2014-11-05T08:46:37-06:00 2013-12-31 381357951 PLANTE & MORAN PLLC 65 EAST STATE ST STE 600 COLUMBUS OH 43215 990 2013-01-01 344428214 FULTON COUNTY HEALTH CENTER FULT 4193352015 725 SOUTH SHOOP AVENUE WAUSEON OH 435671701 PATRICIA A FINN CHIEF EXECUTIVE OFFICER 4193352015 2014-10-29 1 BERNIE OSTROWSKI P00366367 6148493000 2013 2015-11-30 17:44:51Z PATRICIA A FINN 725 SOUTH SHOOP AVENUE WAUSEON OH 435671701 84092946 0 X WWW.FULTONCOUNTYHEALTHCENTER.ORG X 1973 OH SERVE THE PULIC BY PROMOTING AND PROVIDING THE MEANS FOR CONTINUED HEALTH AND WELLNESS. 12 9 925 208 -2642 -2642 120964 123620 76549718 74949439 409095 386887 1096711 583334 78176488 76043280 4750 11750 0 0 40079737 40254564 0 0 0 35808384 35338891 75892871 75605205 2283617 438075 81644882 80598094 39710363 36533612 41934519 44064482 X THE FULTON COUNTY HEALTH CENTER CONTINUALLY STRIVES TO REACH A HIGH DEGREE OF EXCELLENCE IN MEETING THE NEEDS OF BOTH INTERNAL AND EXTERNAL CUSTOMERS 100% OF THE TIME. QUALITY OF PATIENT/RESIDENT CARE AND ALL OF THE INSTITUTIONAL PRACTICES IS THE PRIMARY CRITERION UTILIZED TO MONITOR THE HEALTH CENTER SERVICES AND TO EVALUATE PROPOSED CHANGES OF PROPOSED NEW SERVICES. 1 0 55460267 11750 75210824 SEE SCHEDULE OLOCATION: THE FULTON COUNTY HEALTH CENTER IS LOCATED AT 725 SOUTH SHOOP AVENUE, WAUSEON, OH 43567. THE HEALTH CENTER IS EASILY ACCESSIBLE FROM INTERSTATE 80/90 (OHIO TURNPIKE) AND STATE ROUTE 2. IT IS CENTRALLY LOCATED WITHIN FULTON COUNTY WHERE WAUSEON IS THE COUNTY SEAT. PHILOSOPHY/AUSPICES: THE FULTON COUNTY HEALTH CENTER IS A PRIVATE, NON-PROFIT HOSPITAL, LONG-TERM CARE & INDEPENDENT LIVING FACILITY GOVERNED BY A BOARD OF DIRECTORS. THE HEALTH CENTER IS OPERATED ON THE PRINCIPLE THAT EVERY INDIVIDUAL HAS A BASIC RIGHT TO ATTAIN THE HIGHEST DEGREE OF WELLNESS POSSIBLE BASED ON HIS OR HER OWN NEEDS. THE SERVICES OF THE HOSPITAL SHALL BE AVAILABLE TO ALL INDIVIDUALS REGARDLESS OF RACE, COLOR, SEX, AGE, NATIONAL ORIGIN, RELIGIOUS CREED, ECONOMIC CONDITION OR DISABILITY. COMMITMENT TO QUALITY: THE FULTON COUNTY HEALTH CENTER CONTINUALLY STRIVES TO REACH A HIGH DEGREE OF EXCELLENCE IN MEETING THE NEEDS OF BOTH INTERNAL AND EXTERNAL CUSTOMERS 100% OF THE TIME. QUALITY OF PATIENT/RESIDENT CARE AND ALL OF THE INSTITUTIONAL PRACTICES IS THE PRIMARY CRITERION UTILIZED TO MONITOR THE HEALTH CENTER SERVICES AND TO EVALUATE PROPOSED CHANGES OF PROPOSED NEW SERVICES. LEVEL OF CARE: THE HEALTH CENTER IS A SHORT-TERM GENERAL HOSPITAL OFFERING A FULL RANGE OF