FAIRFIELD MEDICAL CENTER: Form 990, tax year 2014

View the entire original 990 at ProPublica ↗

Organization
FAIRFIELD MEDICAL CENTER (EIN 31-0645626)
Tax period
2014-01-01 to 2014-12-31
Filed
2015-08-14
IRS object ID
201542269349301309
Schema version
2014v5.0
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Return2015-08-14T10:08:15-00:00ReturnTs
Tax Period End2014-12-31TaxPeriodEndDt
Return Type990ReturnTypeCd
Tax Period Begin2014-01-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN310645626EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1Fairfield Medical CenterBusinessNameLine1Txt
FieldValueIRS element (for citing)
Business Name ControlFAIRBusinessNameControlTxt
Phone7406878000PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1401 North Ewing StreetAddressLine1Txt
CityLancasterCityNm
State AbbreviationOHStateAbbreviationCd
ZIP431303371ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonSky L GettysPersonNm
Person TitleCFO TreasurerPersonTitleTxt
Phone7406878011PhoneNum
Signature2015-08-13SignatureDt
Discuss With Paid PreparerfalseDiscussWithPaidPreparerInd
FieldValueIRS element (for citing)
Tax2014TaxYr
Build TS2016-04-25 22:37:26ZBuildTS

Form 990 IRS990

Principal Ofcr Business Name PrincipalOfcrBusinessName

FieldValueIRS element (for citing)
Business Name Line1John R Janoso JrBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line1401 North Ewing StreetAddressLine1Txt
CityLancasterCityNm
State AbbreviationOHStateAbbreviationCd
ZIP43130ZIPCd
FieldValueIRS element (for citing)
Gross Receipts$383,756,280GrossReceiptsAmt
Group Return For AffiliatesfalseGroupReturnForAffiliatesInd
Organization501c3Yes (X)Organization501c3Ind
Website Addresswww.fmchealth.orgWebsiteAddressTxt
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Formation1982FormationYr
Legal Domicile StateOHLegalDomicileStateCd
Activity Or MissionOur mission is to provide efficient, compassionate, safe, high quality healthcare for patients and their families. Fairfield Medical Ctr provides this care to all patients regardless of race, creed, sex, national origin,ActivityOrMissionDesc
Voting Members Governing Body15VotingMembersGoverningBodyCnt
Voting Members Independent15VotingMembersIndependentCnt
Total Employee2355TotalEmployeeCnt
Total Volunteers211TotalVolunteersCnt
Total Gross UBI$364,634TotalGrossUBIAmt
PY Contributions Grants$293,840PYContributionsGrantsAmt
CY Contributions Grants$183,664CYContributionsGrantsAmt
PY Program Service Revenue$224,105,357PYProgramServiceRevenueAmt
CY Program Service Revenue$231,230,002CYProgramServiceRevenueAmt
PY Investment Income$2,724,692PYInvestmentIncomeAmt
CY Investment Income$3,153,110CYInvestmentIncomeAmt
PY Other Revenue$5,992,542PYOtherRevenueAmt
CY Other Revenue$4,838,837CYOtherRevenueAmt
PY Total Revenue$233,116,431PYTotalRevenueAmt
CY Total Revenue$239,405,613CYTotalRevenueAmt
CY Grants And Similar Paid$0CYGrantsAndSimilarPaidAmt
CY Benefits Paid To Members$0CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$107,142,906PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$106,567,980CYSalariesCompEmpBnftPaidAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$0CYTotalFundraisingExpenseAmt
PY Other Expenses$105,561,521PYOtherExpensesAmt
CY Other Expenses$110,651,510CYOtherExpensesAmt
PY Total Expenses$212,704,427PYTotalExpensesAmt
CY Total Expenses$217,219,490CYTotalExpensesAmt
PY Revenues Less Expenses$20,412,004PYRevenuesLessExpensesAmt
CY Revenues Less Expenses$22,186,123CYRevenuesLessExpensesAmt
Total Assets BOY$262,521,097TotalAssetsBOYAmt
Total Assets EOY$283,819,471TotalAssetsEOYAmt
Total Liabilities BOY$131,499,494TotalLiabilitiesBOYAmt
Total Liabilities EOY$137,221,517TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$131,021,603NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$146,597,954NetAssetsOrFundBalancesEOYAmt
MissionOur mission is to provide efficient, compassionate, safe, high quality healthcare for patients and their families. Fairfield Medical Center provides this care to all patients regardless of race, creed, sex, national origin, handicap, age or ability to pay.MissionDesc
Significant New Program SrvcfalseSignificantNewProgramSrvcInd
Significant ChangefalseSignificantChangeInd
Expense$76,854,842ExpenseAmt
Revenue$96,668,800RevenueAmt
DescPatient Care Inpatient Medical, Surgical, Emergency, Maternity, ICU, Psychiatry, and Nursing Services 71,982 admissions, procedures visitsDesc

Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp

FieldValueIRS element (for citing)
Expense$74,034,786ExpenseAmt
Revenue$135,848,833RevenueAmt
DescPatient Care Laboratory, Cardiovascular, Radiology, Therapy, Pharmacy, and Medical Supply Services 2,691,971 procedures dosagesDesc

