2015-11-04T08:34:12-06:00 2014-12-31 381357951 PLANTE & MORAN PLLC 65 EAST STATE ST STE 600 COLUMBUS OH 43215 990 2014-01-01 344428214 FULTON COUNTY HEALTH CENTER FULT 4193352015 725 SOUTH SHOOP AVENUE WAUSEON OH 435671701 PATRICIA A FINN CHIEF EXECUTIVE OFFICER 4193352015 2015-10-27 1 BERNIE OSTROWSKI P00366367 6148493000 2014 2016-04-25 22:37:26Z PATRICIA A FINN 725 SOUTH SHOOP AVENUE WAUSEON OH 435671701 88073710 0 X WWW.FULTONCOUNTYHEALTHCENTER.ORG X 1973 OH SERVE THE PUBLIC BY PROMOTING AND PROVIDING THE MEANS FOR CONTINUED HEALTH AND WELLNESS. 12 9 938 154 -2374 -2374 123620 135069 74949439 78069627 386887 584647 583334 984090 76043280 79773433 11750 2000 0 0 40254564 40317382 0 0 0 35338891 37633931 75605205 77953313 438075 1820120 80598094 82115246 36533612 37256439 44064482 44858807 X THE FULTON COUNTY HEALTH CENTER CONTINUALLY STRIVES TO REACH A HIGH DEGREE OF EXCELLENCE IN MEETING THE NEEDS OF BOTH INTERNAL AND EXTERNAL CUSTOMERS 100% OF THE TIME. QUALITY OF PATIENT/RESIDENT CARE AND ALL OF THE INSTITUTIONAL PRACTICES ARE THE PRIMARY CRITERION UTILIZED TO MONITOR THE HEALTH CENTER SERVICES AND TO EVALUATE PROPOSED CHANGES OF PROPOSED NEW SERVICES. 1 0 69218670 2000 78525987 SEE SCHEDULE OLOCATION: THE FULTON COUNTY HEALTH CENTER IS LOCATED AT 725 SOUTH SHOOP AVENUE, WAUSEON, OH 43567. THE HEALTH CENTER IS EASILY ACCESSIBLE FROM INTERSTATE 80/90 (OHIO TURNPIKE) AND STATE ROUTE 2. IT IS CENTRALLY LOCATED WITHIN FULTON COUNTY WHERE WAUSEON IS THE COUNTY SEAT. PHILOSOPHY/AUSPICES: THE FULTON COUNTY HEALTH CENTER IS A PRIVATE, NON-PROFIT HOSPITAL, LONG-TERM CARE & INDEPENDENT LIVING FACILITY GOVERNED BY A BOARD OF DIRECTORS. THE HEALTH CENTER IS OPERATED ON THE PRINCIPLE THAT EVERY INDIVIDUAL HAS A BASIC RIGHT TO ATTAIN THE HIGHEST DEGREE OF WELLNESS POSSIBLE BASED ON HIS OR HER OWN NEEDS. THE SERVICES OF THE HOSPITAL SHALL BE AVAILABLE TO ALL INDIVIDUALS REGARDLESS OF RACE, COLOR, SEX, AGE, NATIONAL ORIGIN, RELIGIOUS CREED, ECONOMIC CONDITION OR DISABILITY. COMMITMENT TO QUALITY: THE FULTON COUNTY HEALTH CENTER CONTINUALLY STRIVES TO REACH A HIGH DEGREE OF EXCELLENCE IN MEETING THE NEEDS OF BOTH INTERNAL AND EXTERNAL CUSTOMERS 100% OF THE TIME. QUALITY OF PATIENT/RESIDENT CARE AND ALL OF THE INSTITUTIONAL PRACTICES ARE THE PRIMARY CRITERION UTILIZED TO MONITOR THE HEALTH CENTER SERVICES AND TO EVALUATE PROPOSED CHANGES OF PROPOSED NEW SERVICES. LEVEL OF CARE: THE HEALTH CENTER IS A SHORT-TERM GENERAL HOSPITAL OFFERING A FULL RANGE OF SERVICES RELATED TO ACUTE CARE. INCLUDED IN THESE SERVICES AREA A WIDE RANGE OF OUTPATIENT SERVICES THAT INVOLVE DIAGNOSTIC AND REHABILITATIVE TREATMENT. THE HEALTH CENTER ALSO HAS LONG-TERM CARE AND INDEPENDENT LIVING AVAILABLE TO OFFER THE CONTINUUM OF CARE. THE LEVEL OF CARE PROVIDED TO ALL PATIENTS AND RESIDENTS IS THE SAME WHETHER INPATIENT OR OUTPATIENT. THIS IS ACCOMPLISHED THROUGH PROGRESSIVE HEALTH AWARENESS. CENTERS OF EXCELLENCE: AMONG THE SPECIAL STRENGTHS OF THE HEALTH CENTER ARE AN OBSTETRICAL UNIT, A CRITICAL CARE/CARDIAC CARE UNIT, A SHORT TERM INPATIENT AND INTENSIVE OUTPATIENT GERIATRIC PSYCHIATRIC UNIT, ADULT OUTPATIENT AND PARTIAL HOSPITALIZATION, AN EMERGENCY DEPARTMENT THAT IS STAFFED WITH LICENSED PHYSICIANS 24 HOURS PER DAY, EVERY DAY OF THE YEAR, AN INPATIENT AND OUTPATIENT SURGICAL UNIT, SLEEP DISORDER CENTER, RAINBOW HEMATOLOGY/ONCOLOGY TREATMENT CENTER AND OTHER DIAGNOSTIC AND THERAPEUTIC SERVICES. A HOSPITALIST WAS ADDED IN 2012 AND IS AVAILABLE TO INPATIENTS 24/7. TELEMEDICINE STROKE NETWORK WAS INITIATED IN 2014 WITH UTMC AND MERCY ST VS. DAILY OUTPATIENT SPECIALTY CLINICS OFFER THE CONSULTATIVE AND DIAGNOSTIC SERVICES OF SEVERAL TYPES OF MEDICAL SPECIALISTS. LONG-TERM CARE AND INDEPENDENT LIVING FACILITY OFFERING THE CONTINUUM OF CARE FROM THE HOSPITAL AREA. A WIDE RANGE OF ORGANIZED EDUCATIONAL AND HEALTH PROMOTION OPPORTUNITIES, INCLUDING A COMPREHENSIVE DIABETIC EDUCATION PROGRAM, ARE PROVIDED FOR PATIENTS, RESIDENTS, EMPLOYEES AND MEMBERS OF THE SURROUNDING COMMUNITIES. ONCE AGAIN, IN 2014 FULTON COUNTY HEALTH CENTER'S SURGERY DEPARTMENT HAS BEEN RECOGNIZED FOR OUTSTANDING QUALITY CARE IN THE CARECHEX RANKINGS FROM COMPARION MEDICAL ANALYTICS. AS ONE OF THE NATIONS LARGEST PRIVATELY HELD HEALTH CARE INFORMATION SERVICE COMPANIES, COMPARION PROVIDES SERVICES DESIGNED TO MEASURE, MANAGE AND MONITOR THE CLINICAL, FINANCIAL AND MARKET PERFORMANCE OF HEALTH CARE ORGANIZATIONS. CARECHEX RECOGNIZED FULTON COUNTY HEALTH CENTER FOR BEING #1 IN MEDICAL EXCELLENCE IN THE REGIONAL TOLEDO MARKET AREA FOR BOTH JOINT REPLACEMENT SURGERY AND MAJOR ORTHOPEDIC SURGERY.IN 