2014-11-17T09:44:33-06:00 2013-12-31 ERNST & YOUNG US LLP 2100 ONE PPG PLACE PITTSBURGH PA 15222 990 2013-01-01 900059117 University Hospitals Health System Inc Group Return % MICHAEL SZUBSKI UNIV 2168441000 11100 Euclid Avenue - Attn Treasur Suite Cleveland OH 44106 MICHAEL SZUBSKI CFO 2014-11-14 ROBERT VUILLEMOT P01283296 2013 2015-11-30 17:44:51Z Michael Szubski 3605 Warrensville Center Rd Shaker Heights OH 44122 2327281400 true false 3829 X www.UHhospitals.org X OH University Hospitals (the System) is guided by its mission "To Heal. To Teach. To Discover." 168 93 16207 2185 697000 384927 89840000 53111000 2015029000 2106303000 40000 71265000 71151000 95729000 2176060000 2326408000 31771000 34294000 0 0 997592000 1151268000 306000 33000 11510000 907762000 896375000 1937431000 2081970000 238629000 244438000 1533691000 3338270000 214268000 1702200000 1319423000 1636070000 X UNIVERSITY HOSPITALS' MISSION IS TO HEAL. TO TEACH. TO DISCOVER. IN PURSUIT OF THIS MISSION, UNIVERSITY HOSPITALS REMAINS AT THE FOREFRONT OF HEALTH CARE DELIVERY, PHYSICIAN EDUCATION, AND MEDICAL RESEARCH NATIONWIDE. YET WHAT MAKES UNIVERSITY HOSPITALS UNIQUE IS ITS ABILITY TO BRING EXPERTISE AND RESOURCES TOGETHER AND RESPOND TO THE INDIVIDUAL NEEDS OF EVERY PATIENT, REGARDLESS OF THEIR ABILITY TO PAY. THAT FOCUS ON THE PATIENT, COMBINED WITH A REMARKABLE LEVEL OF ACHIEVEMENT IN MEDICAL RESEARCH AND EDUCATION CONTINUES TO PROPEL UNIVERSITY HOSPITALS TO EVEN GREATER SUCCESSES. false false 2052570000 34294000 2185076000 Commitment to the community remains at the core of the System's mission: To Heal. To Teach. To Discover. In 2013, University Hospitals dedicated more than $240 million to community benefit programs in Northeast Ohio consisting of: - Education and training = $53 million - Research = $27 million - Charity care = $59 million - Medicaid shortfall = $68 million - Community health improvement services = $6 million - Other community programs and support = $38 million - Hospital Care Assurance Program (HCAP) receipts = ($11 million) Refer to Schedule H for further detail on how the System measures and reports community benefit. Community benefit for 2013 totaled $240 million. In addition to charity care and insufficient funding from the Medicaid program, the System incurs significant losses related to self-pay patients who fail to make payment for services rendered or insured patients who fail to remit co-payments and deductibles as required under applicable health insurance arrangements. The 2013 provision for bad debt of $60 million represents revenues for services provided that are deemed uncollectible. The UH health system provides work directly for about 19,400 employees and physicians. As the seventh largest employer in Ohio, UH supports the economy as well as state and local governments. UH employees pay more than $56 million annually in state and local income taxes. At the same time, UH provides many more Community benefits directly and indirectly through new or expanded business opportunities and through important capital investments in our facilities. UH has committed - and continues to commit - millions of dollars to facilities and operations within the city of Cleveland and throughout our region, providing construction and hospital-based jobs. State-of-the-art facilities and services at UH Case Medical Center, our world-renowned academic medical center in Cleveland, provide Cleveland residents and people from throughout the region and the world with the finest in primary and specialty health care. The facilities allow us to conduct vital medical research and offer advanced training for students and health professionals. The Quentin & Elisabeth Alexander Neonatal Intensive Care Unit at UH Rainbow Babies & Children's Hospital serves our most vulnerable children. The System's Seidman Cancer Center and emergency facilities at UH Case Medical Center and UH Ahuja Medical Center, continue to provide expanded employment opportunities while extending UH's mission to more patients. New state-of-the-art outpatient health centers in the region have spurred economic growth while giving people access to the care they need close to home and expanding our community benefit programs. The System is proud to contribute to the health of our citizens and to be a positive economic force in our region. For more detailed information on the System's community benefit or to view the 2013 Community Benefit Report, please visit the System's website at www.UHhospitals.org. 2052570000 true true false true false false false true false true true true true true true false false true false false false false false false true false true true true false true false false false false false true true true true true false false true true true true false false true 1539 0 true 16207 true true true false false false false true true false false false false false X 168 93 true false false false true true true true true false false true true true true true true true true true true FL IL KY MI NY OH PA WV WI X X MICHAEL SZUBSKI 2168441000 3605 WARRENSVILLE CENTER RD Shaker Heights OH 44122 X UHHS - Monte Ahuja Director 2.0 X 0 0 0 UHHS - Sheldon G Adelman Director 2.0 X 0 0 0 UHHS - Arthur F Anton Director 2.0 X 0 0 0 UHHS - Craig Arnold Director 2.0 X 0 0 0 UHHS - Katherine A Asbeck Director 2.0 X 0 0 0 UHHS - Andrew Banks Director 2.0 X 0 0 0 UHHS - Paul Clark Director 2.0 X 0 0 0 UHHS - Christopher M Connor Director 2.0 X 0 0 0 UHHS - Margot J Copeland Director 2.0 X 0 0 0 UHHS - David A Daberko Director 2.0 X 0 0 0 UHHS - Heather Ettinger Director 2.0 X 0 0 0 UHHS - John Fitts Ex Off Dir. 2.0 X 0 0 0 UHHS - Brian Hall Director 2.0 X 0 0 0 UHHS - Kenneth Hardy Director 2.0 X 0 0 0 UHHS - M Ann Harlan Director 2.0 X 0 0 0 UHHS - Ronald G Harrington Director 2.0 X 0 0 0 UHHS - Catherine M Kilbane Director 2.0 X 0 0 0 UHHS - Timothy Kraus Ex Off Dir. 2.0 X 0 0 0 UHHS - Joseph Lopez Director 2.0 X 0 0 0 UHHS - Ramon Lugo III Director 2.0 X 0 0 0 UHHS - Henry L Meyer III Director 2.0 X 0 0 0 UHHS - John Morikis Ex Off Dir. 2.0 X 0 0 0 UHHS - Patrick Mullin Ex Off Dir. 2.0 X 0 0 0 UHHS - Ernest Novak Director 2.0 X 0 0 0 UHHS - Vasu Pandrangi MD Ex Off Dir. 2.0 X 0 0 0 UHHS - Gary Pasqualone Ex Off Dir. 2.0 X 0 0 0 UHHS - Sandy Pianalto Vice Chair/Director 2.0 X X 0 0 0 UHHS - Mark Plush Ex Off Dir. 2.0 X 0 0 0 UHHS - Richard W Pogue Director 2.0 X 0 0 0 UHHS - Alfred M Rankin Jr Chair/Director 2.0 X X 0 0 0 UHHS - Willard Raymond Ex Off Dir. (thru 5/13) 2.0 X 0 0 0 UHHS - Gregory Robinson Ex Off Dir. (thru 5/13) 2.0 X 0 0 0 UHHS - Fred C Rothstein MD Pres. UHCMC/Ex Off Dir. 60.0 X 1227683 0 68073 UHHS - Robert Salata MD UHMG Physician/Director 60.0 X 89075 0 3067 UHHS - Thomas A Selden Ex Off Dir. 2.0 X 0 0 0 UHHS - Jerry Sue Thornton PhD Director 2.0 X 0 0 0 UHHS - Les C Vinney Director 2.0 X 0 0 0 UHHS - Thomas F Zenty III CEO/Ex Off Dir. 60.0 X X 2239564 0 375275 UHCMC - Joel Adelman Director 2.0 X 0 0 0 UHCMC - Thomas W Adler Director (thru 5/13) 2.0 X 0 0 0 UHCMC - Robert T Bennett Director (thru 5/13) 2.0 X 0 0 0 UHCMC - David Camiener Director 2.0 X 0 0 0 UHCMC - Paul H Carleton Co-Vice Chair/Director 2.0 X X 0 0 0 UHCMC - Carole A Carr Director 2.0 X 0 0 0 UHCMC - Pamela B Davis MD PhD Ex Off Dir. 2.0 X 0 0 0 UHCMC - Ralph Della Ratta Director 2.0 X 0 0 0 UHCMC - Michael Feuer Director 2.0 X 0 0 0 UHCMC - David Goldberg Director 2.0 X 0 0 0 UHCMC - Robert D Gries Director 2.0 X 0 0 0 UHCMC - Charles Hallberg Director 2.0 X 0 0 0 UHCMC - Christopher Hyland Co-Vice Chair/Director 2.0 X X 0 0 0 UHCMC - Jerry Kelsheimer Director 2.0 X 0 0 0 UHCMC - Dinah Kolesar Ex Off Dir. 2.0 X 0 0 0 UHCMC - Lee Koury Director 2.0 X 0 0 0 UHCMC - Raymond K Lee Director 2.0 X 0 0 0 UHCMC - Gene C Lovett Director 2.0 X 0 0 0 UHCMC - Adrian Maldonado Director 2.0 X 0 0 0 UHCMC - John C Morley Director 2.0 X 0 0 0 UHCMC - Patrick S Mullin Chair/Director 2.0 X X 0 0 0 UHCMC - William J O'Neill Jr Director 2.0 X 0 0 0 UHCMC - Alfred M Rankin Jr Ex Off Dir. (thru 5/13) 2.0 X 0 0 0 UHCMC - Ann P Ranney Director 2.0 X 0 0 0 UHCMC - Julie Adler Raskind Director 2.0 X 0 0 0 UHCMC - David M Reynolds Director 2.0 X 0 0 0 UHCMC - Kenneth C Ricci Director 2.0 X 0 0 0 UHCMC - Robert Risman Director (thru 9/13) 2.0 X 0 0 0 UHCMC - Barbara S Robinson Director 2.0 X 0 0 0 UHCMC - Fred C Rothstein MD Pres./Ex Off Dir. 2.0 X X 0 0 0 UHCMC - Mairan Shaughnessy Director 2.0 X 0 0 0 UHCMC - Gregory Skoda Director 2.0 X 0 0 0 UHCMC - Hilton O Smith Director 2.0 X 0 0 0 UHCMC - Eddie Taylor Director 2.0 X 0 0 0 UHCMC - Richard Walsh MD Ex Off Dir. 2.0 X 0 0 0 UHCMC - Penni Weinberg Director 2.0 X 0 0 0 UHCMC - Djames W Wert Director 2.0 X 0 0 0 UHCMC - Lorna Wisham Director 2.0 X 0 0 0 UHCMC - Jacqueline Woods Director 2.0 X 0 0 0 UHCMC - Christine Wynd Ex Off Dir. 2.0 X 0 0 0 UHCMC - Thomas F Zenty III Ex Off Dir. 2.0 X 0 0 0 UHMG - Eric Bieber MD UH CMO/Director 2.0 X 0 0 UHMG - Paul H Carleton Director 2.0 X 0 0 0 UHMG - Pamela B Davis MD Phd Director 2.0 X 0 0 0 UHMG - Patricia DePompei Director 2.0 X 0 0 0 UHMG - Michael Feuer Director 2.0 X 0 0 0 UHMG - Charles Hallberg Director 2.0 X 0 0 0 UHMG - Clifford V Harding MD Dept. Chair Pathology/Director 60.0 X 305273 0 12129 UHMG - Robert Haynie MD Director 2.0 X 0 0 0 UHMG - Elliott A Kellman Director 2.0 X 0 0 0 UHMG - Michael Konstan MD Dept.Chair Pediatrics/Director 60.0 X 354672 0 23867 UHMG - Cliff Megerian MD Dept. Chair Otolaryngology/Dir 60.0 X 649538 0 40165 UHMG - Michael Nochomovitz MD Pres./Director 60.0 X X 1038904 0 57647 UHMG - William O'Neill Jr Director 2.0 X 0 0 0 UHMG - Jeffrey Ponsky MD Dept. Chair Surgery/Director 60.0 X 706096 0 24771 UHMG - Robert Ronis Dept. Chair Psychiatry/Direct. 60.0 X 247463 0 8826 UHMG - Fred C Rothstein MD Chair/Director 2.0 X X 0 0 0 UHMG - Michael A Szubski Director 2.0 X 0 0 0 UHMG - Richard A Walsh MD Dept. Chair Medicine/Director 60.0 X 475900 0 26249 UHLSF - Ronald Dziedzicki BSN RN Secretary/Director 2.0 X X 0 0 0 UHLSF - Sonia Salvino Treasurer/Director 2.0 X X 0 0 0 UHLSF - Nancy Tinsley Director 2.0 X 278636 0 69406 AMC - Julie Boland Sec. & Treas./Dir. (thru 5/31) 2.0 X X 0 0 0 AMC - Richard Doody Director 2.0 X 0 0 0 AMC - Michael Druzinsky Co-Chair/Director 2.0 X X 0 0 0 AMC - Robert Glick Sec. & Treas./Dir. 2.0 X X 0 0 0 AMC - Richard Hanson Ex Officio Director 10.0 X 881735 0 162861 AMC - Susan V Juris Pres./Ex Officio Director 60.0 X X 506454 0 71497 AMC - John Morikis Vice Chair/Director 2.0 X X 0 0 0 AMC - Thomas Murdough Chair (thru 5/13)/Director 2.0 X X 0 0 0 AMC - Enid Rosenberg Director 2.0 X 0 0 0 AMC - Reggie Rucker Director 2.0 X 0 0 0 AMC - Neil Sethi Director 2.0 X 0 0 0 AMC - Margaret Singerman Director 2.0 X 0 0 0 AMC - John Sinnenberg Director 2.0 X 0 0 0 AMC - Richard Stein Ex Officio Director 2.0 60.0 X 0 432813 61174 AMC - Dan Zelman Director 2.0 X 0 0 0 UHREG - Samuel Ake Secretary/Director 2.0 X X 0 0 0 UHREG - Mary Jo Boehnlein Co-Chair/Ex Officio Dir. 2.0 X 0 0 0 UHREG - Peter R Brumberas Director 2.0 X 0 0 0 UHREG - Mary Ann P Correnti Co-Chair/Ex Officio Dir. 2.0 X 0 0 0 UHREG - Laurie Delgado Pres.(thru 12/13)/Ex Off Dir 60.0 X X 730132 0 64616 UHREG - 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Off. 60.0 X 754677 0 58959 UHHS - Michael A Szubski Treasurer, CFO 60.0 X 1053009 0 207317 UHCMC - Michael Anderson MD Chief Medical Off. 60.0 X 423824 0 113712 UHCMC - Patricia DePompei Pres. RB&C/Macdonald 60.0 X 470337 0 105370 UHCMC - Ronald E Dziedzicki BSN Chief Support Serv. Off. 60.0 X 484963 0 117715 UHCMC - Catherine S Koppelman RN Chief Nursing Off. 60.0 X 507955 0 68726 UHCMC - Nathan Levitan MD Pres. Seidman Cancer Ctr. 60.0 X 886354 0 64489 UHCMC - Janet L Miller Esq Secretary, Chief Legal Off. 2.0 X 0 0 0 UHCMC - Sonia Salvino Treasurer/VP Finance 60.0 X 311445 0 81930 UHMG - Harlin G Adelman Assistant Secretary 2.0 X 455010 0 106626 UHMG - Phyllis Hall VP & Treasurer 60.0 X 433809 0 114478 UHMG - Janet L Miller Esq Secretary 2.0 X 0 0 0 UHLSF - Don M Landek President 60.0 X 190411 0 50152 HCS - Howard Lutz Sec. & Treas. 60.0 X 92816 0 20411 UHACO - Elizabeth Hammack Secretary 2.0 X 193556 0 30686 UHRBC - Drew Hertz MD Vice Pres. 2.0 X 323290 0 1659 UHRBC - Elizabeth Hammack Secretary 2.0 X 0 0 0 UHCCO - Michael Szubski Trasurer 2.0 X 0 0 0 UHCCO - Elizabeth Hammack Secretary 2.0 X 0 0 0 UHHS Sherri Bishop Chief Development Off. 60.0 X 696791 0 150049 UHHS - Peter S Brumleve Chief Marketing Off. 60.0 X 505958 0 88986 UHHCS - Kevin P Cunningham Pharmacy Director 60.0 X 156711 0 27016 UHHS - John V Foley Chief Information Off. 60.0 X 466961 0 86632 GMC - Jason E Glowczewski Pharmacy Director 60.0 X 163106 0 32942 AMC - Alan Hirsch MD CMO, Ahuja 60.0 X 346747 0 59537 UHCMC - Carl Lufter Pharmacy Director 60.0 X 196048 0 31303 UHHS - Cheryl Wahl Chief Compliance Officer 60.0 X 326478 0 68113 UHHS - William A Young President SJMC 60.0 X 437125 0 94279 UHHS - PAUL TAIT CHIEF STRATEGIC PLANNING OFF. 60.0 0.0 X 1176630 0 63151 UHMG - Bahman Guyuron MD Surgeon, Plastic Surgery 60.0 X 1463326 0 30205 UHMG - Christopher Furey MD Orthopaedic Surgeon 60.0 X 1152417 0 38125 UHMG - Jason D Eubanks Orthopaedic Surgeon 60.0 X 1120343 0 24218 UHMG - Nicholas U Ahn MD Orthopaedic Surgeon 60.0 X 1095032 0 36280 UHMG - Matthew Kraay Orthopaedic Surgeon 60.0 X 921187 0 44001 UHCMC - Warren Selman MD Physician/Director (thru 5/13) 60.0 X 902829 0 40047 UHHS - ACHILLES A DEMETRIOU MD PRESIDENT/COO 0.0 X 502389 52828 UHLSF - Michael R Vehovec Fmr. Officer 60.0 X 323495 0 76148 UHHS - Donnie Perkins VP Inclusion & Diversity 60.0 X 261416 0 13746 UHHS - Heidi Gartland Fmr. Key Employee 60.0 X 310414 0 72555 UHMG - Pablo R Ros MD Fmr. Key Employee 60.0 X 621551 0 32415 UHMG - Charles Lanzieri MD Fmr. Key Employee 60.0 X 485685 0 32154 36180783 3054629 4574034 1220 true true false MICROSOFT LICENSING GP PO BOX 842467 DALLAS TX 752842467 SOFTWARE 7526589 MACQUARIE EQUIPMENT FINANCE LLC GPO DRAWER 67-865 DETROIT MI 48267 LEASING 7091105 ACCENTURE LLP PO BBOX 70629 CHICAGO IL 606730629 CONSULTING 5409214 CUMBERLAND CONSULTING GROUP LLC 720 COOL SPRINGS BLVD STE 550 FRANKLIN TN 37067 Consulting 4601879 MCPC IMAGING AND PRINTING LLC PO BOX 697 SANDUSKY OH 44870 INFO TECHNOLOGY SVCS 4049185 97 0 0 1355800 0 0 51755200 3896266 53111000 NET PATIENT SERVICE REVENUE LESS BAD DEBTS 900099 1956662000 1956244000 418000 UHMG SPONSORED REVENUE 900099 46228000 46228000 UHMG RESIDENT TEACHING REVENUE 900099 18629000 18629000 UHMG OTHER CLINICAL REVENUE 900099 16084000 