Prog Srvc Accom Acty3 ProgSrvcAccomActy3Grp

FieldValueIRS element (for citing)
Expense$19,124,114ExpenseAmt
Revenue$1,026,291RevenueAmt
DescPatient Care Nutritional Services 497,201 meals served Patient Care Laundry Services 1,495,688 pounds Patient Care Plant Engineering, Police, Housekeeping, Central Transport, Interest Depreciation 498,426 square feetDesc
FieldValueIRS element (for citing)
Total Program Service Expenses$170,013,742TotalProgramServiceExpensesAmt
Described In Section501c3Yes (true)DescribedInSection501c3Ind
Schedule B RequiredYes (true)ScheduleBRequiredInd
Political Campaign ActyfalsePoliticalCampaignActyInd
Lobbying ActivitiesfalseLobbyingActivitiesInd
Subject To Proxy TaxfalseSubjectToProxyTaxInd
Donor Advised FundfalseDonorAdvisedFundInd
Conservation EasementsfalseConservationEasementsInd
Collections Of ArtfalseCollectionsOfArtInd
Credit CounselingfalseCreditCounselingInd
Temp Or Permanent EndowmentsfalseTempOrPermanentEndowmentsInd
Report Land Building EquipmentYes (true)ReportLandBuildingEquipmentInd
Report Investments Other SecfalseReportInvestmentsOtherSecInd
Report Program Related InvstfalseReportProgramRelatedInvstInd
Report Other AssetsYes (true)ReportOtherAssetsInd
Report Other LiabilitiesYes (true)ReportOtherLiabilitiesInd
Include FIN48 FootnotefalseIncludeFIN48FootnoteInd
Independent Audit Fincl StmtfalseIndependentAuditFinclStmtInd
Consolidated Audit Fincl StmtYes (true)ConsolidatedAuditFinclStmtInd
School OperatingfalseSchoolOperatingInd
Foreign OfficefalseForeignOfficeInd
Foreign ActivitiesfalseForeignActivitiesInd
More Than5000 K To OrgfalseMoreThan5000KToOrgInd
More Than5000 K To IndividualsfalseMoreThan5000KToIndividualsInd
Professional FundraisingfalseProfessionalFundraisingInd
Fundraising ActivitiesfalseFundraisingActivitiesInd
Gaming ActivitiesfalseGamingActivitiesInd
Operate HospitalYes (true)OperateHospitalInd
Audited Financial Stmt AttYes (true)AuditedFinancialStmtAttInd
Grants To OrganizationsYes (true)GrantsToOrganizationsInd
Grants To IndividualsfalseGrantsToIndividualsInd
Schedule J RequiredYes (true)ScheduleJRequiredInd
Tax Exempt BondsYes (true)TaxExemptBondsInd
Invest Tax Exempt BondsfalseInvestTaxExemptBondsInd
Escrow AccountfalseEscrowAccountInd
On Behalf Of IssuerfalseOnBehalfOfIssuerInd
Engaged In Excess Benefit TransfalseEngagedInExcessBenefitTransInd
PY Excess Benefit TransfalsePYExcessBenefitTransInd
Loan OutstandingfalseLoanOutstandingInd
Grant To Related PersonfalseGrantToRelatedPersonInd
Business Rln With Org MemfalseBusinessRlnWithOrgMemInd
Business Rln With Fam MemfalseBusinessRlnWithFamMemInd
Business Rln With Officer EntfalseBusinessRlnWithOfficerEntInd
Deductible Non Cash ContrifalseDeductibleNonCashContriInd
Deductible Art ContributionfalseDeductibleArtContributionInd
Terminate OperationsfalseTerminateOperationsInd
Partial LiquidationfalsePartialLiquidationInd
Disregarded EntityYes (true)DisregardedEntityInd
Related EntityYes (true)RelatedEntityInd
Related Organization Ctrl EntYes (true)RelatedOrganizationCtrlEntInd
Transaction With Control EntYes (true)TransactionWithControlEntInd
Trnsfr Exmpt Non Chrtbl Rltd OrgYes (true)TrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted PrtshpfalseActivitiesConductedPrtshpInd
Schedule O RequiredYes (true)ScheduleORequiredInd
IRP Document173IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Backup Wthld ComplianceYes (true)BackupWthldComplianceInd
Employee2355EmployeeCnt
Employment Tax Returns FiledYes (true)EmploymentTaxReturnsFiledInd
Unrelated Bus Incm Over LimitYes (true)UnrelatedBusIncmOverLimitInd
Form990 T FiledYes (true)Form990TFiledInd
Foreign Financial AccountfalseForeignFinancialAccountInd
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTransInd
Taxable Party NotificationfalseTaxablePartyNotificationInd
Form8886 T FiledfalseForm8886TFiledInd
Nondeductible ContributionsfalseNondeductibleContributionsInd
Quid Pro Quo ContributionsfalseQuidProQuoContributionsInd
Form8282 Property Disposed OffalseForm8282PropertyDisposedOfInd
Rcv Fnds To Pay Prsnl Bnft CntrctfalseRcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft CntrctfalsePayPremiumsPrsnlBnftCntrctInd
Indoor Tanning ServicesfalseIndoorTanningServicesInd
Info In Schedule O Part VIYes (X)InfoInScheduleOPartVIInd
Governing Body Voting Members15GoverningBodyVotingMembersCnt
Independent Voting Member15IndependentVotingMemberCnt
Family Or Business RlnYes (true)FamilyOrBusinessRlnInd
Delegation Of Mgmt DutiesfalseDelegationOfMgmtDutiesInd
Change To Org DocumentsfalseChangeToOrgDocumentsInd
Material Diversion Or MisusefalseMaterialDiversionOrMisuseInd
Members Or StockholdersfalseMembersOrStockholdersInd
Election Of Board MembersfalseElectionOfBoardMembersInd
Decisions Subject To ApprovafalseDecisionsSubjectToApprovaInd
Minutes Of Governing BodyYes (true)MinutesOfGoverningBodyInd
Minutes Of CommitteesYes (true)MinutesOfCommitteesInd
Officer Mailing AddressfalseOfficerMailingAddressInd
Local ChaptersfalseLocalChaptersInd
Form990 Provided To Gvrn BodyfalseForm990ProvidedToGvrnBodyInd
Conflict Of Interest PolicyYes (true)ConflictOfInterestPolicyInd
Annual Disclosure Covered PrsnYes (true)AnnualDisclosureCoveredPrsnInd
Regular Monitoring EnfrcYes (true)RegularMonitoringEnfrcInd
Whistleblower PolicyYes (true)WhistleblowerPolicyInd
Document Retention PolicyYes (true)DocumentRetentionPolicyInd
Compensation Process CEOYes (true)CompensationProcessCEOInd
Compensation Process OtherYes (true)CompensationProcessOtherInd
Investment In Joint VentureYes (true)InvestmentInJointVentureInd
Written Policy Or ProcedureYes (true)WrittenPolicyOrProcedureInd
States Where Copy Of Return Is FldOHStatesWhereCopyOfReturnIsFldCd
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

FieldValueIRS element (for citing)
PersonSky L GettysPersonNm
Phone7406878011PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1401 North Ewing StreetAddressLine1Txt
CityLancasterCityNm
State AbbreviationOHStateAbbreviationCd
ZIP431303371ZIPCd

Form990 Part VII Section A Form990PartVIISectionAGrp (28 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndOfficerOfficerIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmtAverage Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRtFormer Ofcr Director TrusteeFormerOfcrDirectorTrusteeIndKey EmployeeKeyEmployeeIndHighest Compensated EmployeeHighestCompensatedEmployeeInd
Debra Smith
Chair003.00Yes (X)Yes (X)$0$0$0
Ron Burris
Vice Chair003.00Yes (X)Yes (X)$0$0$0
Linda Sheridan
Secretary003.00Yes (X)Yes (X)$0$0$0
James Christian
Director002.00Yes (X)$0$0$0
Adam Custer
Director002.00Yes (X)$0$0$0001.00
Joseph Ginty MD
Director002.00Yes (X)$0$0$0
Dave Oehlers
Director002.00Yes (X)$0$0$0
Barry Ritchey
Director002.00Yes (X)$0$0$0001.00
Carol Seubert Marx
Director002.00Yes (X)$0$0$0
Susan Nixon Stoughton
Director002.00Yes (X)$0$0$0
Milt Taylor Jr
Director002.00Yes (X)$0$0$0
Louis Varga
Director002.00Yes (X)$0$0$0
Renee Wagner
Director002.00Yes (X)$0$0$0
William Yaple
Director002.00Yes (X)$0$0$0
Jeffrey Yenchar MD
Director002.00Yes (X)$0$0$0
Mina H Ubbing
President CEOYes (X)$539,968$0$1,961Yes (X)
Sky L Gettys
CFO, Treasurer048.00Yes (X)$388,072$0$30,555002.00
John R Janoso Jr
President CEO055.00Yes (X)$119,974$0$16,367001.00
Steven D Cox MD
VP - CMO042.00$241,379$209,522$28,494040.00Yes (X)
Howard Sniderman
Chief Operating Officer045.00$265,046$0$33,058Yes (X)
Cynthia Pearsall
VP - CNO050.00$217,685$0$16,481Yes (X)
Jean L Robertson MD
Chief Med. Info. Officer024.00$212,514$0$21,940Yes (X)
Martha Buckley MD
Chief Quality Officer040.00$220,527$0$16,028Yes (X)
Grant R Brame
Physicians Assistant040.00$151,077$0$23,318Yes (X)
Heather B Schultz
Advanced Practice Nurse040.00$156,282$0$11,133Yes (X)
Jeffrey M Ayers MD
Residency Prog. Dir.041.00$148,015$0$21,559001.00Yes (X)
Pamela L Reed
Director OP Services040.00$161,819$0$17,062Yes (X)
Cynthia S Steen
Chief Strategy Dev. Officer040.00$155,084$0$2,956Yes (X)
FieldValueIRS element (for citing)
Total Reportable Comp From Org$2,977,442TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org$209,522TotReportableCompRltdOrgAmt
Total Other Compensation$240,912TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K43IndivRcvdGreaterThan100KCnt
Former Ofcr Employees ListedYes (true)FormerOfcrEmployeesListedInd
Total Comp Greater Than150 KYes (true)TotalCompGreaterThan150KInd
Compensation From Other SrcsfalseCompensationFromOtherSrcsInd