2014, FULTON COUNTY HEALTH CENTER BECAME ONE OF THE FIRST HOSPITALS IN ITS MARKET TO GO LIVE WITH ROBOTIC TELEMEDICINE TECHNOLOGY IN ITS EMERGENCY DEPARTMENT. THE ROBOT IS USED WITH STROKE VICTIMS AND ALLOWS MEDICAL PROFESSIONALS TO CONSULT "LIVE" WITH A NEUROSURGEON AT ST VINCENT MERCY MEDICAL CENTER OR THE UNIVERSITY OF TOLEDO MEDICAL CENTER USING VIDEO AND AUDIO. IN 2013, FULTON COUNTY HEALTH CENTER WAS ALSO AWARDED A THREE YEAR TERM OF ACCREDITATION IN MAMMOGRAPHY. THE ACR GOLD SEAL OF ACCREDITATION REPRESENTS THE HIGHEST LEVEL OF IMAGE QUALITY AND PATIENT SAFETY.IN 2014 FULTON COUNTY HEALTH CENTER CELEBRATED 35 YEARS OF OFFERING H.O.P.E (HELPING OTHER PARENTS EXPERIENCE GRIEF). H.O.P.E SUPPORT GROUP OFFERS SUPPORT FOR PARENTS WHO HAVE EXPERIENCED MISCARRIAGE, STILLBIRTH, OR DEATH OF INFANTS, YOUNG CHILDREN, TEENAGERS, OR ADULTS DUE TO ILLNESS, AN ACCIDENT OR SUICIDE. LIMITATIONS: PATIENTS IN NEED OF TERTIARY CARE ARE REFERRED TO AREA SPECIALTY CENTERS. POPULATION SERVED: THE FULTON COUNTY HEALTH CENTER SERVES THE POPULATION IN FULTON COUNTY AND PATIENTS IN THE IMMEDIATE BORDER AREAS OF ADJACENT COUNTIES. TOTAL POPULATION OF OUR SERVICE AREA IS ESTIMATED BETWEEN 42,000 - 45,000. OUR BEHAVIOR HEALTH SERVICES UNIT PRIMARILY SERVES A FOUR COUNTY AREA INCLUDING FULTON, DEFIANCE, HENRY AND WILLIAMS COUNTIES AS WELL AS FROM OUTSIDE OUR IMMEDIATE GEOGRAPHIC AREA. INSTITUTIONAL RELATIONSHIPS: THE HEALTH CENTER MAINTAINS RELATIONSHIPS WITH AREA NURSING HOMES, CITY AND COUNTY ORGANIZATIONS, AND REGIONAL TERTIARY CARE CENTERS. THE HEALTH CENTER IS A CLINIC-TRAINING SITE FOR A WIDE RANGE OF HEALTH CARE DISCIPLINES.EDUCATION: THE HEALTH CENTER MAINTAINS AN ACTIVE AND ONGOING IN-SERVICE AND CONTINUING EDUCATION PROGRAM FOR OUR STAFF TO KEEP THEM KNOWLEDGEABLE AND CURRENT ON DEVELOPMENTS IN HEALTH CARE DELIVERY. THE HEALTH CENTER ALSO ENCOURAGES EMPLOYEES TO PURSUE HIGHER EDUCATION. 69218670 1 1 0 1 0 0 0 0 0 1 1 0 0 0 1 1 0 1 0 0 0 0 0 0 1 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 1 0 1 0 0 0 1 85 0 1 938 1 0 0 0 0 0 1 1 0 0 0 0 X 12 9 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X JENEE SEIBERT 4193352015 725 SOUTH SHOOP AVE WAUSEON OH 43567 CARL HILL PRESIDENT 0.80 X X 0 0 0 SANDY BARBER VICE PRESIDENT 0.80 X X 0 0 0 SHARON GILLESPIE SECRETARY 0.80 X X 0 0 0 MARK HAGANS TREASURER 0.80 X X 0 0 0 BRETT KOLB DIRECTOR 0.80 X 0 0 0 DAVID GRIESER DIRECTOR 0.80 X 0 0 0 JENNIFER MCCULLOUGH DIRECTOR 0.80 X 0 0 0 ALLEN LIECHTY DIRECTOR 0.80 X 0 0 0 STANLEY MULTHAUF DIRECTOR 0.80 X 0 0 0 JON RUPP DIRECTOR 0.80 X 0 0 0 RICK KAZMIERCZAK DIRECTOR 0.80 X 0 0 0 RICK YODER DIRECTOR 0.80 X 12000 0 0 PATRICIA A FINN CHIEF EXECUTIVE OFFICER 40.00 X 187210 0 32382 DARRELL TOPMILLER DIRECTOR OF FINANCE (JAN - OCT) 40.00 X 114203 0 19511 JOANN SHORT DIRECTOR OF NURSING 40.00 X 107139 0 14721 MARY JO SMALLMAN FM ADMINISTRATOR 40.00 X 85623 0 18357 DANIEL MCKERNAN PHYSICIAN 40.00 X 793550 0 20515 CHRISTOPHER SPIELES PHYSICIAN 40.00 X 643540 0 20515 ALAN RIVERA HOSPITALIST 40.00 X 304841 0 0 SEMEGHAGHA FOFUNG PHYSICIAN 40.00 X 274498 0 8170 CHRISTOPHER MEYER PHYSICIAN 40.00 X 173573 0 20515 2696177 0 154686 14 0 1 0 R & F INC 1133 CORPORATE DRIVE SUITE B HOLLAND OH 43528 OCCUPATIONAL/PHYSICAL/SPEECH THERAPY 1433942 ALLIED MEDICAL SERVICES 1133 CORPORATE DRIVE SUITE B HOLLAND OH 43528 RESPIRATORY THERAPY 671896 APRN SLEEP 1133 CORPORATE DRIVE SUITE B HOLLAND OH 43528 SLEEP STUDIES 670515 INTERIM PHYSICIANS 12140 WOODCREST EXECUTIVE DR SUITE ST LOUIS MO 63141 PHYSICIAN SERVICES 552867 HLES OF OHIO PO BOX 277001 ATLANTA GA 30384 ER DOCTORS 480000 24 23950 37069 74050 135069 PATIENT SERVICES 622110 77881692 77881692 EDUCATION SERVICES 611710 96873 96873 REBATES AND REFUNDS 900099 91062 91062 78069627 696735 696735 326177 360034 -33857 -33857 -33857 7783924 12038 7878199 29851 -94275 -17813 -112088 -94275 -17813 31574 37069 31473 101 101 910 720 190 190 FOOD SALES 621110 339131 339131 EHR REIMBURSEMENT 621110 309087 309087 FITNESS MEMBERSHIPS 621110 130365 130365 239073 111183 -2374 130264 1017656 79773433 78525987 -2374 1114751 X 1500 1500 500 500 591146 591146 30784659 28773322 2011337 1174256 1079541 94715 5815261 5438750 376511 1952060 1794607 157453 53610 53610 104150 104150 9021325 8555904 465421 291050 291050 4282422 1936751 2345671 1160011 1035602 124409 2846518 2418492 428026 49377 47965 1412 1160365 1160365 3909225 2517163 1392062 1037844 454402 583442 MEDICAL SUPPLIES 10017627 10012349 5278 BAD DEBT EXPENSE 3627065 3627065 EDUCATION PROGRAMS 29927 29927 GIFT SHOP EXPENSES 23802 23802 19613 19613 77953313 69218670 8734643 0 299700 546507 