2015-11-10T12:44:28-06:00 2014-12-31 351178661 BLUE & CO LLC 8800 LYRA DRIVE SUITE 450 COLUMBUS OH 43240 990 2014-01-01 310650283 MCCULLOUGH-HYDE MEMORIAL HOSPITAL MCCU 5135245310 110 NORTH POPLAR STREET OXFORD OH 45056 BRYAN HEHEMANN CEO 5135245310 2015-11-09 1 NANCY KIRCHNER P00386751 6148852583 2015-11-09 2014 2016-03-07 17:11:31Z BRYAN HEHEMANN 110 NORTH POPLAR STREET OXFORD OH 45056 59059203 0 X WWW.MHMH.ORG X 1953 OH ACUTE CARE HOSPITAL FACILITY DELIVERING QUALITY SERVICES TO OUR PATIENTS AND THE COMMUNITIES WE SERVE. 10 10 638 230 101428 -50321 319340 1161989 60187052 56885046 32371 -38462 2075373 918584 62614136 58927157 17800 29350 0 0 28295900 29441661 0 0 0 34089514 30501297 62403214 59972308 210922 -1045151 43437362 38544327 19401702 15666789 24035660 22877538 X ACUTE CARE HOSPITAL FACILITY DELIVERING QUALITY SERVICES TO OUR PATIENTS AND THE COMMUNITIES WE SERVE. 0 0 5401519 25986706 SURGERY-IS COMPRISED OF SURGERY, AND ENDO/MINOR PROCEDURES. TOTAL VOLUME IS 4,862 CONSISTING OF IP CARE (14%) AND OUTPATIENT CARE (86%). 5058516 12129070 INPATIENT CARE INPATIENT VOLUME CONSISTED OF 2,008 DISCHARGES AND 6,587 PATIENT DAYS WITH AN AVERAGE LENGTH OF STAY OF 3.3 DAYS. BIRTHS TOTALED 410 WITH A TOTAL OF 955 OBSERVATION DAYS OF SERVICE. 4058227 12598100 PHARMACY-CONSISTING OF CARE PROVIDED TO INPATIENTS (22%) AND OUTPATIENTS (78%). OUTPATIENT CARE INCLUDES A MAJOR PROGRAM FOR ONCOLOGY TREATMENT. 35809856 29350 87811774 OVERALL, INPATIENT AND OUTPATIENT CARE REPRESENT 25% AND 75% OF GROSS PATIENT REVENUE, RESPECTIVELY. 35809856 29350 87811774 50328118 1 1 0 1 0 0 0 0 0 0 1 0 0 1 1 1 1 1 0 0 0 0 0 0 0 0 1 1 1 0 1 1 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 1 0 0 0 1 64 0 1 638 1 1 1 0 0 0 0 0 0 0 0 0 X 10 10 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 IN OH X JAMES MILLER 5135245310 110 NORTH POPLAR STREET OXFORD OH 450561292 JOHN HARLAND MD VICE CHAIRMAN 1.00 X X 0 0 0 SUSAN CROSS LIPNICKEY TRUSTEE 1.00 X 0 0 0 RICHARD M NORMAN CHAIRMAN 1.00 X X 0 0 0 ALAN OAK SECRETARY-TREASURER 1.00 X X 0 0 0 THOMAS W SPEH TRUSTEE 1.00 X 0 0 0 STEPHEN FLEE TRUSTEE 1.00 X 0 0 0 RALPH R GUTOWSKI TRUSTEE 1.00 X 0 0 0 ERIKA DARKS TRUSTEE 1.00 X 0 0 0 HILLARY EVANS MD TRUSTEE 1.00 X 0 0 0 JAMES FORMAL TRUSTEE 1.00 X 0 0 0 BRYAN HEHEMANN CEO 40.00 40.00 X 213624 0 19295 JOHN CLEMENTS VP & CFO 40.00 40.00 X 146434 0 8908 BRYAN MCCULLOUGH PHYSICIAN 40.00 X 577486 0 30024 MARK CRISTELL PT DIRECTOR 40.00 X 137819 0 19965 MATTHEW DAGGY PHYSICIAN 