2015-11-13T09:42:14-06:00 2014-12-31 351178661 BLUE & CO LLC 8800 LYRA DRIVE SUITE 450 COLUMBUS OH 43240 990 2014-01-01 344430716 FISHER-TITUS MEDICAL CENTER FISH 4196688101 272 BENEDICT AVENUE NORWALK OH 44857 DUANE WOODS JR VP OF FINANCE & CFO 4196688101 2015-11-04 1 NANCY L KIRCHNER P00386751 6148852583 2015-11-04 2014 2016-03-07 17:11:31Z LORNA STRAYER 272 BENEDICT AVENUE NORWALK OH 44857 165350892 0 X WWW.FTMC.COM X 1911 OH PROVIDE QUALITY HEALTHCARE IN A COST EFFECTIVE MANNER, WHILE RESPECTING THE DIGNITY AND UNIQUENESS OF EACH INDIVIDUAL WE SERVE. 11 5 1134 192 991762 213506 78006 1502538 117779460 117261193 3408497 7385784 1012473 1190230 122278436 127339745 248606 276265 0 0 60915998 61373353 0 0 0 56329215 52672335 117493819 114321953 4784617 13017792 206627032 204800606 59311711 64402541 147315321 140398065 X PROVIDE QUALITY HEALTHCARE IN A COST EFFECTIVE MANNER, WHILE RESPECTING THE DIGNITY AND UNIQUENESS OF EACH INDIVIDUAL WE SERVE. 0 0 90851722 276265 110099452 SEE SCHEDULE O 4889634 7161741 SEE SCHEDULE O 95741356 1 1 0 1 0 0 0 0 0 0 1 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 1 0 0 0 0 0 0 0 0 1 1 1 0 0 0 1 1 1 1 0 0 1 113 0 1 1134 1 1 1 0 0 0 0 0 0 0 0 0 X 11 5 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 1 1 OH X DAVID V WILSON MBACMA 4196688101 272 BENEDICT AVENUE NORWALK OH 44857 MATT GROSS CHAIRMAN 15.00 3.00 X X 0 0 0 THOMAS C BLEILE VICE CHAIRMAN 8.00 2.00 X X 0 0 0 PERRY DRYDEN TREASURER 12.00 2.00 X X 0 0 0 REV FRED WIECHERS SECRETARY 8.00 X X 0 0 0 JOHN D PAYNE CPA DIRECTOR 10.00 4.00 X 0 0 0 LESLIE D STONEHAM DIRECTOR 4.00 X 0 0 0 WILLIAM B CORNELL MD DIRECTOR 8.00 X 0 0 0 VIRGINIA H POLING DIRECTOR 6.00 X 0 0 0 ERIC SCHMIDT MD DIRECTOR 4.00 2.00 X 0 0 0 GLENN TRIPPE MD DIRECTOR 8.00 2.00 X 0 0 0 ROSS MATLACK PRESIDENT - ENDED MAY 2014 49.50 15.50 X X 420178 0 42325 LORNA STRAYER PRESIDENT/EXECUTIVE VICE PRESIDENT 49.50 15.50 X X 328939 0 95027 DUANE WOODS SENIOR VP OF FINANCE & CFO 44.00 6.00 X 283946 0 55808 CHERIE M SPRAGG VP POPULATION HEALTH 50.00 X 222195 0 76767 PHILLIP J ANNARINO VP HUMAN RESOURCES 45.00 X 219368 0 54876 JOHN BRITTON VP INFORMATION SERVICES 45.00 X 205525 0 16653 GEORGE B ELMER VP STRATEGIC PLANNING AND BUSINESS DEVELOPMENT 50.30 4.70 X 189391 0 32084 SUZANNE S INGLIS SENIOR VP OF NURSING SERVICES 45.00 X 190622 0 38617 DR SHANKAR KURRA SENIOR VP MEDICAL AFFAIRS 45.00 X 310796 0 61731 MITCH ESCH DIRECTOR OF PHARMACY 40.00 X 161824 0 86346 SCOTT P STEINMETZ DIRECTOR OF INFORMATION SV 40.00 X 143797 0 16048 SHARON HARWOOD DIRECTOR COPORATE COMPLIANCE 40.00 X 128902 0 41251 JOHN D OVERMYER ASSISTANT DIRECTOR, PHARMACY 40.00 X 130691 0 49039 LORI LILL ASSISTANT VP. CLINICAL SERVICES 40.00 X 132645 0 46335 PATRICK J MARTIN SENIOR ADVISOR TO PRESIDENT 20.00 0.00 X 231833 0 30609 3300652 0 743516 27 1 1 0 THE ROBINS & MORTON GROUP 5500 MARYLAND WAY SUITE 100 BRENTWOOD TN 37027 BUILDING CONTRACTOR 5435135 CERNER CORPORATION 2800 ROCKCREEK PARKWAY KANSAS CITY MO 64117 HEALTHCARE INFORMATION TECHNOLOGY 4302889 JANOTTA & HERNER 309 MONROE STREET MONROEVILLE OH 44847 BUILDING CONTRACTOR 2266475 CLEVELAND CLINIC FOUNDATION PO BOX 931760 CLEVELAND OH 44193 SPINE CENTER & CARDIOLOGY 1311558 LABORATORY CORP OF AMERICA PO BOX 12140 BURLINGTON NC 27216 BLOOD ADMIN & LAB TESTING 608292 15 169 1502369 30405 1502538 NET PATIENT SERVICES 900099 109107690 109107690 NET NURSING HOME & ASSISTED LIVIN 623000 7161741 7161741 MEDICAL LABORATORY 621500 960289 960289 HEALTH AND ALLIED SERVICES 621990 31473 31473 117261193 951622 951622 68 68 44445241 37746552 264595 6698689 -264595 6434094 6434094 CAFETERIA SALES 722210 499051 499051 OTHER HOSPITAL REVENUE 900099 380941 380941 AUXILIARY SALES 453220 310238 310238 1190230 127339745 116269431 991762 8576014 276265 276265 2844848 1607501 1237347 44114999 37493896 6621103 1987889 1689532 298357 9058678 7709085 1349593 3366939 2861604 505335 281999 211499 70500 119027 59514 59513 504755 504755 9308625 6380726 2927899 533810 513945 19865 3980458 2531835 1448623 4674559 3371719 1302840 2028908 1305957 722951 146411 135135 11276 325730 104574 221156 636791 609944 26847 8890543 8461020 429523 764302 552664 211638 UBI INCOME TAX 30333 30333 MEDICAL SUPPLIES 15295413 15292185 3228 BAD DEBT EXPENSES 2184930 2184930 OHIO HOSPITAL TAX & SN 1558064 1558064 1407677 799429 608248 114321953 95741356 18580597 0 5275 5275 2435468 4209997 12473388 10889873 3470745 371949 2339813 2259003 2052470 2112247 179009937 73631787 101380615 105378150 79734512 70534281 6003708 217542 205542 2517204 2830581 206627032 204800606 28754609 35287206 270271 248380 30205000 28825000 81831 41955 59311711 64402541 X 147296985 140379712 18336 18353 147315321 140398065 206627032 204800606 X 13017792 -7863317 -12071731 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 1 0 1 7473 7473 0 PART II-B, LINE 1: EXECUTIVE MEMBERS OF THE ORGANIZATION, ON AN OCCASIONAL BASIS, MAY WRITE OR SPEAK TO LEGISLATIVE MEMBERS CONCERNING PROPOSED LEGISLATION THAT MIGHT IMPACT THE LOCAL DELIVERY OF HEALTHCARE SERVICES. THE MEDICAL CENTER HAS MEMBERSHIPS IN VARIOUS HEALTHCARE RELATED ASSOCIATIONS, WHICH PROVIDE STATE AND NATIONAL LEADERSHIP ON LEGAL, REGULATORY, QUALITY AND ACCREDITATION ISSUES. AS A PART OF THAT LEADERSHIP ROLE THESE ORGANIZATIONS DO CONTACT LEGISLATORS TO EXPRESS THEIR ASSOCIATION'S POSITIONS ON MATTERS IMPORTANT TO THEIR MEMBERSHIP. THE FOLLOWING ORGANIZATIONS LISTED BELOW SHOW THE PERCENTAGE OF THE DUES THAT REFLECT LOBBYING AS DETERMINED BY THE IRS: OHIO HEALTH CARE ASSOCIATION - 20.72% OF DUES; OHIO HOSPITAL ASSOCIATION - 3.4% OF DUES AND AMERICAN HOSPITAL ASSOCIATION - 22.80% OF DUES. 0 1665894 1665894 112454526 45099428 67355098 0 58227688 25484629 32743059 6661829 3047730 3614099 105378150 X 110539841 -7863317 -8033651 -15896968 126436809 902936 902936 127339745 116473161 3064057 3064057 113409104 912848 912848 114321952 PART X, LINE 2: MANAGEMENT HAS ANALYZED THE TAX POSITIONS TAKEN BY THESE ENTITIES, AND HAS CONCLUDED THAT AS OF DECEMBER 31, 2014 AND 2013, THERE ARE NO UNCERTAIN POSITIONS TAKEN OR EXPECTED TO BE TAKEN THAT WOULD REQUIRE, RECOGNITION OF A LIABILITY OR DISCLOSURE IN THE ACCOMPANYING CONSOLIDATED FINANCIAL STATEMENTS. FISHER-TITUS MEDICAL CENTER INDIVIDUAL ACCRUED UNCERTAIN TAX POSITION WAS $0.00 PART XI, LINE 2D - OTHER ADJUSTMENTS: HEALTH PROMOTIONS OF NORWALK REVENUE 628,602. ADJUSTMENT TO RECOGNIZE FASB #158 (CHANGE IN PENSION LIABILITY) -7,958,173. FISHER-TITUS PAIN MANAGEMENT LLC REVENUE 4,137,675. TRANSERS TO VARIOUS AFFIIATED ENTITIES -4,841,755. PART XI, LINE 4B - OTHER ADJUSTMENTS: HOSPITAL AUXIIARY REVENUE 310,418. HOSPITAL EXPENSE ADJUSTMENTS TO REVENUES 592,518. PART XII, LINE 2D - OTHER ADJUSTMENTS: HEALTH PROMOTIONS OF NORWALK EXPENSES 526,355. FISHER-TITUS PAIN MANAGEMENT LLC EXPENSES 2,537,702. PART XII, LINE 4B - OTHER ADJUSTMENTS: HOSPITAL AUXILIARY EXPENSES 320,330. HOSPITAL EXPENSE ADJUSTMENTS TO REVENUES 592,518. 