SERVICES RELATED TO ACUTE CARE. INCLUDED IN THESE SERVICES ARE A WIDE RANGE OF OUTPATIENT SERVICES THAT INVOLVE DIAGNOSTIC AND REHABILITATIVE TREATMENT. THE HEALTH CENTER ALSO HAS LONG-TERM CARE AND INDEPENDENT LIVING AVAILABLE TO OFFER THE CONTINUUM OF CARE. THE LEVEL OF CARE PROVIDED TO ALL PATIENTS AND RESIDENTS IS THE SAME WHETHER INPATIENT OR OUTPATIENT. THIS IS ACCOMPLISHED THROUGH PROGRESSIVE HEALTH AWARENESS. CENTERS OF EXCELLENCE: AMONG THE SPECIAL STRENGTHS OF THE HEALTH CENTER ARE AN OBSTETRICAL UNIT, A CRITICAL CARE/CARDIAC CARE UNIT, A SHORT TERM INPATIENT AND OUTPATIENT ADULT PSYCHIATRIC UNIT, AN EMERGENCY DEPARTMENT THAT IS STAFFED WITH LICENSED PHYSICIANS 24 HOURS PER DAY, EVERY DAY OF THE YEAR, AN INPATIENT AND OUTPATIENT SURGICAL UNIT, SLEEP DISORDER CENTER, RAINBOW HEMATOLOGY/ONCOLOGY TREATEMENT CENTER AND OTHER DIAGNOSTIC AND THERAPEUTIC SERVICES. A HOSPITALIST WAS ADDED IN 2012 AND IS AVAILABLE TO INPATIENTS 24/7. DAILY OUTPATIENT SPECIALTY CLINICS OFFER THE CONSULTATIVE AND DIAGNOSTIC SERVICES OF SEVERAL TYPES OF MEDICAL SPECIALISTS. LONG-TERM CARE AND INDEPENDENT LIVING FACILITY OFFERING THE CONTINUUM OF CARE FROM THE HOSPITAL AREA. A WIDE RANGE OF ORGANIZED EDUCATIONAL AND HEALTH PROMOTION OPPORTUNITIES, INCLUDING A COMPREHENSIVE DIABETIC EDUCATION PROGRAM, ARE PROVIDED FOR PATIENTS, RESIDENTS, EMPLOYEES AND MEMBERS OF THE SURROUNDING COMMUNITIES. FOR 2013, FULTON COUNTY HEALTH CENTER'S SURGERY DEPARTMENT HAS BEEN RECOGNIZED FOR OUTSTANDING QUALITY CARE BY CARECHEX, A DIVISION OF COMPARISON. AS ONE OF THE NATIONS LARGEST PRIVATELY HELD HEALTHCARE INFORMATION SERVICE COMPANIES, COMPARION PROVIDES SERVICES DESIGNED TO MEASURE, MANAGE AND MONITOR THE CLNICAL, FINANCIAL AND MARKET PERFORMANCE OF HEALTHCARE ORGANIZATIONS. CARECHEX HAS RECOGNIZED FCHC'S SURGERY PROGRAMS IN THREE CATEGORIES: BOTH THE JOINT REPLACEMENT SURGERY AND MAJOR ORTHOPEDIC SURGERY PROGRAMS HAVE BEEN RANKED IN THE TOP 10% IN QUALITY NATIONWIDE FOR MEDICAL EXCELLENCE WHILE THE GENERAL SURGERY PROGRAM HAS BEEN RECOGNIZED AS #1 IN THE TOLEDO-FREMONT OHIO MARKET IN QUALITY FOR MEDCIAL EXCELLENCE.FULTON COUNTY HEALTH CENTER WAS ALSO AWARDED A THREE YEAR TERM OF ACCREDITATION IN MAMMOGRAPY. THE ACR GOLD SEAL OF ACCREDITATION REPRESENTS THE HIGHEST LEVEL OF IMAGE QUALITY AND PATIENT SAFETY.FULTON COUNTY HEALTH CENTER WAS NAMED SILVER PARTNER FOR ORGAN DONATION BY DONATE LIFE OHIO. THIS AWARD WAS ISSUED FOR TAKING ACTION TO PROMOTE ORGAN, EYE AND TISSUE DONATION IN 