16084000 MEDICAL DIRECTOR REVENUE 900099 14182000 14182000 54518000 54239000 279000 2106303000 24294000 24294000 0 0 0 0 0 46971000 46971000 46971000 46971000 439400 1355808 873400 -434000 -434000 0 0 PARKING SERVICES 900099 3521000 3521000 CALL CENTER 900099 1713000 1713000 NET PREMIUM & ADMINISTRATIVE FEES 900099 885000 885000 90044000 90044000 96163000 2326408000 2196535000 697000 76065000 X 34294000 34294000 0 0 0 17890000 17890000 3935000 3935000 910608000 904003000 6605000 67258000 67258000 92586000 90888000 1698000 58991000 58991000 0 1051000 1051000 761000 761000 0 33000 33000 0 181822000 181384000 438000 11478000 10821000 657000 353902000 352863000 1039000 36833000 36833000 0 98752000 98646000 106000 8445000 8169000 276000 0 0 17480000 17480000 0 97591000 97591000 21914000 21914000 TAXES 25524000 25524000 RECRUITMENT 3491000 3491000 ADMINISTRATIVE SERVICES 3012000 3012000 DUES AND MEMBERSHIPS 224000 224000 34095000 33437000 658000 2081970000 2052570000 17890000 11510000 0 0 33341000 192149000 126944000 28200000 318886000 367865000 0 0 0 0 396000 370000 31652000 31898000 3266000 22310000 2533976000 1324245000 913014000 1209731000 3271000 332223000 56416000 618807000 5631000 367552000 0 0 40874000 167165000 1533691000 3338270000 100595000 308614000 0 0 6677000 8369000 0 1086314000 0 0 0 0 0 39978000 0 0 106996000 258925000 214268000 1702200000 X 1080947000 1063229000 220386000 255296000 18090000 317545000 1319423000 1636070000 1533691000 3338270000 X 244438000 -1112000 73321000 X false true X true true true X Public charity classification of each Group Member Public charity classification of each Group Member is shown below: University Hospitals Cleveland Medical Center (UHCMC) - 34-1567805 DBA University Hospitals Case Medical Center 170(b)(1)(A)(iii) 11100 Euclid Ave Cleveland, OH 44106 University Hospitals Bedford Medical Center (BMC) - 34-1271115 170(b)(1)(A)(iii) 44 Blaine Avenue Bedford, OH 44146 University Hospitals Conneaut Medical Center (CMC) - 34-0714550 170(b)(1)(A)(iii) 158 West Main Road Conneaut, OH 44030 BMH Professional Corporation (BMHPC) - 34-1749966 509(a)(3) 158 West Main Road Conneaut, OH 44030 Part I Line 11h (i) Name of supported organization: University Hospitals Conneaut Medical Center (ii) EIN of supported organization: 34-0714550 (iii) Type of org. (described on lines 1-9 above or IRC section): 170(B)(1)(A)(III) (iv) Is the supported org. listed in your governing documents?: Yes (v) Did you notify the supported org. of your support?: Yes (vi) Is the supported org. organized in the US?: Yes (vii) Amount of monetary support: $0 University Hospitals Geauga Medical Center (GMC) - 34-0816492 170(b)(1)(A)(iii) 13207 Ravenna Road Chardon, OH 44024 University Hospitals Geneva Medical Center (UHGMC) - 34-0714461 170(b)(1)(A)(iii) 870 West Main Street Geneva, OH 44041 University Hospitals Ahuja Medical Center - 26-4827222 170(b)(1)(A)(iii) 3999 Richmond Road Beachwood, OH 44122 UHHS Heather Hill Inc. (HHI)- 34-0771884 170(b)(1)(A)(vi) 12340 Bass Lake Road Chardon, OH 44024 UHHS - Heather Hill Rehabilitation Hospital Inc. (UHECC) - 34-1465745 dba University Hospitals Extended Care Campus 170(b)(1)(A)(iii) 12340 Bass Lake Road Chardon, OH 44024 UH Regional Hospitals - 34-1924226 170(b)(1)(A)(iii) 27100 Chardon Road Richmond Hts, OH 44143 University Mednet (UMI) - 34-0750341 170(b)(1)(A)(iii) 23001 Euclid Avenue Cleveland, OH 44117 University Hospitals Home Care Services, Inc. (HCS) - 34-1527536 509(a)(3) 4901 Galaxy Parkway Warrensville Hts, OH 44128 Part I Line 11h (i) Name of supported organization: University Hospitals Cleveland Medical Center (ii) EIN of supported organization: 34-1567805 (iii) Type of org. (described on lines 1-9 above or IRC section): 170(B)(1)(A)(III) (iv) Is the supported org. listed in your governing documents?: Yes (v) Did you notify the supported org. of your support?: Yes (vi) Is the supported org. organized in the US?: Yes (vii) Amount of monetary support: $33,434,000 University Hospitals Laboratory Services Foundation (UHLSF) - 34-1720429 509(a)(3) 11100 Euclid Avenue Cleveland, OH 44106 Part I Line 11h (i) Name of supported organization: University Hospitals Cleveland Medical Center (ii) EIN of supported organization: 34-1567805 (iii) Type of org. (described on lines 1-9 above or IRC section): 170(B)(1)(A)(III) (iv) Is the supported org. listed in your governing documents?: Yes (v) Did you notify the supported org. of your support?: Yes (vi) Is the supported org. organized in the US?: Yes (vii) Amount of monetary support: $26,077,000 University Hospitals Medical Group, Inc. (UHMG) - 20-4881619 170(b)(1)(A)(iii) 11100 Euclid Avenue Cleveland, OH 44106 University NPI Inc. - 34-1571623 509(a)(3) 11100 Euclid Avenue Cleveland, OH 44106 Part I Line 11h (i) Name of supported organization: University Hospitals Cleveland Medical Center (ii) EIN of supported organization: 34-1567805 (iii) Type of org. (described on lines 1-9 above or IRC section): 170(B)(1)(A)(III) (iv) Is the supported org. listed in your governing documents?: Yes (v) Did you notify the supported org. of your support?: Yes (vi) Is the supported org. organized in the US?: Yes (vii) Amount of monetary support: $0 Memorial Hospital Health Foundation - 34-1810018 509(a)(3) 11100 Euclid Avenue Cleveland, OH 44106 Part I Line 11h (i) Name of supported organization: University Hospitals Geneva Medical Center (ii) EIN of supported organization: 34-0714461 (iii) Type of org. (described on lines 1-9 above or IRC section): 170(B)(1)(A)(III) (iv) Is the supported org. listed in your governing documents?: Yes (v) Did you notify the supported org. of your support?: Yes (vi) Is the supported org. organized in the US?: Yes (vii) Amount of monetary support: $0 University Hospitals Accountable Care Organization Inc. - 27-3970270 170(b)(1)(A)(iii) 3605 Warrensville Center Rd. - MSC 9155 Shaker Heights, OH 44122 University Hospitals Coordinated Care Organization - 90-0794903 509(a)(3) 3605 Warrensville Center Rd. - MSC 9155 Shaker Heights, OH 44122 Part I Line 11h (i) Name of supported organization: University Hospitals Accountable Care Organization (ii) EIN of supported organization: 27-3970270 (iii) Type of org. (described on lines 1-9 above or IRC section): 170(B)(1)(A)(III) (iv) Is the supported org. listed in your governing documents?: Yes (v) Did you notify the supported org. of your support?: Yes (vi) Is the supported org. organized in the US?: Yes (vii) Amount of monetary support: $1,033,000 University Hospitals Rainbow Care Connection Inc. - 46-1074672 509(a)(3) 3605 Warrensville Center Rd. - MSC 9155 Shaker Heights, OH 44122 Part I Line 11h (i) Name of supported organization: University Hospitals Accountable Care Organization (ii) EIN of supported organization: 27-3970270 (iii) Type of org. (described on lines 1-9 above or IRC section): 170(B)(1)(A)(III) (iv) Is the supported org. listed in your governing documents?: Yes (v) Did you notify the supported org. of your support?: Yes (vi) Is the supported org. organized in the US?: Yes (vii) Amount of monetary support: $0 RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED X 882 947 127536 135299 128418 136246 248858000 2247480524 248986418 2247616770 1000000 1000000 250000 250000 1000000 1000000 1000000 1000000 4000000 6000000 357890 278602 175388 173650 985530 250000 250000 250000 250000 1000000 1500000 7514 6426 4108 947 18995 25768 105422 22114 FORM 990, SCHEDULE C, PART II-B Software limitiation would not allow completion of Part II-B. It is presented below. 1a - No 1b - Yes 1c - No 1d - Yes $25,768 1e - No 1f - Yes $105,422 1g - Yes $22,114 1h - No 1i - No 1j - Yes $153,304 2a - No 186000 1144000 X false 123867000 3103000 4020000 4020000 126970000 118803000 5064000 3938000 3938000 123867000 107300000 11503000 4198000 4198000 118803000 103637000 3508000 1680000 1680000 107145000 95272000 6956000 4047000 2638000 103637000 0.13900 0.86100 false true true 70070000 70070000 1374588000 596201000 778387000 21703000 10141000 11562000 1018203000 692262000 325941 49412000 25641000 23771000 884115941 INVESTMENTS 618116000 F INVESTMENT DEPOSITED W/TRUSTEE 691000 F 618807000 BENEFICIAL INT. IN FOUNDATION 253123000 F INVESTMENT IN AFFILIATES 114429000 C 367552000 RESEARCH INST OPTION ASSET 32656000 SECURITIES LENDING INVESTMENT 33013000 OTHER ASSETS 101496000 167165000 0 RESEARCH INST OPTION LIABILITY 32656000 DUE TO THIRD PARTIES 28656000 INTEREST PAYABLE 15017000 OTHER CURRENT LIABILITIES 15720000 OTHER LIABILITIES 4129000 ACCRUED WORKERS COMP LIABILITY 52596000 INTEREST RATE SWAP LIABILITY 36817000 SELF INSURED LIABILITY 23538000 NON FUNDED LOSS COST 19102000 DUE TO AFFILIATES 11820000 EMPLOYEE HEALTH PLAN 9619000 PENSION LIABILITY 9255000 258925000 Form 990, Schedule D, Part III, Line 4 The UH art collection includes approximately 2,000 original works of art, many donated over the years. Artwork includes paintings, photos, sculptures and the like. The UH art collection has been established to encourage reflection, and to delight, uplift and comfort our patients, visitors, and employees. Form 990, Schedule D, Part V, Line 4 The intended use of the organization's endowment funds varies depending on donor stipulations. All spending of endowment earnings are done so in accordance with donor intent and applicable law. Endowments are held on the books of the Parent organization of the Group members. Spending allocations are made to the proper UH entity by the Parent to comply with donor wishes. Form 990, Schedule D, Part X, Line 2 The System and most of its subsidiaries, including UHCMC, are not-for-profit corporations as described in Section 501(c)(3) of the Internal Revenue Code (Code) and are exempt from federal income tax pursuant to Section 501(a) of the Code. The System also has certain subsidiaries that are taxable for federal income tax purposes (see note 18). SFI NON-PROFIT 7800 THIRD STREET N 900 ST PAUL MN 55128 PHONE SOLIC false 8403 32945 -24542 8403 32945 -24542 All States GALA 1519837 1172697 347140 461109 335815 GALA 166628 130903 35725 24813 6954 2 108742 52208 56534 34584 10116 1795207 1355808 439399 520506 352885 873391 -433992 true true X true X 250. true X true true true false true true 59370960 59370960 0.02990 429137993 371960225 57177768 0.02880 488508953 371960225 116548728 0.05870 5488367 5488367 0.00280 75580225 22640350 52939875 0.02670 22289263 18653735 3635528 0.00180 57588832 30953766 26635066 0.01340 34207272 34207272 0.01720 195153959 72247851 122906108 0.06190 683662912 444208076 239454836 0.12060 437898 437898 0.00030 437898 437898 0.00030 false 50880000 328205350 366685981 -38480631 X true true 7 1 UH Case Medical Center 11100 Euclid Avenue Cleveland OH 44106 X X X X X IP Psych./IP Rehab./ Skilled Nursing A 2 UH Rainbow Babies & Children's Hospit 11100 Euclid Avenue Cleveland OH 44106 X X X X X X A 3 UH Geauga Medical Center 13207 Ravenna Road Chardon OH 44024 X X X IP Psychiatric Unit A 4 UH Ahuja Medical Center 3999 Richmond Road Beachwood OH 44122 X X X A 5 UH Regional Hospitals 27100 Chardon Road Richmond Heights OH 44143 X X X X A 6 UH Geneva Medical Center 870 West Main Street Geneva OH 44041 X X X A 7 UH Conneaut Medical Center 158 West Main Road Conneaut OH 44030 X X X A A true X X X X X X X X X X 12 true true true X see supplemental information X X X X X false false true true 250. true 400. true X X X X X X X true true X true false true X false false University Hospitals Case Medical Center Part V, Section B, Line 1j In addition to the reporting the items described in Part V, Section B, lines 1a through 1i, the 2012 CHNA examines economic indicators, such as poverty, unemployment, state budget developments, and household income; and health status indicators from sources such as County Health Rankings, the Community Health Status Indicators Project, the Ohio Department of Health, the U.S. Centers for Disease Control and Prevention's (CDC) Behavioral Risk Factor Surveillance System (BRFSS), the Dignity Health Community Needs Index, and the U.S. Department of Agriculture. Data from the U.S. Health Resources and Services Administration (HRSA) regarding federally qualified health centers, medically underserved areas and populations, and health professional shortage areas also were assessed. Qualifications of the firm who conducted the CHNA and a list of collaborating organizations also were included. Part V, Section B, Line 3 The assessment took into account information obtained from 44 interviews with stakeholders who represent the broad interests of the community, including public health officials and experts, and UH Case Medical Center-affiliated clinicians, administrators, and staff. Interviews were conducted in March, April, May, and June of 2010 and in November and December of 2011. Organizations and groups consulted include: Achievement Centers for Children Alcohol, Drug Addiction and Mental Health Services (ADAMHS) Board of Cuyahoga County American Diabetes Association Ashtabula County Health Department Bellefaire JCB Benjamin Rose Institute on Aging Center for Families and Children City of Beachwood City of Bedford City of Cleveland, Ward 9 Cleveland Department of Public Health Cuyahoga County Office of Early Childhood Invest in Children Department of Public Safety, Cleveland Geauga County General Health District Lake County General Health District Lorain County Board of Mental Health Lorain Free Clinic Medina County Health Department Mental Health and Recovery Board of Portage County Neighborhood Family Practice North Coast Health Ministry Ohio Commission on Minority Health Summit County Public Health The Center for Health Affairs The Free Medical Clinic of Greater Cleveland The Gathering Place Trumbull County Health Department UH Case Medical Center UH EMS Training & Disaster Preparedness Institute UH Seidman Cancer Center Part V, Section B, Line 4 The University Hospitals Case Medical Center CHNA was conducted in collaboration with the other University Hospitals facilities: UH Ahuja Medical Center, UH Bedford Medical Center (a campus of UH Regional Hospitals), UH Conneaut Medical Center, UH Geauga Medical Center, UH Geneva Medical Center, UH Rainbow Babies & Children's Hospital, and UH Richmond Medical Center (a campus of UH Regional Hospitals). Part V, Section B, Line 5a The CHNA can be accessed at: http://www.uhhospitals.org/about/community-benefit/community-health-needs- assessment Part V, Section B, Line 7 No hospital facility can address all of the health needs present in its