1 1 X 1 X 1 X 1 1 0 1 1 1 2362 2062651 456955 1605696 0.01430 1 17227629 14515874 2711755 0.02420 2 2362 19290280 14972829 4317451 0.03850 36 62943 890334 66323 824011 0.00730 3 241 147524 14695 132829 0.00120 1 1253136 438117 815019 0.00730 1 47880 47880 0.00040 7 769 307257 50 307207 0.00270 48 63953 2646131 519185 2126946 0.01890 50 66315 21936411 15492014 6444397 0.05740 1 21 142 142 0.00000 2 14500 14500 0.00010 1 410 20826 20826 0.00020 4 431 35468 35468 0.00030 1 2184930 655479 25402385 33047397 -7645012 X 1 1 1 NORTH CENTRAL CARENET PHYSICIAN-HOSPITAL ORGANIZATION 0.50000 0.06980 0.43020 2 FISHER-TITUS PAIN MANAGEMENT LLC PAIN MANAGEMENT 0.51000 0.49000 1 1 FISHER-TITUS MEMORIAL HOSPITAL 272 BENEDICT AVENUE NORWALK OH 44857 X X X FISHER-TITUS MEMORIAL HOSPITAL 1 0 0 1 X X X X X X X X X 14 1 1 1 1 X WWW.FISHER-TITUS.ORG/COMMUNITY-SERVICES/OVERVIEW.HTML X HTTP://WWW.HCNO.ORG/COMMUNITY X 1 14 1 WWW.FISHER-TITUS.ORG/COMMUNITY-SERVICES/OVERVIEW.HTML 0 0 1 X 200.000000000000 300.000000000000 X X 1 1 X X X 1 X X X X X X 1 X 0 X X X 1 X 0 0 FISHER-TITUS MEMORIAL HOSPITAL PART V, SECTION B, LINE 5: HURON COUNTY CONTRACTED WITH THE HOSPITAL COUNCIL OF NORTHWEST OHIO, A NON-PROFIT HOSPITAL ASSOCIATION LOCATED IN TOLEDO, OHIO TO COORDINATE AND MANAGE THE HEALTH ASSESSMENT PROCESS. THE PROJECT COORDINATOR FROM THE HOSPITAL COUNCIL OF NW OHIO CONDUCTED A SERIES OF MEETINGS WITH THE PLANNING COMMITTEE FROM HURON COUNTY. DURING THESE MEETINGS, BANKS OF POTENTIAL SURVEY QUESTIONS FROM THE BEHAVIORAL RISK FACTOR SURVEILLANCE, YOUTH RISK FACTOR BEHAVIOR SURVEILLANCE AND THE NATIONAL SURVEY OF CHILDREN'S HEALTH WERE REVIEWED AND DISCUSSED. BASED ON INPUT FROM THE HURON COUNTY PLANNING COMMITTEE, THE PROJECT COORDINATOR COMPOSED DRAFTS OF SURVEYS CONTAINING 111 ITEMS FOR THE ADULT SURVEY WITH AN ADDITIONAL 30 QUESTIONS FOR PARENTS OF 0-11 YEAR OLDS, AND 77 ITEMS FOR THE ADOLESCENT SURVEY. THE DRAFTS WERE APPROVED BY HEALTH EDUCATION REASEARCHERS AT THE UNIVERSITY OF TOLEDO. THE HOSPITAL COUNCIL OF NW OHIO COLLECTED THE DATA, GUIDED THE HEALTH ASSESSMENT PROCESS AND INTERGRATED SOURCES OF PRIMARY AND SECONDARY DATA INTO THE FINAL REPORT. THE NEEDS OF THE POPULATION, ESPECIALLY THOSE WHO ARE MEDICALLY UNDERSERVED, LOW-INCOME, MINORITY POPULATIONS AND POPULATIONS WITH CHRONIC DISEASE NEEDS WERE TAKEN INTO ACCOUNT THROUGH THE SAMPLE METHODOLOGY THAT SURVEYED THESE POPULATIONS. IN ADDITION, THE ORGANIZATIONS THAT SERVE THESE POPULATIONS PARTICIPATED IN THE HEALTH ASSESSMENT PROCESS. THE PARTICIPANTS WHO HAVE A (PH) AFTER THEIR NAME INDICATES THEY WORK IN THE PUBLIC HEALTH FIELD. THE PARTICIPANTS INCLUDED: TIMOTHY HOLLINGER (PH), KATIE SPAAR (PH), ELAINE BARMAN, (PH), KATHERINE SABOURIN, (PH) ALL FROM HURON PUBLIC HEALTH; LORNA STRAYER (PH), MICHELE SKINN (PH), FISHER-TITUS MEDICAL CENTER; JULIE LANDOLL, (PH), MERCY HOSPITAL OF WILLARD; JOANN VENTURA, (PH), MANDI ARTINO, (PH), THE BELLEVUE HOSPITAL; JEAN KING, (PH), HURON COUNTY BOARD OF MENTAL HEALTH AND ADDICTION SERVICES. KIM SCHUBERT, BELLEVUE CITY SCHOOLS; KAREN MALCOLM, IMMACULATE CONCEPTION SCHOOL; GREGG ELCHERT, MONROEVILLE LOCAL SCHOOLS; BRAD RAMANO, NEW LONDON LOCAL SCHOOLS; WAYNE BABCANEC, NORWALK CATHOLIC SCHOOLS; DENNIS DOUGHTY, NORWALK CITY SCHOOLS; DAVID BRAND, SOUTH CENTRAL SCHOOLS; RODGE WILSON, WESTERN RESERVE LOCAL SCHOOLS; JEFF RITZ, WILLARD CITY SCHOOLS; DEBRA FISHER, CAC OF ERIE, HURON & RICHLAND COUNTIES; RENEE GEROME, (PH), FIRELANDS COUNSELLING & RECOVERY; BOB PATUSKY, CITY OF NORWALK. FISHER-TITUS MEMORIAL HOSPITAL PART V, SECTION B, LINE 6A: MERCY HOSPITAL OF WILLARD, THE BELLEVUE HOSPITAL, FIRELANDS REGIONAL HOSPITAL (COUNSELING & RECOVERY CENTER), HURON COUNTY PUBLIC HEALTH AND HURON COUNTY BOARD OF MENTAL HEALTH AND ADDICTION SERVICES. FISHER-TITUS MEMORIAL HOSPITAL PART V, SECTION B, LINE 11: EACH OF THE HEALTH NEEDS LISTED BELOW IS IMPORTANT AND IS BEING ADDRESSED BY NUMEROUS PROGRAMS AND INITIATIVES SUPPORTED BY FISHER-TITUS MEDICAL CENTER AND OTHER COMMUNITY PARTNERS OF THE HOSPITAL. THE MEDICAL CENTER DOES NOT ADDRESS THESE NEEDS LISTED BELOW AS PART OF THIS IMPLEMENTATION PLAN DUE TO LIMITED FINANCIAL AND HUMAN RESOURCES AND THE NEED TO ALLOCATE SIGNIFICANT RESOURCES ON THE PRIORITY HEALTH NEEDS LISTED IN THE IMPLEMENTATION PLAN. NEEDS NOT ADDRESSED: 1. 14% OF HURON COUNTY ADULTS HAVE BEEN DIAGNOSED WITH ASTHMA;2. 22 % OF HURON COUNTY ADULTS ARE DIAGNOSED WITH ARTHRITIS;3. IN 2014, ONLY TWO-THIRDS (69%) OF HURON COUNTRY YOUTH IN GRADES 6-12 HAD VISITED A DENTIST FOR CHECK-UP EXAM, TEETH CLEANING OR OTHER DENTAL WORK OVER THE PAST 12 MONTHS;4. INSECTS AND MOLD WERE REPORTED AS THE TWO MOST THREATENING ENVIRONMENTAL HEALTH ISSUES BY RESPONDENTS;5. 40% OF ADULTS HAD NOT VISITED A DENTIST OR DENTAL CLINIC IN THE PAST YEAR. PART V, SECTION B LINE 22D THE DISCOUNT RATE FOR SELF-PAY PATIENTS WAS SET TO MATCH THE RATE OF OUR TWO PREDOMINANT COMMERCIAL INSURANCE CONTRACTS WHICH MAKE UP 2/3 OF OUR POPULATION COVERED BY THIRD PARTY INSURANCE. 2 NORWALK MEMORIAL HOME 272 BENEDICT AVENUE NORWALK OH 44857 INTERMEDIATE & SKILLED NURSING FACILITY THE CARRIAGE HOUSE OF FISHER-TITUS 175 SHADY LANE DRIVE NORWALK OH 44857 ASSISTED LIVING FACILITY PART I, LINE 7: THE COSTING METHODOLOGY USED FOR THE CHARITY CARE SEGMENT OF THE LINE 7 TABLE WAS THE IRS WORKSHEET 1, "CHARITY CARE AT COSTS" IN THE INSTRUCTIONS. COST TO CHARGE RATIOS WERE CARRIED OVER FROM THE IRS WORKSHEET 2 AS A BASIS TO ESTIMATE EXPENSES AND WAS APPLIED TO THE GROSS PATIENT CHARIY CARE CHARGES RECORDED IN 2014. THE COSTING METHODOLOGY USED FOR THE UNREIMBURSED MEDICAID SEGMENT ON THE LINE 7 TABLE WERE CALCULATED USING A COST TO CHARGE RATIO EXTRACTED FROM THE MEDICAID COST REPORT DATA. THE COSTING METHODOLOGY USED FOR THE "OTHER BENEFITS" SEGMENT OF THE LINE 7 TABLE WERE CALCULATED USING A COMBINATION OF DIRECT COSTS AND OUR COST ACCOUNTING SYSTEM WHICH TAKES INTO CONSIDERATION ALL PATIENT TYPES AND SEGMENT. 