40.00 X 242064 0 22730 PAUL CANGEMI PHYSICIAN 40.00 X 289191 0 7311 GREGORY CALKINS PHYSICIAN 40.00 X 206675 0 22887 1813293 0 131120 16 0 1 0 WESTERN OHIO ANESTHESIA PO BOX 361036 CINCINNATI OH 45263 ANESTHESIA 395000 MAYO MEDICAL LABORATORIES PO BOX 9146 MINNEAPOLIS MN 55480 MEDICAL 323427 ESCO COMMUNICATIONS INC PO BOX 1243 INDIANAPOLIS IN 46206 NURSE CALL SYSTEM 287219 CHRIST HOSPITAL 2139 AUBURN AVE CINCINNATI OH 45219 PHYSICIAN SERVICES 281923 COMMUNITY BLOOD PO BOX 644634 PITTSBURGH PA 15264 BLOOD AND BLOOD PRODUCTS 274300 25 462295 699694 1161989 PATIENT SERVICES 900099 56885046 56885046 56885046 11915 11915 236452 0 236452 236452 101428 135024 81669 132046 -50377 -50377 -50377 MANAGEMENT INCOME 900099 295605 295605 CAFETERIA/VENDING 722210 242924 242924 WELLNESS CENTER 900099 82564 82564 61039 61039 682132 58927157 57263215 101428 400525 X 29350 29350 533899 395085 138814 21937837 16254173 5683664 5395945 5395945 1573980 1573980 539174 539174 120200 120200 6634065 4287076 2346989 331642 6221 325421 1682700 1131839 550861 2247482 366143 1881339 47333 31858 15475 48312 39380 8932 392585 392585 3370690 3370690 308830 20490 288340 OFFICE /MEDICAL SUPPLIE 10013447 9436483 576964 BAD DEBT 3780521 3780521 MISCELLANEOUS 984316 52486 931830 INDIRECT A&G ALLOCATION 0 18277534 -18277534 59972308 50328118 9644190 0 X 4863 2700 3839824 1629341 8266724 6744043 13000 1104485 1119975 1399254 1465188 78493220 55516661 24528862 22976559 4293350 4593521 43437362 38544327 3547365 3410565 13450826 10648803 355807 2403511 1251614 19401702 15666789 X 24035660 22877538 24035660 22877538 43437362 38544327 X -1045151 86206 -199177 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 6019 6019 0 PART II-B, LINE 1: SUPPORT PROVIDED THRU DUES PAID TO OHA AND AHA FOR DIRECT COMMUNICATION WITH CERTAIN MEMBERS OF FEDERAL, STATE, OR LOCAL GOVERNMENT. 548616 548616 28912436 16647590 12264846 4321731 1829422 2492309 44312336 37039649 7272687 398101 398101 22976559 UNAMORTIZED FINANCE COSTS 103036 DOCTORS' LOANS RECEIVABLE 422537 CASH SURRENDER VALUE 54377 DUE FROM RELATED PARTY 124461 BOARD DESIGNATED INVESTMENTS 3579321 BWC REBATE 309789 4593521 ESTIMATED THIRD PARTY SETTLEMENTS 124429 OTHER LIABILITIES 1127185 1251614 X 59013363 86206 86206 58927157 0 58927157 60171485 199177 199177 59972308 0 59972308 PART X, LINE 2: ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA REQUIRE MANAGEMENT TO EVALUATE TAX POSITIONS TAKEN BY THE HOSPITAL AND RECOGNIZE A TAX LIABILITY IF