTER PART V, SECTION B, LINE 20E: THE ORGANIZATION PROVIDES NOTIFICATION REGARDING THE FAP THROUGH SIGNAGE AND OTHER MECHANISMS. THERE ARE A NUMBER OF WRITTEN CORRESPONDENCES THAT GO OUT TO PATIENTS OVER THE COURSE OF 120 DAYS ONCE THE PATIENT RESPONSIBILITY IS DETERMINED FOR THE AMOUNT DUE RELATED TO SERVICES PROVIDED.PART V, SECTION B, LINE 20C: IF AN INCOMPLETE FAP APPLICATION IS RECEIVED, THE ORGANIZATION'S FINANCIAL COUNSELORS CONTACT THE PATIENT FOR ADDITIONAL INFORMATION. ASHTABULA COUNTY MEDICAL CENTER PART V, SECTION B, LINE 24: ALL PATIENTS ARE CHARGED THE SAME, STANDARD RATE, FOR A PARTICULAR SERVICE. 9 1 - JEFFERSON FAMILY HEALTH CENTER 234 NORTH CHESTNUT STREET JEFFERSON OH 44047 FAMILY HEALTH CENTER 2 - CONNEAUT FAMILY HEALTH CENTER 354 W MAIN ROAD CONNEAUT OH 44030 FAMILY HEALTH CENTER 3 - ACMC CENTER FOR DIGESTIVE HEALTH 2112 LAKE AVENUE ASHTABULA OH 44004 GASTROENTEROLOGY HEALTH CENTER 4 - GENEVA FAMILY HEALTH CENTER 5201 SPIRE CIRCLE GENEVA OH 44041 FAMILY HEALTH CENTER 5 - ASHTABULA FAMILY HEALTH CENTER 2259 LAKE AVENUE ASHTABULA OH 44004 FAMILY HEALTH CENTER 6 - THE ASHTABULA CLINIC 2422 LAKE AVENUE ASHTABULA OH 44004 PAIN MANAGEMENT, OCCUPATIONAL HEALTH 7 - ACMC OCCUPATIONAL HEALTH SERVICES 2422 LAKE AVENUE ASHTABULA OH 44004 OCCUPATIONAL HEALTH 8 - ORWELL FAMILY HEALTH CENTER 8220 OH-45 ORWELL OH 44076 FAMILY HEALTH CENTER 9 - ASHTABULA CENTER FOR SLEEP MEDICINE 2825 LAKE AVENUE ASHTABULA OH 44004 SLEEP CENTER PART I, LINE 3C: TO QUALIFY FOR THE HOSPITAL CARE ASSURANCE PROGRAM, AN INDIVIDUAL MUST (A) BE A RESIDENT OF THE STATE OF OHIO, (B) NOT BE ENROLLED IN THE MEDICAID (INCLUDING MEDICAID HMO) PROGRAM, AND (C) HAVE FAMILY/HOUSEHOLD INCOME LESS THAN 200% OF FEDERAL POVERTY GUIDELINES. IN ADDITION, BEFORE GRANTING FINANCIAL ASSISTANCE, THE HOSPITAL HAS THE RIGHT TO REQUIRE (A) PROOF OF INCOME, (B) A WRITTEN STATEMENT FOR CLAIMS OF $0 INCOME, (C) INFORMATION ABOUT HSA AND HFSA ACCOUNTS, AND/OR (D) THAT AN INDIVIDUAL APPLY FOR MEDICAID. 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 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 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 $ 146,884. 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 2024 MEDICARE COST REPORT. PART III, LINE 3: ASHTABULA COUNTY MEDICAL CENTER DOES NOT HAVE A METHOD TO REASONABLY ESTIMATE THE PORTION OF BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENTS WHO WOULD QUALIFY FOR FINANCIAL ASSISTANCE BUT DID NOT COMPLETE AN APPLICATION. PART II: N/A PART III, LINE 4: SEE THE "PATIENT SERVICE REVENUE AND PATIENT RECEIVABLES" PARAGRAPHS IN NOTE 1 ON PAGES 11-14 IN THE ATTACHED AUDITED FINANCIAL STATEMENTS.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 2024. ACMC IS PAID A PROSPECTIVELY DETERMINED RATE FOR THE MAJORITY OF INPATIENT ACUTE CARE AND OUTPATIENT 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 MEDICAL STAFF DEVELOPMENT PLAN IN WHICH 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. 