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 $ 2,184,930. PART II, COMMUNITY BUILDING ACTIVITIES: IN 2014, FISHER-TITUS'S COMMUNITY BUILDING ACTIVITIES AND BENEFITS PROVIDED $14.1 MILLION TO SUPPORT PROGRAMS THAT IMPACTED THE OVERALL HEALTH OF OUR COMMUNITIES AND THE QUALITY OF LIFE OF OUR RESIDENTS. WHILE HOSPITAL-BASED MEDICAL SERVICES ARE THE MOST OBVIOUS WAY WE HELP, FTMC FULFILLS THE HEALTH-CARE NEEDS OF OUR AREA WITH COMMUNITY HEALTH SCREENINGS, EDUCATION CLASSES, PATIENT ASSISTANCE PROGRAMS AND SUPPORT OF HEALTH-RELATED ACTIVITIES. FTMC EMPLOYEES SERVE ON COMMUNITY AND CIVIC BOARDS, HEALTH-ORIENTED ORGANIZATIONS AND ARE INVOLVED IN ECONOMIC DEVELOPMENT ACTIVITIES THROUGHOUT THE COUNTY. FTMC ALSO WORKS WITH SCHOOLS; WORK SITES AND SAFETY NET PROVIDERS TO PROMOTE HEALTH AND WELLNESS AND PREVENT DISEASE. FISHER-TITUS IS A LEADER IN ENVIRONMENTAL STEWARDSHIP, HAVING EARNED NUMEROUS STATE AND NATIONAL AWARDS. PART III, LINE 4: THE COSTING METHODOLOGY USED FOR COMPLETING THE SCHEDULE H PART III, LINE 2 IS DERIVED FROM THE BAD DEBT EXPENSE INCLUDED IN THE AUDITED FINANCIAL STATEMENTS ADJUSTED BY THE AMOUNT OF THE WRITE-OFFS OF THE ACCOUNTS THAT WENT TO BAD DEBT. COST TO CHARGE RATIOS WERE CARRIED OVER FROM IRS WORKSHEET 2 "RATIO OF PATIENT CARE COSTS TO CHARGES" AS A BASIS TO ESTIMATE EXPENSE AND WAS APPLIED TO THE BAD DEBT EXPENSE RECORDED IN 2014. PART III, LINE 3 AS A TAX-EXEMPT HOSPITAL, NOT-FOR-PROFIT ORGANIZATION, WE MUST PROVIDE NECESSARY MEDICAL CARE TO ALL, REGARDLESS OF THE PATIENT'S ABILITY TO PAY FOR THE SERVICES PROVIDED. MAKING QUALITY PATIENT CARE AVAILABLE TO ALL IN OUR COMMUNITY, REGARDLESS OF THEIR ECONOMIC MEANS, QUALIFIES BAD DEBT AS COMMUNITY BENEFIT. THE IDENTIFICATION OF PATIENTS ELIGIBLE FOR CHARITY CARE IS SOLELY BASED ON THE COOPERATION OF THE PATIENT TO PROVIDE THE ORGANIZATION ENOUGH FAMILY AND FINANCIAL INFORMATION TO DETERMINE ELIGIBILTY TO MATCH OUR PROGRAMS. HISTORICALLY, IN ADDITION TO THE INTERNALLY IDENTIFIED CHARITY, 13-15% OF THE ACCOUNT BALANCES TURNED TO COLLECTION WERE SUBSEQUENTLY IDENTIFIED BY THE AGENCY AS CHARITY AND RETURNED. THIS CHARITY IS RECORDED ONLY WHEN IT HAS BEEN IDENTIFIED THROUGH VERIFICATION OF INABILITY TO PAY. WE DO BELIEVE THERE IS A SECOND, RELATIVELY EQUAL SEGMENT OF THE BAD DEBT THAT WOULD QUALIFY FOR CHARITY. PATIENTS WITH POOR CREDIT RATINGS AND MULTIPLE CREDITORS MAKING COLLECTION EFFORT FINDS LITTLE VALUE IN COMPLETING THE CHARITY APPLCIATION PROCESS TO ONLY ELIMINATE ONE CREDITOR AND HAVE NO IMPROVEMENT TO THEIR FINANCIAL STATUS.WE ESTIMATE THAT UNDER THE CURRENT ECONOMIC CONDITIONS UNIDENTIFIED CHARITY IN BAD DEBT EXPENSE IS ESTIMATED TO BE AN ADDITIONAL $655,479 OR 30% OF BAD DEBT. SINCE THIS CALCUALTION IS ON AN ACCRUAL BASIS, WE BELEIVE ESTIMATING 15% FOR CHARITY TO BE IDENTIFIED IN FUTURE YEARS AND AN ADDITIONAL 15% FOR BALANCES NEVER IDENTIFIED AS CHARITY IS A VERY CONSERVATIVE AND REASONABLE ESTIMATE OF THIS CHARITY CARE VALUE. PART III, LINE 4 FOOTNOTE "ALLOWANCES FOR UNCOLLECTIBLE ACCOUNTS": THE PROVISION FOR BAD DEBTS IS BASED UPON MANAGEMENT'S ASSESSMENT OF HISTORICAL AND EXPECTED NET COLLECTIONS CONSIDERING BUSINESS AND ECONOMIC CONDITIONS, TRENDS IN THE HEALTHCARE COVERAGE AND OTHER COLLECTION INDICATORS. PERIODICALLY THROUGHOUT THE YEAR, MANAGEMENT ASSESSES THE ADEQUACY OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS BASED UPON SPECIFIC ACCOUNTS, HISTORICAL WRITE OFF EXPERIENCE AND CURRENT MARKET CONDITIONS. THE RESULTS OF THIS REVIEW ARE THEN USED TO MAKE ANY MODIFICATIONS TO THE PROVISION FOR BAD DEBTS TO ESTABLISH THE MOST UP TO DATE APPROPRIATE ALLOWANCE FOR UNCOLLECTIBLE RECEIVABLES. PART III, LINE 8: FISHER-TITUS MEDICAL CENTER'S MEDICARE ALLOWABLE COSTS WERE CALCULATED USING A COST TO CHARGE RATIO EXTRACTED FROM THE MEDICARE COST REPORT DATA. THE MEDICAL CENTER BELIEVES THAT ALL OF THE $7.6 MILLION DOLLAR SHORTFALL SHOULD BE CONSIDERED AS COMMUNITY BENEFIT, BECAUSE OUR MISSION IS TO PROMOTE HEALTH IN THE COMMUNITY AND WE DO NOT LIMIT THE CARE AVAILABLE TO ANY PATIENTS, INCLUDING THOSE COVERED BY MEDICARE. THE IRS COMMUNITY BENEFIT STANDARD INCLUDES THE PROVISION OF CARE TO THE ELDERLY. THIS YEAR, MEDICARE ACCOUNTED FOR 44% OF HOSPITAL REVENUES AND THESE MEDICARE BENEFICIARIES WERE PROVIDED CARE IN SPITE OF THIS SHORTFALL. CARING FOR THE MEDICARE BENEFICIARIES RELIEVES THE FEDERAL GOVERNMENT OF THE BURDEN OF PAYING THE TRUE COST FOR THEIR CARE AS THESE PATIENTS TYPICALLY HAVE LOW AND/OR FIXED INCOMES. TAX EXEMPT HOSPITALS ARE ALSO EXPECTED TO PARTICIPATE IN THE MEDICARE PROGRAM. MEDICARE SHORTFALLS MUST BE ABSORBED BY THE MEDICAL CENTER IN ORDER TO CONTINUE TREATING THE ELDERLY IN OUR COMMUNITY. PART III, LINE 9B THE CHARITY POLICY IS A SUBSET OF THE OVERALL COLLECTION POLICY. WHEN PATIENTS ARE IDENTIFIED AS QUALIFYING FOR ANY OF THE CHARITY CATEGORIES WE SEARCH ACCOUNTS RECEIVABLE AND ACCOUNTS PLACED WITH COLLECTION AGENCIES AND PACKAGE THEM WITH THE APPLICATION. IN ADDITION, CHARITY INFORMATION IS SHARED WITH OUR RELATED ORGANIZATIONS AND FORMS THE BASIS FOR THEIR CHARITY ADJUSTMENTS. IN ADDITION, WITH PATIENT APPROVAL, WE MAY CONTACT LOCAL PHYSICIAN PRACTICES WITH THE INFORMATION AS MANY WILL ADJUST THEIR BALANCES BASED UPON THE INFORMATION PROVIDED. PART VI, LINE 2: FISHER-TITUS SPONSORED AND COLLABORATED WITH THE HURON COUNTY PUBLIC HEALTH AND OTHER HEALTH ORGANIZATIONS, SCHOOLS, NON-PROFITS AND BUSINESSES (CALLED HURON COUNTY HEALTH PARTNERS) TO DEVELOP AND FUND THE HURON COUNTY HEALTH NEEDS ASSESSMENT IN 2014. LOCAL COMMUNITY AGENCIES WERE INVITED TO PARTICIPATE IN THE HEALTH ASSESSMENT PROCESS, INCLUDING CHOOSING QUESTIONS FOR THE SURVEYS, PROVIDING GOVERNMENT DATA, REVIEWING DRAFT REPORTS AND PLANNING THE COMMUITY RELEASE OF THE DATA AND SETTING PRIORITIES. THERE WERE OVER 50 KEY LEADERS FROM THE COMMUNITY THAT REPRESENTED PUBLIC HEALTH, LAW ENFORCEMENT, SCHOOLS, CHURCHES, LOCAL OFFICIALS, SOCIAL AGENCIES AND OTHER VARIOUS COMMUNITY MEMBERS IN ATTENDANCE AT THE PUBLIC RELEASE OF THE COMMUNITY HEALTH NEEDS ASSESSMENT. AT THE EVENT, PARTICIPANTS, PARTICIPATED IN FOCUS GROUPS AND PRIORITIES WERE CHOOSEN FOR AREAS OF HEALTH CONCERN FOR HURON COUNTY TO FOCUS ON OVER THE NEXT FEW YEARS. FTMC USED THIS INFORMATION TO ADD AND EXPAND SERVICES AND TO RECRUIT PHYSICIANS TO MEET THE THEN IDENTIFIED MEDICAL NEEDS OF OUR COMMUNITY. FROM THESE PRIORITIES, FTMC HAS DEVELOPED NUMEROUS PROGRAMS TARGETING THE COUNTY'S HIGH RATE OF ADULTS WHO ARE OVERWEIGHT OR OBESE; HAVE DIABETES AND/OR CARDIOVASCULAR ISSUES. PROGRAMS INCLUDING NUTRITION AND EXERCISE EDUCATION IN KINDERGARTENS THROUGHOUT HURON COUNTY; WALK WITH A DOC AND WELLNESS WALKS THAT PROVIDE NOT ONLY EXERCISE, BUT ALSO EDUCATION; GLUCOSE AND BLOOD PRESSURE SCREENINGS WHERE ABNORMAL RESULTS ARE SHARED WITH THE INDIVIDUAL'S PRIMARY CARE PHYSICIANS. PART