9605640 7268446 12530516 12100278 1482044 1499206 1067481 983322 80925417 44945069 37510223 35980348 16286631 21463738 0 0 1815859 2273401 80598094 82115246 6263099 6886621 52161 45398 27311668 26595000 2906684 3729420 36533612 37256439 X 44012482 44806807 52000 52000 44064482 44858807 80598094 82115246 X 1820120 -65504 -960291 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 5944 5944 0 PART II-B, LINE 1: TOTAL DUES PAYMENTS TO OHA AND AHA THAT WERE USED BY THE ORGANIZATIONS FOR LOBBYING PURPOSES: - OHIO HOSPITAL ASSOCIATION: 3.4% OF $31,281; $1,064 - AMERICAN HOSPITAL ASSOCIATION: 22.8% OF $17,984; $4,100 - FULTON MANOR OHCA: 19.01% OF $4,105; $780 318958 1460 99 320517 318411 440 107 318958 355607 8280 294 45770 318411 353930 1260 417 355607 347069 6305 556 353930 0.83800 0.16200 0.00000 0 0 2586056 2586056 42199709 20248045 21951664 33174656 23636705 9537951 2964996 1060319 1904677 35980348 FAIR VALUE OF INTEREST RATE SWAP 3729420 3729420 X PART V, LINE 4: ENDOWMENT FUNDS WILL BE USED AS DIRECTED BY THE DONOR. BOARD DESIGNATED FUNDS ARE A MEMORIAL ACCOUNT AND FUNDS WILL BE SPENT AS DIRECTED BY THE BOARD OF DIRECTORS. PART X, LINE 2: THE INTERNAL REVENUE SERVICE HAS RULED THAT THE HOSPITAL AND ITS SUBSIDIARIES ARE EXEMPT FROM FEDERAL INCOME TAXES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND, ACCORDINGLY, NO TAX PROVISION IS REFLECTED IN THE CONSOLIDATED FINANCIAL STATEMENTS. 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 THE IRS OR OTHER APPLICABLE TAXING AUTHORITIES. MANAGEMENT HAS ANALYZED THE TAX POSITIONS TAKEN BY THE HOSPITAL AND HAS CONCLUDED THAT AS OF DECEMBER 31, 2014, THERE ARE NO UNCERTAIN POSITIONS TAKEN OR EXPECTED TO BE TAKEN THAT WOULD REQUIRE RECOGNITION OF A LIABILITY OR DISCLOSURE IN THE CONSOLIDATED FINANCIAL STATEMENTS. THE HOSPITAL IS SUBJECT TO ROUTINE AUDITS BY TAXING JURISDICTIONS; HOWEVER, THERE ARE CURRENTLY NO AUDITS FOR ANY TAX PERIODS IN PROGRESS. MANAGEMENT BELIEVES IT IS NO LONGER SUBJECT TO INCOME TAX EXAMINATIONS FOR YEARS PRIOR TO DECEMBER 31, 2011. GOLF OUTING 49763 34890 14873 10179 5625 1457 225 GERANIUM SALE 5578 0 5578 4156 55341 34890 20451 10179 5625 1457 4381 21642 -1191 1 1 X 1 X 1 X 1 1 0 0 2185847 3338319 -1152472 0.00000 8169109 3737488 4431621 0.05960 439390 301066 138324 0.00190 10794346 7376873 3417473 0.06150 720148 96873 623275 0.00840 4064385 3651260 413125 0.00560 23107 4447 18660 0.00030 4807640 3752580 1055060 0.01430 15601986 11129453 4472533 0.07580 101557 101557 0.00140 101557 101557 0.00140 0 3627065 108812 15659667 16816542 -1156875 X 1 1 1 1 FULTON COUNTY HEALTH CENTER 725 S SHOOP AVE WAUSEON OH 43567 WWW.FULTONCOUNTYHEALTHCENTER.ORG/ 1177AHR X X X X FULTON COUNTY HEALTH CENTER 1 0 0 1 X X X X X X X X X 13 1 0 1 1 X HTTPS://WWW.FULTONCOUNTYHEALTHCENTER.ORG/MEDIA/49929/20 X X 1 13 1 HTTPS://WWW.FULTONCOUNTYHEALTHCENTER.ORG/ 0 0 1 X 200.000000000000 400.000000000000 X 1 1 X X X 1 X X X X X X 1 X 0 X X X X 1 X 0 0 FULTON COUNTY HEALTH CENTER PART V, SECTION B, LINE 5: FULTON 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 HOSPITAL COUNCIL HAS BEEN COMPLETING COMPREHENSIVE HEALTH ASSESSMENTS SINCE 1999. THE PROJECT COORDINATOR FROM THE HOSPITAL COUNCIL OF NW OHIO HOLDS A MASTER'S DEGREE IN PUBLIC HEALTH AND CONDUCTED A SERIES OF MEETINGS WITH THE PLANNING COMMITTEE FROM FULTON COUNTY. DURING THESE MEETINGS, BANKS OF POTENTIAL SURVEY QUESTIONS FROM THE BEHAVIORAL RISK FACTOR SURVEILLANCE, YOUTH RISK BEHAVIOR SURVEILLANCE, AND NATIONAL SURVEY OF CHILDREN'S HEALTH SURVEYS WERE REVIEWED AND DISCUSSED. BASED ON INPUT FROM THE FULTON COUNTY PLANNING COMMITTEE, THE PROJECT COORDINATOR COMPOSED DRAFTS OF SURVEYS CONTAINING 149 ITEMS FOR THE ADULT SURVEY AND 81 ITEMS FOR THE ADOLESCENT SURVEY. THE DRAFTS WERE REVIEWED AND APPROVED BY HEALTH RESEARCHERS AT THE UNIVERSITY OF TOLEDO.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 AND OVER-SAMPLED MINORITY POPULATIONS. IN ADDITION, THE ORGANIZATIONS THAT SERVE THESE POPULATIONS PARTICIPATED IN THE HEALTH ASSESSMENT AND COMMUNITY PLANNING PROCESS, SUCH AS FULTON COUNTY HEALTH DEPARTMENT, THE FULTON COUNTY HEALTH CENTER, AND JOB AND FAMILY SERVICES. THE PARTICIPANTS INCLUDED:A (PH) AFTER THEIR NAME INDICATES THEY WORK IN THE PUBLIC HEALTH FIELD OR TEACH PUBLIC HEALTH. FOUR COUNTY ADAMHS BOARD:LES MCCASLIN, CHIEF EXECUTIVE OFFICERFULTON COUNTY BOARD OF DEVELOPMENTAL DISABILITIES:BETH FRIESS, SUPERINTENDENTFULTON COUNTY HEALTH CENTER:PATRICIA FINN, CHIEF EXECUTIVE OFFICERSTEVE MCCOY, DIRECTOR OF MARKETING AND PLANNINGSHARON MORR, DIRECTOR OF CORPORATE AND COMMUNITY HEALTH PROMOTIONFULTON COUNTY HEALTH