THE HOSPITAL HAS TAKEN AN UNCERTAIN POSITION THAT MORE LIKELY THAN NOT WOULD NOT BE SUSTAINED UPON EXAMINATION BY VARIOUS FEDERAL AND STATE TAXING AUTHORITIES. MANAGEMENT HAS ANALYZED THE TAX POSITIONS TAKEN BY THE HOSPITAL, 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 FINANCIAL STATEMENTS. THE HOSPITAL IS SUBJECT TO ROUTINE AUDITS BY TAXING JURISDICTIONS; HOWEVER, THERE ARE CURRENTLY NO AUDITS FOR ANY TAX PERIODS IN PROGRESS. PART XII, LINE 2D - OTHER ADJUSTMENTS: RENTAL EXPENSE RECLASS 199,177. 1 1 1 X 1 X 1 1 0 1 1 836185 913325 -77140 0.00000 5422148 2653030 2769118 0.04620 6258333 3566355 2691978 0.04620 146392 146392 0.00240 1600 1600 0.00000 147992 147992 0.00240 6406325 3566355 2839970 0.04860 1 3780521 65916 8327271 10672710 -2345439 X 1 1 1 1 MCCULLOUGH HYDE MEMORIAL HOSPITAL 110 N POPLAR ST OXFORD OH 45056 X X X MCCULLOUGH-HYDE MEMORIAL HOSPITAL 1 0 0 1 X X X X X X X X 13 1 1 0 1 X HTTP://MHMH.ORG/ABOUT-ANNUAL.ASPX X 1 13 1 HTTP://MHMH.ORG/ABOUT-ANNUAL.ASPX 0 0 1 X 100.000000000000 300.000000000000 X 1 1 X X 1 X X X 1 X X 1 X X X X 1 X 0 0 MCCULLOUGH-HYDE MEMORIAL HOSPITAL PART V, SECTION B, LINE 6A: REGIONAL HEALTH NEEDS ASSESSEMENT CONDUCTED BY GREATER CINCINNATI HEALTH COUNCIL MCCULLOUGH-HYDE MEMORIAL HOSPITAL PART V, SECTION B, LINE 7D: COMMUNITY FORUMS MCCULLOUGH-HYDE MEMORIAL HOSPITAL PART V, SECTION B, LINE 22D: APPLIED 30% DISCOUNT PART V, SECTION B, LINE 16 FINANCIAL ASSISTANCE POLICY WEBSITE AVAILABILITY MCCULLOUGH-HYDE MEMORIAL HOSPITAL PART V, SECTION B, LINE 16A WEBSITE: HTTP://WWW.MHMH.ORG/PATIENTS-REFUND.ASPX MCCULLOUGH-HYDE MEMORIAL HOSPITAL PART V, SECTION B, LINE 16B WEBSITE: HTTP://WWW.MHMH.ORG/PATIENTS-REFUND.ASPX 6 MCCULLOUGH-HYDE MEMORIAL HOSPITAL 5151 MORNING SUN ROAD OXFORD OH 45056 PHYSICAL THERAPY MCCULLOUGH-HYDE MEMORIAL HOSPITAL 10058 COOLEY RD BROOKVILLE IN 47012 OUTPATIENT MCCULLOUGH-HYDE MEMORIAL HOSPITAL 1390 EATON RD HAMILTON OH 45013 PHYSICAL THERAPY MCCULLOUGH-HYDE MEMORIAL HOSPITAL 2449 ROSS-MILLVILLE RD HAMILTON OH 45013 OUTPATIENT, URGENT CARE, PT MCCULLOUGH-HYDE MEMORIAL HOSPITAL 79 W CENTRAL AVENUE CAMDEN OH 45311 OUTPATIENT MCCULLOUGH-HYDE MEMORIAL HOSPITAL 961 MAIN STREET HAMILTON OH 45013 ORTHO PHYSICIAN OFFICE PART II, COMMUNITY BUILDING ACTIVITIES: MCCULLOUGH-HYDE MEMORIAL HOSPITAL PROMOTES HEALTH AND WELLBEING IN OUR COMMUNITY IN NUMEROUS WAYS NOT LISTED IN THE COMMUNITY EVENTS AND PROGRAMS SECTION OF THE 990. EXAMPLES INCLUDE: 1. MHMH HELPED PROMOTE WELLNESS BY PROVIDING MEETING SPACE TO THE INFANT/CHILD LOSS BEREAVEMENT SUPPORT GROUP AND FIBROMYALGIA SUPPORT GROUP. 