VI, LINE 3: PATIENTS ARE INTERVIEWED AFTER REGISTRATION TO ASSIST THEM IN DETERMINING EACH PATIENT'S ELIGIBILITY FOR FINANCIAL ASSISTANCE PROGRAMS AVAILABLE INTERNALLY AND EXTERNALLY. FTMC HAS BILINGUAL SIGNAGE POSTED IN THE ADMITTING/REGISTRATION AREAS, BILLING OFFICE AND FINANCIAL COUNSELING OFFICES, AND IN THE INPATIENT GUIDES IN ALL PATIENT ROOMS. THE FTMC WEBSITE HAS A SECTION ABOUT THE FINANCIAL ASSISTANCE PROGRAM AND CONTRACT INFORMATION. A MESSAGE ABOUT FINANCIAL ASSISTANCE AND CHARITY CARE ALSO IS INCLUDED ON THE BILLS THAT ARE SENT TO THE PATIENTS. MANY MATERIALS ARE BILINGUAL AND INTERPRETATION SERVICES ARE AVAILABLE. THE MEDICAL CENTER SUPPORTS AN OUTSIDE COUNSELOR DEDICATED TO HELPING PATIENTS BECOME QUALIFIED FOR MEDICAID OR OTHER GOVERNMENT PROGRAMS. THEY ALSO REFER PATIENTS WHO DON'T QUALIFY FOR THOSE PROGRAMS TO OUR FTMC FINANCIAL COUNSELORS FOR ASSISTANCE WITH H.C.A.P., FISHER-TITUS CHARITY AND FISHER-TITUS COMMUNITY ASSISTANCE PROGRAMS. OUR SOCIAL SERVICES DEPARTMENT REGULARLY REFERS PATIENTS IN NEED TO OUR FINANCIAL COUNSELORS FOR ASSISTANCE. WE ALSO TAKE REFERRALS FROM THE LOCAL COUNTY HUMAN SERVICES AGENCIES, VICTIMS OF VIOLENT CRIMES, LOCAL HEALTH DEPARTMENTS, LOCAL LAW ENFORCEMENT AGENCIES, CHURCHES, ETC. FTMC IS VERY PROACTIVE IN TAKING THE MESSAGE TO OUR COMMUNITY. BROCHURES ARE AVAILABLE AT COMMUNITY OUTREACH EVENTS HELD IN THE HOSPITAL AND AT OUTSIDE COMMUNITY EVENTS. FTMC COMMUNICATES THE INFORMATION ABOUT CHARITY CARE PROGRAMS THROUGH ITS COMMUNITY NEWSLETTER AND LOCAL NEWS MEDIA. PART VI, LINE 4: THE FISHER-TITUS MEDICAL CENTER PROVIDES COMPREHENSIVE STATE-OF-THE ART HEALTH CARE SERVICES TO THE RESIDENTS OF HURON AND ERIE AS WELL AS PORTIONS OF OTHER CONTIGUOUS COUNTIES WITH THE LATEST MEDICAL ADVANCEMENTS. FISHER-TITUS'S PRIMARY AREA IS THE GREATER HURON COUNTY AREA IN NORTH CENTRAL OHIO, WHICH IS HOME TO AROUND 60.000 RESIDENTS. FTMC'S 50 ACRE CAMPUS IS IN THE COUNTY SEAT OF NORWALK, WHICH IS THE LARGEST CITY IN THE COUNTY WITH OVER 17,000 RESIDENTS. FTMC HAS NUMEROUS MEDICAL OFFICES THROUGHOUT THE COUNTY TO PROVIDE EASY ACCESS TO PHYSICIANS FOR COMMUNITY RESIDENTS. THE COUNTY IS HOME TO SEVERAL LARGE MANUFACTURERS WHO HAVE EXPERIENCED MAJOR JOB LOSSES OVER THE PAST 10 YEARS. HURON COUNTY WAS TIED (PIKE AND OTTAWA) FOR THE 4TH HIGHEST LEVEL OF UNEMPLOYMENT IN MARCH 2015. THE LARGEST PERCENTAGE OF RESIDENTS ARE CHILDREN UNDER 18 WITH THOSE 65 AND OLDER MAKING UP 13.6% OF THE POPULATION. 94% OF THE RESIDENTS ARE CAUCASIAN WITH 5.7% OF THE POPULATION BEING HISPANIC OR LATINO (OF ANY RACE). IN 2012 THE MEDIAN HOUSEHOLD INCOME (FAMILIES) WAS $56,441 COMPARED TO OHIO'S MEDIAN HOUSEHOLD INCOME OF $60,022. IN 2012, 13.2% OF INDIVIDUALS WERE LIVING IN POVERTY WITH THOSE AGED 9-17 LIVING IN POVERTY ESTIMATED TO BE 20%. THE OVERALL TRENDS INDICATED A DECLINE IN EMPLOYMENT BASED MEDICAL INSURANCE AND INCREASING UNINSURED AND RELIANCE ON GOVERNMENT PROGRAMS. PART VI, LINE 5: THE BOARD OF DIRECTORS IS COMPOSED OF AREA RESIDENTS INCLUDING BUSINESS AND COMMUNITY LEADERS, PHYSICIANS AND OTHER INTERESTED PERSONS. THESE VOLUNTEERS GIVE COUNTLESS HOURS OF SERVICE TO THE MEDICAL CENTER IN THEIR OVERSIGHT ROLE. THEY ARE INVOLVED IN THE COMMUNITY NEEDS ASSESSMENT PROCESS, IN FUNDRAISING, AND IN GENERAL STEWARDHSIP. FTMC'S MEDICAL STAFF IS OPEN AND PRIVILEGES ARE GRANTED TO ALL QUALIFIED PHYSICIANS WHO APPLY AND MEET THE STANDARDS OF THE MEDICAL CENTER PRIVILEGING PROCESS. THE MEDICAL CENTER UTILIZES SURPLUS FUNDS TO MAINTAIN ACCESS TO PATIENT SERVICES AND TO EXPAND ACCESS POINTS OF CARE TO PATIENTS THROUGHOUT THE COMMUNITY INCLUDING, BUT NOT LIMITED TO THE FOLLOWING:1. EDUCATIONAL PROGRAMS THAT PROVIDE CLASSES AND INFORMATION ON TOBACCO CESSATION, HEALTHY AGING, CHILDBIRTH, INFANT CARE, EARLY PREGNANCY AND MORE.2. FREE BLOOD PRESSURE AND DIABETES SCREENINGS, AND MAMMOGRAMS TO QUALIFYING INDIVIDUALS, FREE OR LOW-COST SCREENINGS FOR BREAST, PROSTATE, SKIN AND COLORECTAL CANCERS AS WELL AS OSTEOPOROSIS ASSESSMENTS. 1 FISHER-TITUS FOUNDATION 272 BENEDICT AVE NORWALK OH 44857 341476934 501(C)(3) 95500 PLEDGE TO HELP PURCHASE EQUIPMENT NORWALK AREA UNITED FUND 10 WEST MAIN ST NORWALK OH 44857 340906312 501(C)(3) 20000 CONTRIBUTION TO HELP THE LOCAL COMMUNITY NORWALK ECONOMIC DEVELOPMENT 10 1/2 WEST MAIN ST NORWALK OH 44857 341787391 501(C)(3) 14500 CONTRIBUTION TO HELP THE LOCAL COMMUNITY SHELBY CHRISTIAN & MISSIONARY CHURCH 105 E SMILEY AVE SHELBY OH 44875 341354574 501(C)(3) 69725 FMV MISC CATH LAB MEDICAL SUPPLIES SUPPLIES TO AID IN CARRYING OUT THE ORGANIZATION'S CHARITABLE PURPOSE TEEN LEADERSHIP CORPS 26 E CEDAR POINT ROAD SANDUSKY OH 44870 260324010 5000 CONTRIBUTIONS TO TEEN LEADERSHIP CLASSES CITY OF NORWALK 100 REPUBLIC ST NORWALK OH 44857 SECTION 115 5000 GRANT FOR HEALTHY BEHAVIOUR EVENTS WEEKENDS WITHOUT HUNGER 895 MEADOW LAND NORWALK OH 44857 5000 WEEKENDS WITHOUT HUNGER PROGRAM SHELBY CHRISTIAN & MISSIONARY CHURCH 105 E SMILEY AVE SHELBY OH 44875 341354574 501(C)(3) 61540 FMV MISC MEDICAL AND OPERATING SUPPLIES SUPPLIES TO AID IN CARRYING OUT THE ORGANIZATION'S CHARITABLE PURPOSE 6 2 PART I, LINE 2: THE MEDICAL CENTER REVIEWS EACH GRANT OR DONATION REQUEST BEFORE IT IS MADE. X X X X X X 1 1 0 0 0 0 0 0 0 ROSS MATLACK PRESIDENT - ENDED MAY 2014 346884 0 72750 0 544 0 17252 0 25073 0 462503 0 0 0 LORNA STRAYER PRESIDENT/EXECUTIVE VICE PRESIDENT 270407 0 57540 0 992 0 78297 0 16730 0 423966 0 0 0 DUANE WOODS SENIOR VP OF FINANCE & CFO 217909 0 65521 0 516 0 37349 0 18459 0 339754 0 0 0 CHERIE M SPRAGG VP POPULATION HEALTH 165288 0 38212 0 18695 0 67532 0 9235 0 298962 0 0 0 PHILLIP J ANNARINO VP HUMAN RESOURCES 167112 0 51144 0 1112 0 31140 0 23736 0 274244 0 0 0 JOHN BRITTON VP INFORMATION SERVICES 171256 0 34020 0 249 0 16653 0 0 0 222178 0 0 0 GEORGE B ELMER VP STRATEGIC PLANNING AND BUSINESS D 166110 0 22186 0 1095 0 8962 0 23122 0 221475 0 0 0 SUZANNE S INGLIS SENIOR VP OF NURSING SERVICES 169876 0 17500 0 3246 0 29627 0 8990 0 229239 0 0 0 DR SHANKAR KURRA SENIOR VP MEDICAL AFFAIRS 275370 0 34731 0 695 0 40618 0 21113 0 372527 0 0 0 MITCH ESCH DIRECTOR OF PHARMACY 149912 0 10526 0 1386 0 69866 0 16480 0 248170 0 0 0 SCOTT P STEINMETZ DIRECTOR OF INFORMATION SV 132083 0 11317 0 397 0 7608 0 8440 0 159845 0 0 0 SHARON HARWOOD DIRECTOR COPORATE COMPLIANCE 120271 0 8247 0 384 0 27021 0 14230 0 170153 0 0 0 JOHN D OVERMYER ASSISTANT DIRECTOR, PHARMACY 128522 0 1040 0 1129 0 48768 0 271 0 179730 0 0 0 LORI LILL ASSISTANT VP. CLINICAL SERVICES 123323 0 8575 0 747 0 33429 0 12906 0 178980 0 0 0 PATRICK J MARTIN SENIOR ADVISOR TO