Contractor Compensation ContractorCompensationGrp (5 entries)

Address Line1ContractorAddress/USAddress/AddressLine1TxtCityContractorAddress/USAddress/CityNmState AbbreviationContractorAddress/USAddress/StateAbbreviationCdZIPContractorAddress/USAddress/ZIPCdServicesServicesDescCompensationCompensationAmt
McKesson
PO Box 98347ChicagoIL606930001Information Technology Services$3,499,364
Renovo Solutions
1801 E Parkcourt Place Bldg DSanta AnaCA92701Biomedical Services$3,292,445
Central Ohio Orthopedic Consultants
2405 N Columbus Street Suite 120LancasterOH43130Physician Services$552,986
Bricker & Eckler
100 South Third StreetColumbusOH43215Attorney Fees$493,946
Medical Staffing Options
PO Box 75357ChicagoIL60675Rent$485,162
FieldValueIRS element (for citing)
Cntrct Rcvd Greater Than100 K23CntrctRcvdGreaterThan100KCnt
All Other Contributions$183,664AllOtherContributionsAmt
Total Contributions$183,664TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp

FieldValueIRS element (for citing)
DescPatient Service Revenue NetDesc
Total Revenue Column$231,230,002TotalRevenueColumnAmt
Related Or Exempt Func Income$231,230,002RelatedOrExemptFuncIncomeAmt
FieldValueIRS element (for citing)
Total Program Service Revenue$231,230,002TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$1,784,937TotalRevenueColumnAmt
Exclusion$1,784,937ExclusionAmt

Gross Rents GrossRentsGrp

FieldValueIRS element (for citing)
Real$601,561RealAmt

Less Rental Expenses LessRentalExpensesGrp

FieldValueIRS element (for citing)
Real$507,357RealAmt

Rental Income Or Loss RentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Real$94,204RealAmt

Net Rental Income Or Loss NetRentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Total Revenue Column$94,204TotalRevenueColumnAmt

Gross Amount Sales Assets GrossAmountSalesAssetsGrp

FieldValueIRS element (for citing)
Securities$145,139,739SecuritiesAmt
Other$71,744OtherAmt

Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp

FieldValueIRS element (for citing)
Securities$143,703,198SecuritiesAmt
Other$140,112OtherAmt

Gain Or Loss GainOrLossGrp

FieldValueIRS element (for citing)
Securities$1,436,541SecuritiesAmt
Other-$68,368OtherAmt

Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp

FieldValueIRS element (for citing)
Total Revenue Column$1,368,173TotalRevenueColumnAmt

Other Revenue Misc OtherRevenueMiscGrp (3 entries)

DescDescTotal Revenue ColumnTotalRevenueColumnAmtExclusionExclusionAmtBusinessBusinessCdUnrelated Business RevenueUnrelatedBusinessRevenueAmt
Cafeteria Sales$935,859$935,859
Patronage Dividends$562,187$562,187900099
Outside Reference Lab$326,605621500$326,605

Miscellaneous Revenue MiscellaneousRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$2,919,982TotalRevenueColumnAmt
Related Or Exempt Func Income$2,881,953RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$38,029UnrelatedBusinessRevenueAmt
FieldValueIRS element (for citing)
Other Revenue Total$4,744,633OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$239,405,613TotalRevenueColumnAmt
Related Or Exempt Func Income$234,111,955RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$364,634UnrelatedBusinessRevenueAmt
Exclusion$3,282,983ExclusionAmt
FieldValueIRS element (for citing)
Info In Schedule O Part IXYes (X)InfoInScheduleOPartIXInd

Grants To Domestic Orgs GrantsToDomesticOrgsGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Grants To Domestic Individuals GrantsToDomesticIndividualsGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Foreign Grants ForeignGrantsGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Benefits To Members BenefitsToMembersGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

FieldValueIRS element (for citing)
Total$2,375,938TotalAmt
Program Services$1,274,084ProgramServicesAmt
Management And General$1,101,854ManagementAndGeneralAmt

Comp Disqual Persons CompDisqualPersonsGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

FieldValueIRS element (for citing)
Total$82,510,866TotalAmt
Program Services$72,443,168ProgramServicesAmt
Management And General$10,067,698ManagementAndGeneralAmt

Pension Plan Contributions PensionPlanContributionsGrp

FieldValueIRS element (for citing)
Total$4,714,019TotalAmt
Program Services$3,534,284ProgramServicesAmt
Management And General$1,179,735ManagementAndGeneralAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

FieldValueIRS element (for citing)
Total$10,937,576TotalAmt
Program Services$6,375,266ProgramServicesAmt
Management And General$4,562,310ManagementAndGeneralAmt

Payroll Taxes PayrollTaxesGrp

FieldValueIRS element (for citing)
Total$6,029,581TotalAmt
Program Services$5,223,916ProgramServicesAmt
Management And General$805,665ManagementAndGeneralAmt

Fees For Services Management FeesForServicesManagementGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Fees For Services Legal FeesForServicesLegalGrp

FieldValueIRS element (for citing)
Total$669,420TotalAmt
Management And General$669,420ManagementAndGeneralAmt

Fees For Services Accounting FeesForServicesAccountingGrp

FieldValueIRS element (for citing)
Total$78,045TotalAmt
Management And General$78,045ManagementAndGeneralAmt

Fees For Services Lobbying FeesForServicesLobbyingGrp

FieldValueIRS element (for citing)
Total$0TotalAmt
FieldValueIRS element (for citing)
Fees For Services Prof FundraisingFeesForServicesProfFundraising

Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Fees For Services Other FeesForServicesOtherGrp

FieldValueIRS element (for citing)
Total$22,127,652TotalAmt
Program Services$9,337,483ProgramServicesAmt
Management And General$12,790,169ManagementAndGeneralAmt