community. The Hospital is committed to adhering to its Mission and remaining financially healthy so that it can continue to enhance its clinical, teaching and research activities and to provide a wide range of community benefits. The Implementation Strategy did not address the following two (2) community health needs identified in the 2012 CHNA: A) Lack of Affordable and Accessible Dental Services: The Hospital does not offer adult dental services and, therefore, will not address this specific need. The Hospital collaborates closely with Case Western Reserve University School of Dental Medicine to refer patients for free dental care. B) Lack of Transportation to Health Services: The Hospital does not have a transportation program; however, on occasion the Hospital will assist patients with transportation to the Hospital consistent with federal regulatory guidelines. University Hospitals Rainbow Babies and Children's Hospital Part V, Section B, Line 1j In addition to the reporting the items described in Part V, Section B, lines 1a through 1i, the 2012 CHNA examines economic indicators, such as poverty, unemployment, state budget developments, and household income; and health status indicators from sources such as County Health Rankings, the Community Health Status Indicators Project, the Ohio Department of Health, the U.S. Centers for Disease Control and Prevention's (CDC) Behavioral Risk Factor Surveillance System (BRFSS), the Dignity Health Community Needs Index, and the U.S. Department of Agriculture. Data from the U.S. Health Resources and Services Administration (HRSA) regarding federally qualified health centers, medically underserved areas and populations, and health professional shortage areas also were assessed. Qualifications of the firm who conducted the CHNA and a list of collaborating organizations also were included. Part V, Section B, Line 3 The assessment took into account information obtained from 44 interviews with stakeholders who represent the broad interests of the community, including public health officials and experts, and UH Rainbow Babies & Children's Hospital-affiliated clinicians, administrators, and staff. Interviews were conducted in March, April, May, and June of 2010 and in November and December of 2011. Organizations and groups consulted include: Achievement Centers for Children Alcohol, Drug Addiction and Mental Health Services (ADAMHS) Board of Cuyahoga County American Diabetes Association Ashtabula County Health Department Bedford City Schools Bellefaire JCB Catholic Charities, Elyria Center for Families and Children City of Beachwood City of Bedford City of Cleveland, Ward 9 Cleveland Department of Public Health Cuyahoga County Office of Early Childhood Invest in Children Department of Public Safety, Cleveland Geauga County General Health District Lake County General Health District Lorain County Board of Mental Health Lorain Free Clinic Medina County Health Department Mental Health and Recovery Board of Portage County Neighborhood Family Practice North Coast Health Ministry North Olmsted Schools Ohio Commission on Minority Health Summit County Public Health The Center for Health Affairs The Free Medical Clinic of Greater Cleveland The Gathering Place Trumbull County Health Department Part V, Section B, Line 4 The University Hospitals Rainbow Babies & Children's Hospital CHNA was conducted in collaboration with the other University Hospitals facilities: UH Case Medical Center, UH Ahuja Medical Center, UH Bedford Medical Center (a campus of UH Regional Hospitals), UH Conneaut Medical Center, UH Geauga Medical Center, UH Geneva Medical Center, and UH Richmond Medical Center (a campus of UH Regional Hospitals). Part V, Section B, Line 5a The CHNA can be accessed at: http://www.uhhospitals.org/about/community-benefit/community-health-needs- assessment Part V, Section B, Line 7 No hospital facility can address all of the health needs present in its community. The Hospital is committed to adhering to its Mission and remaining financially healthy so that it can continue to enhance its clinical, teaching and research activities and to provide a wide range of community benefits. The Strategy does not address the following seven (7) community health needs identified in the 2012 CHNA: A) Lack of Transportation to Health Services: The Hospital does not have a transportation program; however, on occasion the Hospital will assist patients with transportation to the Hospital consistent with federal regulatory guidelines. B) High Rates of Sexual Violence: The Cleveland Rape Crisis Center addresses issues related to sexual violence against both women and men. The Hospital provides sexual assault nurse examiners in its pediatric emergency department. C) High Rates of Smoking: The Hospital provides a free smoking cessation program for its employees who desire to stop smoking; it does not have a smoking cessation program targeting youth in the community. D) High Rates of Unsafe Sex: Sex education is not within the Hospital's scope of clinical outreach; however, there are programs available at UH Case Medical Center, such as the John T. Carey Special Immunology Unit, that provide HIV care, education and research through a subsidized clinical program. The staff provides education and speakers to high schools, community centers and other forums on the importance of safe sex in the prevention of HIV/AIDS. E) Prevalent Alcohol and Drug Use: A number of community organizations address youth drug abuse prevention and treatment, including Catholic Charities Chemical Dependency Services, the Covenant, New Directions, Northern Ohio Recovery Association and Recovery Resources. F) High Rates of Unemployment and Financial Hardship: While the Hospital is a significant employer within its PSA, unemployment and financial hardship are not a part of the Hospital's Mission. G) Low Educational Achievement: Addressing educational achievement is not a part of the Hospital's Mission. University Hospitals Geauga Medical Center Part V, Section B, Line 1j In addition to the reporting the items described in Part V, Section B, lines 1a through 1i, the 2012 CHNA examines economic indicators, such as poverty, unemployment, state budget developments, and household income; and health status indicators from sources such as County Health Rankings, the Community Health Status Indicators Project, the Ohio Department of Health, the U.S. Centers for Disease Control and Prevention's (CDC) Behavioral Risk Factor Surveillance System (BRFSS), the Dignity Health Community Needs Index, and the U.S. Department of Agriculture. Data from the U.S. Health Resources and Services Administration (HRSA) regarding federally qualified health centers, medically underserved areas and populations, and health professional shortage areas also were assessed. Qualifications of the firm who conducted the CHNA and a list of collaborating organizations also were included. Part V, Section B, Line 3 The assessment took into account information obtained from 16 interviews with stakeholders who represent the broad interests of the community, including public health officials and experts, and UH Geauga Medical Center-affiliated clinicians, administrators, and staff. Interviews were conducted in March, April, May, and June of 2010 and in November and December of 2011. Organizations and groups consulted include: American Diabetes Association Ashtabula County Health Department Bellefaire JCB Geauga County General Health District Lake County General Health District North Coast Health Ministry Ohio Commission of Minority Health The Center for Health Affairs Part V, Section B, Line 4 The University Hospitals Geauga Medical Center CHNA was conducted in collaboration with the other University Hospitals facilities: UH Case Medical Center, UH Ahuja Medical Center, UH Bedford Medical Center (a campus of UH Regional Hospitals), UH Conneaut Medical Center, UH Geneva Medical Center, UH Rainbow Babies & Children's Hospital, and UH Richmond Medical Center (a campus of UH Regional Hospitals). Part V, Section B, Line 5a The CHNA can be accessed at: http://www.uhhospitals.org/about/community-benefit/community-health-needs- assessment Part V, Section B, Line 7 No hospital facility can address all of the health needs present in its community. The Hospital is committed to adhering to its Mission and remaining financially healthy so that it can continue to enhance its clinical, teaching and research activities and to provide a wide range of community benefits. The Strategy does not address the following three (3) community health needs identified in the 2012 CHNA: A) Poor Air Quality: Air quality is managed primarily by the Ohio Environmental Protection Agency, county health department air pollution programs, and the Ohio Department of Health; B) High Rates of Unemployment and Financial Hardship; C) Low Educational Achievement: Educational needs of the community are met by the school district. The Hospital does not have as a part of its Mission the improvement of the population's general education. University Hospitals Ahuja Medical Center Part V, Section B, Line 1j In addition to the reporting the items described in Part V, Section B, lines 1a through 1i, the 2012 CHNA examines economic indicators, such as poverty, unemployment, state budget developments, and household income; and health status indicators from sources such as County Health Rankings, the Community Health Status Indicators Project, the Ohio Department of Health, the U.S. Centers for Disease Control and Prevention's (CDC) Behavioral Risk Factor Surveillance System (BRFSS), the Dignity Health Community Needs Index, and the U.S. Department of Agriculture. Data from the U.S. Health Resources and Services Administration (HRSA) regarding federally qualified health centers, medically underserved areas and populations, and health professional shortage areas also were assessed. Qualifications of the firm who conducted the CHNA and a list of collaborating organizations also were included. Part V, Section B, Line 3 The assessment took into account information obtained from 29 interviews with stakeholders who represent the broad interests of the community, including public health officials and experts, and UH Ahuja Medical Center-affiliated clinicians, administrators, and staff. Interviews were conducted in March, April, May, and June of 2010 and in November and December of 2011. Organizations and groups consulted include: Achievement Centers for Children Alcohol, Drug Addiction and Mental Health Services (ADAMHS) Board of Cuyahoga County American Diabetes Association Bellefaire JCB Benjamin Rose Institute on Aging Center for Families and Children City of Beachwood City of Bedford Cleveland Department of Public Health Cuyahoga County Office of Early Childhood Invest in Children Lake County General Health District Medina County Health Department Mental Health and Recovery Board of Portage County Neighboring Family Practice North Coast Health Ministry Ohio Commission of Minority Health Summit County Public Health The Center for Health Affairs The Free Medical Clinic of Greater Cleveland The Gathering Place Part V, Section B, Line 4 The University Hospitals Ahuja Medical Center CHNA was conducted in collaboration with the other University Hospitals facilities: UH Case Medical Center, UH Bedford Medical Center (a campus of UH Regional Hospitals), UH Geauga Medical Center, UH Conneaut Medical Center, UH Geneva Medical Center, UH Rainbow Babies & Children's Hospital, and UH Richmond Medical Center (a campus of UH Regional Hospitals). Part V, Section B, Line 5a The CHNA can be accessed at: http://www.uhhospitals.org/about/community-benefit/community-health-needs- assessment Part V, Section B, Line 7 No hospital facility can address all of the health needs present in its community. The Hospital is committed to adhering to its Mission and remaining financially healthy so that it can continue to enhance its clinical, teaching and research activities and to provide a wide range of community benefits. The Strategy does not address the following seven (7) community health needs identified in the 2012 CHNA: A) Lack of Accessible and Affordable Dental Care: The Hospital does not offer dental care; B) Lack of Transportation to Health Services: The Hospital is accessible via public transportation; C) High Rates of Unsafe Sex: The Hospital does not offer obstetric/gynecological services or counseling in unsafe sexual practices; D) Prevalent Drug Use: Drug and alcohol prevention and recovery services are provided by community agencies, including the Moore Counseling Services and Alcoholics Anonymous; E) Poor Infant and Maternal Care: The Hospital does not offer maternal-fetal services; F) Poor Air Quality: Air quality is managed primarily by the Ohio Environmental Protection Agency, county health department air pollution programs, and the Ohio Department of Health. Air quality improvement is not part of the Hospital's Mission; G) Low Educational Achievement: These needs are addressed by the school districts. Improved education of the general population is not part of the Hospital's Mission. UH Regional Hospitals Part V, Section B, Line 1j In addition to the reporting the items described in Part V, Section B, lines 1a through 1i, the 2012 CHNA examines economic indicators, such as poverty, unemployment, state budget developments, and household income; and health status indicators from sources such as County Health Rankings, the Community Health Status Indicators Project, the Ohio Department of Health, the U.S. Centers for Disease Control and Prevention's (CDC) Behavioral Risk Factor Surveillance System (BRFSS), the Dignity Health Community Needs Index, and the U.S. Department of Agriculture. Data from the U.S. Health Resources and Services Administration (HRSA) regarding federally qualified health centers, medically underserved areas and populations, and health professional shortage areas also were assessed. Qualifications of the firm who conducted the CHNA and a list of collaborating organizations also were included. Part V, Section B, Line 3 The assessment took into account information obtained from 33 interviews for the Bedford Campus and 25 interviews for the Richmond Campus. These stakeholders represent the broad interests of each community, including public health officials and experts, and UH Regional Hospitals-affiliated clinicians, administrators, and staff. Interviews were conducted in March, April, May, and June of 