PRESIDENT 129817 0 78683 0 23333 0 13409 0 17200 0 262442 0 0 0 SCHEDULE J PART 1 PART I LINE 4A & PART II LINE 1: INCLUDED IN MR. MATLACK'S TOTAL W-2 COMPENSATION OF $420,178 IS $208,013 WHICH REPRESENTS THE PORTION OF HIS SALARY IN HIS CAPACITY AS PRESIDENT AND CEO WHICH ENDED ON MAY 30, 2014 AND $212,165 AS PART OF HIS SEVERANCE PAY WHICH WILL BE PAID OVER 24 MONTHS. PART I LINE 4B: INCLUDED IN MS. STRAYER'S TOTAL W-2 COMPENSATION OF $328,939 IS $205,504 WHICH REPRESENTS THE PORTION OF HER SALARY IN HER CAPACITY AS PRESIDENT AND CEO WHICH STARTED JUNE-2014 AND $123,435 IN HER CAPACITY AS EXECUTIVE VICE PRESIDENT DURING THE FIRST HALF OF THE YEAR. INCLUDED IN THE TOTAL CONTRIBUTIONS TO DEFERRED COMPENSATION OF $78,297 IN COLUMN C IS $46,752 OF VESTED DEFERRED WAGES AND QUALIFIED RETIREMENT PLAN CONTRIBUTIONS AND $31,545 FOR THE CURRENT YEAR ACCRUAL OF A NON-VESTED, NON-QUALIFIED RETIREMENT PLAN. THIS PLAN PROVIDES AN ADDITIONAL RETIREMENT BENEFIT BASED ON YEARS OF ELIGIBLE SERVICE AND VESTED STATUS AND REMAINS SUBJECT TO SUBSTANTIAL RISK OF FORFEITURE. PART I LINE 4B & PART II, LINE 3: INCLUDED IN MR. WOOD'S TOTAL CONTRIBUTION TO DEFERRED COMPENSATION OF $37,349 IN COLUMN C IS $14,128 OF DEFERRED WAGES AND QUALIFIED RETIRMENT PLAN CONTRIBUTIONS AND $23,221 FOR THE CURRENT YEAR ACCRUAL OF NON-VESTED NON-QUALIFIED RETIREMENT PLAN. THIS PLAN PROVIDES AN ADDITIONAL RETIREMENT BENEFIT BASED ON YEARS OF ELIGIBLE SERVICE AND VESTED STATUS AND REMAINS SUBJECT TO A SUBSTANTIAL RISK OF FORFEITURE. PART I LINE 4B & PART II, LINE 9 - INCLUDED IN MR. KURRA'S TOTAL CONTRIBUTIONS TO DEFERRED COMPENSATION OF $40,618 IN COLUMN C IS $10,537 OF DEFERRED WAGES AND QUALIFIED RETIREMENT PLAN CONTIRBUTIONS AND $30,081 FOR THE CURRENT YEAR ACCRUAL OF A NON VESTED, NON-QUALIFIED RETIREMENT PLAN. THIS PLAN PROVIDES AN ADDITIONAL RETIREMENT BENEFIT BASED ON YEARS OF ELIGIBLE SERVICE AND VESTED STATUS REMAINS SUBJECT TO A SUBSTANTIAL RISK OF FORFEITURE. PART I LINE 4B & PART II, LINE 5 - INCLUDED IN MR. ANNARINO'S TOTAL CONTRIBUTIONS TO DEFERRED COMPENSATION OF $31,140 IN COLUMN C IS $12,922 OF DEFERRED WAGES AND QUALIFIED RETIREMENT PLAN CONTRIBUTIONS AND $18,218 FOR THE CURRENT YEAR ACCRUAL OF A NON-VESTED NON-QUALIFIED RETIREMENT PLAN. THIS PLAN PROVIDES AN ADDITIONAL RETIREMENT BENEFIT BASED ON YEARS OF ELIGIBLE SERVICE AND VESTED STATUS REMAINS SUBJECT TO A SUBSTANTIAL RISK OF FORFEITURE. PART I LINE 4B & PART II, LINE 8 - INCLUDED IN MS INGLIS'S TOTAL CONTRIBUTIONS TO DEFERRED COMPENSATION OF $29,627 IN COLUMN C IS $11,475 OF DEFERRED WAGES AND QUALIFIED RETIREMENT PLAN CONTRIBUTIONS AND $18,152 FOR THE CURRENT YEAR ACCRUAL OF A NON-VESTED NON-QUALIFIED RETIREMENT PLAN. THIS PLAN PROVIDES AN ADDITIONAL RETIREMENT BENEFIT BASED ON YEARS OF ELIGIBLE SERVICE AND VESTED STATUS REMAINS SUBJECT TO AN SUBSTANTIAL RISK OF FORFEITURE. PART 1 LINE 3 - RESPONSIBILITY FOR DETERMINING AND RECOMMENDING EXECUTIVE COMPENSATION RESTS WITH THE JOINT PERSONNEL COMMITTEE OF THE FISHER-TITUS MEDICAL CENTER AND NORWALK AREA HEALTH SYSTEMS, INC. BOARDS. THE COMMITTEE RETAINS AN INDEPENDENT EXECUTIVE COMPENSATION CONSULTANT TO ESTABLISH CASH COMPENSATION TARGET RANGES AND IDENTIFY REASONABLE AND CUSTOMARY BENEFIT PROGRAMS FOR EXECUTIVES. THE INDEPENDENT CONSULTANT REPORTS TO THE JOINT PERSONNEL COMMITTEE ON RELEVANT PEER GROUPS, CASH COMPENSATION REPORTED IN AVAILABLE SURVEYS FOR THE PEER GROUP AND TRENDS IN BENEFITS AND PERQUISITE PROGRAMS CUSTOMARILY AVAILABLE AMONG THE PEER GROUP FOR EXECUTIVES. RECOMMENDATIONS BY THE CONSULTANT ARE PRESENTED TO THE JOINT PERSONNEL COMMITTEE WHICH PREPARES MINUTES OF ITS DELIBERATIONS REGARDING EXECUTIVE COMPENSATION INCLUDING RECOMMENDATIONS THAT ARE PROVIDED TO EACH OF THE DIRECTORS OF FTMC AND NAHS. THE RECOMMENDATIONS TO BE ACTED ON MUST BE APPROVED FIRST BY THE JOINT PERSONNEL COMMITTEE AND THEN BY THE MEDICAL CENTER'S BOARD OF DIRECTORS BEFORE FINALLY BEING CONSIDERED BY THE SYSTEM'S BOARD OF DIRECTORS. THE MINUTES OF EACH BOARD MEETING WHERE ACTION IS TAKEN REFLECT SUCH ACTION. THE PROCESS IS PERFORMED ANNUALLY IN THE SPRING AND WAS LAST DONE IN MAY 2014. A COUNTY OF HURON OHIO 346400672 447540CC7 2007-06-28 28622597 SEE PART VI BELOW 0 0 0 B COUNTY OF HURON OHIO 346400672 447540BN4 2003-01-08 30000000 SEE PART VI BELOW 0 0 0 A 28838308 564200 7215711 21058397 2008 1 0 1 1 B 30714144 524983 263425 27308799 2616937 2005 1 0 1 1 A 0 0 0 1 1 0 0 0 B 0 0 0 1 1 0 0 0 A 0 0 1 0 0 0 0 0 1 B 0 0 1 0 1 0 0 0 1 A 0 B 0 PART I, LINE A SERIES 2007A BONDS - PURPOSE WAS TO ACQUIRE, CONSTRUCT AND INSTALL A VASCULAR HEART ADDITION TO THE HOSPITAL'S MAIN CAMPUS AS WELL AS SUPPORT SERVICES AND THE RENOVATION OF THE EXISTING EMERGENCY ROOM. PART I, LINE B SERIES 2003A BONDS - PURPOSE WAS TO ACQUIRE, CONSTRUCT AND INSTALL A MULTI-STORY ADDITION TO THE HOSPITAL'S MAIN CAMPUS DEVOTED TO INPATIENT SERVICES AS WELL AS SUPPORT SERVICES AND THE RENOVATION OF SEVERAL AREAS OF THE EXISTING FACILITY. PART II, LINE 3, COLUMN A INCLUDED IN THE TOTAL PROCEEDS OF $28,838,308 IS INVESTMENT EARNINGS OF $215,711. PART II, COLUMN B, LINE 3 INCLUDED IN THE TOTAL PROCEEDS OF $30,714,144 IS INVESTMENT EARNINGS OF $714,144. PART II, LINE 11, COLUMN A $21,058,397 OF THE PROCEEDS WERE USED TO REFUND THE HOSPITAL'S COUNTY OF HURON REVENUE BONDS, SERIES 1996B AND A PORTION OF SERIES 2003A BONDS. PART II, COLUMN B, LINE 11 $2,616,937 OF THE PROCEEDS WERE USED TO REFUND THE HOSPITAL'S COUNTY OF HURON REVENUE BONDS, SERIES 1995A BONDS. MRS JOHN BRITTON SPOUSE OF KEY EMPLOYEE 50987 EMPLOYMENT 0 BAYLESS PATHMARK SEE PART V 130115 INDEPENDENT CONTRACTOR 0 MS SCHWAB FAMILY MEMBER OF OFFICER, LORNA STRAYER 68227 EMPLOYMENT 0 MS RILEY FAMILY MEMBER OF DIRECTOR, MATT GROSS 51249 EMPLOYMENT 0 BATTLES INSURANCE AGENCY SEE PART V 763275 VENDOR 0 PART IV PART IV LINE 2 - DR. WILLIAM CORNELL, BOARD MEMBER IS AN EMPLOYED PHYSICIAN OF BAYLESS PATHMARKPART IV LINE 3 - MS. SCHWAB HAS A FAMILY RELATIONSHIP WITH OFFICER LORNA STRAYERPART IV LINE 4 - MS. RILEY HAS A FAMILY RELATIONSHIP, WITH A BOARD MEMBER MATT GROSSPART IV LINE 5 - PERRY DRYDEN, BOARD MEMBER IS PRESIDENT OF BATTLES INSURANCE AGENCY AND 50% OWNER. X 1 26857 FAIR MARKET VALUE X BUILT-IN GRILL 1 3548 FAIR MARKET VALUE 0 1 0 FORM 990, PART III, LINE 4A STATEMENT OF PROGRAM SERVICE ACCOMPLISHMENTS FISHER-TITUS MEDICAL CENTER (FTMC) IS AN INDEPENDENT NON-PROFIT COMMUNITY HEALTHCARE ORGANIZATION GOVERNED BY A BOARD OF DIRECTORS COMPOSED OF AREA RESIDENTS INCLUDING BUSINESS AND COMMUNITY LEADERS, PHYSICIANS AND OTHER INTERESTED INDIVIDUALS. FTMC IS