Advertising AdvertisingGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Information Technology InformationTechnologyGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Royalties RoyaltiesGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Occupancy OccupancyGrp

FieldValueIRS element (for citing)
Total$3,922,053TotalAmt
Program Services$3,604,763ProgramServicesAmt
Management And General$317,290ManagementAndGeneralAmt

Travel TravelGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Pymt Travel Entrtnmnt Pub Ofcl PymtTravelEntrtnmntPubOfclGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Conferences Meetings ConferencesMeetingsGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Interest InterestGrp

FieldValueIRS element (for citing)
Total$3,043,377TotalAmt
Program Services$2,769,473ProgramServicesAmt
Management And General$273,904ManagementAndGeneralAmt

Payments To Affiliates PaymentsToAffiliatesGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Depreciation Depletion DepreciationDepletionGrp

FieldValueIRS element (for citing)
Total$13,400,579TotalAmt
Program Services$8,165,035ProgramServicesAmt
Management And General$5,235,544ManagementAndGeneralAmt

Insurance InsuranceGrp

FieldValueIRS element (for citing)
Total$1,485,033TotalAmt
Management And General$1,485,033ManagementAndGeneralAmt

Other Expenses OtherExpensesGrp (3 entries)

DescDescTotalTotalAmtProgram ServicesProgramServicesAmtManagement And GeneralManagementAndGeneralAmt
Supplies$47,025,358$46,640,013$385,345
Physician Fees$7,928,917$7,794,144$134,773
Other Expenses$10,971,076$2,852,113$8,118,963

All Other Expenses AllOtherExpensesGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$217,219,490TotalAmt
Program Services$170,013,742ProgramServicesAmt
Management And General$47,205,748ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$8,833,417BOYAmt
EOY$11,363,967EOYAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

FieldValueIRS element (for citing)
BOY$47,925,724BOYAmt
EOY$32,283,164EOYAmt

Accounts Receivable AccountsReceivableGrp

FieldValueIRS element (for citing)
BOY$24,785,317BOYAmt
EOY$23,824,129EOYAmt

Inventories For Sale Or Use InventoriesForSaleOrUseGrp

FieldValueIRS element (for citing)
BOY$3,872,371BOYAmt
EOY$4,297,523EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

FieldValueIRS element (for citing)
BOY$3,704,573BOYAmt
EOY$4,600,626EOYAmt
FieldValueIRS element (for citing)
Land Bldg Equip Cost Or Other Bss$261,528,631LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec$149,591,282LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
BOY$86,252,691BOYAmt
EOY$111,937,349EOYAmt

Investments Pub Traded Sec InvestmentsPubTradedSecGrp

FieldValueIRS element (for citing)
BOY$55,696,669BOYAmt
EOY$62,195,067EOYAmt

Intangible Assets IntangibleAssetsGrp

FieldValueIRS element (for citing)
BOY$4,515,499BOYAmt
EOY$4,515,499EOYAmt

Other Assets Total OtherAssetsTotalGrp

FieldValueIRS element (for citing)
BOY$26,934,836BOYAmt
EOY$28,802,147EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$262,521,097BOYAmt
EOY$283,819,471EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$14,101,009BOYAmt
EOY$13,751,540EOYAmt

Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$98,479,656BOYAmt
EOY$96,940,936EOYAmt

Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp

FieldValueIRS element (for citing)
BOY$1,684,695BOYAmt
EOY$1,784,357EOYAmt

Other Liabilities OtherLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$17,234,134BOYAmt
EOY$24,744,684EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$131,499,494BOYAmt
EOY$137,221,517EOYAmt
FieldValueIRS element (for citing)
Organization Follows SFAS117Yes (X)OrganizationFollowsSFAS117Ind

Unrestricted Net Assets UnrestrictedNetAssetsGrp

FieldValueIRS element (for citing)
BOY$131,021,603BOYAmt
EOY$146,597,954EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$131,021,603BOYAmt
EOY$146,597,954EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$262,521,097BOYAmt
EOY$283,819,471EOYAmt
FieldValueIRS element (for citing)
Info In Schedule O Part XIYes (X)InfoInScheduleOPartXIInd
Reconcilation Revenue Expnss$22,186,123ReconcilationRevenueExpnssAmt
Net Unrlzd Gains Losses Invst$459,709NetUnrlzdGainsLossesInvstAmt
Other Changes In Net Assets-$7,069,481OtherChangesInNetAssetsAmt
Method Of Accounting AccrualYes (X)MethodOfAccountingAccrualInd
Accountant Compile Or ReviewfalseAccountantCompileOrReviewInd
FS AuditedYes (true)FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

FieldValueIRS element (for citing)
Consolidated Basis Fincl StmtYes (X)ConsolidatedBasisFinclStmtInd
FieldValueIRS element (for citing)
Audit CommitteeYes (true)AuditCommitteeInd
Federal Grant Audit RequiredfalseFederalGrantAuditRequiredInd

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
HospitalYes (X)HospitalInd
Public Support CY1700.00000PublicSupportCY170Pct
Public Support CY5090.00000PublicSupportCY509Pct
Investment Income CY0.00000InvestmentIncomeCYPct

Schedule B IRS990ScheduleB

Contributor Information ContributorInformationGrp

FieldValueIRS element (for citing)
ContributorRESTRICTEDContributorNum

Contributor Business Name ContributorBusinessName

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor US Address ContributorUSAddress

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Total ContributionsRESTRICTEDTotalContributionsAmt

Schedule D IRS990ScheduleD

FieldValueIRS element (for citing)
Incl Escrow Custodial Acct LiabfalseInclEscrowCustodialAcctLiabInd

Land LandGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$5,439,732OtherCostOrOtherBasisAmt
Book Value$5,439,721BookValueAmt

Buildings BuildingsGrp

FieldValueIRS element (for citing)
Investment Cost Or Other Basis$87,455InvestmentCostOrOtherBasisAmt
Other Cost Or Other Basis$93,621,396OtherCostOrOtherBasisAmt
Depreciation$54,653,649DepreciationAmt
Book Value$39,055,202BookValueAmt

Leasehold Improvements LeaseholdImprovementsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$3,356,295OtherCostOrOtherBasisAmt
Depreciation$3,094,339DepreciationAmt
Book Value$261,956BookValueAmt

Equipment EquipmentGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$123,284,518OtherCostOrOtherBasisAmt
Depreciation$88,658,461DepreciationAmt
Book Value$34,626,057BookValueAmt

Other Land Buildings OtherLandBuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$35,739,235OtherCostOrOtherBasisAmt
Depreciation$3,184,822DepreciationAmt
Book Value$32,554,413BookValueAmt
FieldValueIRS element (for citing)
Total Book Value Land Buildings$111,937,349TotalBookValueLandBuildingsAmt

Other Securities OtherSecuritiesGrp (2 entries)

DescDesc
Financial derivatives and other financial products
Closely-held equity interests

Other Assets Org OtherAssetsOrgGrp (6 entries)