2010 and in November and December of 2011. Organizations and groups consulted for the Bedford campus include: Cleveland Department of Public Health Alcohol, Drug Addiction and Mental Health Services (ADAMHS) Board of Cuyahoga County North Coast Health Ministry Summit County Public Health The Free Medical Clinic of Greater Cleveland American Diabetes Association Ohio Commission on Minority Health Cuyahoga County Office of Early Childhood Invest in Children City of Beachwood City of Bedford Heights City of Bedford The Gathering Place Bedford City Schools Bellefaire JCB Center for Families and Children Achievement Centers for Children Benjamin Rose Institute on Aging Neighborhood Family Practice Center for Families and Children Maple Heights Senior Center The Center for Health Affairs Organizations and groups consulted for the Richmond campus include: Cleveland Department of Public Health Alcohol, Drug Addiction and Mental Health Services (ADAMHS) Board of Cuyahoga County North Coast Health Ministry Lake County General Health District The Free Medical Clinic of Greater Cleveland American Diabetes Association The Gathering Place Ohio Commission on Minority Health Cuyahoga County Office of Early Childhood Invest in Children The Gathering Place Bellefaire JCB Center for Families and Children Achievement Centers for Children Benjamin Rose Institute on Aging Neighborhood Family Practice Center for Families and Children The Center for Health Affairs City of Beachwood City of Bedford Part V, Section B, Line 4 The UH Regional Hospitals' CHNA was conducted in collaboration with the other University Hospitals facilities: UH Case Medical Center, UH Ahuja Medical Center, UH Conneaut Medical Center, UH Geauga Medical Center, UH Geneva Medical Center, and UH Rainbow Babies & Children's Hospital. Part V, Section B, Line 5a The CHNA can be accessed at: http://www.uhhospitals.org/about/community-benefit/community-health-needs- assessment Part V, Section B, Line 7 No hospital facility can address all of the health needs present in its community. The Hospital is committed to adhering to its Mission and remaining financially healthy so that it can continue to enhance its clinical, teaching and research activities and to provide a wide range of community benefits. The Strategy does not address the following community health needs identified in the 2012 CHNA including eleven (11) for the Bedford Campus and eight (8) for the Richmond Campus: Bedford Campus A) Access to Affordable Dental Care: The Bedford Campus does not offer dental services. B) High Rates of Emergency Room Use: The Bedford Campus has no current plans to change its emergency services at this time. C) Lack of Transportation to Health Services: The Bedford Campus does not offer transportation services. D) Lack of Accessible and Affordable Prescription Medications: The Bedford Campus does not have a retail pharmacy on site. E) Poor Mental and Behavioral Health Status and Lack of Services: This need is addressed by other community agencies, including the Mental Health Assessment Service, community psychiatric supportive treatment, and behavioral health counseling and therapy service through REACH Counseling Services. F) Physical Environment Needs - Poor Air Quality: The improvement of physical environmental needs is not part of the Hospital's Mission at the Bedford Campus. G) Prevalent Drug Use: Drug and alcohol prevention and recovery services are provided by community agencies, including the Number 12 Foundation and Alcoholics Anonymous and are not part of the Hospital's Mission at the Bedford Campus. H) High Rates of Unemployment and Financial Hardship. I) Unsafe Sex: This is addressed by the Planned Parenthood Regional Medical Center and is not part of the Hospital's Mission at the Bedford Campus. J) Child Mortality and Child Motor Vehicle Deaths: The Bedford Campus does not offer pediatric services; however, UH Rainbow Babies & Children's Hospital (Rainbow) provides extensive programming, outreach and prevention activities to address these needs in the Bedford Campus' PSA and SSA including proper car safety seat installation education, support of the national Click It or Ticket campaign, the provision of Impaired Driver Education. The Rainbow Injury Prevention Center is the lead agency for the Cuyahoga County DUI Task Force and the Speed, Reckless and Aggressive Driving (SRAD) Reduction Task Force, which are comprised of local law enforcement agencies, judges, prosecutors, political leaders, businesses, schools and community members who work together to reduce drunk and drugged driving and improve traffic safety through a combination of community education and enforcement efforts. The Rainbow Injury Prevention Center also protects child passengers throughout Northeast Ohio by aiding parents and caregivers about how best to restrain their child passengers, providing assistance with the proper use and installation of car seats, and working to ensure that all families, regardless of their financial circumstances, have access to the resources that promote safe travel for children. K) Low Educational Achievement: This identified need is primarily addressed by the Bedford School District and the State of Ohio. The Hospital does not have as part of its Mission the improvement of the population's general education. Richmond Campus A) Lack of Access to Affordable Dental Care: The Richmond Campus does not offer dental services. B) Lack of Transportation to Health Services: The Richmond Campus does not offer transportation services. C) Prevalent Drug Use: Drug and alcohol prevention and recovery services are provided by community agencies, including the Moore Counseling Services and Alcoholics Anonymous. D) Poor Air Quality: Air quality is managed primarily by the Ohio Environmental Protection Agency, county health department air pollution programs, and the Ohio Department of Health. E) High Rates of Unemployment and Financial Hardship: The Richmond Campus continues to be one of the largest employers in its community. F) High Rates of Unsafe Sex: This health need is primarily addressed through outreach programs supported by the Cuyahoga County Board of Health and is not part of the Hospital's outreach services. G) High Rates of Suicide: While the Richmond Campus is home to the UH Case Medical Center's inpatient psychiatric unit, the Richmond Campus does not provide suicide prevention services as part of its Mission. H) Low Educational Achievement: This need is primarily addressed by the Richmond Heights School District and the State of Ohio. The Hospital does not have as part of its Mission the improvement of the population's general education. University Hospitals Geneva Medical Center Part V, section B, Line 1j In addition to the reporting the items described in Part V, Section B, lines 1a through 1i, the 2012 CHNA examines economic indicators, such as poverty, unemployment, state budget developments, and household income; and health status indicators from sources such as County Health Rankings, the Community Health Status Indicators Project, the Ohio Department of Health, the U.S. Centers for Disease Control and Prevention's (CDC) Behavioral Risk Factor Surveillance System (BRFSS), the Dignity Health Community Needs Index, and the U.S. Department of Agriculture. Data from the U.S. Health Resources and Services Administration (HRSA) regarding federally qualified health centers, medically underserved areas and populations, and health professional shortage areas also were assessed. Qualifications of the firm who conducted the CHNA and a list of collaborating organizations also were included. Part V, Section B, Line 3 The assessment took into account information obtained from 16 interviews with stakeholders who represent the broad interests of the community, including public health officials and experts, and UH Geneva Medical Center-affiliated clinicians, administrators, and staff. Interviews were conducted in March, April, May, and June of 2010 and in November and December of 2011. Organizations and groups consulted include: Lake County General Health District Ashtabula County Health Department American Diabetes Association Ohio Commission on Minority Health Bellfaire JCB Center for Families and Children Benjamin Rose Institute on Aging The Center for Health Affairs Part V, Section B, Line 4 The University Hospitals Geneva Medical Center CHNA was conducted in collaboration with the other University Hospitals facilities: UH Case Medical Center, UH Ahuja Medical Center, UH Bedford Medical Center (a campus of UH Regional Hospitals), UH Conneaut Medical Center, UH Geauga Medical Center, UH Rainbow Babies & Children's Hospital, and UH Richmond Medical Center (a campus of UH Regional Hospitals). Part V, Section B, Line 5a The CHNA can be accessed at: http://www.uhhospitals.org/about/community-benefit/community-health-needs- assessment Part V, Section B, Line 7 No hospital facility can address all of the health needs present in its community. The Hospital is committed to adhering to its Mission and remaining financially healthy so that it can continue to enhance its clinical, teaching and research activities and to provide a wide range of community benefits. The Strategy does not address the following seven (7) community health needs identified in the 2012 CHNA: A) Lack of Accessible and Affordable Dental Care: The Hospital does not offer dental care services. B) Infant and Maternal Care - Related Community Health Needs: The Hospital does not offer fetal/maternal services. C) Mental and Behavioral Health Needs: The Hospital does not offer mental and behavioral health services. D) High Rates of Suicide: The Hospital does not offer mental and behavioral health services. These services are addressed by other agencies within the community such as Community Counseling and Signature Health. E) Poor Air Quality: Air quality is an issue that is managed primarily by the Ohio Environmental Protection Agency, county health department air pollution programs and the Ohio Department of Health. Improvement of air quality is not a part of the Hospital's Mission. F) High Rates of Unemployment and Financial Hardship. G) Low Educational Achievement: Educational needs of the community are met by the local school districts and Ohio Department of Education. The Hospital does not have as a part of its Mission the improvement of the population's general education. University Hospitals Conneaut Medical Center Part V, Section B, Line 1j In addition to the reporting the items described in Part V, Section B, lines 1a through 1i, the 2012 CHNA examines economic indicators, such as poverty, unemployment, state budget developments, and household income; and health status indicators from sources such as County Health Rankings, the Community Health Status Indicators Project, the Ohio Department of Health, the U.S. Centers for Disease Control and Prevention's (CDC) Behavioral Risk Factor Surveillance System (BRFSS), the Dignity Health Community Needs Index, and the U.S. Department of Agriculture. Data from the U.S. Health Resources and Services Administration (HRSA) regarding federally qualified health centers, medically underserved areas and populations, and health professional shortage areas also were assessed. Qualifications of the firm who conducted the CHNA and a list of collaborating organizations also were included. Part V, Section B, Line 3 The assessment took into account information obtained from 14 interviews with stakeholders who represent the broad interests of the community, including public health officials and experts, and UH Conneaut Medical Center-affiliated clinicians, administrators, and staff. Interviews were conducted in March, April, May, and June of 2010 and in November and December of 2011. Organizations and groups consulted include: Ashtabula County Health Department American Diabetes Association Ohio Commission on Minority Health Bellfaire JCB Center for Families and Children Benjamin Rose Institute on Aging The Center for Health Affairs Part V, Section B, Line 4 The University Hospitals Conneaut Medical Center CHNA was conducted in collaboration with the other University Hospitals facilities: UH Case Medical Center, UH Ahuja Medical Center, UH Bedford Medical Center (a campus of UH Regional Hospitals), UH Geauga Medical Center, UH Geneva Medical Center, UH Rainbow Babies & Children's Hospital, and UH Richmond Medical Center (a campus of UH Regional Hospitals). Part V, Section B, Line 5a The CHNA can be accessed at: http://www.uhhospitals.org/about/community-benefit/community-health-needs- assessment Part V, Section B, Line 7 No hospital facility can address all of the health needs present in its community. The Hospital is committed to adhering to its Mission and remaining financially healthy so that it can continue to enhance its clinical, teaching and research activities and to provide a wide range of community benefits. The Strategy does not address the following four (4) community health needs identified in the 2012 CHNA: A) Infant and Maternal Care - Related Community Health Needs: The Hospital does not offer fetal/maternal services. B) Mental and Behavioral Health Needs: The Hospital does not offer mental and behavioral health services. C) Social and Economic Factors - Low Educational Achievement: Educational needs of the community are met by the school district. The Hospital does not have as a part of its Mission the improvement of the population's general education. D) High Rates of Unemployment and Financial Hardship: The Hospital continues to be one of the largest employers in its community. Part V, line 12i To further clarify residency criteria, to qualify for Financial Assistance at a UH facility a patient must be a resident of Northeast Ohio (UH's service area comprises an eight county region) or be a patient in a UH hospital facility's primary and secondary service area seeking treatment at one of UH's wholly-owned and operated hospital facilities that provide patient care. Part V, Line 14g UH provides a summary of its Financial Assistance Policy on its website rather than the entire detailed policy. The summary is simpler for patients to read and understand. This summary is publicized through the UH website, on all patient statements/bills, in areas of hospital registration and financial counseling, in patient access or financial assistance offices, through financial counselors, and through other methods as required by state or federal law. UH provides a copy of the entire financial assistance policy upon request. Part V, Line 18 No boxes are checked for this line due to the fact that no UH hospital facilities or other organizations engaged in any of the actions described in Part V, Line 17. 