2. MHMH ASSISTED OUR LOCAL SCHOOL DISTRICT WITH IDENTIFIEDHEALTH/WELLNESS NEEDS. EXAMPLES INCLUDE: A. DEVELOPED AND PROVIDED CRISIS CARDS FOR ALL 8TH GRADERS AND ALL COUNSELORS IN THE SCHOOL DISTRICT B. DEVELOPED CURRICULUM THAT COMBINED TRADITIONAL LEARNING WITH EXERCISE TO HELP FIGHT OBESITY IN OUR ELEMENTARY STUDENTS C. DEVELOPED AND HELD MINI HEALTH SEMINARS FOR 6TH GRADE STUDENTS ON SLEEP, NUTRITION, EXERCISE AND MENTAL HEALTH 3. MHMH PROVIDED OFFICE SPACE AND MEETING SPACE FOR THE OXFORD COLLEGE CORNER CLINIC, WHICH IS A CLINIC THAT PROVIDES FREE HEALTH CARE TO THE UNINSURED AND UNDERINSURED ADULTS IN OUR COMMUNITY 4. MHMH IMPROVED ITS EMPLOYEE WELLNESS PROGRAM BY: A. IMPLEMENTING A HEALTH RISK ASSESSMENT FOR ITS EMPLOYEES TO IDENTIFY HEALTH NEEDS/CONCERNS IN OUR EMPLOYEE POPULATION B. OFFERING MAMMOGRAMS AND PROSTATE SCREENING TO APPROPRIATE EMPLOYEES FREE OF CHARGE C. INCENTIVIZING EMPLOYEES TO ADOPT HEALTHIER BEHAVIOR PART III, LINE 2: A COST-TO-CHARGE RATIO WAS DERIVED FROM WORKSHEET 2 OF THE 2014 IRSINSTRUCTIONS FOR SCHEDULE H AS A COSTING METHODOLOGY USED TO CALCULATE THEAMOUNTS REPORTED IN PART III, LINE 2 AND LINE 3 FOR THE ORGANIZATION'S BADDEBT EXPENSE AT COST. PART III, LINE 3: THE HOSPITAL HAS A DETAILED FINANCIAL ASSISTANCE POLICY WHICH STATES THAT TO PARTICIPATE IN CHARITY CARE CANDIDATES MUST COOPERATE FULLY. IN ADDITION THE HOSPITAL EDUCATES PATIENTS WILL LIMITED ABILITY TO PAY REGARDING FINANCIAL ASSISTANCE. FOR THIS REASON THE ORGANIZATION BELIEVES THAT IT ACCURATELY CAPTURES ALL CHARITY CARE DEDUCTIONS PROVIDED ACCORDING TO THE FINANCIAL ASSISTANCE POLICY AND THE AMOUNT OF BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S CHARITY CARE POLICY IS NEGLIGIBLE. PART III, LINE 4: ACCOUNTS RECEIVABLE ARE REDUCED BY AN ALLOWANCE FOR DOUBTFUL ACCOUNTS BASED ON THE HOSPITAL'S EVALUATION OF ITS MAJOR PAYOR SOURCES OF REVENUE, THE AGING OF THE ACCOUNTS, HISTORICAL LOSSES, CURRENT ECONOMIC CONDITIONS, AND OTHER FACTORS UNIQUE TO THE SERVICE AREA AND THE HEALTHCARE INDUSTRY. FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PAYMENTS, WHICH INCLUDES BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND COPAYMENT BALANCES DUE FOR WHICH THIRD-PARTY COVERAGE EXISTS FOR PART OF THE BILL, THE HOSPITAL RECORDS A SIGNIFICANT PROVISION FOR BAD DEBTS IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST EXPERIENCE, WHICH INDICATES THAT