DescDescBook ValueBookValueAmt
Unamortized bond financing expense$931,792
Due from related organizations$5,821,228
Notes receivable/income guarantee$1,495,804
Investment in subsidiary$15,529,122
Other receivables$1,865,401
Third party settlements$3,158,800
FieldValueIRS element (for citing)
Total Book Value Other Assets$28,802,147TotalBookValueOtherAssetsAmt

Other Liabilities Org OtherLiabilitiesOrgGrp (3 entries)

DescDescAmtAmt
Federal income taxes
Accrued payroll and benefits$17,852,993
Other Liabilities$6,891,691
FieldValueIRS element (for citing)
Total Liability$24,744,684TotalLiabilityAmt

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Financial Assistance PolicyYes (true)FinancialAssistancePolicyInd
Written PolicyYes (true)WrittenPolicyInd
FPG Reference Free CareYes (true)FPGReferenceFreeCareInd
Percent100Yes (X)Percent100Ind
FPG Reference Discounted CareYes (true)FPGReferenceDiscountedCareInd
Percent300Yes (X)Percent300Ind
Free Care Medically IndigentYes (true)FreeCareMedicallyIndigentInd
Financial Assistance BudgetYes (true)FinancialAssistanceBudgetInd
Expenses Exceed BudgetfalseExpensesExceedBudgetInd
Annual Community Bnft ReportYes (true)AnnualCommunityBnftReportInd
Report Publically AvailableYes (true)ReportPublicallyAvailableInd

Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp

FieldValueIRS element (for citing)
Total Community Benefit Expns$2,645,349TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$2,645,349NetCommunityBenefitExpnsAmt
Total Expense0.01220TotalExpensePct

Unreimbursed Medicaid UnreimbursedMedicaidGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$32,797,310TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$24,819,976DirectOffsettingRevenueAmt
Net Community Benefit Expns$7,977,334NetCommunityBenefitExpnsAmt
Total Expense0.03670TotalExpensePct

Total Financial Assistance Typ TotalFinancialAssistanceTyp

FieldValueIRS element (for citing)
Total Community Benefit Expns$35,442,659TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$24,819,976DirectOffsettingRevenueAmt
Net Community Benefit Expns$10,622,683NetCommunityBenefitExpnsAmt
Total Expense0.04890TotalExpensePct

Community Health Services CommunityHealthServicesGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$2,178,742TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$84,328DirectOffsettingRevenueAmt
Net Community Benefit Expns$2,094,414NetCommunityBenefitExpnsAmt
Total Expense0.00960TotalExpensePct

Health Professions Education HealthProfessionsEducationGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$1,311,798TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$4,600DirectOffsettingRevenueAmt
Net Community Benefit Expns$1,307,198NetCommunityBenefitExpnsAmt
Total Expense0.00600TotalExpensePct

Subsidized Health Services SubsidizedHealthServicesGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$15,838,674TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$10,461,377DirectOffsettingRevenueAmt
Net Community Benefit Expns$5,377,297NetCommunityBenefitExpnsAmt
Total Expense0.02480TotalExpensePct

Research ResearchGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$126,493TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$15,293DirectOffsettingRevenueAmt
Net Community Benefit Expns$111,200NetCommunityBenefitExpnsAmt
Total Expense0.00050TotalExpensePct

Cash And In Kind Contributions CashAndInKindContributionsGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$231,585TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$231,585NetCommunityBenefitExpnsAmt
Total Expense0.00110TotalExpensePct

Total Other Benefits TotalOtherBenefitsGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$19,687,292TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$10,565,598DirectOffsettingRevenueAmt
Net Community Benefit Expns$9,121,694NetCommunityBenefitExpnsAmt
Total Expense0.04200TotalExpensePct

Total Community Benefits TotalCommunityBenefitsGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$55,129,951TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$35,385,574DirectOffsettingRevenueAmt
Net Community Benefit Expns$19,744,377NetCommunityBenefitExpnsAmt
Total Expense0.09090TotalExpensePct

Economic Development EconomicDevelopmentGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$17,149TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$17,149NetCommunityBenefitExpnsAmt
Total Expense0.00010TotalExpensePct

Community Support CommunitySupportGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$1,979TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$1,979NetCommunityBenefitExpnsAmt

Environmental Improvements EnvironmentalImprovementsGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$11,276TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$11,276NetCommunityBenefitExpnsAmt
Total Expense0.00010TotalExpensePct

Leadership Development LeadershipDevelopmentGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$123,100TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$123,100NetCommunityBenefitExpnsAmt
Total Expense0.00060TotalExpensePct

Coalition Building CoalitionBuildingGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$4,932TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$4,932NetCommunityBenefitExpnsAmt

Total Communtity Building Acty TotalCommuntityBuildingActyGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$158,436TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$158,436NetCommunityBenefitExpnsAmt
Total Expense0.00080TotalExpensePct
FieldValueIRS element (for citing)
Bad Debt Expense ReportedYes (true)BadDebtExpenseReportedInd
Bad Debt Expense$9,483,304BadDebtExpenseAmt
Bad Debt Expense Attributable$1,128,513BadDebtExpenseAttributableAmt
Reimbursed By Medicare$59,364,897ReimbursedByMedicareAmt
Cost Of Care Reimbursed By Medcr$56,277,117CostOfCareReimbursedByMedcrAmt
Medicare Surplus Or Shortfall$3,087,780MedicareSurplusOrShortfallAmt

Costing Methodology Used CostingMethodologyUsedGrp

FieldValueIRS element (for citing)
Cost Accounting SystemYes (X)CostAccountingSystemInd
FieldValueIRS element (for citing)
Written Debt Collection PolicyYes (true)WrittenDebtCollectionPolicyInd
Financial Assistance PrvsnYes (true)FinancialAssistancePrvsnInd

Management Co And Jnt Ventures ManagementCoAndJntVenturesGrp

Entity Name EntityName

FieldValueIRS element (for citing)
Business Name Line1Southeast Ohio Sleep DisordersBusinessNameLine1Txt
FieldValueIRS element (for citing)
Primary ActivitiesSleep LabPrimaryActivitiesTxt
Org Profit Or Ownership0.51000OrgProfitOrOwnershipPct
Physicians Profit Or Ownership0.49000PhysiciansProfitOrOwnershipPct
FieldValueIRS element (for citing)
Hospital Facilities1HospitalFacilitiesCnt

Hospital Facilities HospitalFacilitiesGrp

FieldValueIRS element (for citing)
Facility1FacilityNum

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1Fairfield Medical CenterBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line1401 North Ewing StreetAddressLine1Txt
CityLancasterCityNm
State AbbreviationOHStateAbbreviationCd
ZIP43130ZIPCd
FieldValueIRS element (for citing)
Website Addresswww.fmchealth.orgWebsiteAddressTxt
Licensed HospitalYes (X)LicensedHospitalInd
General Medical And SurgicalYes (X)GeneralMedicalAndSurgicalInd
Emergency Room24 HrsYes (X)EmergencyRoom24HrsInd
Facility Reporting Group1FacilityReportingGroupCd

Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp

Hospital Facility Name HospitalFacilityName

FieldValueIRS element (for citing)
Business Name Line11BusinessNameLine1Txt
FieldValueIRS element (for citing)
Facility1FacilityNum
First Licensed CY Or PYfalseFirstLicensedCYOrPYInd
Tax Exempt Hospital CY Or PYfalseTaxExemptHospitalCYOrPYInd
CHNA ConductedYes (true)CHNAConductedInd
Community DefinitionYes (X)CommunityDefinitionInd
Community DemographicsYes (X)CommunityDemographicsInd
Existing ResourcesYes (X)ExistingResourcesInd
How Data ObtainedYes (X)HowDataObtainedInd
Community Health NeedsYes (X)CommunityHealthNeedsInd
Other Health IssuesYes (X)OtherHealthIssuesInd
Community Hlth Needs Id ProcessYes (X)CommunityHlthNeedsIdProcessInd
Consulting ProcessYes (X)ConsultingProcessInd
Information GapsYes (X)InformationGapsInd
CHNA Conducted13CHNAConductedYr
Take Into Account Others InputYes (true)TakeIntoAccountOthersInputInd
CHNA Conducted With Other FcltsfalseCHNAConductedWithOtherFcltsInd
CHNA Conducted With Non FcltsYes (true)CHNAConductedWithNonFcltsInd
CHNA Report Widely AvailableYes (true)CHNAReportWidelyAvailableInd
Rpt Available On Own WebsiteYes (X)RptAvailableOnOwnWebsiteInd
Own Website URLfmchealth.orgOwnWebsiteURLTxt
Paper Copy Public InspectionYes (X)PaperCopyPublicInspectionInd
Implementation Strategy AdoptYes (true)ImplementationStrategyAdoptInd
Implementation Strategy Adpt14ImplementationStrategyAdptYr
Strategy Posted WebsitefalseStrategyPostedWebsiteInd
Strategy AttachedYes (true)StrategyAttachedInd
Organization Incur Excise TaxfalseOrganizationIncurExciseTaxInd
Elig Criteria ExplainedYes (true)EligCriteriaExplainedInd
FPG Family Incm Lmt Free DscntYes (X)FPGFamilyIncmLmtFreeDscntInd
FPG Family Incm Lmt Free Care0000000100.000000000000FPGFamilyIncmLmtFreeCarePct
FPG Family Incm Lmt Dscnt Care0000000300.000000000000FPGFamilyIncmLmtDscntCarePct
Medical Indigency CriteriaYes (X)MedicalIndigencyCriteriaInd
Insurance Status CriteriaYes (X)InsuranceStatusCriteriaInd
Underinsurance Stat CriteriaYes (X)UnderinsuranceStatCriteriaInd
Explained BasisYes (true)ExplainedBasisInd
App Financial Asst ExplnYes (true)AppFinancialAsstExplnInd
Described InfoYes (X)DescribedInfoInd
Described Suprt DocYes (X)DescribedSuprtDocInd
Provided Hospital ContactYes (X)ProvidedHospitalContactInd
Provided Nonprofit ContactYes (X)ProvidedNonprofitContactInd
Includes Publicity MeasuresYes (true)IncludesPublicityMeasuresInd
FAP Available On WebsiteYes (X)FAPAvailableOnWebsiteInd
FAP Available On Website URLXFAPAvailableOnWebsiteURLTxt
FAP Summary On WebsiteYes (X)FAPSummaryOnWebsiteInd
FAP Summary On Website URLXFAPSummaryOnWebsiteURLTxt
FAP Avlbl On Request No ChargeYes (X)FAPAvlblOnRequestNoChargeInd
FAP App Avlbl On Request No ChrgYes (X)FAPAppAvlblOnRequestNoChrgInd
FAP Sum Avlbl On Request No ChrgYes (X)FAPSumAvlblOnRequestNoChrgInd
FAP Notice DisplayedYes (X)FAPNoticeDisplayedInd
Communtity Notified FAPYes (X)CommuntityNotifiedFAPInd
FAP Actions On NonpaymentYes (true)FAPActionsOnNonpaymentInd
Permit No ActionsYes (X)PermitNoActionsInd
Collection ActivitiesfalseCollectionActivitiesInd
FAP Notified Upon AdmissionYes (X)FAPNotifiedUponAdmissionInd
FAP Notified Before DischargeYes (X)FAPNotifiedBeforeDischargeInd
FAP Notified All PatientsYes (X)FAPNotifiedAllPatientsInd
Documented Elig DeterminationYes (X)DocumentedEligDeterminationInd
Nondis Emergency Care PolicyYes (true)NondisEmergencyCarePolicyInd
Average Negotiated RatesYes (X)AverageNegotiatedRatesInd
Amounts Generally BilledfalseAmountsGenerallyBilledInd
Gross ChargesfalseGrossChargesInd

Supplemental Information SupplementalInformationGrp (3 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
Group Fairfield Medical Center Line Part V, Section B, Line 5The community health assessment was cross-sectional in nature and included a written survey of adults and adolescents within Fairfield County. From the beginning, community leaders were actively engaged in the planning process and helped define the content, scope, and sequence of the study. Active engagement of community members throughout the planning process is regarded as an important step in completing a valid needs assessment.
Group Fairfield Medical Center Line Part V, Section B, Line 6bThe CHNA was conducted in association with The Fairfield Department of Health, Fairfield Community Health Center and United Way of Fairfield County.
Group Fairfield Medical Center Line Part V, Section B, Line 11Fairfield Medical Center has always been an advocate of health care access in the area and has provided needed medical care for many years, regardless of ability to pay. Fairfield Medical Center has a state-of-the-art Cardiovascular Lab and a well-equipped Cardio Fitness Center to provide care for those who need it, and programs to help increase the fitness level of those in the area so that they wont need the Cardiovascular Lab. Obesity is a known risk factor for cardiovascular disease FMC is working diligently with other area agencies to help the population increase fitness and lower the rate of obesity. Obesity is also a factor in cancer diagnosis. FMC has many programs available to encourage Tobacco Cessation, exercise and healthy eating to lower the risk of cancer and get more healthy overall. FMC has a Diabetes Support Group to help those with diabetes maintain a healthier lifestyle through better diet. We have excellent physicians who can help those with arthritis and asthma. While most of the issues were addressed in multiple ways, due to funding and expertise, we were not able to address the problems of sexual behaviour, pregnancy outcome or possession of firearms in the home.