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.). EVERY 3 YEARS ACMC CONDUCTS A COMMUNITY HEALTH NEEDS ASSESSMENT. THE FINDINGS FROM THAT ASSESSMENT ARE USED TO DEVELOP AN IMPLEMENTATION PLAN TO ADDRESS THE KEY HEALTH NEEDS IN THE COMMUNITY. 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 56.88% MEDICARE, 18.49% MEDICAID, 22.79% COMMERCIAL, 1.84% SELF PAY. STATISTICS INCLUDED IN THE 2019 CHNA SHOW THAT ASHTABULA COUNTY'S POVERTY RATE IS 19.8% (AMONG THE HIGHEST IN THE STATE), 85.7% OF COUNTY RESIDENTS HAVE A HIGH SCHOOL DIPLOMA, THE MEDIAN HOUSEHOLD INCOME IS $43,017, AND THE MEDIAN PER CAPITA INCOME IS $21,936. PART VI, LINE 5: ACMC IS AN ACTIVE PARTICIPANT AND SPONSOR OF EVENTS LIKE RELAY FOR LIFE, WALK TO END ALZHEIMER'S AND AMERICAN HEART WALK AND SPONSOR OF HEALTH-RELATED EVENTS OF COMMUNITY ORGANIZATIONS (EXAMPLES: COMMUNITY ACTION HEALTH FAIR). ACMC PUBLISHES A COMMUNITY MAGAZINE TWICE A YEAR WITH HEALTHCARE INFORMATION AND TIPS FOR HEALTHY LIVING. THE WEBSITE CONTAINS HEALTH INFORMATION AND DOWNLOADABLE RESOURCES. THE HOSPITAL HOLDS A WOMEN'S HEART HEALTH EVENT EACH YEAR AND A COMMUNITY CONNECTION FAIR TO INTRODUCE RESIDENTS TO HEALTHCARE SERVICES AND OTHER SERVICES TO ADDRESS SDOH. 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). STAFF (PHYSICIANS, CLINICIANS, ETC.) APPEAR ON LOCAL CABLE TV SHOW 2X/MONTH TO SHARE HEALTH INFORMATION. ACMC ALSO PROVIDES AN ATHLETIC TRAINER TO THREE HIGH SCHOOLS (NO COST TO THE SCHOOL DISTRICTS FOR THIS SERVICE). ADDITIONALLY, ACMC PARTICIPATES WITH LOCAL SOCIAL SERVICE AGENCIES ON THEIR PROGRAMS THAT ARE DESIGNED TO IMPROVE THE HEALTH AND WELL-BEING OF ASHTABULA COUNTY RESIDENTS. EXAMPLES INCLUDE: FEED THE HOPE, BRIDGES OUT OF POVERTY, REMOTE AREA MEDICAL CLINIC. ACMC HOLDS A DINNER MONTHLY (MARCH-OCTOBER) AT WHICH AN ACMC PROFESSIONAL PRESENTS HEALTH INFORMATION AND ANSWERS QUESTIONS. DINNER IS PROVIDED AT NO COST TO THE ATTENDEES. 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 2021 COMMUNITY BENEFIT REPORT PUBLISHED BY THE CLEVELAND CLINIC STATED $1.41 BILLION WAS SPENT BY THE CLEVELAND CLINIC IN 2021 ON COMMUNITY BENEFIT PROGRAMS. PART VI, LINE 7: N/A X X X 0 0 0 0 0 0 0 0 0 SHINOJ PATTALI MD PHYSICIAN 620348 0 717606 0 180 0 13800 0 33706 0 1385640 0 0 0 ALEXANDER TAICH PHYSICIAN 1234085 0 54909 0 270 0 13800 0 43677 0 1346741 0 0 0 DAVID NOVAK MD VICE-CHIEF OF STAFF (END 12/31/24) 631658 0 114667 0 414 0 13800 0 68862 0 829401 0 0 0 THEODORE G ECKMAN PHYSICIAN 677107 0 68258 0 162 0 9692 0 13477 0 768696 0 0 0 DAVID WEINERMAN PHYSICIAN 615643 0 70691 0 270 0 13800 0 43538 0 743942 0 0 0 NATHANIEL S FRANLEY MD PHYSICIAN 652435 0 41971 0 150 0 13800 0 22128 0 730484 0 0 0 DANIEL B KEATON MD CHIEF OF STAFF (END 12/31/24) 318761 0 0 0 414 0 8184 0 24467 0 351826 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 HUMAN RESOURCES