MANY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. THE DIFFERENCE BETWEEN THE STANDARD RATES (OR THE DISCOUNTED RATES IF NEGOTIATED) AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS.THE DECEMBER 31, 2014 AND 2013 ALLOWANCE FOR DOUBTFUL ACCOUNTS OF $6,534,397 AND $8,059,531, RESPECTIVELY, RELATES TO RESERVES FOR SELF-PAY BALANCES.THE ALLOWANCE FOR DOUBTFUL ACCOUNTS REPRESENTS A PERCENT OF SELF-PAY ACCOUNTS RECEIVABLE AT DECEMBER 31, 2014 AND 2013, RESPECTIVELY. THE HOSPITAL'S SELF-PAY PROVISION FOR BAD DEBTS DECREASED $3,103,530 FROM $6,884,053 IN 2013 TO $3,780,523 IN 2014. THE DECREASE IN THE PROVISION FOR BAD DEBTS WAS A RESULT OF DECREASED SELF-PAY REVENUE. ALLOWANCE FOR DOUBTFUL ACCOUNTS AT DECEMBER 31, 2014 DECREASED DUE TO THE DECREASED BALANCE OF SELF-PAY ACCOUNTS AT YEAR END.THE HOSPITAL DOES NOT MAINTAIN A MATERIAL ALLOWANCE FOR DOUBTFUL ACCOUNTS FROM THIRD-PARTY PAYORS, NOR DID IT HAVE SIGNIFICANT WRITE-OFFS FROM THIRD-PARTY PAYORS RELATING TO DOUBTFUL ACCOUNTS. PART III, LINE 8: THE SOURCE USED TO DETERMINE THE AMOUNT OF MEDICARE ALLOWABLE COSTS REPORTED FOR PART III, SECTION B, MEDICARE HAS BEEN PROVIDED FROM THE YEAR ENDED DECEMBER 31, 2014 REPORT: HOSPITAL STATEMENT OF REIMBURSABLE COST. PART III, LINE 9B: ONCE IT HAS BEEN DETERMINED THAT A PATIENT QUALIFIES FOR CHARITY CARE/FINANCIAL ASSISTANCE, COLLECTION PRACTICES ARE STOPPED. PART VI, LINE 2: MCCULLOUGH-HYDE PARTICIPATED IN A PROCESS OF COMMUNITY NEEDS ASSESSMENT DURING 2013. THE PROCESS INCLUDED THE FOLLOWING ELEMENTS:1. A NEEDS ASSESSMENT THAT SERVES AS A FOUNDATION FOR DEVELOPING AN IMPLEMENTATION STRATEGY TO ADDRESS THOSE NEEDS. THE QUESTION OF HOW THE HOSPITAL CAN BEST USE ITS LIMITED RESOURCES TO ASSIST COMMUNITIES IN NEED WILL BE ADDRESSED IN THE IMPLEMENTATION PHASE.2. THE NEEDS ASSESSMENT SEEKS TO IDENTIFY PRIORITY HEALTH STATUS AND ACCESS ISSUES FOR OUR SERVICE AREA. MCCULLOUGH-HYDE MEMORIAL HOSPITAL IS COMMITTED TO TAKING A LEADERSHIP ROLE IN THE ASSESSMENT AND IMPLEMENTATION PHASES. THE ASSESSMENT FOCUSED ON THE FOLLOWING QUESTIONS: -WHO IN THE COMMUNITY IS MOST VULNERABLE IN TERMS OF HEALTH STATUS OR ACCESS TO CARE? -WHAT ARE THE UNIQUE HEALTH STATUS AND/OR ACCESS NEEDS FOR OUR POPULATION? -WHERE DO THESE PEOPLE LIVE IN OUR COMMUNITY? -WHY ARE THESE PROBLEMS PRESENT?3. MCCULLOUGH-HYDE MEMORIAL HAS IDENTIFIED ITS COMMUNITY AS THE RESIDENTS OF FIVE (5) COUNTIES. IN OHIO: BUTLER AND PREBLE AND IN INDIANA: FAYETTE, FRANKLIN AND UNION. OHIO COUNTIES REPRESENT 