DEPARTMENT:MICHAEL P. ORICKO, M.S.E.P.H, HEALTH COMMISSIONER (PH)CINDY ROSE, RN, BSN, DIRECTOR OF NURSING (PH)KIM CUPP, RS, BS, DIRECTOR OF ENVIRONMENTAL HEALTH (PH)RACHEL KINSMAN, HEALTH EDUCATION COORDINATOR (PH)FULTON COUNTY FAMILY & CHILDREN FIRST COUNCIL:KAREN PENNINGTON, COORDINATORLOU MOODY, MSN, PROJECT DIRECTOR, HEALTHY CHOICES CARING COMMUNITIES FULTON COUNTY HEALTH CENTER PART V, SECTION B, LINE 7D: THE ASSESSMENT IS AVAILABLE ON THE FOLLOWING ADDITIONAL WEBSITES: FULTON COUNTY HEALTH DEPARTMENTHTTP://WWW.FULTONCOUNTYHEALTHCENTER.ORG/MEDIA/49929/2013-FULTON-COUNTY-COMMUNITY-NEEDS-ASSESSMENT.PDFHOSPITAL COUNCIL OF NORTHWEST OHIOHTTP://WWW.HCNO.ORG/PDF/COUNTIES/FULTON%20COUNTY%20FINAL%20REPORT%20REV%207-22-13.PDFALSO, HARD COPIES OF THE FULL REPORT WERE GIVEN TO ALL KEY LEADERS AT THE COMMUNITY EVENT. FULTON COUNTY HEALTH CENTER PART V, SECTION B, LINE 11: THE FULL COPY OF THE IMPLEMENTATION PLAN CAN BE FOUND ON THE FOLLOWING WEBSITE: HTTPS://WWW.FULTONCOUNTYHEALTHCENTER.ORG/MEDIA/51554/CHIP-FINAL-10-03-2013.PDF. THE EXECUTION OF THE 3 YEAR PLAN WILL BE STARTED SEPTEMBER 23, 2013 WITH PROGRESS MONITORED MONTHLY FOR TWO MONTHS AND THEN WILL BE MONITORED QUARTERLY. THE HOSPITAL IMPLEMENTATION PLAN WAS FINALIZED IN SEPTEMBER 2013 AND APPROVED BY THE HOSPITAL BOARD ON SEPTEMBER 23, 2013. AT EACH MEETING, THE MEMBERS OF THE FULTON COUNTY PARTNERS FOR HEALTH MEET TO DISCUSS GOALS AND PROGRESS. FULTON COUNTY HEALTH CENTER IS A MEMBER OF THE FULTON COUNTY PARTNERS FOR HEALTH. THIS GROUP HAS COLLABORATED TO ADDRESS SPECIFIC HEALTH NEEDS IN THE COMMUNITY. EACH AGENCY HAS BEEN ASSIGNED SPECIFIC GOALS AND RESPONSIBILITIES. THE PRIMARY ISSUES THE FULTON COUNTY PARTNERS FOR HEALTH GROUP CHOSE TO ADDRESS ARE AS FOLLOWS:YOUTH AND ADULT OBESITY-RELATED BEHAVIORS - INCREASE CONSUMPTION OF FRUITS AND VEGETABLES, AND OTHER HEALTHY FOODS - INCREASE EXERCISE - INCREASE BREASTFEEDINGCARDIOVASCULAR HEALTH - INCREASE AWARENESS OF CVD RISK FACTORS - EMPOWER THE COMMUNITY BY SUPPORTING HIGH QUALITY HEALTH CARE, MANAGING CONDITIONS AFFECTIVELY, GETTING ACTIVE, EATING HEALTHY, STAYING SMOKE FREE, AND REDUCING SODIUM AND TRANS-FATS.YOUTH AND ADULT DEPRESSIONS AND SUICIDE - INCREASE AWARENESS AND SCREENING - EXPAND CURRENT PROGRAMMINGYOUTH BULLYING - INCREASE EVIDENCE BASED PROGRAMMING WITH YOUTH - EDUCATE PARENTSTHE HOSPITAL IS FOCUSING ON THE FOLLOWING HEALTH NEEDS: - ADULT AND YOUTH WEIGHT CONTROL - THE FULTON COUNTY HEALTH CENTER WILL INCREASE THE NUMBER OF BUSINESSES PROVIDING WELLNESS PROGRAMS AND INSURANCE INCENTIVE PROGRAMS TO THEIR EMPLOYEES. THEY WILL ALSO IMPLEMENT THE OHA HEALTHY HOSPITALS INITIATIVE.ADULT CARDIOVASCULAR HEALTH - THE FULTON COUNTY HEALTH CENTER WILL WORK WITH THE HEALTH DEPARTMENT AND HELP ME GROW TO IMPLEMENT THE GO, SLOW, WHOA PROGRAM. THEY WILL ALSO DISTRIBUTE THE RESOURCE ASSESSMENT TO THE COMMUNITY.IN ADDITION, TO THE ABOVE, THE HOSPITAL IS CONTINUES TO SUPPORT THESE HEALTH INITIATIVES WITH THE FOLLOWING FREE AND/OR LOW COSTS HEALTH SCREENINGS TO THE COMMUNITY: - CHOLESTEROL/B/P SCREENINGS AT COMMUNITY LIBRARIES AND COUNTY HIGH SCHOOLS- BLOOD GLUCOSE AND B/P SCREENINGS AT VARIOUS COMMUNITY EVENTS- HEALTH FAIRS OPEN TO THE COMMUNITY & SPECIAL HEALTH SCREENING EVENTS FOR THE FARM COMMUNITY. TESTS/SCREENINGS OFFERED INCLUDE: COMPREHENSIVE METABOLIC PROFILE, BMI AND BODY COMPOSITION TESTING, BONE DENSITY SCREENINGS, HEMOCULT TESTS, SUN EXPOSURE SCREENINGSTHE HOSPITAL CONTINUES TO PROVIDE A VARIETY OF HEALTH AND FITNESS CLASSES THROUGHOUT THE COUNTY AND SURROUNDINGS. THESE CLASSES ARE AS FOLLOWS: - LOW CHOLESTEROL LIVING - SALT SENSE - HEALTHY EATING IN THE REAL WORLD - WEIGHT & NUTRITION MANAGEMENT - LIFESTYLE MANAGEMENT - DIABETIC EDUCATION - VARIOUS FITNESS CLASSES FOR ALL AGES THE FULTON COUNTY HEALTH CENTER WILL PROVIDE SUPPORT TO OTHER HEALTH IMPROVEMENT INITIATIVES THROUGH THEIR REPRESENTATION ON VARIOUS COMMUNITY BOARDS AND COALITIONS. (SEE LIST)BOARDS - DELTA CHAMBER OF COMMERCE HANDS OF GRACE, FAITH IN ACTION - SERVING ELDERLY & DISABLED IN FULTON COUNTY FULTON COUNTY HEART RADIOTHON AMERICAN CANCER SOCIETY - VOLUNTEER LEADERSHIP COUNCIL COALITIONS- FULTON COUNTY AGING CONSORTIUM NORTHWEST OHIO TOBACCO PREVENTION COALITIONHEALTHY CHOICES CARING COMMUNITIES (HC3) (DRUG FREE COMMUNITIES) AMERICAN CANCER SOCIETY - RELAY FOR LIFE FULTON COUNTY EMPLOYEES - WELLNESS COMMITTEE NORTH STAR STEEL WELLNESS COMMITTEE HEALTHY OHIO BUSINESS COUNCIL LINKING EMPLOYEES ASSISTANCE PROGRAMS (LEAP) FULTON COUNTY SAFE COMMUNITIES COALITION FULTON/HENRY NETWORKING SUICIDE PREVENTION COALITIONRESOURCE RESTRICTIONS DO NOT ALLOW THE