Supplemental Information Detail SupplementalInformationDetail (8 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
Part III Line 3The poverty rate, as listed online in the census for Fairfield County, is 11.9. That percentage was multiplied times the bad debt expense to estimate the amount attributable to patients eligible under the organizations financial assistance policy.
Part III Line 4An allowance for uncollectible accounts is established on an aggregate basis by using historical write-off factors applied to unpaid accounts based on aging. Loss rate factors are based on historical loss experience and adjusted for economic conditions and other trends affecting the Centers ability to collect outstanding amounts. Uncollectible amounts are written off against the allowance for doubtful accounts in the period they are determined to be uncollectible. The information can be found on page 8 of the financial statements.
Part III Line 8The total for Medicare Cost is taken directly from the Medicare Cost Report.
Part III Line 9bIn all instances of debt collection, patients are given information regarding financial assistance available. In addition, patients are made aware of the availability of financial assistance with an acknowledgement letter of services rendered, regardless of ability to pay or payment source. FMC will do everything possible to help those who qualify for charity care to be made aware of the assistance available. We also provide financial counselors to assist patients in filling out the necessary forms for assistance. The following options are available A. Payment in the form of cash, credit card or checks. A discount is offered with payment at the time of service and within 10 days of receiving the hospital bill. B. H.E.L.P. Bank Financial Program C. Hospital Payment Program D. Assistance with application to Medicare or Medicaid E. Hospital Care Assurance Program HCAP F. Hospital Assistance Program summary defining Fairfield Medical Centers financial opportunities. G. Assistance for the uninsured patient.
Part VI Line 3An employee from Contracts and Collections meets with patients before discharge to discuss the many options available under the organizations charity care policy. Those policies are also posted throughout the hospital, including registration, and go into the billing envelopes.
Part VI Line 4Fairfield Medical Center serves a large geographic area, including Fairfield County 504 square miles and surrounding counties. The demographics include the edge of the Appalacian community. We stay in touch with community organizations of all kinds to keep current on the needs of the community. A committe meets regularly to keep in touch with the perceptions of the community in order to better serve our constituents.
Part VI Line 5Fairfield Medical Center actively promotes community health through education at community groups, newspaper articles and collaboration with other community groups.
Part VI, Line 7OH

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Grant Records MaintainedYes (true)GrantRecordsMaintainedInd

Recipient Table RecipientTable

Recipient Business Name RecipientBusinessName

FieldValueIRS element (for citing)
Business Name Line1Fairfield Medical Center FoundationBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line1401 North Ewing StreetAddressLine1Txt
CityLancasterCityNm
State AbbreviationOHStateAbbreviationCd
ZIP43130ZIPCd
FieldValueIRS element (for citing)
Recipient EIN208952945RecipientEIN
IRC Section501c3IRCSectionDesc
Cash Grant$283,427CashGrantAmt
FieldValueIRS element (for citing)
Total501c3 Org1Total501c3OrgCnt

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Severance PaymentYes (true)SeverancePaymentInd
Supplemental Nonqual Rtr PlanYes (true)SupplementalNonqualRtrPlanInd
Equity Based Comp ArrngmfalseEquityBasedCompArrngmInd
Comp Based On Revenue Of Flng OrgfalseCompBasedOnRevenueOfFlngOrgInd
Comp Bsd On Rev Related OrgsfalseCompBsdOnRevRelatedOrgsInd
Comp Bsd Net Earns Flng OrgfalseCompBsdNetEarnsFlngOrgInd
Comp Bsd Net Earns Rltd OrgsfalseCompBsdNetEarnsRltdOrgsInd
Any Non Fixed PaymentsYes (true)AnyNonFixedPaymentsInd
Initial Contract ExceptionfalseInitialContractExceptionInd

Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (12 entries)

TitleTitleTxtBase Compensation Filing OrgBaseCompensationFilingOrgAmtBonus Filing OrganizationBonusFilingOrganizationAmountOther Compensation Filing OrgOtherCompensationFilingOrgAmtNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmtTotal Compensation Filing OrgTotalCompensationFilingOrgAmtDeferred Compensation Flng OrgDeferredCompensationFlngOrgAmtCompensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmtBonus Related OrganizationsBonusRelatedOrganizationsAmtOther Compensation Rltd OrgsOtherCompensationRltdOrgsAmtDeferred Comp Rltd OrgsDeferredCompRltdOrgsAmtTotal Compensation Rltd OrgsTotalCompensationRltdOrgsAmt
Mina H Ubbing
President CEO$38,289$50,181$451,498$1,961$541,929
Sky L Gettys
CFO, Treasurer$248,208$57,895$81,969$12,355$418,627$18,200
Steven D Cox MD
VP - CMO$199,157$41,422$800$10,600$267,148$15,169$130,106$9,281$70,135$2,725$212,247
Howard Sniderman
Chief Operating Officer$230,253$33,593$1,200$14,858$298,104$18,200
Cynthia Pearsall
VP - CNO$189,842$26,643$1,200$3,484$234,166$12,997
Jean L Robertson MD
Chief Med. Info. Officer$206,644$5,870$6,641$234,454$15,299
Grant R Brame
Physicians Assistant$103,612$23,938$23,527$10,888$172,838$10,873
Heather B Schultz
Advanced Practice Nurse$105,924$24,769$25,589$129$167,415$11,004
Jeffrey M Ayers MD
Residency Prog. Dir.$148,015$10,887$169,574$10,672
Pamela L Reed
Director OP Services$156,633$4,286$900$5,640$178,881$11,422
Cynthia S Steen
Chief Strategy Dev. Officer$147,233$7,251$600$2,956$158,040
Martha Buckley MD
Chief Quality Officer$220,527$627$236,555$15,401

Schedule K IRS990ScheduleK

Tax Exempt Bonds Issues TaxExemptBondsIssuesGrp

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd

Issuer Name IssuerName

FieldValueIRS element (for citing)
Business Name Line1County of Fairfield OhioBusinessNameLine1Txt
FieldValueIRS element (for citing)
Bond Issuer EIN316400066BondIssuerEIN
CUSIP304286AM9CUSIPNum
Bond Issued2013-06-27BondIssuedDt
Issue Price$98,511,516IssuePriceAmt
PurposeTo refund prior issue and to fund new surgical unit.PurposeDesc

Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd
Retired$56,264,480RetiredAmt
In Reserve Fund$6,320,525InReserveFundAmt
Issuance Costs From Proceeds$926,511IssuanceCostsFromProceedsAmt
Capital Expenditures$35,000,000CapitalExpendituresAmt
Current RefundingYes (true)CurrentRefundingInd
Advance RefundingfalseAdvanceRefundingInd
Final Allocation MadefalseFinalAllocationMadeInd
Adequate Books And Rec MaintYes (true)AdequateBooksAndRecMaintInd

Tax Exempt Bonds Private Bus Use TaxExemptBondsPrivateBusUseGrp

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd
Owning Bond Financed PropertyfalseOwningBondFinancedPropertyInd
Any Lease ArrangementsfalseAnyLeaseArrangementsInd
Mgmt Contract Bond Fincd PropfalseMgmtContractBondFincdPropInd
Any Research AgreementsfalseAnyResearchAgreementsInd

Tax Exempt Bonds Arbitrage TaxExemptBondsArbitrageGrp

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd
Form8038 T FiledfalseForm8038TFiledInd
Rebate Not Due YetfalseRebateNotDueYetInd
Exception To RebatefalseExceptionToRebateInd
No Rebate DuefalseNoRebateDueInd
Variable Rate IssuefalseVariableRateIssueInd
Hedge Identified In Bks And RecfalseHedgeIdentifiedInBksAndRecInd
Gross Proceeds Invested In GICfalseGrossProceedsInvestedInGICInd
Gross Proceeds InvestedfalseGrossProceedsInvestedInd
Written Proc To Monitor ReqsfalseWrittenProcToMonitorReqsInd