DEPARTMENT EXAMINES THE MARKET RATES TO DETERMINE A STARTING SALARY. A OHIO HIGHER EDUCATIONAL FACILITY COMMISSION 346849674 677510CY3 2022-05-18 76303245 HEALTHCARE FACILITY REVENUE BONDS, SERIES 2022 0 0 0 A 76303245 1440400 74862845 2024 0 0 1 1 A 0 0 0 0 0 0 1 A 0 1 0 0 1 0 0 0 1 A 1 KIMBERLY GIANGOLA FAMILY MEMBER OF JOSEPH GIANGOLA, ACMC TRUSTEE 38205 EMPLOYMENT AGREEMENT WITH ACMC 0 BRITTANY COACH FAMILY MEMBER OF PEG CARLO, ACMC TRUSTEE 98722 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 A, LINE 6 THE CLEVELAND CLINIC FOUNDATION IS THE SOLE SPECIAL MEMBER OF ASHTABULA COUNTY MEDICAL CENTER. FORM 990, PART VI, SECTION A, LINE 7A THE BOARD MEMBERS ARE APPOINTED BY THE CLEVELAND CLINIC FOUNDATION, THE SPECIAL MEMBER. FORM 990, PART VI, SECTION A, LINE 7B THE FOLLOWING MATTERS REQUIRE THE APPROVAL OF THE CLEVELAND CLINIC FOUNDATION, THE SPECIAL MEMBER: (A) CHANGES TO THE ARTICLES OF INCORPORATION OR THE CODE OF REGULATIONS THAT WOULD HAVE A MATERIAL ADVERSE IMPACT ON THE SPECIAL MEMBER'S RIGHTS; (B) ANY AFFILIATION OF ACMC OR ITS SUBSIDIARIES OR AFFILIATES WITH ANY OTHER HOSPITAL, HOSPITAL SYSTEM, OR HEALTH CARE SYSTEM WHICH INCLUDES HOSPITALS AS PART OF SUCH SYSTEM; (C) ANY MATERIAL CHANGE TO ACMC'S OPERATION OR PURPOSE SUCH THAT ACMC'S PRINCIPAL ACTIVITY CEASES TO BE AN ACUTE CARE INPATIENT HOSPITAL OF NO LESS THAN 200 LICENSED BEDS; (D) SELECTION OF ACMC'S PRESIDENT/CEO; AND (E) REVIEW AND COORDINATION WITH ACMC OF ALL MANAGED CARE AND EMPLOYER CONTRACTS. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 REPORT IS PUBLISHED TO THE BOARD OF DIRECTORS' WEBSITE PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C EACH TRUSTEE, PRINCIPAL OFFICER, MEMBER OF A COMMITTEE WITH BOARD-DELEGATED POWERS, AND KEY EMPLOYEE SHALL ANNUALLY SIGN A STATEMENT, WHICH AFFIRMS THAT SUCH PERSON HAS RECEIVED A COPY OF THE CONFLICTS OF INTEREST POLICY, HAS READ AND UNDERSTANDS THE POLICY, HAS AGREED TO COMPLY WITH THE POLICY, AND UNDERSTANDS THAT THE CORPORATION IS A CHARITABLE ORGANIZATION AND THAT IN ORDER TO MAINTAIN ITS FEDERAL TAX EXEMPTION IT MUST ENGAGE PRIMARILY IN ACTIVITIES WHICH ACCOMPLISH ONE OR MORE OF ITS TAX-EXEMPT PURPOSES. IF A PERSON COVERED BY THE CONFLICT OF INTEREST POLICY BELIEVES HE OR SHE HAS A POTENTIAL CONFLICT OF INTEREST, THAT PERSON IS TO DISCLOSE THE CONFLICT TO THE BOARD. AFTER DISCLOSURE OF THE FINANCIAL INTEREST AND ALL MATERIAL FACTS, AND AFTER ANY DISCUSSION WITH THE INTERESTED PERSON, HE OR SHE SHALL LEAVE THE BOARD OR COMMITTEE MEETING WHILE THE DETERMINATION OF A CONFLICT OF INTEREST IS DISCUSSED AND VOTED UPON. THE REMAINING BOARD OR COMMITTEE MEMBERS SHALL DECIDE IF A CONFLICT OF INTEREST EXISTS. THE DISCLOSING PERSON MAY MAKE A PRESENTATION REGARDING THE PROPOSED TRANSACTION/POTENTIAL CONFLICT OF INTEREST AT THE BOARD OR COMMITTEE MEETING, BUT AFTER SUCH PRESENTATION, HE OR SHE SHALL LEAVE THE MEETING DURING THE DISCUSSION