COMPOSED OF THE FOLLOWING FOUR OPERATING DIVISIONS: FISHER-TITUS MEMORIAL HOSPITAL THE HOSPITAL PROVIDES INPATIENT AND OUTPATIENT HEALTHCARE SERVICES TO THE RESIDENTS OF HURON, ERIE AND THE ADJACENT COUNTIES OF SANDUSKY, CRAWFORD, LORAIN, ASHLAND AND RICHLAND. IN 2014, THE HOSPITAL PROVIDED 13,248 DAYS OF INPATIENT CARE TO 3,591 PATIENTS. THE HOSPITAL ALSO PROVIDED 88,470 PATIENTS WITH 134,478 OUTPATIENT AND 27,856 EMERGENCY ROOM VISITS DURING THE YEAR. THE NORWALK MEMORIAL HOME THE NORWALK MEMORIAL HOME PROVIDES SKILLED AND LONG-TERM CARE IN ITS TRANSITIONAL AND EXTENDED CARE UNITS. DURING 2014, THE HOME SERVED 394 RESIDENTS AND PROVIDED 23,595 DAYS OF CARE. THE HOME HEALTH CENTER HOME HEALTH AGENCY THE HOME HEALTH CENTER PROVIDED 15,328 HOME VISITS TO 310 DIFFERENT PATIENTS IN 2014. THE CARRIAGE HOUSE OF FISHER-TITUS OPENED IN 1998, THE CARRIAGE HOUSE IS A 48-UNIT ASSISTED LIVING FACILITY, WHICH PROVIDED 16,606 DAYS OF ASSISTED LIVING CARE TO 55 RESIDENTS IN 2014. PROGRAM EXPANSIONS, IMPROVEMENTS, AND ACCREDITATIONS RANKED MOST WIRED AND TOPS IN SAFETY FOR THIRD CONSECUTIVE YEAR IN 2014 FISHER-TITUS WAS NAMED ONE OF HEALTHCARE'S TOP 100 MOST WIRED U.S. HOSPITALS FOR THE THIRD CONSECUTIVE YEAR. THE AWARD RECOGNIZES FISHER-TITUS FOR ITS ACCOMPLISHMENTS AS THE NATION'S FIRST ALL-DIGITAL SMART COMMUNITY HOSPITAL AND CONTINUED ADVANCEMENTS IN PATIENT-FOCUSED TECHNOLOGY AIMED AT PROVIDING THE HIGHEST LEVEL OF CLINICAL QUALITY, PATIENT SAFETY, AND COORDINATION OF CARE. FISHER-TITUS ALSO EARNED AN A-PLUS GRADE FOR THE THIRD YEAR IN A ROW FOR PATIENT SAFETY BY THE NATIONAL INDEPENDENT RANKING ORGANIZATION, THE LEAPFROG GROUP. ELECTRONIC MEDICAL RECORDS - FISHER TITUS MEDICAL CENTER ALSO IS RANKED AT HIMSS LEVEL 6 (THE HIGHEST LEVEL BEING LEVEL 7) FOR ELECTRONIC MEDICAL RECORD (EMR) ADOPTION BY THE HEALTH INFORMATION AND MANAGEMENT SYSTEMS SOCIETY. A MAJOR FOCUS FOR 2014 WAS TO CONTINUE TO GROW THE PATIENT PORTAL AND PREPARE FOR ICD 10. FACILITY AND PROGRAM EXPANSIONS THE $16 MILLION SURGERY EXPANSION PROJECT, WHICH BEGAN IN MARCH 2013, IS ONE OF THE MOST COMPLEX CONSTRUCTION PROJECTS TO-DATE AT FISHER-TITUS. THERE ARE TWO REASONS FOR THAT: THE DEPARTMENT IS LOCATED IN THE CENTER OF THE OLDER PART OF THE FACILITY AND SURGERIES AND OTHER PROCEDURES MUST CONTINUE WHILE UNDER CONSTRUCTION. PHASE 1, WHICH INCLUDED A NEW SURGERY SEATING AREA, TWO NEW ORS, SURGERY CONTROL ROOM, STERILE PROCESSING AND FROZEN SECTION AREAS, WAS COMPLETED IN 2013. THE PROJECT IS SCHEDULED TO BE FULLY COMPLETED IN APRIL OF 2015. FISHER-TITUS MEDICAL CENTER'S $2.4 MILLION NORTH SIDE MEDICAL OFFICE AT 368 MILAN AVENUE OPENED IN FALL 2014 AND INCLUDES AN 11,762-SQUARE-FOOT MEDICAL OFFICE BUILDING WHICH HOUSES NORTHERN OHIO FOOT & ANKLE SPECIALISTS, LLC; FISHER-TITUS INDUSTRIAL HEALTH SERVICES; FISHER-TITUS CONVENIENT CARE; OUTPATIENT LABORATORY SERVICES AND PHYSICAL THERAPY SERVICES. THE NEW FACILITY ADDS MUCH CONVENIENCE TO RESIDENTS IN THE NORTHERN PART OF THE FISHER-TITUS SERVICES AREA. FISHER-TITUS MEDICAL CARE, LLC EMPLOYED PROVIDER GROUP CONTINUED TO GROW IN 2014. FISHER-TITUS MEDICAL CARE, LLC SPECIALTIES INCLUDE FAMILY MEDICINE WITH SAME-DAY APPOINTMENTS, INTERNAL MEDICINE, GENERAL SURGERY, BEHAVIORAL HEALTH, PULMONARY MEDICINE, CONVENIENT CARE AND HOSPITALISTS (PHYSICIANS WHO CARE FOR PATIENTS WHILE THEY ARE IN THE HOSPITAL). TWENTY-SEVEN PHYSICIANS AND ALLIED HEALTH PROFESSIONALS SERVED PATIENTS IN 2014. FISHER-TITUS MEDICAL CARE, LLC PHYSICIANS ARE MEMBERS OF THE 90-MEMBER FISHER-TITUS MEDICAL STAFF REPRESENTING 24 MEDICAL SPECIALTIES. EDUCATION AND RESEARCH - TO ENSURE THAT WE HAVE THE QUALITY WORKFORCE WE NEED TO CARE FOR OUR COMMUNITY IN THE FUTURE, WE ARE COMMITTED TO THE EDUCATION OF CURRENT AND FUTURE CAREGIVERS, AND WE WORK WITH EHOVE CAREER CENTER, ASHLAND UNIVERSITY, BOWLING GREEN STATE UNIVERSITY FIRELANDS CAMPUS, LORAIN COUNTY COMMUNITY COLLEGE, NORTH CENTRAL STATE COLLEGE, TERRA COMMUNITY COLLEGE, THE OHIO STATE UNIVERSITY, AND OHIO UNIVERSITY TO PROVIDE INTERNSHIPS, INSTRUCTORS, CLASSROOM SPACE, AND CLINICAL TRAINING. WE ARE PLEASED TO BE ABLE TO OFFER A COMPREHENSIVE LEARNING EXPERIENCE UTILIZING OUR STATE-OF-THE-ART FACILITIES AND ADVANCED TECHNOLOGY. EXCELLENT PHYSICIANS: IN 2014, 34 NEW MEMBERS WERE ADDED TO THE FISHER-TITUS MEDICAL STAFF. THE MEDICAL STAFF IS COMPOSED OF BOTH INDEPENDENT PRACTITIONERS AS WELL AS PHYSICIANS AND PROVIDERS EMPLOYED BY FISHER-TITUS MEDICAL CARE, LLC. THE MEDICAL CARE GROUP GREW TO 27 PROVIDERS REPRESENTING FAMILY MEDICINE, INTERNAL MEDICINE, BEHAVIORAL HEALTH, GENERAL SURGERY, PULMONARY MEDICINE AND WOMEN'S HEALTH. FISHER-TITUS ACTIVELY RECRUITS SPECIALISTS TO SERVE THE NEEDS OF THE SERVICE AREA. JOINING THE MEDICAL CARE TEAM IN 2014 WERE: AMY WILBER, D.O., OBSTETRICS & GYNECOLOGY; TARA KERSEY-BARRETT, D.O., FAMILY MEDICINE; JESSICA RAPP, D.O., FAMILY MEDICINE; MICHAEL NILL, M.D., GENERAL SURGERY; MOHAMED SWEDEH, M.D., PULMONARY MEDICINE; RACHEL VELISHEK, LPCC, BEHAVIORAL HEALTH; SARA BELDON, CNP, CONVENIENT CARE; AND HOSPITALISTS DIANA RODRIGUEZ, CNP; HASAN AMIR, M.D.; KRISTEN GENNARI, M.D.; MBANEFO OJUKWU, M.D.; MOHAMAD SAAB, D.O.; PATRICK BRESLIN, D.O.; RENEE OSBORN, CNP; AND TIMOTHY MUMMERT, D.O. AWARDS AND ACCREDITATIONS - THROUGHOUT THE YEARS FISHER-TITUS HAS BEEN HIGHLY SUCCESSFUL IN MEETING THE CHALLENGES OF AN INCREASINGLY COMPLEX HEALTH-CARE INDUSTRY AND HAS PROVIDED EXCEPTIONAL SERVICE QUALITY TO MEMBERS OF THE SURROUNDING COMMUNITIES. FISHER-TITUS IS ACCREDITED BY THE HEALTHCARE FACILITIES ACCREDITATION PROGRAM (HFAP), IS A LEVEL 3 TRAUMA CENTER, PRIMARY STROKE CENTER, AND A FULLY ACCREDITED CHEST PAIN CENTER. IN 2014, FOR THE THIRD CONSECUTIVE YEAR, FISHER-TITUS EARNED AN A HOSPITAL SAFETY SCORE BY THE LEAPFROG GROUP ON ITS NATIONAL REPORT CARD ON PREVENTABLE MEDICAL ERRORS, INJURIES, ACCIDENTS, AND INFECTIONS. ALSO, IN 2014, FISHER-TITUS RECEIVED HEALTH CARE'S MOST WIRED HOSPITAL FOR THE THIRD YEAR IN A ROW. THE MEDICAL CENTER'S FOCUS ON QUALITY CARE AND EXCEPTIONAL SERVICE IS EVIDENCED BY THE MANY HOSPITAL AND DEPARTMENTAL ACCREDITATIONS, AWARDS, AND RECOGNITIONS RECEIVED IN 2014: * HEALTHCARE FACILITIES ACCREDITATION PROGRAM * A+ RANKING BY THE LEAPFROG GROUP * HEALTHCARE'S MOST WIRED AWARD * FULLY ACCREDITED CHEST PAIN CENTER/AMERICAN COLLEGE OF CHEST PAIN CENTER * COMMISSION ON CANCER ACCREDITATION WITH COMMENDATIONS * OHIO DEPARTMENT OF HEALTH MAMMOGRAPHY QUALITY STANDARDS * AMERICAN COLLEGE OF RADIOLOGY ACCREDITATION FOR DIGITAL MAMMOGRAPHY * AMERICAN ASSOCIATION OF RESPIRATORY CARE, QUALITY RESPIRATORY