63% OF THE SERVICE AREA WHILE INDIANA COUNTIES COMPRISE 37%.4. BASED ON THE DATA GATHERED, THE MAJOR NEEDS OF THE COMMUNITY SERVED BY MCCULLOUGH-HYDE MEMORIAL ARE ACCESS TO CARE AND OBESITY (INCLUDING RELATED ISSUES SUCH AS DIABETES AND HEART DISEASE).THE FULL TEXT OF THIS NEEDS ASSESSMENT IS AVAILABLE ON THE HOSPITAL'S WEBSITE. PART VI, LINE 3: FINANCIAL COUNSELORS ARE LOCATED IN THE PATIENT ACCESS AREAS AND PATIENTS ARE OFTEN REFERRED TO THEM AFTER THE COMPLETION OF THE REGISTRATION PROCESS. IN THE EVENT THAT FINANCIAL COUNSELORS ARE NOT AVAILABLE PATIENT ACCESS STAFF IS EDUCATED ON THE CHARITY CARE/FINANCIAL ASSISTANCE POLICIES AND HAVE APPLICATIONS AVAILABLE. CHARITY CARE INFORMATION IS ALSO INCLUDED ON OUR PATIENT STATEMENTS. ALL CUSTOMER SERVICE REPRESENTATIVES ARE FAMILIAR WITH OUR POLICIES AND CAN SPEAK TO OUR CUSTOMERS ABOUT CHARITY CARE/FINANCIAL ASSISTANCE ELIGIBILITY. BROCHURES EXPLAINING CHARITY CARE/FINANCIAL ASSISTANCE ARE ALSO AVAILABLE IN VARIOUS LOCATIONS THROUGHOUT THE HOSPITAL. PART VI, LINE 4: MCCULLOUGH HYDE MEMORIAL HOSPITAL SERVES A DIVERSE DEMOGRAPHIC INCLUDING THE NORTHWESTERN CORNER OF BUTLER COUNTY, OHIO, THE SOUTHWESTERN CORNER OF PREBLE COUNTY, OHIO AND THE COUNTIES OF FRANKLIN, UNION AND FAYETTE IN INDIANA. THE MAIN CAMPUS IS LOCATED IN OXFORD, OHIO, THE HOME OF MIAMI UNIVERSITY WITH A POPULATION RANGING TO NEARLY 30,000 DURING THE SCHOOL YEAR TO HALF THAT NUMBER DURING THE SUMMER.MHMH COUNTS ITS PRIMARY SERVICE AREA AS THE FOLLOWING: OXFORD,OH - 45056 - POPULATION 29,739 BROOKVILLE, IN - 47012 - POPULATION 10,455 COLLEGE CORNER, OH - 45003 - POPULATION 971 EATON, OH - 45320 - POPULATION 15,354 SOMERVILLE, OH - 45064 - 2,963 CAMDEN, OH - 45311 - 7,215 LIBERTY, IN - 47353 - 5,698 WEST COLLEGE CORNER, IN - 47003 - 834 TOTAL PRIMARY SERVICE AREA POPULATION = 73,229AND ITS SECONDARY SERVICE AREAS ARE THE FOLLOWING: HAMILTON, OH - 45013 - 54,814 CONNERSVILLE, IN - 47331 - 23,438 METAMORA, IN - 47030 - 1,631 OKEANA, OH - 45053 - 3,712 TOTAL SECONDARY SERVICE AREA POPULATION = 83,595IN TERMS OF SOCIO-ECONOMIC DEMOGRAPHICS, THE EDUCATIONAL ATTAINMENT IS LOWER THAN COUNTY, STATE AND NATIONAL AVERAGES AND THE UNEMPLOYMENT HIGHER THAN COUNTY, STATE AND NATIONAL AVERAGES IN ALL OF THE UNINCORPORATED AND RURAL AREAS SERVED BY MHMH. ALL OF THE AREAS IN INDIANA AND THE RURAL AREAS IN PREBLE AND BUTLER COUNTIES (CAMDEN, SOMERVILLE) ARE DESIGNATED AS HEALTH PROFESSIONAL SHORTAGE AREAS BY THE NATIONAL HEALTH SERVICE CORPS.MCCULLOUGH HYDE HAS RECRUITED, SUPPORTED AND WILL CONTINUE TO RECRUIT AND SUPPORT BOTH PRIMARY CARE PHYSICIANS AND SPECIALISTS TO MEET THE NEEDS OF RESIDENTS OF THESE COMMUNITIES. 