2013.FULTON COUNTY HOSPITAL BECAME THE FIRST HOSPITAL IN NORTHWEST OHIO REGION TO INSTALL A 128-SLICE CT SCANNER IN ITS RADIOLOGY DEPARTMENT DURING 2013. LOADED WITH TOP OF THE LINE HARDWARE AND SOFTWARE, FULTON COUNTY HEALTH CENTER IS ABLE TO OFFER A VARIETY OF NEW SERVICES SUCH AS: 3D HEART SCANS WITH CALCIUM SCORING, ULTRA LOW DOES LUNG SCANS, AND 3D BONE SCANS FOR FRACTURES AND METAL REMOVAL FOR FRACTURES.LIMITATIONS: PATIENTS IN NEED OF TERTIARY CARE ARE REFERRED TO AREA SPECIALTY CENTERS. POPULATION SERVED: THE FULTON COUNTY HEALTH CENTER SERVES THE POPULATION IN FULTON COUNTY AND PATIENTS IN THE IMMEDIATE BORDER AREASOF ADJACENT COUNTIES. TOTAL POPULATION OF OUR SERVICE AREA IS ESTIMATED BETWEEN 42,000 - 45,000. THE STRESS UNIT PRIMARILY SERVES A FOUR COUNTY AREA INCLUDING FULTON, DEFIANCE, HENRY AND WILLIAMS COUNTIES AS WELL AS FROM OUTSIDE OUR IMMEDIATE GEOGRAPHIC AREA. INSTITUTIONAL RELATIONSHIPS: THE HEALTH CENTER MAINTAINS RELATIONSHIPS WITH AREA NURSING HOMES, CITY AND COUNTY ORGANIZATIONS, AND REGIONALTERTIARY CARE CENTERS. THE HEALTH CENTER IS A CLINIC-TRAINING SITE FOR A WIDE RANGE OF HEALTH CARE DISCIPLINES.EDUCATION: THE HEALTH CENTER MAINTAINS AN ACTIVE AND ONGOING IN-SERVICE AND CONTINUING EDUCATION PROGRAM FOR OUR STAFF TO KEEP THEMKNOWLEDGEABLE AND CURRENT ON DEVELOPMENTS IN HEALTH CARE DELIVERY. THE HEALTH CENTER ALSO ENCOURAGES EMPLOYEES TO PURSUE HIGHER EDUCATION. 55460267 1 1 0 1 0 0 0 0 0 1 1 0 0 0 1 1 0 1 0 0 0 0 0 0 1 0 1 1 1 0 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 1 0 1 0 0 0 1 98 0 1 925 1 0 0 0 0 0 1 1 0 0 0 0 X 12 9 0 0 0 0 0 0 0 1 1 1 0 1 1 1 1 1 1 1 1 0 OH X DARRELL TOPMILLER 4193352015 725 SOUTH SHOOP AVE WAUSEON OH 43567 DALE L NAFZIGER PRESIDENT (END IN FEB) 0.80 X X 0 0 0 CARL HILL VP (JAN-FEB)/ PRESIDENT(MAR-DEC) 0.80 X X 0 0 0 SANDY BARBER SECRETARY(JAN-FEB)/VP(MAR-DEC) 0.80 X X 0 0 0 SHARON GILLESPIE TREASURER(JAN-FEB)/SECRETARY(MAR-DEC) 0.80 X X 0 0 0 MARK HAGANS DIRECTOR(JAN-FEB)/TREASURER(MAR-DEC) 0.80 X X 0 0 0 BRETT KOLB DIRECTOR 0.80 X 0 0 0 DAVID GRIESER DIRECTOR 0.80 X 0 0 0 JENNIFER MCCULLOUGH DIRECTOR 0.80 X 0 0 0 ALLEN LIECHTY DIRECTOR 0.80 X 0 0 0 STANLEY MULTHAUF DIRECTOR 0.80 X 0 0 0 JASON ROW DIRECTOR (END IN FEB) 0.80 X 12600 0 0 JON RUPP DIRECTOR 0.80 X 0 0 0 RICK KAZMIERCZAK DIRECTOR 0.80 X 0 0 0 RICK YODER DIRECTOR 0.80 X 12600 0 0 PATRICIA A FINN CHIEF EXECUTIVE OFFICER 40.00 X 187002 0 30729 DARRELL TOPMILLER DIRECTOR OF FINANCE 40.00 X 114562 0 19065 JOANN SHORT