HOSPITAL TO ADDRESS ALL OF THE NEEDS IDENTIFIED THROUGH THE HEALTH ASSESSMENT. OF THE PRIORITY NEEDS IDENTIFIED BY THE COMMUNITY PLANNING PROCESS, THE HOSPITAL IS NOT DIRECTLY ADDRESSING ALL OF THE ISSUES OF YOUTH AND ADULT OBESITY RELATED BEHAVIORS, CARDIOVASCULAR HEALTH, YOUTH AND ADULT DEPRESSION AND SUICIDE, AND YOUTH BULLYING. THIS IS BECAUSE MANY COMMUNITY AGENCIES ACROSS FULTON COUNTY ARE ADDRESSING THESE ISSUES THROUGH THE FOLLOWING ACTION STEPS: -THE FULTON COUNTY HEALTH DEPARTMENT WILL WORK TO EXPAND THE GROW IT, TRY IT, LIKE IT! PROGRAM TO PRESCHOOLS AND THE C.A.T.C.H. PROGRAM IN SCHOOLS. THEY WILL INITIATE FORMALIZED BREASTFEEDING POLICIES FOR EMPLOYERS. ALONG WITH FULTON COUNTY HEALTH CENTER AND HELP ME GROW THEY WILL IMPLEMENT GO, SLOW, WHOA PROGRAM. LASTLY, THEY ARE GOING TO IMPLEMENT MILLION HEARTS INITIATIVE.-HELP ME GROW WILL IMPLEMENT GO, SLOW, WHOA PROGRAM ALONG WITH THE FULTON COUNTY HEALTH DEPARTMENT AND FULTON COUNTY HEALTH CENTER. -FULTON COUNTY PARTNERS FOR HEALTH WILL CREATE A BRANDED LOGO WITH A CONSISTENT MESSAGE TO INCREASE ADULT CARDIOVASCULAR HEALTH.-FOUR COUNTY ADAMHS BOARD WILL CREATE A MENTAL HEALTH DETOXIFICATION UNIT, AND WILL EXPAND EVIDENCE-BASED PROGRAMS TARGETING YOUTH. THEY WILL ALSO, INCREASE THE NUMBER OF PRIMARY CARE PHYSICIANS SCREENING FOR DEPRESSION DURING OFFICE VISITS (PQH2 AND PQH9).-FOUR COUNTY FAMILY CENTER WILL ASSIST FOUR COUNTY ADAMHS BOARD IN EXPANDING EVIDENCE-BASED PROGRAMS TARGETING YOUTH, AND INCREASE THE NUMBER OF PRIMARY CARE PHYSICIANS SCREENING FOR DEPRESSION DURING OFFICE VISITS (PQH2 AND PQH9). -PIKE DELTA YORK SCHOOLS WILL IMPLEMENT THE OLWEUS PREVENTION PROGRAM IN FULTON COUNTY SCHOOLS.-CENTER FOR CHILD AND FAMILY ADVOCACY WILL WORK WITH PIKE DELTA YORK SCHOOLS TO IMPLEMENT THE OLWEUS PREVENTION PROGRAM IN FULTON COUNTY SCHOOLS.-THE BOARD OF COMMISSIONERS, AGING CONSORTIUM, AND JOB AND FAMILY SERVICES ARE GOING TO IMPLEMENT A TRANSPORTATION SYSTEM. FULTON COUNTY HEALTH CENTER PART V, SECTION B, LINE 16I: FCHC HAS SIGNS POSTED AT EACH PLACE THAT REGISTERS PATIENTS TO INFORM THEM OF FINANCIAL ASSISTANCE AVAILABLE. ALSO, EACH BILLING STATEMENT SENT TO THE PATIENT PROVIDES INFORMATION ON WHO THE PATIENT MAY CONTACT FOR INFORMATION REGARDING FINANCIAL ASSISTANCE. IN ADDITION, FINANCIAL COUNSELORS VISIT CERTAIN PATIENTS IN THE EMERGENCY DEPARTMENT AND ON THE INPATIENT FLOORS TO DISCUSSS THE FINANCIAL ASSISTANCE AVAILABLE TO THEM. FINALLY, FCHC PUBLICIZED THEIR POLICY THROUGH THE FOLLOWING WAYS: POSTED ON THE HOSPITAL FACILITY'S WEBSITE, ATTACHED TO BILLING INVOICES, POSTED IN THE HOSPITAL FACILITY'S EMERGENCY ROOMS AND WAITING ROOMS, POSTED IN THE HOSPITAL FACILITY'S ADMISSIONS OFFICES, PROVIDED IN WRITING TO PATIENTS ON ADMISSION TO THE HOSPITAL FACILITY, AND MADE AVAILABLE UPON REQUEST. PART V, SECTION B, LINE 16B HTTPS://WWW.FULTONCOUNTYHEALTHCENTER.ORG/MEDIA/51500/2014-HCAP-FINANCIAL-ASSISTANCE-PROGRAM.PDF PART V, SECTION B, LINE 16 FINANCIAL ASSISTANCE POLICY WEBSITE AVAILABILITY FULTON COUNTY HEALTH CENTER PART V, SECTION B, LINE 16B WEBSITE: WWW.FULTONCOUNTYHEALTHCENTER.ORG 2 FULTON MANOR 725 SOUTH SHOOP AVENUE WAUSEON OH 43567 SKILLED NURSING HOME FCHC MEDICAL CARE LLC 725 SOUTH SHOOP AVENUE WAUSEON OH 43567 PHYSICIAN PRACTICES PART I, LINE 7: COST OF CHARITY CARE IS CALCULATED USING COST-TO-CHARGE RATIO FROM WORKSHEET 2. COST OF MEDICAID IS PER THE MEDICAID COST REPORT. THE REMAINING ITEMS ARE CALCULATED BASED ON ACTUAL COSTS OF SPECIFIC PROGRAMS WITHOUT THE USE OF A COST ACCOUNTING SYSTEM. PART I, LINE 7G: THE FCHC EMERGENCY ROOM QUALIFIED AS A SUBSIDIZED HEALTH SERVICE IN 2014. PART I, LN 7 COL(F): THE AMOUNT OF BAD DEBT EXPENSE THAT WAS REMOVED FROM THE CALCULATION IN PART I LINE 7 COLUMN (F) TOTALED $3,627,065. PART II, COMMUNITY BUILDING ACTIVITIES: FCHC INCURRED $101,557 EXPENSES RELATED TO RECRUITING AND MAINTAINING QUALIFIED PHYSICIANS AND SPECIALISTS TO THE HOSPITAL. THESE PHYSICIANS AND SPECIALISTS ARE CRITICAL TO ENHANCING THE HEALTH AND LEVEL OF CARE PROVIDED TO THE COMMUNITY. WITHOUT FCHC RECRUITING AND MAINTAINING THESE PHYSICIANS, THE COMMUNITY WOULD NOT HAVE ACCESS TO THESE DOCTORS. PART III, LINE 2: FCHC CALCULATES BAD DEBT EXPENSE PER THE FINANCIAL STATEMENTS. PART III, LINE 3: FCHC USED A 3% CALCULATION OF TOTAL BAD DEBT PER THE FINANCIAL STATEMENTS IN ORDER TO ESTIMATE THE AMOUNT OF BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENTS WHO WOULD HAVE BEEN ELIGIBLE UNDER THE ORGANIZATION'S FINANCIAL ASSISTANCE POLICY. THE PERCENTAGE IS ESTIMATED BASED ON PRIOR HISTORY AND REVIEW OF CHARITY LOGS.ANY BAD DEBT EXPENSE THAT IS ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S CHARITY FINANCIAL ASSISTANCE POLICY WOULD BE RECLASSIFIED FROM BAD DEBT TO CHARITY CARE ONCE IT IS IDENTIFIED. THE ENTIRE AMOUNT OF THE BAD DEBT EXPENSE IS REVERSED AND ASSIGNED TO CHARITY CARE. PART III, LINE 4: FINANCIAL STATEMENT FOOTNOTE REGARDING BAD DEBT: ACCOUNTS RECEIVABLE FOR PATIENTS, INSURANCE COMPANIES, AND GOVERNMENTAL AGENCIES ARE BASED ON GROSS CHARGES. AN ALLOWANCE FOR CONTRACTUAL ADJUSTMENTS AND INTERIM PAYMENT ADVANCES IS BASED ON EXPECTED PAYMENT RATES FROM PAYORS BASED ON CURRENT REIMBURSEMENT METHODOLOGIES. THIS AMOUNT ALSO INCLUDES AMOUNTS RECEIVED AS INTERIM PAYMENTS UNPAID CLAIMS BY CERTAIN PAYORS. ACCOUNTS RECEIVABLE ARE REDUCED BY AN ALLOWANCE FOR DOUBTFUL ACCOUNTS.IN EVALUATING THE COLLECTIBILITY OF ACCOUNTS RECEIVABLE, THE HOSPITAL ANALYZES ITS PAST HISTORY AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYOR SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND PROVISION FOR BAD DEBTS. MANAGEMENT REGULARLY REVIEWS DATA ABOUT THESE MAJOR PAYOR SOURCES OR REVENUE IN EVALUATING THE SUFFICIENCY OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS.FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY COVERAGE, THE HOSPITAL ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS AND A PROVISION FOR BAD DEBTS, IF NECESSARY (FOR EXAMPLE, FOR EXPECTED UNCOLLECTIBLE DEDUCTIBLES AND COPAYMENTS ON ACCOUNTS FOR WHICH THE THIRDPARTY PAYOR HAS NOT YET PAID, OR FOR PAYORS WHO ARE KNOWN TO BE HAVING FINANCIAL DIFFICULTIES THAT MAKE THE REALIZATION OF AMOUNTS DUE UNLIKELY). FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS (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 IN THE PERIOD THEY ARE DETERMINED TO BE UNCOLLECTIBLE. PART III, LINE 8: MEDICARE ALLOWABLE COSTS TAKEN FROM THE FILED MEDICARE COST REPORT WERE CALCULATED USING A COST TO CHARGE RATIO. ANY SHORTFALLS GENERATED ARE CONSIDERED TO BE A COMMUNITY BENEFIT. PART III, LINE 9B: THE PRACTICES FULTON COUNTY HEALTH CENTER UTILIZES TO COLLECT FROM PATIENTS INCLUDES: PATIENTS ARE SENT STATEMENTS FOR OUTSTANDING BALANCES FOR A PERIOD OF TIME NOT LESS THAN 105 DAYS, AFTER AN EFFORT HAS BEEN MADE TO COLLECT THE BALANCE OR PLAN A PATIENT-PAY ACCOUNT PAYMENT PLAN THROUGH A SERIES OF 4 LETTERS AND 2 TELEPHONE CONTACTS DURING THE AFOREMENTIONED 105 DAY PERIOD, THE ACCOUNT IS TURNED OVER TO A COLLECTION AGENCY FOR FURTHER COLLECTION EFFORTS OR LEGAL ACTION. COLLECTION EFFORTS ARE NOT ENFORCED FOR BALANCES KNOWN TO QUALIFY UNDER CHARITY CARE OR OTHER FINANCIAL ASSISTANCE CRITERIA. PART VI, LINE 2: EVERY THREE YEARS, THE ORGANIZATION PERFORMS A COMMUNITY HEALTH NEEDS ASSESSMENT TO DETERMINE THE CURRENT HEALTH NEEDS WITHIN THE COMMUNITY. IN ADDITION, THE MEDICAL STAFF PROVIDES THE HOSPITAL WITH HEALTH CARE NEEDS WITHIN THE COMMUNITY BASED ON THEIR OWN PATIENT HEALTH CARE NEEDS. PART VI, LINE 3: FCHC HAS SIGNS POSTED AT EACH PLACE THAT REGISTERS PATIENTS TO INFORM THEM OF FINANCIAL ASSISTANCE AVAILABLE. ALSO, EACH BILLING STATEMENT SENT TO THE PATIENTS PROVIDES INFORMATION ON WHO THE PATIENT MAY CONTACT FOR INFORMATION REGARDING FINANCIAL ASSISTANCE. IN ADDITION, FINANCIAL COUNSELORS VISIT CERTAIN PATIENTS IN THE EMERGENCY DEPARTMENT AND ON THE INPATIENT FLOORS TO DISCUSS THE FINANCIAL ASSISTANCE AVAILABLE TO THEM. FINALLY, FCHC PUBLICIZES THEIR POLICY THROUGH THE FOLLOWING WAYS: POSTED ON THE HOSPITAL FACILITY'S WEBSITE, ATTACHED TO BILLING INVOICES, POSTED IN THE HOSPITAL FACILITY'S EMERGENCY ROOMS AND WAITING ROOMS, POSTED IN THE HOSPITAL FACILITY'S ADMISSIONS OFFICES, PROVIDED IN WRITING TO PATIENTS ON ADMISSION TO THE HOSPITAL FACILITY, AND MADE AVAILABLE UPON REQUEST. PART VI, LINE 4: FCHC SERVES FULTON COUNTY, OHIO AS THE PRIMARY SERVICE AREA, AS WELL AS PORTIONS OF HENRY & WILLIAMS COUNTIES IN OHIO AND MORENCI, MICHIGAN AS THE SECONDARY SERVICE AREA. THE POPULATION THAT THE HOSPITAL SERVICES RANGES FROM 40,000 TO 45,000. THERE ARE NO OTHER HOSPITALS IN FULTON COUNTY. THE PERCENTAGE OF PERSONS BELOW THE POVERTY LEVEL IS APPROXIMATELY 9-11%. THE AVERAGE MEDIAN HOUSEHOLD INCOME IS APPROXIMATELY $59,000. APPROXIMATELY 9% OF FULTON COUNTY RESIDENTS ARE UNINSURED. ALMOST 73% OF RESIDENTS ARE ADULTS OVER THE AGE OF 19, 11% ARE YOUTH AGES 12-18 YEARS AND 16% ARE ADOLESCENTS UNDER THE AGE OF 11. THE MAJORITY (95%) OF THE POPULATION ARE CAUCASIAN. HISPANICS (8%), AFRICAN AMERICANS (<1%), ASIAN (<1%) AND TWO OR MORE RACES (2%) COMPRISE THE REST OF THE POPULATION. PART VI, LINE 5: ALL OF THE ORGANIZATION'S BOARD MEMBERS RESIDE IN THE SERVICE AREA OF THE HOSPITAL. BOARD MEMBERS REPRESENT AND LIVE IN THE CITIES AND