31 UH Chagrin Highlands Medical Center 3909 Orange Place Orange Village OH 44122 Outpatient Health Center UH Westlake Medical Center - A 960 Clague Road Westlake OH 44145 Outpatien Health Center & surgical center UH Landerbrook Health Center 5885 Landerbrook Drive Mayfield Heights OH 44124 Outpatient Health Center UH Twinsburg Health Center 8819 Commons Blvd Suite 100 Twinsburg OH 44087 Outpatient Health Center UH Sharon Health Center 5133 Ridge Rd Wadsworth OH 44281 Outpatient Health Center UH Mentor Health Center 9000 Mentor Avenue Mentor OH 44060 Outpatien Health Center & Surgical Center UH Concord Health Center 7500 Auburn Road PainsvilleConcord JED OH 44077 Outpatient Health Center UH Ahuja Medical Office Building 1000 Auburn Dr Beachwood OH 44122 Outpatient Health Center UH Lyndhurst Surgery Center 29017 Cedar Road Lyndhurst OH 44124 Outpatient Health Center UH ST John Medical Office Building 29000 Center Ridge Road Westlake OH 44145 Outpatient Health Center UH Medina Health Center 4001 Carrick Dr Medina OH 44256 Outpatient Health Center UH Health Center-Landerbrook 5850 Landerbrook Drive Mayfield Heights OH 44124 Outpatient Health Center UH Adult Sleep Lab East 3628 Park East Dr Beachwood OH 44122 Outpatient Health Center UH Crocker Corp Ctr 2055 Crocker Road Westlake OH 44145 Outpatient Health Center UH Euclid Health Center 18599 Lake Shore Blvd Euclid OH 44119 Outpatient Health Center UH Geauga Physical Therapy 12460 Lake Bass Road Chardon OH 44024 Outpatient Health Center UH Rehab & Sports Med - Warrensville 4480 Richmond Road Warrensville Heights OH 44122 Outpatient Health Center UH Mayfield Village Health Center 730 SOM Center Road Suite 110 Mayfield Village OH 44143 Outpatient Health Center UH University Suburban Health Center 1611 South Green Road South Euclid OH 44121 Outpatient Health Center UH Hudson Health Center 5778 Darrow Road Hudson OH 44236 Outpatient Health Center UH Madison Clinic 701 North Lake Street Madison OH 44057 Outpatient Health Center UH Ashtabula Medical Arts Center 2131 Lake Avenue Ashtabula OH 44004 Outpatient Health Center UH Cedars on the Green 2054 So Green Road South Euclid OH 44141 Outpatient Health Center UH Otis Moss 8819 Quincy Avenue Cleveland OH 44106 Outpatient Health Center UH Bedford Medical Office Center 50 Blaine Avenue Bedford OH 44146 Outpatient Health Center UH Centre Pointe Bldg - Solon Health Ctr 34055 Solon Road Solon OH 44139 Outpatient Health Center UH Aurora Health Center 55 North Chillicothe Road Aurora OH 44202 Outpatient Health Center UH Park East 3619 Park East Drive Beachwood OH 44122 Outpatient Health Center UH JCC - Jewish Community Center 26001 South Woodland Road Beachwood OH 44122 Outpatient Health Center UH SCC at Medina 970 East Washington Street Medina OH 44256 Outpatient Health Center UH Park West Surgical Center 1 Park West Blvd Akron OH 44320 Outpatient Health Center Part I, Line 3c The amount of financial assistance discount granted by UH in 2013 was based on the following guidelines: Patients must attest to being uninsured; Provide necessary financial information to demonstrate financial need or medical indigency; Are residents of Northeast Ohio or a patient in a UH hospital facilities primary and secondary service area; Do not participate in and are not eligible for any third party payment program (whether governmental or private), health savings accounts, medical savings accounts, and/or similar types of health insurance- like programs available to pay for hospital services rendered; Are at or below 400% of the currently applicable Federal Poverty Guidelines; and Either: Do not qualify for a means-tested third party payment program (whether governmental or private); Or, appear to qualify for a third party payment program and agree to apply (or allow UH to apply on their behalf) for benefits or payments under the program, but are ultimately found not to qualify for such program. Patients meeting all the requirements will be eligible for financial assistance, including free and discounted care: UH hospital facilities will provide free care to patients whose family income is less than 250% of the current FPG; UH Hospital facilities will discount all applicable patient balances so that patients will not be billed gross charges and will not be obligated to pay more than the Medicare reimbursement amount for such care; If a patients family income is between 251% and 400% of the currently applicable Federal Poverty Guidelines, UH hospital facilities will discount bills to the amount of Medicare reimbursement amount for such care. UH participates in Ohio's Hospital Care Assurance Program (HCAP). Through HCAP, UH provides basic, medically necessary hospital-level services free of charge to Ohio residents whose income is below the poverty level (below 100 percent of the FPG). Patients who meet that income criterion must fill out and sign an application for HCAP. Part I, Line 6a The Parent organization, University Hospitals (34-0714775), prepares an Annual Community Benefit Report that encompasses all of University Hospitals Health System including the subordinate organizations completing Schedule H. Part I, Line 7 AMOUNTS CALCULATED AND REPORTED IN THIS TABLE WERE DERIVED FROM THE MOST ACCURATE, AVAILABLE SOURCES. A COST-TO-CHARGE RATIO WAS USED TO DETERMINE FINANCIAL ASSISTANCE COST USING HOSPITAL FINANCIAL STATEMENTS. MEDICAID SHORTFALL FOR GROUP SUBORDINATES WAS CALCULATED; 1) BASED ON THE TAX YEAR'S MEDICAID COST REPORT ADJUSTED TO REFLECT FULL COSTS TO DIRECT OFFSETTING REVENUE FROM THE MEDICAID COST REPORT, OR 2) BASED ON A COST-TO-CHARGE RATIO AND MEDICAID REVENUES DERIVED USING FINANCIAL STATEMENTS. INCLUDED IN THIS MEDICAID SHORTFALL IS THE OHIO STATE CHILDREN'S HEALTH INSURANCE PROGRAM (SCHIP) SHORTFALL. COMMUNITY HEALTH IMPROVEMENT AND COMMUNITY BENEFIT OPERATIONS COSTS HAVE BEEN REPORTED BASED ON ACTUAL DIRECT COSTS USING ACTUAL OR AVERAGE EMPLOYEE COMPENSATION RATES AND ADDING INDIRECT COSTS WHICH ARE CALCULATED BY A COST ACCOUNTING SYSTEM AS A PERCENTAGE OF TOTAL COST. THE MEDICARE COST REPORT, ADJUSTED TO REFLECT FULL COSTS, WAS USED TO DETERMINE GROSS COMMUNITY BENEFIT EXPENSE AMOUNTS FOR HEALTH PROFESSIONS EDUCATION; DIRECT OFFSETTING REVENUES ARE INCLUDED FROM MEDICARE, CHILDREN'S HOSPITALS GRADUATE MEDICAL EDUCATION, AND MEDICAID FOR DIRECT MEDICAL EDUCATION. RESEARCH AMOUNTS WERE ALSO BASED ON THE MEDICARE COST REPORT, ADJUSTED TO REFLECT FULL COSTS, USING COSTS ASSIGNED TO RESEARCH COST CENTERS, LESS INDUSTRY-SPONSORED RESEARCH DIRECT AND INDIRECT COSTS. THE EXPENSE OF RESTRICTED CASH CONTRIBUTIONS IS REPORTED BASED ON THE ACTUAL VALUE OF THE CONTRIBUTION BEFORE INDIRECT COST; RESTRICTED IN-KIND CONTRIBUTIONS ARE REPORTED AT FAIR MARKET VALUE. IN CALCULATING GROSS AND NET COMMUNITY BENEFIT EXPENSES, CARE WAS TAKEN TO AVOID DOUBLE-COUNTING COMMUNITY BENEFIT EXPENSES. THE SYSTEM'S NET COMMUNITY BENEFIT CONTRIBUTION FOR FISCAL YEAR 2013 TOTALED $240 MILLION AS COMPARED TO THE RESTATED 2012 COMMUNITY BENEFIT TOTAL OF $240 MILLION. THE 2013 COMMUNITY BENEFIT NUMBER CONSISTED OF CHARITY CARE ($59 MILLION), MEDICAID SHORTFALL ($68 MILLION), RESEARCH ($27 MILLION), EDUCATION AND TRAINING ($53 MILLION), AND COMMUNITY HEALTH IMPROVEMENT SERVICES, PROGRAMS AND SUPPORT ($44 MILLION), LESS HOSPITAL CARE ASSURANCE PROGRAM ("HCAP") ($11 MILLION). TO MEASURE AND REPORT COMMUNITY BENEFIT, THE SYSTEM HAS FOLLOWED INTERNAL REVENUE SERVICE GUIDELINES. AS SUCH, THE INFORMATION FOR 2013 REPRESENTS THE NEW REQUIREMENT TO OFFSET VARIOUS COMMUNITY BENEFIT PROGRAMS WITH RELATED REVENUE RECEIVED. FOR 2013, THIS REVENUE OFFSET WAS $33 MILLION. THE 2012 INFORMATION PROVIDED ABOVE ($240 MILLION) HAS BEEN RESTATED FOR COMPARATIVE PURPOSES TO INCLUDE THE NEW REVENUE OFFSET REQUIREMENT. FOR 2012, THIS AMOUNT WOULD HAVE BEEN $33 MILLION. Part I, Line 7g Line 7g includes the costs and direct offsetting revenue associated with certain hospital services that qualify to be reported as a subsidized health service. The total amount of gross community benefit expense included in line 7g for these clinics is: $22,289,263. The total amount of associated direct offsetting revenue is $18,653,735. The total amount of net community benefit expense included in line 7g is $3,635,528. Part II, Line 10 Although difficult to measure and not reported numerically, UH benefits the community through important community building activities that ultimately promote improved health and well-being for the surrounding population. Guided by our community health needs assessments and community hospital boards of directors, UH continues to meet community needs through economic development opportunities, local, regional and national disaster preparedness efforts, advocacy and coalition building, among others. Part III, Line 4 The hospitals financial statements are used to determine the bad debt expense as reported on line 2. Text to Audited Financial Statement Footnote - Provision for Bad Debt; In addition to charity care and insufficient funding from the Medicaid program, there are significant losses related to self-pay patients who fail to make payment for services rendered or insured patients who fail to remit co-payments and deductibles as required under applicable health insurance arrangements. The provision for bad debts represents revenues for services provided that are deemed to be uncollectible. Provision for bad debts totaled $60,418,000 and $54,983,000 for the years ended December 31, 2013 and 2012, respectively. End text to footnote. The bad debt expense disclosed on the Audited Financial Statements attached to this filing includes amounts for entities (for profits) that are not included in this return. This footnote can be found on Page 12. Part III, Line 8 As a safety-net to the community, UH hospitals provided services to many low-income Medicare recipients. The Medicare losses sustained at these hospitals are a result of Medicare reimbursing at less than operating costs. IRS Rev. Rul. 69-545, which established the community benefit standard for hospitals, provides that if a hospital serves patients covered by governmental health benefits (including Medicare), then this indicates the hospital operates to promote the health of the community. In turn, treating Medicare patients is considered a community benefit. Costs were derived using the Medicare Cost Report. Part III, Line 9b Patient liabilities for services rendered by UH hospital facilities shall be collected from all patients. Amounts owed by patients qualifying for charity care under the UH hospitals facilities charity/financial assistance policy shall not be billed to patients at amounts that are more than the amounts generally billed to Medicare patients. Part VI, Line 2 Commitment to the community remains at the core of the System's mission: To Heal. To Teach. To Discover. The System supports numerous community building activities through all System entities and not just those reported within the UH Group 990. Many of our community building activities are difficult to quantify or report within the specific categories provided in Schedule H, as they occur System-wide and not at specific entity levels. The System is proud to contribute to the economic growth of the communities we serve. The UH health system provides employment directly for about 19,400 employees and physicians. As the seventh largest employer in Ohio, UH supports the economy as well as state and local governments. System employees paid more than $56 million annually in state and local income taxes during 2013. UH provided many more community building activities, directly and indirectly, through new or expanded business opportunities and through important capital investments in our facilities. UH has committed - and continues to commit - millions of dollars to facilities and operations within the city of Cleveland and throughout our region, providing construction and hospital-based jobs. New state-of-the-art outpatient health centers in the region have spurred economic growth while giving people access to the care they need close to home and expanding our community benefit programs. The System's supply chain management strategy encompasses supplier diversity to include minority and women-owned business enterprises providing them opportunities to be our partners and suppliers of goods and services throughout the System. THE SYSTEM SEEKS TO INCORPORATE ENVIRONMENTAL RESPONSIBILITY AND IS WORKING TOWARDS REDUCING ITS ENVIRONMENTAL FOOTPRINT THROUGHOUT THE COMMUNITIES IT SERVES. WITH REGARD TO UH BUILDINGS AND MAJOR RENOVATIONS, UH ENDEVORS TO INCORPORATE DESIGN AND CONSTRUCTION STRATEGIES of third-party best-practice guides such as the U.S. Green Building Council's Leadership in Energy and Environmental Design (LEED) Certification System, the EPA's ENERGY STAR Performance Rating, and Healthcare Without Harm's Green Guide for HealthCare. Our Vision 2010 construction projects incorporated sustainable design strategies. The U.S. Green Building Council awarded University Hospitals Ahuja Medical Center a LEED New Construction 2009 (NCv2009) Silver certification - making the new hospital the first health care facility in the country to receive NCv2009 certification. UH Seidman Cancer Center anticipates LEED Certification as well. UH assesses the health care need of its communities as part of the regular strategic planning process which includes assessments of environmental, demographic, and economic factors. The System also uses UH patient surveys regarding health care utilization and works actively with various partners throughout the communities we serve. UH has collaboratively worked with community organizations in our medical centers' service areas (i.e. neighborhood connections, local departments of public health, local disease foundations, etc.). The System also works closely with local governments and elected officials to understand their communities' needs and work to implement programs and activities to assist in responding to those needs. In addition, the members of various UH Boards are active members within the communities we serve and provide an understanding of and collaborative feedback related to the needs of the communities. The System is proud to contribute to the health