DIRECTOR OF NURSING 40.00 X 105257 0 14107 MARY JO SMALLMAN FM ADMINISTRATOR 40.00 X 85297 0 17373 DANIEL MCKERNAN PHYSICIAN 40.00 X 792954 0 19566 CHRISTOPHER SPIELES PHYSICIAN 40.00 X 642944 0 19566 SEMEGHAGHA FOFUNG PHYSICIAN 40.00 X 274267 0 7698 ALAN RIVERA HOSPITALIST 40.00 X 237491 0 0 RONALD MUSIC PHYSICIAN 40.00 X 167955 0 19566 2632929 0 147670 13 0 1 0 R & F INC 6444 MONROE STREET SUITE 5 SYLVANIA OH 43560 OCCUPATIONAL/PHYSICAL/SPEECH THERAPY 1423543 ALLIED MEDICAL SERVICES 6444 MONROE STREET SUITE 5 SYLVANIA OH 43560 RESPITORY THERAPY 757244 INTERIM PHYSICIANS 12140 WOODCREST EXECUTIVE DR SUITE ST LOUIS MO 63141 PHYSICIAN SERVICES 723592 APRN SLEEP 6444 MONROE STREET SUITE 5 SYLVANIA OH 43560 SLEEP STUDIES 517145 HLES OF OHIO PO BOX 277001 ATLANTA GA 30384 ER DOCTORS 480000 20 7850 47419 68351 123620 PATIENT SERVICES 622110 74727665 74727665 EDUCATION SERVICES 611710 130877 130877 REBATES AND REFUNDS 900099 90897 90897 74949439 519559 519559 346646 391887 -45241 -45241 23848 -69089 7486879 9895 7605046 24400 -118167 -14505 -132672 -132672 27167 47419 27298 -131 -131 926 1035 -109 -109 FOOD SALES 621110 320586 320586 FITNESS MEMBERSHIPS 621110 97483 97483 EHR REIMBURSEMENT 621110 85297 85297 125449 54757 -2642 73334 628815 76043280 75210824 -2642 711478 X 10250 10250 1500 1500 618017 618017 31046931 22664260 8382671 1187322 866745 320577 5385668 3931538 1454130 2016626 1472137 544489 113420 113420 138957 138957 7673220 5601451 2071769 293696 293696 4270896 2477120 1793776 918994 533017 385977 3005209 2193803 811406 55196 40293 14903 1186013 687888 498125 3489402 2023853 1465549 1195714 1195714 MEDICAL SUPPLIES 10293852 10293852 BAD DEBT EXPENSE 2604887 2604887 EDUCATION PROGRAMS 54922 31855 23067 GIFT SHOP EXPENSES 26103 15140 10963 18410 10678 7732 75605205 55460267 20144938 0 281734 299700 17796173 9605640 11639093 12530516 1527788 1482044 951500 1067481 79497488 41987265 37338036 37510223 9823572 16286631 7500 0 2279486 1815859 81644882 80598094 6791464 6263099 50069 52161 27996667 27311668 4872163 2906684 39710363 36533612 X 41882519 44012482 52000 52000 41934519 44064482 81644882 80598094 X 438075 -184139 1876027 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 5223 5223 0 PART II-B, LINE 1: TOTAL DUES PAYMENTS TO OHA AND AHA THAT WERE USED BY THE ORGANIZATIONS FOR LOBBYING PURPOSES: OHIO HOSPITAL ASSOCIATION: 3.4% OF $30,975; $1,053 AMERICAN HOSPITAL ASSOCIATION: 23.65% OF $17,631; $4,170 318411 440 107 0 318958 355607 8280 