VILLAGES OF FULTON COUNTY AND ARE NEITHER EMPLOYEES NOR INDEPENDENT CONTRACTORS OF THE ORGANIZATION. THE ORGANIZATION EXTENDS MEDICAL STAFF PRIVILEGES TO ALL QUALIFIED PHYSICIANS IN ITS COMMUNITY THAT MEET THE MEDICAL STAFF BYLAW REQUIREMENTS. THE ORGANIZATION REINVESTS SURPLUS FUNDS INTO THE ORGANIZATION IN THE FORM OF NEW EQUIPMENT, RENOVATIONS, AND ADDITIONAL SERVICES. THE ORGANIZATION HAD 15% OF ITS REVENUE SOURCED FROM MEDICAID AND UNINSURED PATIENTS. FCHC INCURRED $101,557 EXPENSES RELATED TO RECRUITING AND MAINTAINING QUALIFIED PHYSICIANS AND SPECIALISTS TO THE HOSPITAL. THESE PHYSICIANS AND SPECIALISTS ARE CRITICAL TO ENHANCING THE HEALTH AND LEVEL OF CARE PROVIDED TO THE COMMUNITY. WITHOUT FCHC RECRUITING AND MAINTAINING THESE PHYSICIANS, THE COMMUNITY WOULD NOT HAVE ACCESS TO THESE DOCTORS. DURING 2014, FCHC PARTICIPATED IN THE SUMMER FOOD SERVICE PROGRAM (SFSP) IN WAUSEON. SFSP WAS ESTABLISHED TO ENSURE THAT LOW-INCOME CHILDREN AGES 1 TO 18 RECEIVE NUTRITIOUS MEALS IN THE SUMMER MONTHS. THESE FREE MEALS MEET FEDERAL NUTRITION GUIDELINE AND ARE PROVIDED TO ALL CHILDREN ATTENDING THE PROGRAM. FCHC WAS RESPONSIBLE FOR PREPARING AND DELIVERING THESE MEALS. FCHC PROVIDED 2,590 MEALS TO CHILDREN AT TWO LOCATIONS DURING THE MONTHS OF JUNE, JULY AND AUGUST. THERE ARE MANY CHILDREN THAT COUNT ON THESE MEALS FOR PROPER NUTRITION. PART VI, LINE 6: N/A X X 0 0 0 0 0 0 0 0 0 PATRICIA A FINN CHIEF EXECUTIVE OFFICER 187210 0 0 0 0 0 9691 0 22691 0 219592 0 0 0 DANIEL MCKERNAN PHYSICIAN 793550 0 0 0 0 0 0 0 20515 0 814065 0 0 0 CHRISTOPHER SPIELES PHYSICIAN 643540 0 0 0 0 0 0 0 20515 0 664055 0 0 0 ALAN RIVERA HOSPITALIST 304841 0 0 0 0 0 0 0 0 0 304841 0 0 0 SEMEGHAGHA FOFUNG PHYSICIAN 274498 0 0 0 0 0 0 0 8170 0 282668 0 0 0 CHRISTOPHER MEYER PHYSICIAN 173573 0 0 0 0 0 0 0 20515 0 194088 0 0 0 A COUNTY OF FULTON OHIO 346400540 2011-10-20 28755000 SEE PART VI 0 0 0 A 28755000 318130 28436870 2009 1 0 1 1 A 0 0 1 1 1 1 0.00000 0.00000 0.00000 0 0 0 A 0 1 0 0 1 0 0 0 0 A 0 FORM 990, SCHEDULE K, PART III, LINE 3A: FOOTNOTE: UNDER THE SAFE-HARBOR PROVISIONS OF REVENUE PROCEDURE 97-13, THE MANAGEMENT CONTRACTS DO NOT RESULT IN PRIVATE BUSINESS USES. FORM 990, SCHEDULE K, PART III, LINE 3C: FOOTNOTE: FULTON COUNTY HEALTH CENTER'S ONCOLOGY DEPARTMENT PARTICIPATES IN THE TOLEDO ONCOLOGY CANCER DRUG RESEARCH PROGRAM. RESEARCH AGREEMENTS RELATED TO THIS PROGRAM DO NOT RESULT IN PRIVATE BUSINESS USE. FORM 990, SCHEDULE K, PART I, LINE A, COLUMN (F): FOOTNOTE: CURRENT REFUNDING OF $28,500,000 FULTON COUNTY HEALTH CENTER, COUNTY OF FULTON, OHIO, ADJUSTABLE RATE DEMAND REVENUE BOND SERIES 2005, ISSUED DECEMBER 1, 2005. FORM 990, SCHEDULE K, PART II, LINE 11: FOOTNOTE: PROCEEDS USED TO REFUND BONDS DESCRIBED IN PART I, LINE A, COLUMN (F), AS REFERRED TO IN PART II, LINE 14. THE ORGANIZATION ENTERED INTO A QUALIFIED HEDGE WITH RESPECT TO THE REFUNDED BOND ISSUE. PURSUANT TO TREASURY REGULATIONS SECTION 1.48-4(H)(3)(IV)(A), THE HEDGE WAS DEEMED TERMINATED UPON ISSUANCE OF THE 2011 REFUNDING BONDS. UNDER TREASURY REGULATIONS SECTION 1.148-4(H)(3)(IV)(C), FOR REBATE PURPOSES THE DEEMED TERMINATION OF THE HEDGE RESULTS IN A DEEMED TERMINATION PAYMENT THAT IS ALLOCATED TO THE 2011 REFUNDING ISSUE. AS A RESULT OF THIS PROVISION, FOR REBATE PURPOSES A PORTION OF THE PROCEEDS OF THE 2011 REFUNDING ISSUE IS DEEMED TO CONSTITUTE A PAYMENT TO THE HEDGE PROVIDER. THE ORGANIZATION HAS REPORTED THE MANNER IN WHICH THE PROCEEDS WERE ACTUALLY SPENT IN PART II, LINES 1-11. FORM 990, SCHEDULE K, PART IV, LINE 4A: FOOTNOTE: AS DISCUSSED IN THE SUPPLEMENTAL INFORMATION PROVIDED IN PART II, LINE 11, THE ORGANIZATION ENTERED INTO A QUALIFIED HEDGE WITH RESPECT TO THE BONDS THAT ARE DESCRIBED IN PART I, LINE A, COLUMN (F), WHICH WERE REFUNDED BY THE 2011 REFUNDING ISSUE. THE QUALIFIED HEDGE WAS DEEMED TERMINATED PURSUANT TO TREASURY REGULATIONS SECTION 1.148-4(H)(3)(IV)(A). THE PAYMENTS ON THE HEDGE DO NOT CLOSELY CORRESPOND TO THE PRINCIPAL PAYMENTS ON THE 2011 REFUNDING ISSUE AND THE HEDGE HAS THEREFORE NOT BEEN IDENTIFIED AS A QUALIFYING HEDGE WITH RESPECT TO THE 2011 REFUNDING ISSUE. FORM 990, SCHEDULE K, PART III, LINE 7: FOOTNOTE: FULTON COUNTY HEALTH CENTER DOES NOT BELIEVE THAT THE BOND ISSUE MEETS THE PRIVATE SECURITY OR PAYMENT TEST, BUT BECAUSE THERE IS NO PRIVATE BUSINESS USE OF THE BOND-FINANCED FACILITIES, IT HAS NOT FORMALLY CALCULATED WHETHER THE PRIVATE SECURITY OR PAYMENT TEST HAS BEEN MET. JANET M BUEHRER EMPLOYEE OF FCHC/SISTER TO SHARON GILLEPSIE (BOARD MEMBER) 42953 W-2 WAGES 0 DAWN M KOLB EMPLOYEE OF FCHC/WIFE TO BRETT KOLB (BOARD MEMBER) 45868 W-2 