CARE AWARD * AMERICAN DIABETES ASSOCIATION EDUCATION RECOGNITION CERTIFICATE * LABORATORY SERVICES CAP ACCREDITATION * BLOOD GAS LABORATORY CAP ACCREDITATION COMMUNITY HEALTH AND OUTREACH PROGRAMS FISHER-TITUS MEDICAL CENTER'S COMMUNITY BENEFITS EXTEND OUTSIDE OUR WALLS TO FAMILIES, BUSINESS, SCHOOLS, CHURCHES AND NEIGHBORHOODS THROUGH OUTREACH PROGRAMS AND OTHER COORDINATED CARE ACTIVITIES THAT MAKE OUR COMMUNITIES HEALTHIER PLACES TO LIVE, WORK AND WORSHIP. OUR GOAL IS TO HELP ALL RESIDENTS EQUALLY ACCESS THE CARE THEY NEED, AND HELP THEM LEARN TO MANAGE THEIR CONDITIONS AND LIVE HEALTHIER, SAFER LIVES. IN 2014 A NEW HURON COUNTY HEALTH NEEDS ASSESSMENT WAS COMPLETED AND PUBLISHED. FISHER-TITUS WAS A LEADER IN THE PROCESS AND PARTNERED WITH HEALTH-RELATED AND CIVIC ORGANIZATIONS THROUGHOUT THE COUNTY TO BOTH FUND THE PROJECT AND ASSIST IN THE ASSESSMENT PROCESS. FROM THAT REPORT, THE BOARD OF DIRECTORS OF FISHER-TITUS MEDICAL CENTER DETERMINED THAT CERTAIN HEALTH NEEDS IDENTIFIED IN THE ASSESSMENT SHOULD BE ADDRESSED AS THE HIGHEST PRIORITY THROUGH AN IMPLEMENTATION STRATEGY. THE PRIORITIES INCLUDE: SUPPORTING INITIATIVES GEARED TO HEALTHY WEIGHT; IMPROVING ACCESS TO MENTAL HEALTH SERVICES; REDUCING SUBSTANCE ABUSED THROUGH PREVENTION, SCREENING AND TREATMENT; IMPROVING ACCESS TO CARE; AND IMPROVING THE PUBLIC HEALTH INFRASTRUCTURE. FORM 990, PART II, LINE 4A PROGRAM SERVICE ACCOMPLISHMENTS CONTINUED FISHER-TITUS SUPPORTS OTHER AREA NON-PROFIT COMMUNITY ORGANIZATIONS THAT ARE COMMITTED TO COMMUNITY HEALTH IMPROVEMENT THROUGH FINANCIAL INVESTMENTS, IN-KIND SERVICE AND EMPLOYEE VOLUNTEERISM. MANY OF OUR COMMUNITY BENEFIT PROGRAMS ARE ORGANIZED TO WORK COLLABORATIVELY WITH COMMUNITY GROUPS, SCHOOLS AND GOVERNMENT ORGANIZATIONS TO EFFECTIVELY LEVERAGE RESOURCES AND ADDRESS IDENTIFIED COMMUNITY NEEDS. IN 2014, WE OFFERED COMMUNITY HEALTH EDUCATION PROGRAMS, INCLUDING SCHOOL-BASED PROGRAMS, SUPPORT GROUPS, COMMUNITY-BASED HEALTH FAIRS AND SCREENINGS, AND WALKING AND FITNESS PROGRAMS THAT IMPACTED OUR RESIDENTS THROUGH 63,953 ENCOUNTERS. AUXILIARY AND VOLUNTEER SERVICE: - DURING 2014, OUR 182 CARING VOLUNTEERS DONATED 42,681 HOURS OF AUXILIARY AND VOLUNTEER SERVICES TO THE MEDICAL CENTER. VOLUNTEERS PROVIDE A VARIETY OF SERVICES INCLUDING HELPING FAMILY MEMBERS, PROVIDING TRANSPORTATION, ASSISTING AT COMMUNITY HEALTH PROGRAMS, DELIVERING REFRESHMENTS, MAIL AND FLOWERS TO HOSPITAL PATIENTS AND RESIDENTS OF THE NORWALK MEMORIAL HOME PLUS ESCORTING PATIENTS THROUGHOUT THE BUILDING. THEY ALSO PERFORM CLERICAL DUTIES, STAFF THE MEDICAL CENTER'S GIFT SHOP AND ORGANIZE SEVERAL FUND-RAISING EVENTS THROUGHOUT THE YEAR. VOLUNTEER "AMBASSADORS" HAVE INSTRUCTED PATIENTS SINCE APRIL, 2010 ON THE USE OF THE TELEVISION/COMPUTER SCREENS LOCATED IN EACH PATIENT ROOM. VOLUNTEERS WORKING IN THIS CAPACITY ARE AT FISHER-TITUS MEDICAL CENTER SEVEN DAYS PER WEEK EACH MORNING FOR 2 HOURS. AMONG THE ITEMS PATIENTS ARE INSTRUCTED ON ARE HOW TO ACCESS THE DAY'S MENU, MEDICAL INFORMATION PERTAINING TO THE PERSON'S HEALTH PROBLEMS, ACCESSING THE INTERNET, PLAYING GAMES, OBTAINING THE NAMES OF CAREGIVERS AS THEY ENTER THE PATIENT'S ROOM, CHOOSING MOVIES, ETC. THE PATIENT THEN MAY USE A REMOTE CONTROL OR A WIRELESS KEYBOARD TO ACCESS THIS INFORMATION. INFORMATION SERVICES PROVIDES ALL COMPUTER TRAINING FOR VOLUNTEERS THAT WORK IN THIS CAPACITY. COMMUNITY HEALTH IMPROVEMENT SERVICES: NUMEROUS HEALTH SCREENINGS ARE OFFERED THROUGHOUT THE YEAR AT THE MEDICAL CENTER AND AT VARIOUS COMMUNITY LOCATIONS AND EVENTS THROUGHOUT OUR SERVICE AREA. THESE PROGRAMS INCLUDE SCREENING FOR BLOOD PRESSURE, BLOOD GLUCOSE, CHOLESTEROL LEVELS, SKIN CANCER, PROSTATE CANCER, OSTEOPOROSIS AND SCREENING MAMMOGRAMS. IN ADDITION, THE MEDICAL CENTER SPONSORS NUMEROUS SUPPORT GROUPS TO PROVIDE EDUCATION, CARE AND EMOTIONAL SUPPORT TO INDIVIDUALS AND FAMILIES AFFECTED BY DISABILITIES AND CHRONIC MEDICAL CONDITIONS. FTMC'S HEALTH MINISTRY PROGRAM, FORMED IN 2000, HAS BEEN A VERY EFFECTIVE GRASSROOTS INITIATIVE TO GATHER INFORMATION AND PROVIDE HEALTH PROGRAMS THROUGHOUT HURON COUNTY. CURRENTLY 50 AREA CONGREGATIONS ARE MEMBERS OF THE FTMC HEALTH MINISTRY PROGRAM WHICH PROVIDES HEALTH AND WELLNESS INFORMATION AND PROGRAMS IN AREA CHURCHES. THE MEDICAL CENTER IN PARTNERSHIP WITH ITS PHYSICIANS AND OTHER COMMUNITY ORGANIZATIONS PROVIDES PUBLIC FORUMS AND EDUCATIONAL SESSIONS ON A VARIETY OF TOPICS, WHICH ARE SOMETIMES HELD IN TANDEM WITH THE HEALTH SCREENINGS PROVIDED. WE ALSO PROVIDE NUMEROUS HEALTH FAIRS DURING THE YEAR IN SEVERAL LOCATIONS THROUGHOUT THE COUNTY AND SURROUNDING COMMUNITIES IN OUR SERVICE AREA. THESE COMMUNITY HEALTH IMPROVEMENT SERVICES BENEFITED 62,943 PEOPLE IN 2014 AT A COST OF $824,011. PROFESSIONAL MEDICAL EDUCATION: THE MEDICAL CENTER SUPPORTS THE FAMILY PRACTICE RESIDENCY PROGRAM AT FIRELANDS REGIONAL MEDICAL CENTER TO ENHANCE THE AVAILABILITY OF FAMILY PRACTICE PHYSICIANS WITHIN THE LOCAL COMMUNITY. FTMC FUNDS THE COST OF A FAMILY PRACTICE RESIDENT THAT SHARES TIME BETWEEN THE HOSPITAL'S EMERGENCY ROOM AND THE COUNTY HEALTH DEPARTMENT CARING FOR THE UNDERSERVED. IN ADDITION, FTMC SUPPORTS AND STAFFS SEVERAL CLASSES FOR HEALTH PROFESSIONALS INCLUDING HEALTHCARE PROVIDER CPR, ADVANCED CARDIAC LIFE SUPPORT, BASIC LIFE SUPPORT INSTRUCTOR COURSE AND PEDIATRIC ADVANCE LIFE SUPPORT. THE TOTAL COST OF PROFESSIONAL MEDICAL EDUCATION PROVIDED TO 241 PARTICIPANTS WAS $132,829. SUBSIDIZED HEALTH SERVICES: THE MEDICAL CENTER ALSO SUBSIDIZES CERTAIN HEALTH SERVICES AND PROCESSES IN ORDER TO ADDRESS SPECIFIC HEALTH ISSUES IN THE COMMUNITY, PROVIDE CARE TO THE UNDERSERVED, OR ENHANCE THE OVERALL QUALITY OF HEALTHCARE WITHIN THE COMMUNITY. ALSO, THE MEDICAL CENTER SUBSIDIZED THE COST OF ELECTRONIC MEDICAL RECORD SOFTWARE USED BY PHYSICIANS IN OUR SERVICE AREA. THE SOFTWARE ENHANCES THE ACCURACY AND SPEED OF MEDICAL INFORMATION AVAILABLE TO HEALTHCARE PROVIDERS WITHIN THE AREA AND TO ASSIST THE COMMUNITY IN MOVING TOWARD A REGIONAL HEALTH INFORMATION DATABASE. THE COST ASSOCIATED WITH THE HEALTH SERVICES AND ELECTRONIC MEDICAL RECORDS SYSTEM IN 2014 WAS $815,019. DONATIONS AND COMMUNITY SUPPORT: THE MEDICAL CENTER MAKES CASH AND NON-CASH CONTRIBUTIONS ANNUALLY TO LOCAL NON-PROFIT ORGANIZATIONS THAT BENEFIT THE HEALTH AND DEVELOPMENT OF OUR LOCAL COMMUNITY AND ITS RESIDENTS. IN ADDITION, THE MEDICAL CENTER SUPPORTS AREA SCHOOLS BY AWARDING SPECIAL HEALTH EDUCATION GRANTS TO SCHOOL DISTRICTS IN OUR SERVICE TERRITORY TO FUND INNOVATIVE PROGRAMS IN THE AREAS OF SCIENCE, MATH, HEALTH AND HEALTH RELATED