294 45770 318411 353930 1260 417 355607 347069 6305 556 353930 463238 5300 923 121940 452 347069 0.83700 0.16300 0.00000 0 0 2529020 2529020 41640210 18798031 22842179 32639785 22220556 10419229 2688473 968678 1719795 37510223 FAIR VALUE OF INTEREST RATE SWAP 2906684 2906684 X PART V, LINE 4: ENDOWMENT FUNDS WILL BE USED AS DIRECTED BY THE DONOR. BOARD DESIGNATED FUNDS ARE A MEMORIAL ACCOUNT AND FUNDS WILL BE SPENT AS DIRECTED BY THE BOARD OF DIRECTORS. PART X, LINE 2: THE INTERNAL REVENUE SERVICE HAS RULED THAT THE HOSPITAL AND ITS SUBSIDIARIES ARE EXEMPT FROM FEDERAL INCOME TAXES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND, ACCORDINGLY, NO TAX PROVISION IS REFLECTED IN THE CONSOLIDATED FINANCIAL STATEMENTS. ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA REQUIRE MANAGEMENT TO EVALUATE TAX POSITIONS TAKEN BY THE HOSPITAL AND RECOGNIZE A TAX LIABILITY IF THE HOSPITAL HAS TAKEN AN UNCERTAIN POSITION THAT MORE LIKELY THAN NOT WOULD NOT BE SUSTAINED UPON EXAMINATION BY THE IRS OR OTHER APPLICABLE TAXING AUTHORITIES. MANAGEMENT HAS ANALYZED THE TAX POSITIONS TAKEN BY THE HOSPITAL AND HAS CONCLUDED THAT AS OF DECEMBER 31, 2013, THERE ARE NO UNCERTAIN POSITIONS TAKEN OR EXPECTED TO BE TAKEN THAT WOULD REQUIRE RECOGNITION OF A LIABILITY OR DISCLOSURE IN THE CONSOLIDATED FINANCIAL STATEMENTS. THE HOSPITAL IS SUBJECT TO ROUTINE AUDITS BY TAXING JURISDICTIONS; HOWEVER, THERE ARE CURRENTLY NO AUDITS FOR ANY TAX PERIODS IN PROGRESS. MANAGEMENT BELIEVES IT IS NO LONGER SUBJECT TO INCOME TAX EXAMINATIONS FOR YEARS PRIOR TO DECEMBER 31, 2010. PART XI LINE 8: CHANGE IN FAIR VALUE OF INTEREST RATE SWAP GOLF OUTING 55590 46224 9366 4898 6568 1257 237 GERANIUM SALE 6356 0 6356 4791 61946 46224 15722 4898 6568 1257 5028 17751 -2029 1 1 X 1 X 1 X 1 1 0 0 2661566 2095961 565605 0.00770 6137277 2623926 3513351 0.04810 897032 329425 567607 0.00780 9695875 5049312 4646563 0.06360 731942 87266 644676 0.00880 21659 3631 18028 0.00020 753601 90897 662704 0.00900 10449476 5140209 5309267 0.07260 0 2604887 78147 18213511 18927948 -714437 X 1 1 1 1 FULTON COUNTY HEALTH CENTER 725 S SHOOP AVE WAUSEON OH 43567 X X X X FULTON COUNTY HEALTH CENTER 1 1 X X X X X X X X X 13 1 0 1 X HTTPS://WWW.FULTONCOUNTYHEALTHCENTER.ORG/ X X X X X X X X X X X 0 0 1 1 200.000000000000 1 400.000000000000 1 X X X X 1 1 X X X X X X X 1 0 X X X X 1 X 0 0 FULTON COUNTY HEALTH CENTER PART V, SECTION B, LINE 3: FULTON COUNTY CONTRACTED WITH THE HOSPITAL COUNCIL OF NORTHWEST OHIO, A