WAGES 0 FORM 990, PART III, LINE 2 IN AUGUST OF 2014, OUR MENTAL AND BEHAVIORAL HEALTH SERVICES WERE EXPANDED TO OFFER GERIATRIC BEHAVIORAL HEALTH SERVICES TO THOSE 65 AND OLDER. FORM 990, PART VI, SECTION B, LINE 11 A COPY OF THE FORM 990 IS PROVIDED TO AND REVIEWED BY EACH OF THE ORGANIZATION'S BOARD OF DIRECTORS, DIRECTOR OF FINANCE - JENEE SEIBERT, AND CHIEF EXECUTIVE OFFICER - PATRICIA A. FINN, BEFORE THE FORM IS FILED. FORM 990, PART VI, SECTION B, LINE 12C CONFLICT OF INTEREST QUESTIONNAIRES ARE DISTRIBUTED ANNUALLY TO THE BOARD OF DIRECTORS AND DEPARTMENT HEADS. NEW BOARD MEMBERS ARE INTERVIEWED BY THE ADMINISTRATOR AND AT THAT TIME, DISCUSS WHETHER ANY CONFLICTS OF INTEREST EXIST. THE BOARD MEMBER IS PRESENTED TO THE EXECUTIVE COMMITTEE WHO REVIEWS ALL PERTINENT INFORMATION TO DETERMINE IF THERE IS A CONFLICT OF INTEREST AND WHETHER THAT PERSON CAN SERVE AS A BOARD MEMBER. VENDORS ARE REVIEWED REGULARLY BY DEPARTMENT HEADS TO DETERMINE IF ANY RELATIONSHIPS EXIST PER THE CONFLICT OF INTEREST QUESTIONNAIRES. AN OFFICER, DIRECTOR, OR KEY EMPLOYEE WHO HAS A CONFLICT OF INTEREST SHALL DISCLOSE THE CONFLICT OF INTEREST WHEN IT ARISES, AND BEFORE ACTION ON THE TRANSACTION OR CLAIM IN QUESTION. DISCLOSURE IS REQUIRED EVEN IF A DECISION CONCERNING THE TRANSACTION OR CLAIM IS NOT SUBJECT TO APPROVAL BY THE OFFICER, DIRECTOR, OR KEY EMPLOYEE OR THE BOARD OR COMMITTEE ON WHICH THE OFFICER, DIRECTOR, OR KEY EMPLOYEE SERVES. THE POLICY PROVIDES A PROCEDURE FOR REPORTING POTENTIAL CONFLICTS WHEN THEY ARISE AND BEFORE ACTION TO APPROVE OR AUTHORIZE THE TRANSACTION IS TAKEN. THE POLICY COVERS DIRECTORS, OFFICERS, EMPLOYEES OR AGENTS OF FULTON COUNTY HEALTH CENTER AND MEMBERS OF COMMITTEES AUTHORIZED TO APPROVE TRANSACTIONS OR ASSERT CLAIMS ON BEHALF OF THE FULTON COUNTY HEALTH CENTER. THE BOARD OF DIRECTORS, OTHER THAN ANY BOARD MEMBER DIRECTLY INVOLVED WITH THE CONFLICT, DETERMINES WHETHER A CONFLICT OF INTEREST INVOLVING AN INDIVIDUAL COVERED BY THE POLICY EXISTS AND REVIEWS ACTUAL CONFLICTS. INDIVIDUALS WITH CONFLICTS ARE NOT PERMITTED TO PARTICIPATE IN DELIBERATIONS OR VOTE TO AUTHORIZE A TRANSACTION OR ASSERTION OF A CLAIM. FORM 990, PART VI, SECTION B, LINE 15 THE COMPENSATION OF THE ORGANIZATION'S CHIEF EXECUTIVE OFFICER, PATRICIA A. FINN, IS APPROVED BY THE BOARD OF DIRECTORS. THE ORGANIZATION PARTICIPATES WITH THE OHA AND USES THEIR WAGE SURVEYS TO HELP DETERMINE THE ADMINISTRATOR'S COMPENSATION. THE ADMINISTRATOR'S COMPENSATION IS REVIEWED ANNUALLY AND DECISIONS ARE DOCUMENTED IN THE BOARD OF DIRECTOR MEETING MINUTES. THE COMPENSATION OF OFFICERS AND KEY EMPLOYEES ARE REVIEWED BY THE BOARD OF DIRECTORS. THE ORGANIZATION PARTICIPATES WITH THE OHA AND USES THEIR WAGE SURVEYS TO HELP DETERMINE OFFICER COMPENSATION. THE BOARD APPROVES THE COMPENSATION OF EMPLOYEES IN THE AGGREGATE. OFFICER COMPENSATION IS REVIEWED ANNUALLY AND DECISIONS ARE DOCUMENTED IN THE BOARD OF DIRECTOR MEETING MINUTES. THE COMPENSATION REVIEW PROCESS FOR THE CEO, OFFICERS, AND KEY EMPLOYEES WAS LAST PERFORMED IN FEBRUARY 2014. A COST OF LIVING RAISE WAS RECEIVED AT THE BEGINNING OF 2015. THIS WAGE INCREASE WAS CONSISTENT WITH THE WAGE INCREASE FOR ALL FCHC PERSONNEL. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS FORM 990 AVAILABLE FOR PUBLIC INSPECTION UPON REQUEST. GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND THE FINANCIAL STATEMENTS ARE NOT AVAILABLE TO THE PUBLIC. FORM 990, PART IX, LINE 11G PROFESSIONAL SERVICES: PROGRAM SERVICE EXPENSES 5,629,852. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 5,629,852. HUMAN RESOURCES: PROGRAM SERVICE EXPENSES 82,529. MANAGEMENT AND GENERAL EXPENSES 7,241. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 89,770. CONSULTING: PROGRAM SERVICE EXPENSES 4,949. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 4,949. DIRECTORSHIP/HOUSEKEEPING/OTHER SERVICES: PROGRAM SERVICE EXPENSES 185,076. MANAGEMENT AND GENERAL EXPENSES 458,180. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 643,256. BILLING & COLLECTIONS: PROGRAM SERVICE EXPENSES 2,653,498. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,653,498. FORM 990, PART XI, LINE 9: CHANGE IN FAIR VALUE OF INTEREST SWAP AGREEMENTS -960,291. FORM 990, PART XII, LINE 2C: THE OVERSIGHT OF THE AUDIT OF THE FINANCIAL STATEMENTS HAS NOT CHANGED SINCE THE PRIOR YEAR. FCHC MEDICAL CARE LLC 725 S SHOOP AVE WAUSEON OH 435671702 010877201 PHYSICIAN BILLING AND PHYSICIAN PRACTICES OH 6397699 2674714 FULTON COUNTY HEALTH CENTER FCHC MEDICAL SERVICES LLC 725 S SHOOP AVE WAUSEON OH 435671702 010877202 HOLD LAND OH 0 356584 FULTON COUNTY HEALTH CENTER