1 TALAWANDA ATHLETIC BOOSTERS 5301 UNIVERSITY BLVD OXFORD OH 45056 311062296 10200 SCHOOL PROGRAMS SANE OF BUTLER COUNTY PO BOX 18818 FAIRFIELD OH 45018 311604036 7500 FORENSIC CARE OXFORD FREE CLINIC PO BOX 390 OXFORD OH 45056 204253386 11650 COMMUNITY SUPPORT X X X X 0 1 0 0 0 0 0 0 0 BRYAN HEHEMANN CEO 213624 0 0 0 0 0 938 0 18357 0 232919 0 0 0 JOHN CLEMENTS VP & CFO 146434 0 0 0 0 0 938 0 7970 0 155342 0 0 0 BRYAN MCCULLOUGH PHYSICIAN 577486 0 0 0 0 0 938 0 29086 0 607510 0 0 0 MARK CRISTELL PT DIRECTOR 128283 0 9536 0 0 0 938 0 19027 0 157784 0 0 0 MATTHEW DAGGY PHYSICIAN 240464 0 1600 0 0 0 938 0 21792 0 264794 0 0 0 PAUL CANGEMI PHYSICIAN 289191 0 0 0 0 0 938 0 6373 0 296502 0 0 0 GREGORY CALKINS PHYSICIAN 206675 0 0 0 0 0 938 0 21949 0 229562 0 0 0 PART I, LINE 4B BRYAN HEHEMANN - NONQUALIFIED RETIREMENT PLAN FUNDED ANNUALLY - $15,000. A BUTLER COUNTY-SERIES 2009A 316000061 2013-09-19 10314685 REFUNDING OF 2009 SERIES 0 0 0 B BUTLER COUNTY-SERIES 2009B 316000061 2013-09-19 3131352 REFUNDING OF 2009 SERIES 0 0 0 A 10437650 10314685 64196 187162 2011 1 0 1 1 B 3158524 3131352 19490 46661 2011 1 0 1 1 A 0 0 0 0 0 0 1 B 0 0 0 0 0 0 1 A 0 0 0 0 0 0 0 0 0 B 0 0 0 0 0 0 0 0 0 A 1 B 1 BRYAN MCCULLOUGH PHYSICIAN BRIDGE LOAN X 13000 13000 0 0 1 13000 FORM 990, PART VI, SECTION B, LINE 11 THE PROCESS OF REVIEWING THE FORM 990 ENTAILS A DETAILED REVIEW BY THE ORGANIZATION'S ACCOUNTING DEPARTMENT. THE GOVERNING BODY RECEIVES AN ELECTRONIC COPY OF THE FORM 990 INCLUDING REQUESTED SCHEDULES, AS ULTIMATELY FILED WITH THE IRS, FOR REVIEW AND APPROVE PRIOR TO FILING WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C THE WRITTEN CONFLICT OF INTEREST POLICY IS REGULARLY AND CONSISTENTLY MONITORED AND COMPLIANCE ENFORCED BY THE CORPORATE COMPLIANCE OFFICER AND CORPORATE COMPLIANCE COMMITTEE OF THE BOARD OF DIRECTORS. THE SCOPE OF THIS POLICY INCLUDES HOSPITAL AND MEDICAL STAFF MEMBERS AND MEMBER OF THE BOARD OF DIRECTORS. THE POLICY IS IN PLACE TO PROTECT THE INTERESTS OF MCCULLOUGH-HYDE MEMORIAL HOSPITAL IN SITUATIONS WHERE INDIVIDUALS HAVE THE OPPORTUNITY TO ADVANCE THEIR OWN INTERESTS, OR THE INTERESTS OF OTHERS WITH WHOM THEY HAVE A RELATIONSHIP, IN A WAY THAT IS DETRIMENTAL TO THE INTEREST OF THE HOSPITAL. A SELF DISCLOSURE FORM IS REQUIRED ON ANY POTENTIAL CONFLICTS OF INTEREST. THE