of our citizens and to be a positive economic force in our region. For more detailed information on the System's community benefit or to view the 2013 Community Benefit Report, please visit the System's website at www.UHhospitals.org. Part VI, Line 3 UH informs and educates patients and persons who may be billed for patient care about options for resolution of their balances, including assistance under government programs and under the UH Financial Assistance Program ("Assistance Program") in a variety of ways. Signage for the state of Ohio Health Care Assurance Program (HCAP) and the UH Patient Financial Assistance program can be found in locations where patients register for care, patient access areas, and various points of entry such as our emergency departments. Supplemental brochures that reflect the UH Patient Financial Assistance Program and the HCAP program are also available. Information about the Assistance Program can also be found on the UH website in addition to being provided on the backs of patient statements, including a toll free phone number to call for assistance from one of our financial counselors. Part VI, Line 4 University Hospitals Case Medical Center The community served by the Hospital is defined based on the geographic origins of the Hospital's inpatients. The Primary Service Area ("PSA") is the geographic area from which the majority of the Hospital's patients originate. The Secondary Service Area ("SSA") is where an additional population of the Hospital's inpatients reside. The PSA is comprised of eight counties in Ohio: Ashtabula, Cuyahoga, Geauga, Lake, Lorain, Medina, Portage and Summit. The SSA is comprised of another seven Ohio counties: Ashland, Erie, Huron, Mahoning, Stark, Trumbull and Wayne. In 2010, the Hospital's PSA included about 2,873,000 persons and its SSA included a population of approximately 1,128,000 persons for a total service area population of approximately 4 million. With approximately 1.3 million residents, Cuyahoga County accounted for nearly 32 percent of the Hospital's PSA population. In 2010, approximately 92 percent of the Hospital's inpatients originated from the PSA. Cuyahoga County accounted for approximately 69 percent of the Hospital's discharges in 2010 (the most recent data at the time the 2012 CHNA was conducted from 2010). University Hospitals Rainbow Babies and Children's Hospital The community served by the Hospital is defined based on the geographic origins of the Hospital's inpatients. The Primary Service Area ("PSA") is the geographic area from which the majority of the Hospital's patients originate. The Secondary Service Area ("SSA") is where an additional population of the Hospital's inpatients reside. The PSA is comprised of eight Ohio counties: Ashtabula, Cuyahoga, Geauga, Lake, Lorain, Medina, Portage and Summit. The SSA is comprised of another seven Ohio counties: Ashland, Erie, Huron, Mahoning, Stark, Trumbull and Wayne. In 2010, approximately 91 percent of the Hospital's inpatients originated from the PSA. Cuyahoga County accounted for approximately 58 percent of the Hospital's discharges in 2010 (the most recent data at the time the 2012 CHNA was conducted from 2010). In 2010, the Hospital's PSA's general population included about 663,114 persons under the age of 18 and its SSA included a population of approximately 252,313 persons under the age of 18 resulting in a combined pediatric population of approximately 915,427 persons. With approximately 295,000 residents under the age of 18, Cuyahoga County alone accounted for nearly 32 percent of the population served by the Hospital. University Hospitals Geauga Medical Center The community served by the Hospital is defined based on the geographic origins of the Hospital's inpatients. The Primary Service Area ("PSA") is the geographic area from which the majority of the Hospital's patients originate. The Secondary Service Area ("SSA") is where an additional population of the Hospital's inpatients reside. The PSA is comprised of seven ZIP codes in Ashtabula, Geauga and Lake counties in Ohio. The SSA is comprised of 20 ZIP codes in Ashtabula, Cuyahoga, Geauga, Lake, Portage and Trumbull counties. In 2010, the PSA and SSA were home to approximately 344,974 persons, almost all of whom live in Ashtabula, Geauga and Lake counties. In 2010, more than 82 percent of the Hospital's inpatients lived in the specified ZIP codes (the most recent data at the time the 2012 CHNA was conducted from 2010). University Hospitals Ahuja Medical Center The community served by the Hospital is defined based on the geographic origins of the Hospital's inpatients. The Primary Service Area ("PSA") is the geographic area from which the majority of the Hospital's patients originate. The Secondary Service Area ("SSA") is where an additional population of the Hospital's inpatients reside. The PSA is comprised of nine ZIP codes in Cuyahoga County, Ohio. The SSA is comprised of 17 ZIP codes in Cuyahoga, Geauga, Lake, Medina, Portage and Summit counties in Ohio. In 2010, the PSA and SSA were home to approximately 618,101 persons. In 2010, 61 percent of the Hospital's combined service area population lived in Cuyahoga County (the most recent data at the time the 2012 CHNA was conducted from 2010). UH Regional Hospitals The community served by the Richmond Campus is defined based on the geographic origins of the Richmond Campus' inpatients. The Primary Service Area ("PSA") is the geographic area from which the majority of the Richmond Campus' patients originate. The Secondary Service Area ("SSA") is where an additional population of the Richmond Campus' inpatients reside. The PSA is comprised of eight ZIP codes in Cuyahoga and Lake counties, Ohio. The SSA is comprised of six ZIP codes in Cuyahoga and Lake counties. In 2010, the PSA and SSA were home to approximately 378,551 persons. In 2010, 74 percent of the Richmond Campus' inpatients lived in the specified ZIP codes (the most recent data at the time the 2012 CHNA was conducted from 2010). The Bedford Campus' PSA and SSA include nine ZIP codes in Cuyahoga, Portage and Summit counties in Ohio that in 2010 were home to approximately 202,616 persons. In 2010, 81 percent of the Bedford Campus' inpatients lived in the specified ZIP codes. University Hospitals Geneva Medical Center The community served by the Hospital is defined based on the geographic origins of the Hospital's inpatients. The Primary Service Area ("PSA") is the geographic area from which the majority of the Hospital's patients originate. The Secondary Service Area ("SSA") is where an additional population of the Hospital's inpatients reside. The PSA is comprised of two ZIP codes in Ashtabula and Lake counties in Ohio. The SSA is comprised of two ZIP codes in Ashtabula County. In 2010, the PSA and SSA were home to approximately 71,123 persons. In 2010, 85 percent of the Hospital's inpatients lived in these ZIP codes (the most recent data at the time the 2012 CHNA was conducted from 2010). University Hospitals Conneaut Medical Center The community served by the Hospital is defined based on the geographic origins of the Hospital's inpatients. The Primary Service Area ("PSA") is the geographic area from which the majority of the Hospital's patients originate. The Secondary Service Area ("SSA") is where an additional population of the Hospital's inpatients reside. The PSA and SSA are each comprised of two ZIP codes in Ashtabula County, Ohio. In 2010, the PSA and SSA were home to approximately 67,074 persons. In 2010, 84 percent of the hospital's inpatients lived in these ZIP codes (the most recent data at the time the 2012 CHNA was conducted from 2010). Part VI, Line 5 UH continues to invest in itself and the community through enhanced clinical services, educational programs, research, and capital improvements that meet the health care needs of communities and patients it serves. UH provides an outstanding balance of high-quality clinical care within its walls, and community health outreach to local populations. As indicated in the above response to Part VI, Line 4, UH has made significant investments in access to care for low income and vulnerable populations. Four UH Health Clinics are located in areas designated as Health Professional Shortage Areas (HPSAs) by the Health Resources and Services Administration (HRSA). These clinics include the Douglas Moore Health Clinic, Women's Health Center, Rainbow Ambulatory Practice, and Family Medicine Clinic, all located on the UH Case Medical Center campus. HRSA also designates Medically Underserved Areas (MUAs) and Medically Underserved Populations (MUPs) based on specific criteria. Twenty-five areas within the UH service area including Cuyahoga, Lorain, and Summit Counties qualify as MUAs, while one population in Kent, Portage County is a designated MUP. Cuyahoga County alone accounts for 20 MUAs located in 13 zip codes, representing 12 towns. The UH System's two critical access hospitals in Ashtabula County sit in Appalachia, as designated by the Appalachian Regional Commission. UH is committed to training the next generation of physicians, nurses, specialists and other allied health care providers annually. Many of these students and trainees complete their education and take their knowledge and expertise to other parts of the state or country, thereby benefiting other communities. UH works to increase health and medical knowledge through government and non-profit funded research. The shared knowledge derived from these efforts improves the health and well-being of people throughout the nation and the world when they lead to new standards of care, new medical devices, or breakthroughs in tackling diseases. Part VI, Line 6 University Hospitals (parent organization) together with its affiliates and subsidiaries is an integrated, health care delivery system. The System includes an academic medical center, six wholly-owned community hospital locations, two of which are critical access facilities, a nationally recognized children's hospital, a nationally recognized cancer center, ambulatory health care centers and physician practice offices throughout the region. The System also provides skilled nursing, elder health, rehabilitation and home care services. UH serves an essential role in the community by providing diverse populations throughout the Northeast Ohio region with comprehensive health care - from primary care to highly specialized medical care for the most serious of health problems. It provides the same quality and compassionate service to all, no matter their income, ability to pay or socioeconomic status. UH cares for the well-insured and the uninsured; men, women and children from every community in the region, from urban centers, small towns, rural areas and suburbs. Part VI, Line 7 N/A false American Cancer Society 10501 Euclid Ave Cleveland OH 44106 251798733 501(c)3 20000 General Support American Heart Association PO Box 1590 Hagerstown MD 217401590 135613797 501(c)3 13000 General Support American Liver Foundation 921 E 86th Indianapolis IN 46240 362883000 501(c)3 14000 General Support Arthritis Foundation 4630 Richmond Rd Cleveland OH 44128 581341679 501(c)3 15000 General Support Autism Speaks Inc 4700 Rockside Rd Independence OH 44131 202329938 501(c)3 8000 General Support Case Western Reserve 10900 Euclid Ave Cleveland OH 44106 341018992 501(c)3 33246000 General Support Cleveland Foodbank 15500 South Waterloo Rd Cleveland OH 44110 341292848 501(c)3 8000 General Support Cleveland Hearing & Speech Center 11635 Euclid Ave Cleveland OH 44106 340714648 501(c)3 6000 General Support Cleveland Rape Crisis Center 526 Superior Ave 1400 Cleveland OH 44114 510164315 501(c)3 10000 General Support Crohns Colitis Foundation 4700 Rockside Rd Independence OH 44131 136193105 501(c)3 10000 General Support Cuyahoga Community College Foundation 700 Carnegie Ave Cleveland OH 44115 340896630 501(c)3 38000 General Support Epilepsy Foundation of NE Ohio 2800 Euclid Ave Ste 450 Cleveland OH 44115 237198807 501(c)3 10000 General Support FLYING HORSE FARMS 3 EASTON OVAL STE 330 COLUMBUS OH 43219 203498125 501(c)3 15000 General Support Gathering Place 23300 Commerce Park Dr Cleveland OH 44122 341879035 501(c)3 100000 General Support Hattie Larham Foundation 9772 Daigonal Rd Mantua OH 44255 341897312 501(c)3 10000 General Support Kidney Foundation of Ohio 2831 Prospect Ave Cleveland OH 44115 340827748 501(c)3 20000 General Support March of Dimes of NE Ohio 5425 Warner Rd Ste 10 Cleveland OH 44125 131846366 501(c)3 15000 General Support Medwish Intl PO Box 181484 Cleveland OH 44118 341903712 501(c)3 10000 General Support MILESTONES ORGANIZATION 23880 COMMERCE PARK Beachwood OH 44122 200721205 501(c)3 10000 General Support Playhouse Square Foundation 1501 Euclid Ave Ste 200 Cleveland OH 44115 237304942 501(c)3 30000 General Support Ronald Mcdonald House 10415 Euclid Ave Cleveland OH 44111 341269123 501(c)3 210000 General Support Susan G Komen Race for the Cure 26210 Emery Rd Ste 307 Cleveland OH 44128 341793460 501(c)3 75000 General Support 22 Schedule I, Part I, Line 2 Donations made by members of the Group Return to charitable organizations are made in furtherance of the recipient organizations' exempt purposes and are considered unrestricted with regard to use of funds. X X X X X X false true false false false false false true true true UHHS - William L Annable MD Chief Quality Off. 340380 0 133060 0 67081 0 12618 0 13979 0 567118 0 0 0 UHHS - Elliot A Kellman Chief HRO 420502 0 189856 0 129266 0 52742 0 19606 0 811972 0 0 0 UHHS - Janet L Miller Esq Secretary, CLO 419810 0 396232 0 535894 0 48042 0 10193 0 1410171 0 584844 0 UHHS - Fred C Rothstein MD Pres. UHCMC/Ex Off Dir. 645882 0 326438 0 255363 0 46602 0 21471 0 1295756 0 41391 0 UHHS - Steven D Standley Chief Admin. Off. 437326 0 194977 0 122374 0 45320 0 13639 0 813636 0 18900 0 UHHS - Michael A Szubski Treasurer, CFO 598983 0 415131 0 38895 0 177365 0 29952 0 1260326 0 145997 0 UHHS - Thomas F Zenty III CEO/Ex Off Dir. 1073404 0 594891 0 571269 0 364727 0 10548 0 2614839 0 299683 0 UHCMC - Michael Anderson MD Chief Medical Off. 316403 0 100321 0 7100 0 78628 0 35084 0 537536 0 0 0 UHCMC - Patricia DePompei Pres. RB&C/Macdonald 365051 0 103066 0 2220 0 74423 0 30947 0 575707 0 0 0 UHCMC - Ronald E Dziedzicki BSN Chief Support Serv. Off. 370355 0 110141 0 4467 0 102049 0 15666 0 602678 0 0 0 UHCMC - Catherine S Koppelman R Chief Nursing Off. 315560 0 121369 0 71026 0 49436 0 19290 0 576681 0 0 0 UHCMC - Nathan Levitan MD Pres. Seidman Cancer Ctr. 520549 0 211822 0 153983 0 45034 0 19455 0 950843 0 0 0 UHCMC - Sonia Salvino Treasurer/VP Finance 237560 0 72395 0 1490 0 62265 0 19665 0 393375 0 0 0 UHCMC - Warren Selman MD Physician/Director (thru 5/13) 814680 0 26708 0 61441 0 13599 0 26448 0 942876 0 0 0 UHMG - Harlin G Adelman Assistant Secretary 284055 0 120972 0 49983 0 77821 0 28805 0 561636 0 18967 0 UHMG - Phyllis Hall VP & Treasurer 310979 0 120624 0 2206 0 92571 0 21907 0 548287 0 0 0 UHMG - Clifford V Harding MD Dept. Chair Pathology/Director 223352 0 45979 0 35942 0 8823 0 3306 0 317402 0 0 0 UHMG - Michael Konstan MD Dept.Chair Pediatrics/Director 287764 0 26708 0 40200 0 13319 0 10548 0 378539 0 0 0 UHMG - Randall Marcus MD Dept.Chair Orthopaedics/Direct 628605 0 38311 0 70193 0 12662 0 22387 0 772158 0 0 0 UHMG - Cliff Megerian MD Dept. Chair Otolaryngology/Dir 578786 0 23356 0 47396 0 13687 0 26478 0 689703 0 0 0 UHMG - Howard Nearman MD Dept. Chair Anesthesia/Directo 391853 0 35510 0 60413 0 12440 0 20295 0 520511 0 0 0 UHMG - Michael Nochomovitz MD Pres./Director 618867 0 275552 0 144485 0 46658 0 10989 0 1096551 0 0 0 UHMG - Jeffrey Ponsky MD Dept. Chair Surgery/Director 588921 0 26708 0 90467 0 11333 0 13438 0 730867 0 0 0 UHMG - Robert Ronis Dept. Chair Psychiatry/Direct. 