Procedures Corrective Action ProceduresCorrectiveActionGrp

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd
Procedures Corrective ActionfalseProceduresCorrectiveActionInd

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (7 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
Form 990, Part VI, Section A, Line 2Various members of the Board of Directors are key employees and/or officers of organizations that may conduct normal, arms length transactions with one another.
Form 990, Part VI, Section B, Line 11bThe 990 is reviewed by the President and Treasurer of the organization after review by the Controller. Then it is made available for Board Member review prior to filing.
Form 990, Part VI, Section B, Line 12cDirectors, President, Vice Presidents, Managers, Case Management employees, Contracts Collections employees, employees with direct purchasing responsibilities, employed physicians, and employees who are contracted or shared with other organizations are required to complete an annual questionnaire disclosing potential conflicts of interest. If a known or perceived conflict of interest arises, the Compliance Officer investigates, documents, and works to resolve the conflict of interest.
Form 990, Part VI, Section B, Line 15 a bAnnually, the Compensation Committee compares officer and key employee compensation to regional industry averages. This committee consists of independent members of the Board of Directors. Compensation adjustment recommendations are submitted, to be included in the budget, to the Finance and Audit Committee. Compensation adjustments are taken to the Board of Directors for final approval, and if approved are then implemented.
Form 990, Part VI, Section C, Line 19The governing documents, conflict of interest, and financials are made available to the public by requests made to FMC management.
Form 990, Part IX, Line 11gOther fees for services include lab testing, administrative consulting, outsourced biomedical services, outsourced collection services, outsourced IT services and other general purchased services.
Form 990, Part XI, Line 9The other change in net assets reported represents intercompany transfers between Fairfield Medical Center and related organizations see Schedule R for fixed asset purchases, shared employees, expenses, and other intercompany transactions.

Schedule R IRS990ScheduleR

Id Disregarded Entities IdDisregardedEntitiesGrp

Disregarded Entity Name DisregardedEntityName

FieldValueIRS element (for citing)
Business Name Line1Home Health ResourcesBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line1401 North Ewing StreetAddressLine1Txt
CityLancasterCityNm
State AbbreviationOHStateAbbreviationCd
ZIP43130ZIPCd
FieldValueIRS element (for citing)
EIN311159707EIN
Primary ActivitiesDurable Med. Equip.PrimaryActivitiesTxt
Legal Domicile StateOHLegalDomicileStateCd

Direct Controlling Entity Name DirectControllingEntityName

FieldValueIRS element (for citing)
Business Name Line1Zane Properties CorporationBusinessNameLine1Txt

Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (2 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdExempt Code SectionExemptCodeSectionTxtPublic Charity StatusPublicCharityStatusTxtBusiness Name Line1DirectControllingEntityName/BusinessNameLine1TxtControlled OrganizationControlledOrganizationIndDirect Controlling NADirectControllingNACd
Fairfield Healthcare Professionals Inc
401 North Ewing StreetLancasterOH43130311425884Physician PracticesOH501c311aFairfield Medical Centerfalse
Fairfield Medical Center Foundation
401 North Ewing StreetLancasterOH43130208952945FundraisingOH501c37falseN/A

Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp (2 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdBusiness Name Line1DirectControllingEntityName/BusinessNameLine1TxtPredominant Income TypePredominantIncomeTypeTxtDisproportionate AllocationsDisproportionateAllocationsIndGeneral Or Managing PartnerGeneralOrManagingPartnerIndOwnershipOwnershipPct
Southeast Ohio Sleep Disorders Center LLC
135 North Ewing Street FL 3LancasterOH43130311639116Sleep disorder trmtOHFairfield Medical CenterRelatedfalseYes (true)0.51000
Simplified Healthcare Solutions LLC
5980 Wilcox Place Suite FDublinOH43016201720030Claims review/processingOHFairfield Medical CenterRelatedfalseYes (true)1.00000

Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp

Related Organization Name RelatedOrganizationName

FieldValueIRS element (for citing)
Business Name Line1Zane Properties CorporationBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line1401 North Ewing StreetAddressLine1Txt
CityLancasterCityNm
State AbbreviationOHStateAbbreviationCd
ZIP43130ZIPCd
FieldValueIRS element (for citing)
EIN311202009EIN
Primary ActivitiesHolding CompanyPrimaryActivitiesTxt
Legal Domicile StateOHLegalDomicileStateCd

Direct Controlling Entity Name DirectControllingEntityName

FieldValueIRS element (for citing)
Business Name Line1Fairfield Medical CenterBusinessNameLine1Txt
FieldValueIRS element (for citing)
Entity TypeC CorpEntityTypeTxt
Ownership1.00000OwnershipPct
Controlled OrganizationfalseControlledOrganizationInd
FieldValueIRS element (for citing)
Receipt Of Int Annts Rnts RyltsYes (true)ReceiptOfIntAnntsRntsRyltsInd
Gift Grnt Or Cap Contri To Oth OrgfalseGiftGrntOrCapContriToOthOrgInd
Gift Grnt Cap Contri From Oth OrgfalseGiftGrntCapContriFromOthOrgInd
Loans Or Guarantees To Other OrgfalseLoansOrGuaranteesToOtherOrgInd
Loans Or Guarantees From Oth OrgfalseLoansOrGuaranteesFromOthOrgInd
Div Related OrganizationfalseDivRelatedOrganizationInd
Asset Sale To Other OrgYes (true)AssetSaleToOtherOrgInd
Asset Purchase From Other OrgfalseAssetPurchaseFromOtherOrgInd
Asset ExchangefalseAssetExchangeInd
Rental Of Facilities To Oth OrgfalseRentalOfFacilitiesToOthOrgInd
Rental Of Fclts From Oth OrgYes (true)RentalOfFcltsFromOthOrgInd
Perform Of Services For Oth OrgfalsePerformOfServicesForOthOrgInd
Perform Of Services By Other OrgYes (true)PerformOfServicesByOtherOrgInd
Sharing Of FacilitiesfalseSharingOfFacilitiesInd
Paid Employees SharingYes (true)PaidEmployeesSharingInd
Reimbursement Paid To Other OrgYes (true)ReimbursementPaidToOtherOrgInd
Reimbursement Paid By Other OrgYes (true)ReimbursementPaidByOtherOrgInd
Transfer To Other OrgYes (true)TransferToOtherOrgInd
Transfer From Other OrgfalseTransferFromOtherOrgInd

Transactions Related Org TransactionsRelatedOrgGrp (11 entries)

Transaction TypeTransactionTypeTxtInvolvedInvolvedAmt
Southeast Ohio Sleep Disorders Center LLC
a$44,090
Fairfield Healthcare Professionals Inc
a$12,000
Fairfield Healthcare Professionals Inc
g$145,336
Zane Properties Corporation
k$192,540
Simplified Healthcare Solutions LLC
m$187,519
Fairfield Healthcare Professionals Inc
o$5,177,644
Zane Properties Corporation
p$60,709
Fairfield Healthcare Professionals Inc
q$2,225,000
Fairfield Healthcare Professionals Inc
r$3,387,844
Zane Properties Corporation
q$110,820
Zane Properies Corporation
r$50,000

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