EDUCATION. THE TOTAL COST OF THESE DONATIONS AND SUPPORT IN 2014 WAS $307,207. PART VI, SECTION A LINE 1B INFORMATION RELATING TO FAMILY MEMBERS OF SOME OF THE ORGANIZATION'S GOVERNING BODY COMPENSATED BY THE ORGANIZATION OR INVOLVED IN BUSINESS TRANSACTIONS WITH THE ORGANIZATION IS INCLUDED IN PART IV OF SCHEDULE L, TRANSACTIONS WITH INTERESTED PERSONS. HOWEVER, MEMBERS OF THE ORGANIZATION'S GOVERNING BODY ARE PROMINENT CITIZENS IN THE COMMUNITIES SERVED BY THE ORGANIZATION FOR PURPOSES OF SATISFYING THE COMMUNITY BENEFIT STANDARD ESTABLISHED BY REVENUE RULING 69-545, 1969-2 C.B. 117. FORM 990, PART VI, SECTION A, LINE 6 THE SOLE MEMBER OF FISHER-TITUS MEDICAL CENTER IS THE PARENT COMPANY NORWALK AREA HEALTH SYSTEMS, INC., AN OHIO NONPROFIT CORPORATION. FORM 990, PART VI, SECTION A, LINE 7A THE FOLLOWING POWERS ARE RESERVED EXCLUSIVELY TO THE MEMBER (NORWALK AREA HEALTH SYSTEM, INC): A) TO ELECT THE DIRECTORS OF THE CORPORATION, AND TO REMOVE THEM AT WILL OR WITHOUT CAUSE. FORM 990, PART VI, SECTION A, LINE 7B THE FOLLOWING POWERS ARE RESERVED EXCLUSIVELY TO THE MEMBER (NORWALK AREA HEALTH SYSTEM, INC): A) TO AMEND OR REPEAL THE ARTICLES OF INCORPORATION AND THE CODE OF REGULATIONS; B) TO APPROVE THE ANNUAL OPERATING AND CAPITAL BUDGETS OF THE CORPORATION; C) TO APPROVE ANY CAPITAL OR OTHER EXTRAORDINARY EXPENDITURES IN EXCESS OF THE AMOUNT PRESCRIBED FROM TIME TO TIME BY THE MEMBER, WHICH AMOUNT SHALL BE REVIEWED BY THE MEMBER ANNUALLY; D) TO APPROVE ANY BORROWING OF ANY SUM OF MONEY FOR ANY PURPOSE IN EXCESS OF THE AMOUNT PRESCRIBED FROM TIME TO TIME BY THE MEMBER, WHICH AMOUNT SHALL BE REVIEWED BY THE MEMBER ANNUALLY; E) TO APPROVE ANY MERGER OF THE CORPORATION OR ANY SALE OF SUBSTANTIALLY ALL ITS ASSETS; TO DISSOLVE OR TERMINATE THE EXSISTENCE OF THE CORPORATION AND TO DETERMINE THE DISTRIBUTION OF ASSETS UPON SUCH TERMINATION. FORM 990, PART VI, SECTION B, LINE 11 THE BOARD OF DIRECTORS OF THE FISHER-TITUS MEDICAL CENTER DELEGATED THE RESPONSIBILITY FOR THE REVIEW OF THE MEDICAL CENTER'S FORM 990, PLUS ALL REQUIRED SCHEDULES AND ATTACHMENTS, TO THE MEDICAL CENTER'S AUDIT COMMITTEE. THE MEMBERS OF THIS COMMITTEE HAVE A STRONG BACKGROUND IN ACCOUNTING, LEGAL, FINANCE, AND BUSINESS AND HAVE THE TECHNICAL EXPERTISE TO PERFORM A SUBSTANTIVE REVIEW. THE AUDIT COMMITTEE REVIEWED THE MEDICAL CENTER'S FORM 990 PRIOR TO FILING AND REPORTED TO THE MEDICAL CENTER'S BOARD OF DIRECTORS REGARDING THE RESULTS OF THEIR REVIEW. IN ADDITION, EACH MEMBER OF THE MEDICAL CENTER'S BOARD OF DIRECTORS HAD ACCESS TO A COPY OF THE FORM 990 FOR VIEWING PRIOR TO FILING VIA A SECURE INTERNET WEBSITE AND A PAPER COPY WAS AVAILABLE FOR REVIEW AT THE BOARD MEETINGS. FORM 990, PART VI, SECTION B, LINE 12C ALL OF OUR AFFILIATED CORPORATE BOARD MEMBERS ARE REQUIRED TO COMPLETE A CONFLICT OF INTEREST STATEMENT UPON JOINING THE BOARD AND ANNUALLY THROUGHOUT THEIR TENURE. THESE ARE RETAINED BY ADMINISTRATION. AREAS OF CONFLICT ARE REVIEWED AND ADDRESSED AS NECESSARY TO THE TRANSACTIONS OF THE BOARD. IF AN AREA OF CONFLICT ARISES, BOARD MEMBERS ARE EXCUSED AND PROHIBITED FROM PARTICIPATING IN THE BOARD'S DELIBERATIONS AND DISCUSSIONS REGARDING THE AREA OF CONFLICT. FORM 990, PART VI, SECTION B, LINE 15 RESPONSIBILITY FOR DETERMINING AND RECOMMENDING EXECUTIVE COMPENSATION RESTS WITH THE JOINT PERSONNEL COMMITTEE OF THE FISHER-TITUS MEDICAL CENTER AND NORWALK AREA HEALTH SYSTEMS, INC. BOARDS. THE COMMITTEE RETAINS AN INDEPENDENT EXECUTIVE COMPENSATION CONSULTANT TO HELP ESTABLISH CASH COMPENSATION TARGET RANGES AND IDENTIFY REASONABLE AND CUSTOMARY BENEFIT PROGRAMS FOR EXECUTIVES. THE INDEPENDANT CONSULTANT REPORTS TO THE JOINT PERSONNEL COMMITTEE ON RELEVANT PEER GROUPS, CASH COMPENSATION REPORTED IN AVAILABLE SALARY SURVEYS FOR THE PEER GROUP, AND TRENDS IN BENEFITS AND PERQUISITE PROGRAMS CUSTOMARILY AVAILABLE AMONG THE PEER GROUP FOR EXECUTIVES. RECOMMENDATIONS BY THE CONSULTANT ARE PRESENTED TO THE JOINT PERSONNEL COMMITTEE WHICH PREPARES MINUTES OF ITS DELIBERATIONS REGARDING EXECUTIVE COMPENSATION INCLUDING RECOMMENDATIONS THAT ARE PROVIDED TO EACH OF THE DIRECTORS OF FTMC AND NAHS. THE RECOMMENDATIONS TO BE ACTED ON MUST BE APPROVED FIRST BY THE JOINT PERSONNEL COMMITTEE AND THEN BY THE MEDICAL CENTER'S BOARD OF DIRECTORS BEFORE FINALLY BEING CONSIDERED BY THE SYSTEM'S BOARD OF DIRECTORS. THE MINUTES OF EACH BOARD MEETING WHERE ACTION IS TAKEN REFLECT SUCH ACTION. THE PROCESS IS PERFORMED ANNUALLY IN THE SPRING AND WAS LAST DONE IN MAY 2014 FORM 990, PART VI, SECTION C, LINE 19 WE ISSUE AN ANNUAL REPORT TO THE COMMUNITY THAT IS PLACED IN THE LOCAL NEWSPAPER AND ON OUR WEBSITE THAT PROVIDES OUR OPERATING FINANCIAL STATEMENT, COMMUNITY BENEFIT FIGURES BROKEN DOWN BY CHARITY CARE & FINANCIAL ASSISTANCE, UPAID COSTS OF MEDICAID, COMMUNITY HEALTH & OUTREACH PROGRAMS, DONATIONS & COMMUNITY SUPPORT, SUBSIDIZED HEALTH SERVICES & PROFESSIONAL MEDICAL EDUCATION, & UNPAID COSTS OF MEDICARE & BAD DEBT. AS REQUIRED, WE OFFER A TIMELY RESPONSE TO WRITTEN REQUESTS FOR COPIES OF THE 990S AS WELL AS HAVING THE 990S AVAILABLE UPON THE PREMISES FOR THE PUBLIC TO REVIEW AND ON THE GUIDESTAR INTERNET WEBSITE. ADDITIONALLY, OUR CONFLICT OF INTEREST POLICY, CODE OF REGULATIONS, AND GOVERNING DOCUMENTS ARE ALSO AVAILABLE UPON WRITTEN REQUEST. FORM 990, PART XI, LINE 9: FASB #158 ADJUSTMENT (CHANGE IN PENSION LIABILTIY) -7,958,173. TRANSFER OF FUNDS TO AFFILIATED ORGANIZATION, NORWALK AREA HEALTH SYSTEMS -500,000. PAIN MANAGEMENT JOINT VENTURE DIVIDNED PAYMENTS TO FISHER-TITUS MEDICAL CTR 728,197. INTERTRANSFER OF FUNDS BETWEEN AFFLIATED 501(C)(3) ORGANIZATIONS -4,341,755. FTMC HOLDING 265 LLC 265 BENEDICT AVENUE NORWALK OH 44857 344430716 REAL ESTATE OH 48577 1107308 FISHER TITUS MEDICAL CENTER NORTH CENTRAL HOLDING LLC 272 BENEDICT AVENUE NORWALK OH 44857 344430716 REAL ESTATE OH 0 0 FISHER TITUS MEDICAL CENTER NORWALK AREA HEALTH SYSTEMS 272 BENEDICT AVENUE NORWALK OH 44857 341476935 SYSTEM PARENT OH 501(C)(3) LINE 11C, III-FI N/A 0 FISHER-TITUS FOUNDATION 272 BENEDICT AVENUE NORWALK OH 44857 341476937 FOUNDATION OH 501(C)(3) LINE 7 NORWALK AREA HEALTH SYSTEMS 0 NORWALK AREA HEALTH SERVICES 272 BENEDICT AVENUE NORWALK OH 44857 341476934 AMBULANCE OH 501(C)(3) LINE 9 NORWALK AREA HEALTH SYSTEMS 0 FISHER-TITUS PAIN MANAGEMENT LLC 272 BENEDICT AVENUE NORWALK OH 44857 271471272 PAIN MANAGEMENT OH FISHER TITUS MEDICAL CENTER RELATED 815986 709803 0 0 0.51000 HEALTH PROMOTIONS OF NORWALK 272 BENEDICT AVENUE NORWALK OH 44857 341502102 SUPPORT PROF. 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