174859 0 46712 0 25892 0 7215 0 1611 0 256289 0 0 0 UHMG - Richard A Walsh MD Dept. Chair Medicine/Director 374982 0 42312 0 58606 0 12401 0 13848 0 502149 0 0 0 UHLSF - Don M Landek President 166550 0 14813 0 9048 0 36878 0 13274 0 240563 0 0 0 UHLSF - Nancy Tinsley Director 211416 0 66168 0 1052 0 63891 0 5515 0 348042 0 0 0 AMC - Richard Hanson Ex Officio Director 541735 0 334451 0 5549 0 133194 0 29667 0 1044596 0 90979 0 AMC - Susan V Juris Pres./Ex Officio Director 323432 0 120858 0 62164 0 43820 0 27677 0 577951 0 0 0 AMC - Richard Stein Ex Officio Director 0 428943 0 0 0 3870 0 35517 0 25657 0 493987 0 0 UHREG - Laurie Delgado Pres.(thru 12/13)/Ex Off Dir 321826 0 121965 0 286341 0 36033 0 28583 0 794748 0 253493 0 UHREG - Rosemary Leeming MD CMO/Director 196786 0 0 0 33936 0 11530 0 28116 0 270368 0 0 0 UHREG - David Rapkin MD Chief of Staff/Director 387669 0 0 0 35521 0 12487 0 30869 0 466546 0 0 0 UHREG - Joseph Shawi MD Vice Chief of Staff/Director 0 189394 0 0 0 1858 0 25770 0 30327 0 247349 0 0 CMC - Benjamin Bryant MD Ex Officio Director(thru 5/12) 0 290870 0 0 0 8153 0 41160 0 17971 0 358154 0 0 CMC - Robert David Pres./Ex Officio Director 119303 0 50669 0 408 0 34366 0 13416 0 218162 0 0 0 CMC - Arpan Desai MD Director 0 414629 0 0 0 1431 0 6147 0 28369 0 450576 0 0 CMC - Karen McNeil Ex Officio Director(thru 5/12) 129776 0 11666 0 1142 0 14892 0 1567 0 159043 0 0 0 GMC - M Steven Jones Pres./Ex Officio Director 305484 0 117683 0 2956 0 93570 0 13393 0 533086 0 0 0 GMC - John Tumbush MD Director 0 194382 0 0 0 1821 0 27015 0 2430 0 225648 0 0 UHGMC - Robert David Pres./Ex Officio Director 119302 0 50670 0 408 0 34365 0 13416 0 218161 0 0 0 UHGMC - Raimantas Drublionis MD Ex Officio Director 0 332866 0 0 0 635 0 20413 0 1659 0 355573 0 0 HCS - Keith Maitland Pres./Director 205987 0 90279 0 38834 0 42306 0 30302 0 407708 0 0 0 UHACO - Eric J Bieber MD Pres./Director 523294 0 266776 0 2970 0 125866 0 21175 0 940081 0 0 0 UHACO - Elizabeth Hammack Secretary 170084 0 16198 0 7274 0 14773 0 15913 0 224242 0 0 0 UHRBC - Brent Carson Treas./Director 199019 0 66644 0 1379 0 53191 0 28480 0 348713 0 0 0 UHRBC - Marillee Gallagher MD Director 0 326274 0 0 0 4653 0 15717 0 7109 0 353753 0 0 UHRBC - Richard Grossberg MD Director 304311 0 0 0 920 0 12813 0 29183 0 347227 0 0 0 UHRBC - Ken Lakota Director 114279 0 10638 0 2764 0 12380 0 26934 0 166995 0 0 0 UHRBC - James Underwood MD Director 0 142771 0 0 0 543 0 13996 0 27675 0 184985 0 0 UHRBC - Drew Hertz MD Vice Pres. 302289 0 20000 0 1001 0 0 0 1659 0 324949 0 0 0 UHCCO - David Cogan MD Director 0 300736 0 20938 0 7833 0 33117 0 13370 0 375994 0 0 UHCCO - James Covielo MD Director 0 218607 0 0 0 751 0 0 0 19229 0 238587 0 0 UHCCO - Sean Hoynes MD Director 0 345799 0 125000 0 1209 0 25157 0 30395 0 527560 0 0 UHCCO - George Kikano MD Director 184792 0 41911 0 28249 0 9234 0 10854 0 275040 0 0 0 UHCCO - William Steiner II MD Director 0 178024 0 0 0 2914 0 0 0 11880 0 192818 0 0 UHMG - Bahman Guyuron MD Surgeon, Plastic Surgery 954506 0 395913 0 112907 0 11978 0 18227 0 1493531 0 0 0 UHMG - Christopher Furey MD Orthopaedic Surgeon 1084398 0 0 0 68019 0 13687 0 24438 0 1190542 0 0 0 UHMG - Jason D Eubanks Orthopaedic Surgeon 1046441 0 0 0 73902 0 13779 0 10439 0 1144561 0 0 0 UHMG - Nicholas U Ahn MD Orthopaedic Surgeon 989513 0 0 0 105519 0 13584 0 22696 0 1131312 0 0 0 UHMG - Matthew Kraay Orthopaedic Surgeon 847414 0 0 0 73773 0 13403 0 30598 0 965188 0 0 0 UHHS Sherri Bishop Chief Development Off. 337503 0 357394 0 1894 0 118169 0 31880 0 846840 0 88142 0 UHHS - Peter S Brumleve Chief Marketing Off. 386540 0 79191 0 40227 0 75939 0 13047 0 594944 0 0 0 UHHCS - Kevin P Cunningham Pharmacy Director 142290 0 13956 0 465 0 8311 0 18705 0 183727 0 0 0 UHHS - John V Foley Chief Information Off. 394612 0 70069 0 2280 0 61408 0 25224 0 553593 0 0 0 GMC - Jason E Glowczewski Pharmacy Director 153838 0 8505 0 763 0 11841 0 21101 0 196048 0 0 0 AMC - Alan Hirsch MD CMO, Ahuja 306984 0 25734 0 14029 0 34320 0 25217 0 406284 0 0 0 UHCMC - Carl Lufter Pharmacy Director 168920 0 15317 0 11811 0 17307 0 13996 0 227351 0 0 0 UHHS - Donnie Perkins VP Inclusion & Diversity 189036 0 46129 0 26251 0 10915 0 2831 0 275162 0 0 0 UHHS - Cheryl Wahl Chief Compliance Officer 226540 0 99302 0 636 0 57409 0 10704 0 394591 0 0 0 UHHS - William A Young President SJMC 316177 0 118488 0 2460 0 65620 0 28659 0 531404 0 0 0 UHHS - Heidi Gartland Fmr. Key Employee 233292 0 75558 0 1564 0 61104 0 11451 0 382969 0 0 0 UHMG - Pablo R Ros MD Fmr. Key Employee 530697 0 26708 0 64146 0 13889 0 18526 0 653966 0 0 0 UHMG - Charles Lanzieri MD Fmr. Key Employee 437427 0 0 0 48258 0 12903 0 19251 0 517839 0 0 0 UHLSF - Michael R Vehovec Fmr. Officer 230228 0 92126 0 1141 0 74157 0 1991 0 399643 0 0 0 UHHS - PAUL TAIT CHIEF STRATEGIC PLANNING OFF. 361526 0 356471 0 458633 0 37067 0 26084 0 1239781 0 472618 0 UHHS - ACHILLES A DEMETRIOU MD PRESIDENT/COO 0 425434 76955 42735 10093 555217 0 Schedule J, Part I, Line 4b The following persons participated in, or received payment from a nonqualified retirement plan (457(f) or SERP) in 2013: - Harlin G. Adelman (No payments received in 2013) - Michael R. Anderson, M.D. (No payments received in 2013) - William L. Annable ($57,307-SERP) - Eric Bieber, M.D. (No payments received in 2013) - Sherri L. Bishop (No payments received in 2013) - Peter Brumleve (No payments received in 2013) - Robert G. David (No payments received in 2013) - Laurie S. Delgado ($245,656-SERP, $26,092-457f) - Achilles A. Demetriou, M.D. ($55,101-SERP) - Patricia M. Depompei (No payments received in 2013) - Ronald E. Dziedzicki (No payments received in 2013) - John V. Foley (No payments received in 2013) - Phyllis Hall (No payments received in 2013) - Richard Hanson (No payments received in 2013) - Steven M. Jones (No payments received in 2013) - Susan V. Juris ($54,283-SERP) - Elliot A. Kellman ($117,792-SERP) - Catherine S. Koppelman ($66,381-SERP) - Nathan Levitan, M.D. ($148,364-SERP) - Keith Maitland ($36,808-SERP) - Janet L. Miller ($505,431-SERP, $25,459-457F) - Michael L. Nochomovitz, M.D. ($134,969-SERP) - Fred C. Rothstein, M.D. ($196,757-SERP, $48,266-457f) - Sonia Salvino (No payments received in 2013) - Steven D. Standley ($95,502-SERP, 22,548-457f) - Michael A. Szubski (No payments received in 2013) - Paul G. Tait ($454,613-SERP) - Nancy Tinsley (No payments received in 2013) - Allen Tracy (No payments received in 2013) - Michael R. Vehovec (No payments received in 2013) - Cheryl Wahl (No payments received in 2013) - William Young (No payments received in 2013) - Thomas F. Zenty III ($334,606-SERP, $215,542-457f) Schedule J, Part I, Line 7 Certain employees disclosed in Part VII receive bonuses, 457f payments, and SERP payments which would qualify as non-fixed payments. Schedule J, Part I, Line 8 Certain employee compensation disclosed in Part VII meet the requirements of the initial contract exception. SCHEDULE J, PART II FORM 990 REPORTING REQUIREMENTS RELATED TO ITEMS SUCH AS DEFERRED COMPENSATION PROGRAMS REQUIRE DUAL REPORTING IN SOME YEARS FOR VARIOUS PARTICIPANTS. AS SUCH, AMOUNTS MAY BE SHOWN IN PART VII AND SCHEDULE J DURING A YEAR IN WHICH THOSE AMOUNTS WERE DEFERRED, AND AGAIN IN SUBSEQUENT YEARS IN PART VII AND SCHEDULE J WHEN ACTUALLY PAID. ONLY SCHEDULE J INCLUDES A COLUMN (F), NOTING THESE AMOUNTS WERE PREVIOUSLY REPORTED. Residence Inn See Part V 193000 See Part V false First Energy See Part V 228000 See Part V false First Energy See Part V 228000 See Part V false Lee Ponsky MD See Part V 11000 See Part V false Diana Ponsky MD See Part V 166000 See Part V false Schedule L Part IV Line 1 Residence Inn Relationship Between Interested Person and Organization: Former UHCMC Director Richard Horvitz owns many Residence Inns in the local area. Description of Transaction: Residence Inn rents rooms to UHCMC for sleep studies or other activities. These transactions were all at arms length. Line 2 First Energy Relationship Between Interested Person and Organization: Former UHCMC Director Ernest J. Novak is a Director of First Energy. Description of Transaction: First Energy subsidiary The Illuminating Co. provided energy services to UHCMC in 2013. These transactions were all at arms length. Line 3 First Energy Relationship Between Interested Person and Organization: Former UHCMC Director Lorna Wisham is employed at First Energy. Description of Transaction: First Energy subsidiary The Illuminating Co. provided energy services to UHCMC in 2013. These transactions were all at arms length. Line 4 Lee Ponsky, M.D. Relationship Between Interested Person and Organization: Family Member of Jeffrey Ponsky, M.D. UHMG Director. Description of Transaction: A family member of Dr. Ponsky is employed by UHMG. Line 5 Diana Ponsky, M.D. Relationship Between Interested Person and Organization: Family Member of Jeffrey Ponsky, M.D. UHMG Director. Description of Transaction: A family member of Dr. Ponsky is employed by UHMG. In accordance with IRS requirements, business transactions involving individuals and entities that are interested persons with respect to University Hospitals Health System, Inc. (EIN: 34-0714775) are reported on Part IV of the Schedule L included with the separate Form 990 filed by University Hospitals Health System Inc. X 42 186162 Appraisals X 39 FMV X 4049 FMV/Receipt X 69 1698164 Med. Value at Transf X 3 57780 FMV X Miscellaneous 307 463719 FMV false true false Form 990, Schedule M, Part I, Column (b): the numbers reported in Part I, Column (b) represent the number of items contributed. UH Entity DBA Names/Acronyms The list below shows all the entities included in this Group Return along with any applicable dba names and/or acronyms that will be used throughout this return. For purposes of this Group Return University Hospitals is at times noted as "UH". University Hospitals Cleveland Medical Center (UHCMC) - 34-1567805 dba University Hospitals Case Medical Center 11100 Euclid Ave Cleveland, OH 44106 University Hospitals Ahuja Medical Center, Inc. (AMC) - 26-4827222 11100 Euclid Avenue Cleveland, OH 44106 University Hospitals Bedford Medical Center (BMC) - 34-1271115 44 Blaine Avenue Bedford, OH 44146 University Hospitals Conneaut Medical Center (CMC) - 34-0714550 158 West Main Road Conneaut, OH 44030 BMH Professional Corporation (BMHPC) - 34-1749966 158 West Main Road Conneaut, OH 44030 University Hospitals Geauga Medical Center (GMC) - 34-0816492 13207 Ravenna Road Chardon, OH 44024 University Hospitals Geneva Medical Center (UHGMC) - 34-0714461 870 West Main Street Geneva, OH 44041 UHHS Heather Hill Inc. (HHI) - 34-0771884 12340 Bass Lake Road Chardon, OH 44024 UHHS - Heather Hill Rehabilitation Hospital Inc. (UHECC) - 34-1465745 dba University Hospitals Extended Care Campus 12340 Bass Lake Road Chardon, OH 44024 UH Regional Hospitals (UHRH) - 34-1924226 27100 Chardon Road Richmond Hts, OH 44143 University Mednet (UMI) - 34-0750341 23001 Euclid Avenue Cleveland, OH 44117 University Hospitals Home Care Services, Inc. (HCS) - 34-1527536 4901 Galaxy Parkway Warrensville Hts, OH 44128 University Hospitals Laboratory Services Foundation (UHLSF) - 34-1720429 11100 Euclid Avenue Cleveland, OH 44106 University Hospitals Medical Group (UHMG) - 20-4881619 11100 Euclid Avenue Cleveland, OH 44106 University NPI Inc. - 34-1571623 11100 Euclid Avenue Cleveland, OH 44106 Memorial Hospital Health Foundation - 34-1810018 11100 Euclid Avenue Cleveland, OH 44106 University Hospitals Accountable Care Organization Inc. 3605 Warrensville Center Rd - MSC 9155 Shaker Hts, OH 44122 University Hospitals Coordinated Care Organization 3605 Warrensville Center Rd - MSC 9155 Shaker Hts, OH 44122 University Hospitals Rainbow Care Connection Inc. 3605 Warrensville Center Rd - MSC 9155 Shaker Hts, OH 44122 Treasury Regulation Section 1.6033-2(d)(5) Pursuant to Treasury Regulation Section 1.6033-2(d)(5), University Hospitals Health System, Inc. ("Parent Organization") has elected to report information about contributions, gifts and grants, and compensation and other information about officers, directors, trustees, key employees, certain highly compensated employees, and certain professional contractors on a consolidated basis for all the members of its Group Exemption, including the Parent Organization, on the University Hospitals Health System, Inc. Group Return. Form 990, Part I, Line 6 The total number of volunteers is provided by each UH Medical Center's volunteer coordinator. Volunteers provide assistance in many different departments throughout the UH medical centers. The roles of a volunteer fall into three categories: patient contact, limited patient contact and no patient contact. Roles in the patient contact category include those where the volunteer is working directly with a patient or the patient's family. Examples of volunteer roles from this category include but are not limited to pastoral care volunteers and newborn nursery volunteers. Volunteers who serve in roles where there is limited patient contact work in areas where they may be working more with hospital staff than our patients or visitors. Examples of volunteer roles under the limited patient contact