COVERED PERSON COMPLETES THE CONFLICT OF INTEREST QUESTIONNAIRE AND SUBMITS IT TO THEIR DIRECT SUPERVISOR OR ADMINISTRATIVE REPRESENTATIVE, CORPORATE COMPLIANCE OFFICER OR THE COMPLIANCE COMMITTEE. THE ISSUE IS REVIEWED WITH ONE OF THE FOLLOWING WRITTEN RECOMMENDATIONS/CONCLUSIONS: 1) CIRCUMSTANCES DO NOT PRESENT A PROBLEM 2) ALTERNATE ARRANGEMENTS ARE MADE THAT ARE ACCEPTABLE TO THE INDIVIDUAL AND DO NOT PRESENT A PROBLEM OR 3) ALTERNATE ARRANGEMENTS ARE NOT ACCEPTABLE AND THE CONFLICT IS DEALT WITH ON AN INDIVIDUAL BASIS. THE COVERED PERSONS ARE REQUIRED TO REFRAIN FROM PARTICIPATING IN ANY DELIBERATION OR DECISIONS ON SUCH TRANSACTIONS. FORM 990, PART VI, SECTION B, LINE 15 THE COMPENSATION COMMITTEE OF THE BOARD OF DIRECTORS HAS RESPONSIBILITY FOR EXECUTIVE COMPENSATION STRUCTURES AND PROCESSES. THIS INCLUDES THE CEO AND OTHER OFFICIERS OF THE CORPORATION. THE COMMITTEE IS COMPRISED OF THE CHAIRPERSON OF THE BOARD AND TWO BOARD MEMBERS. FINDINGS AND RECOMMENDATIONS ARE REPORTED TO THE FULL BOARD OF DIRECTORS WHO HAS FINAL APPROVAL OF THE PLAN. THE COMPENSATION COMMITEE PERFORMS THE CEO EVALUATION WITH THE OVERALL RATING BEING USED IN DETERMINING COMPENSATION ALONG WITH AVAILABLE MARKET DATA. MARKET DATA IS COMPLIED BY THE DIRECTOR OF HUMAN RESOURCES AND PRESENTED TO THE COMMITTEE. A WRITTEN RECORD OF THE EVALUATION RESULTS, COMPARABILITY DATA AND THE CONCLUSIONS/RECOMMENDATION OF THE COMMITTEE ARE MAINTAINED AND PRESENTED TO THE FULL BOARD OF DIRECTORS. THE FINAL DECISION OF THE BOARD IS DOCUMENTED IN BOARD MEETING MINUTES. FORM 990, PART VI, SECTION C, LINE 19 THESE DOCUMENTS ARE AVAILABLE UPON REQUEST. IN ADDITION, THE FINANCIAL STATEMENTS ARE PRESENTED TO THE CITY OF OXFORD ANNUALLY AT A MEETING THAT IS OPEN TO THE PUBLIC. FORM 990, PART IX, LINE 11G PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 4,287,076. MANAGEMENT AND GENERAL EXPENSES 2,346,989. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 6,634,065. FORM 990 PAGE 10 PART X LINE 11G CONTRACTED WAGES = $2,305,387 PURCHASED SERVICES = $4,141,954 FORM 990, PART XI, LINE 9: EXPENSES ALLOCATED TO 990T -199,177. MCCULLOUGH-HYDE MEMORIAL HOSPITAL ENDOWMENT 110 NORTH POPLAR OXFORD OH 45056 237374256 OBTAIN CHARITABLE CONTRIBUTIONS, MANAGE THEM AND DISBURSE BY BOARD DIRECTION OH 501(C)(3) LINE 11A, I N/A 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 MCCULLOUGH-HYDE MEMORIAL HOSPITAL ENDOWMENT C 136175 ACTUAL MCCULLOUGH-HYDE MEMORIAL HOSPITAL ENDOWMENT Q 284138 ACTUAL