OF, AND THE VOTE ON, THE PROPOSED TRANSACTION OR ARRANGEMENT THAT RESULTS IN THE CONFLICT OF INTEREST. THE CHAIRPERSON OF THE BOARD OR COMMITTEE SHALL, IF APPROPRIATE, APPOINT A DISINTERESTED PERSON OR COMMITTEE TO INVESTIGATE ALTERNATIVES TO THE PROPOSED TRANSACTION OR ARRANGEMENT. AFTER EXERCISING DUE DILIGENCE, THE BOARD OR COMMITTEE SHALL DETERMINE WHETHER THE CORPORATION CAN OBTAIN A MORE ADVANTAGEOUS TRANSACTION OR ARRANGEMENT WITH REASONABLE EFFORTS FROM A PERSON OR ENTITY THAT WOULD NOT GIVE RISE TO A CONFLICT OF INTEREST. IF A MORE ADVANTAGEOUS TRANSACTION OR ARRANGEMENT IS NOT REASONABLY ATTAINABLE UNDER CIRCUMSTANCES THAT WOULD NOT GIVE RISE TO A CONFLICT OF INTEREST, THE BOARD OR COMMITTEE SHALL DETERMINE BY A MAJORITY VOTE OF THE DISINTERESTED TRUSTEES WHETHER THE TRANSACTION OR ARRANGEMENT IS IN THE CORPORATION'S BEST INTEREST AND FOR ITS OWN BENEFIT AND WHETHER THE TRANSACTION IS FAIR AND REASONABLE TO THE CORPORATION AND SHALL MAKE ITS DECISION AS TO WHETHER TO ENTER INTO THE TRANSACTION OR ARRANGEMENT IN CONFORMITY WITH SUCH DETERMINATION. IF THE BOARD OR COMMITTEE HAS REASONABLE CAUSE TO BELIEVE THAT A MEMBER HAS FAILED TO DISCLOSE ACTUAL OR POSSIBLE CONFLICTS OF INTEREST, IT SHALL INFORM THE MEMBER OF THE BASIS FOR SUCH BELIEF AND AFFORD THE MEMBER AN OPPORTUNITY TO EXPLAIN THE ALLEGED FAILURE TO DISCLOSE. IF, AFTER HEARING THE RESPONSE OF THE MEMBER AND MAKING SUCH FURTHER INVESTIGATION AS MAY BE WARRANTED IN THE CIRCUMSTANCES, THE BOARD OR COMMITTEE DETERMINES THAT THE MEMBER HAS IN FACT FAILED TO DISCLOSE AN ACTUAL OR POSSIBLE CONFLICT OF INTEREST, IT SHALL TAKE APPROPRIATE DISCIPLINARY AND CORRECTIVE ACTION. FORM 990, PART VI, SECTION B, LINE 15 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 HUMAN RESOURCES DEPARTMENT EXAMINES THE MARKET RATES TO DETERMINE A STARTING SALARY. 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: LEONARD STEPP, PRESIDENT/CEO; ALANNA DAMES, VP FINANCE/CFO; AND AMANDA CLARK, CNO. FORM 990, PART IX, LINE 11G PURCHASED MEDICAL SERVICES: PROGRAM SERVICE EXPENSES 19,950,130. MANAGEMENT AND GENERAL EXPENSES 6,942,686. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 26,892,816. FORM 990, PART XI, LINE 9: EQUITY INCOME IN AFFLIATE 6,358,069. EFFECT OF RECOGNITION PROVISION AT MEASUREMENT DATE OF PENSION OBLIGATION 247,868. NET ASSET TRANSFER FROM A RELATED ENTITY 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, 2024. 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 12A, I ASHTABULA COUNTY MEDICAL CENTER 1 GLENBEIGH 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 2131 LAKE AVENUE SUITE 2 ASHTABULA OH 44004 341143158 HOME HEALTH SERVICES OH 501(C)(3) LINE 10 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 162963 CASH RECEIVED ASHTABULA REGIONAL HOME HEALTH SERVICES Q 192861 CASH RECEIVED GLENBEIGH Q 883360 CASH RECEIVED ASHTABULA COUNTY MEDICAL CENTER FOUNDATION C 3758454 CASH RECEIVED