include but are not limited to flower delivery volunteers and Atrium gift shop volunteers. And finally, examples of volunteer roles from the no patient contact category include but are not limited to mailroom and clerical volunteers (working in offices throughout the UH medical centers). Part V, Line 2a University Hospitals Health System, Inc. acts as a common pay agent for the various entities that comprise the System. As a result the number of employees reported on Form W-3 will be different than what is shown in Part V Line 2a because this Group Return does not encompass all entities for which the Parent acts as a common pay agent. Form 990, Part VI, Section A, Line 2 The following information regarding family and business relationships was obtained while reviewing conflict of interest questionnaire responses received from Directors, Officers, and Key Employees. University Hospitals relies upon these questionnaire responses to determine these relationships. Mr. James Supplee (CMC Director) and Mr. Charles Deck (CMC Director) have a business relationship. Mr. Craig Parker (UHGMC Director) and Mr. Willard Raymond (UHGMC Director) have a business relationship. Mr. John Morley (UHCMC Director) and Mr. William O'Neill Jr. (UHCMC Director) have a business relationship. Mr. Fred C. Rothstein, M.D. (UHCMC Director) and Mr. Michael Feuer (UHCMC Director) have a business relationship. Mr. Lee Koury (UHCMC Director) and Mr. Gregory Skoda (UHCMC Director) have a business relationship. Form 990, Part VI, Section A, Line 6 University Hospitals Health System, Inc. is the Sole Member of the organizations included in this return. Its rights include electing the Board of Directors and approving significant decisions of each organization's Board. Form 990, Part VI, Section A, Line 7a University Hospitals Health System, Inc. (Sole Member) elects the Board of Directors, including the designation of the Directors to be the Chairperson and Vice Chairperson of the Board. Form 990, Part VI, Section A, Line 7b CERTAIN GOVERNING RESPONSIBILITIES ARE RESERVED AT THE PARENT ORGANIZATION, UNIVERSITY HOSPITALS HEALTH SYSTEM, INC. (SOLE MEMBER). Examples include approving matters relating to finances and financing, matters relating to investments, legal matters, material assets sales or transfers, strategic plan, officers, and Directors to the Organizations Board. form 990, Part VI, Section B, Line 11 The Form 990 for University Hospitals Health System, Inc. Group Return is approved for filing by University Hospitals Health System Inc.'s (Parent Organization) governing body. The Audit and Compliance Committee has been delegated authority to review and approve Form 990 by the UH Board. The Compensation Committee reviews relevant disclosures related to compensation sections of the return. The Board receives a complete copy of the return to review before it is filed with the Internal Revenue Service. Certain members of Senior management review the form while overseeing this process. form 990, Part VI, Section B, Line 12c UH has adopted three Conflict of Interest policies: the first relates to UH and all its subsidiaries and applies to all directors, officers, other disqualified persons, pursuant to the intermediate sanctions regulations, the second applies to UH management (supervisors and above) and the third applies to physicians. UH regularly and consistently monitors and enforces compliance with the Conflict of Interest policies. Individuals to which the Conflict of Interest policies apply are required to complete an annual disclosure and provide information regarding any interests that may be potential conflicts pursuant to the Conflict of Interest policies. Individuals covered by the policies are required to provide any changes to or new disclosures should they occur. All disclosures and subsequent updates to disclosures are reviewed by the UH Compliance and Ethics Department. Board-level conflicts are reviewed and approved, if appropriate, by the Audit and Compliance Committee of the UH Board and/or the UH Board. If a conflict exists with a Director, certain restrictions may be imposed, such as excusing the Director from the room during discussion and/or voting with regard to a proposed transaction. Education regarding conflicts of interest is included in the annual compliance training that includes all Directors, employees and physicians. form 990, Part VI, Section B, Line 15 Executive compensation is approved by the Compensation Committee of the Board (the "Committee"). The Committee has retained an independent compensation consultant who provides information to the Committee on changes and trends in executive compensation and objective third party information on competitive and comparable executive compensation and benefit level/programs. The Consultant collects and provides to the Committee, appropriate market compensation and benefits information, appropriate market practices for comparable organizations' positions and best practices. The Consultant also provides advice on developing and modifying UH's executive compensation philosophy. Form 990, Part VI, Section C, Line 19 The Financial Statements for University Hospitals Health System, Inc. and its Subsidiaries are made publicly available through the use of DAC Bond (disclosure dissemination agent) and can be found on the internet at www.dacbond.com The organization's governing documents and conflict of interest policy may be made available upon request. Form 990, Part VII, Section A The individuals listed below serving as current Officers/Directors are also employees of other UH entities included in this Group Return. The hours listed in this section reflect only the individual's time spent directly related to the activity of the board on which they serve. UHMG - Harlin G. Adelman UHECC - Rebecca Ivcic UHLSF - Nancy Tinsley UHACO - Elizabeth Hammack UHRBC - Brent Carson UHRBC - Richard Grossberg, M.D. UHRBC - Ken Lakota UHRBC - Drew Hertz, M.D. UHCCO - George Kikano, M.D. Form 990, Part VII, Section A, Compensation for Richard Hanson Mr. Richard Hanson is University Hospitals President of Community Hospitals & Ambulatory Networks. In this role he oversees all of the community hospitals. He also serves on all of the community hospitals' boards. Mr. Hanson serves on multiple boards, however, his total compensation is being reported only on one board. If an allocation of compensation were made to each entity a disclosure would not be necessary. Form 990, Part VII, Section A, Frederick C. Rothstein, M.D. Dr. Rothstein is the President of University Hospitals Cleveland Medical Center (UHCMC) of which he is listed as an Officer and a Director. Dr. Rothstein also is an Executive Vice President of University Hospitals Health System, Inc. (UHHS) and serves on its Board as Director. Dr. Rothstein is paid by UHHS and as such his compensation is disclosed in relation to the UHHS Board. To avoid any confusion his hours per week are listed at 60 for both UHCMC and UHHS. Form 990, Part XI, Line 9, Changes in Net Assets Net Change in Temporarily Restricted Net Assets $29,325,000 Net Change in Permanently Restricted Net Assets $11,570,000 Equity Transfer ($25,681,000) Less: Rest. Gifts Included on Form 990, Pg 1, Ln 8 ($43,442,000) Investments in Subsidiaries ($18,345,000) Additional Minimum Liability $70,615,000 NA Released for PPE $7,017,000 Other Changes $42,262,000 Total to Form 990, Part XI, Line 9 $73,321,000 Form 990, Part IX, Line 11g, Breakdown of Expense Collection Agency Fees $6,795,000 Consulting Fees $28,248,000 Medical/Clinical Purchased Services $36,067,000 Other Purchased Services $110,712,000 Total To Form 990, Part IX, Line 11g $181,822,000 IN ORDER TO PROVIDE A MORE COMPLETE AND ACCURATE PICTURE OF UNIVERSITY HOSPITALS HEALTH SYSTEM'S FINANCIAL INFORMATION, UH HAS INCLUDED ALL FINANCIAL DATA FOR BOTH THE CONSOLIDATED GROUP AND PARENT ORGANIZATION IN THIS FORM 990 FOR PARTS VIII, IX AND X, INCLUDING SUPPLEMENTAL INFORMATION REQUIRED IN SCHEDULE D. ANY PRIOR YEAR INFORMATION REPORTED FOR THESE SECTIONS HAS NOT BEEN ADJUSTED TO INCLUDE THE UHHS PARENT INFORMATION WHICH MAY RESULT IN LARGE VARIANCES FROM YEAR TO YEAR. THE PRIOR YEAR INFORMATION HAS BEEN REPORTED AS IT WAS FILED FOR THE 2012 REPORTING YEAR. PLEASE REFER TO THE AUDITED FINANCIAL STATEMETNS ATTACHED TO THIS RETURN AND THE SEPARATELY FILED FORM 990 FOR THE UH PARENT FOR ADDITIONAL INFORMATION. Form 990, Parts VIII, IX, and X Form 990 Reconciliation of Group Presentation UHHS Group and UHHS Group UHHS Parent (without UHHS Part VIII Combined UH Parent Eliminations Parent) Line 1h 53,111,000 10,021,000 - 43,090,000 Line 2g 2,106,303,000 184,299,000 (165,866,000) - Line 3 24,294,000 24,250,000 - 44,000 Line 7a 46,971,000 46,971,000 - - Line 8c (434,000) - - (434,000) Line 11e 96,163,000 38,916 - - Line 12 2,326,408,000 305,182,000 (165,866,000) 2,187,092,000 *Total revenue reported on line 12 of $2,326,408,000 consisted of $2,196,535,000 exempt function expense, $697,000 of unrelated business revenue, and $76,065,000 of revenue excluded from tax under sections 512-514. UHHS Group and UHHS Group UHHS Parent (without UHHS Part ix Combined UH Parent Eliminations Parent) Line 1 34,294,000 - - 34,294,000 Line 5 17,890,000 11,262,000 - 6,628,000 LINE 6 3,935,000 44,000 - 3,891,000 Line 7 910,608,000 77,362,000 - 833,246,000 Line 8 67,258,000 16,200,000 - 51,058,000 Line 9 92,586,000 4,990,000 - 87,596,000 Line 10 58,991,000 6,788,000 - 52,203,000 Line 11b 1,051,000 1,041,000 - 10,000 Line 11c 761,000 376,000 - 385,000 Line 11e 33,000 - - 33,000 Line 11 181,822,000 - (165,866,000) 316,443,000 Line 12 11,478,000 9,399,000 - 2,079,000 Line 13 353,902,000 7,497,000 - 346,405,000 Line 14 36,833,000 34,835,000 - 1,998,000 Line 16 98,752,000 4,754,000 - 93,998,000 Line 17 8,445,000 1,397,000 - 7,048,000 Line 20 17,480,000 17,481,000 - (1,000) Line 22 97,591,000 29,520,000 - 68,071,000 Line 23 21,914,000 (10,097,000) - 32,011,000 Line 24 66,346,000 17,487,000 - 48,859,000 Line 25 2,081,970,000 261,581,000 (165,866,000) 1,986,255,000 *Total functional expenses reported on line 25 of $2,081,970,000 consisted of $2,052,570,000 program service expenses, $17,890,000 of management and general expenses, and $11,510,000 of fundraising expenses. UHHS Group and UHHS Group UHHS Parent (without UHHS Part X Combined UH Parent Eliminations Parent) Line 2 192,149,000 178,521,000 - 13,628,000 Line 3 28,200,000 8,681,000 - 19,519,000 Line 4 367,865,000 12,936,000 - 354,929,000 Line 7 370,000 - - 370,000 Line 8 31,898,000 - - 31,898,000 Line 9 22,310,000 18,352,000 - 3,958,000 Line 10c 1,209,731,000 313,569,000 - 896,162,000 Line 11 332,223,000 332,223,000 - - Line 12 618,807,000 618,517,000 - 290,000 Line 13 367,552,000 1,362,438,000 (1,064,536,000) 69,650,000 Line 15 167,165,000 29,402,000 - 137,763,000 Line 16 3,338,270,000 2,874,639,000 (1,064,536,000) 1,528,167,000 Line 17 308,614,000 196,019,000 - 112,595,000 Line 19 8,369,000 (338,000) - 8,707,000 Line 20 1,086,314,000 1,086,314,000 - - Line 23 39,978,000 39,978,000 - - Line 25 258,925,000 163,025,000 - 95,900,000 Line 26 1,702,200,000 1,484,998,000 - 217,202,000 Line 27 1,063,229,000 1,063,599,000 (1,064,536,000) 1,064,166,000 Line 28 255,296,000 28,142,000 - 227,154,000 Line 29 317,545,000 297,900,000 - 19,645,000 Line 33 1,636,070,000 1,389,641,000 (1,064,536,000) 1,310,965,000 Line 34 3,338,270,000 2,874,639,000 (1,064,536,000) 1,528,167,000 TAX EXEMPT BOND INFORMATION THE UH SYSTEM'S TAX-EXEMPT BONDS WERE ISSUED IN THE NAME OF THE PARENT ORGANIZATION, UNIVERSITY HOSPITALS HEALTH SYSTEM, INC. (EIN: 34-0714775). THEREFORE, THE IRS REQUIRES THAT INFORMATION RELATED TO THESE BONDS BE REPORTED ON SCHEDULE K, SUPPLEMENTAL INFORMATION OF TAX-EXEMPT BONDS, INCLUDED WITH THE SEPARATE FORM 990 FILED BY THE UH PARENT ORGANIZAITON. The UH System has the following tax-exempt bond issues outstanding: -2013 Ohio Higher Education Facility Commission Bonds; Issue Price: $124,142,966 -2012 Ohio Higher Education Facility Commission Bonds; Issue Price: $23,775,000 -2012 Ohio Higher Education Facility Commission Bonds; Issue Price: $55,371,387 -2012 Ohio Higher Education Facility Commission Bonds; Issue Price: $40,710,000 -2012 Ohio Higher Education Facility Commission Bonds; Issue Price: $189,782,379 -2010 Ohio Higher Education Facility Commission Bonds; Issue Price: $71,125,000 -2010 Ohio Higher Education Facility Commission Bonds; Issue Price: $94,797,375 -2009 Ohio Higher Education Facility Commission Bonds; Issue Price: $100,914,641 -2007 Ohio Higher Education Facility Commission Bonds; Issue Price: $290,313,879 -2003 Cuyahoga County, Ohio Bonds; Issue Price: $14,389,000 Biomotiv LLC 3605 Warrensville Center Rd - MSC Shaker Heights OH 44122 273995417 Developing Therap DE NA n/a Western Reserve Assurance Co Ltd SPC 23 Lime Tree Bay Ave PO Box 1051GT Grand Cayman CJ KY1 - 1102 980462740 Liability Insur. CJ C corp University Hospitals Holdings Inc 11100 Euclid Ave Cleveland OH 44106 341768931 Holding Company OH C corp University Hospitals Physician Services 11100 Euclid Ave Cleveland OH 44106 341768929 Physician Admin. OH C corp University Primary Care Practices Inc 11100 Euclid Ave Cleveland OH 44106 341768928 Physicians Group OH C corp University Hospitals Health System MCO 11100 Euclid Ave Cleveland OH 44106 341843674 Workers Comp. OH C corp UHHS Provder & Ceentral Verification Org 11100 Euclid Ave Cleveland OH 44106 341908517 Medical Mgmt. OH C corp Cedar Brainard Surgery Center Inc 11100 Euclid Ave Cleveland OH 44106 204957632 Holding Company OH C corp University Hospitals Health Care Enterpr 11100 Euclid Ave Cleveland OH 44106 341510005 Medical Mgmt OH C corp BMH Development Corp 158 West Main Street Conneaut OH 44030 341346212 Land Development OH C corp Conneaut Health Enterprises Inc PO Box 648 Conneaut OH 44060 341503949 Inactive OH C corp false true true false false false false true false false true true false false true true true true UH Ahuja Medical CenterUniversity Hospitals S 58519176 General Ledger UH Ahuja Medical CenterUniversity Hospitals P 6380149 General Ledger UH Ahuja Medical CenterUniversity Hospitals M 120410 General Ledger UH Ahuja Medical CenterUH Cleveland Medical S 66242 General Ledger UH Ahuja Medical CenterUH Cleveland Medical C 1107222 General Ledger UH Ahuja Medical CenterUH Cleveland Medical P 1093068 General Ledger UH Ahuja Medical CenterUH Laboratory Service M 99105 General Ledger UH Ahuja 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