NON-PROFIT HOSPITAL ASSOCIATION, LOCATED IN TOLEDO, OHIO, TO COORDINATE AND MANAGE THE HEALTH ASSESSMENT PROCESS. THE HOSPITAL COUNCIL HAS BEEN COMPLETING COMPREHENSIVE HEALTH ASSESSMENTS SINCE 1999. THE PROJECT COORDINATOR FROM THE HOSPITAL COUNCIL OF NW OHIO HOLDS A MASTER'S DEGREE IN PUBLIC HEALTH AND CONDUCTED A SERIES OF MEETINGS WITH THE PLANNING COMMITTEE FROM FULTON COUNTY. DURING THESE MEETINGS, BANKS OF POTENTIAL SURVEY QUESTIONS FROM THE BEHAVIORAL RISK FACTOR SURVEILLANCE, YOUTH RISK BEHAVIOR SURVEILLANCE, AND NATIONAL SURVEY OF CHILDREN'S HEALTH SURVEYS WERE REVIEWED AND DISCUSSED. BASED ON INPUT FROM THE FULTON COUNTY PLANNING COMMITTEE, THE PROJECT COORDINATOR COMPOSED DRAFTS OF SURVEYS CONTAINING 149 ITEMS FOR THE ADULT SURVEY AND 81 ITEMS FOR THE ADOLESCENT SURVEY. THE DRAFTS WERE REVIEWED AND APPROVED BY HEALTH RESEARCHERS AT THE UNIVERSITY OF TOLEDO.THE NEEDS OF THE POPULATION, ESPECIALLY THOSE WHO ARE MEDICALLY UNDERSERVED, LOW-INCOME, MINORITY POPULATIONS AND POPULATIONS WITH CHRONIC DISEASE NEEDS, WERE TAKEN INTO ACCOUNT THROUGH THE SAMPLE METHODOLOGY THAT SURVEYED THESE POPULATIONS AND OVER-SAMPLED MINORITY POPULATIONS. IN ADDITION, THE ORGANIZATIONS THAT SERVE THESE POPULATIONS PARTICIPATED IN THE HEALTH ASSESSMENT AND COMMUNITY PLANNING PROCESS, SUCH FULTON COUNTY HEALTH DEPARTMENT, THE FULTON COUNTY HEALTH CENTER, AND JOB AND FAMILY SERVICES. THE PARTICIPANTS INCLUDED:A (PH) AFTER THEIR NAME INDICATES THEY WORK IN THE PUBLIC HEALTH FIELD OR TEACH PUBLIC HEALTH. FOUR COUNTY ADAMHS BOARD:LES MCCASLIN, CHIEF EXECUTIVE OFFICERFULTON COUNTY BOARD OF DEVELOPMENTAL DISABILITIES:BETH FRIESS, SUPERINTENDENTFULTON COUNTY HEALTH CENTER:PATRICIA FINN, CHIEF EXECUTIVE OFFICERSTEVE MCCOY, DIRECTOR OF MARKETING AND PLANNINGSHARON MORR, DIRECTOR OF CORPORATE AND COMMUNITY HEALTH PROMOTIONFULTON COUNTY HEALTH DEPARTMENT:MICHAEL P. ORICKO, M.S.E.P.H, HEALTH COMMISSIONER (PH)CINDY ROSE, RN, BSN, DIRECTOR OF NURSING (PH)KIM CUPP, RS, BS, DIRECTOR OF ENVIRONMENTAL HEALTH (PH)RACHEL KINSMAN, HEALTH EDUCATION COORDINATOR (PH)FULTON COUNTY FAMILY & CHILDREN FIRST COUNCIL:KAREN PENNINGTON, COORDINATORLOU MOODY, MSN, PROJECT DIRECTOR, HEALTHY CHOICES CARING COMMUNITIES FULTON COUNTY HEALTH CENTER PART V, SECTION B, LINE 5D: THE ASSESSMENT IS AVAILABLE ON THE FOLLOWING ADDITIONAL WEBSITES: FULTON COUNTY HEALTH DEPARTMENTHTTP://WWW.FULTONCOUNTYHEALTHCENTER.ORG/MEDIA/49929/2013-FULTON-COUNTY-COMMUNITY-NEEDS-ASSESSMENT.PDFHOSPITAL COUNCIL OF NORTHWEST OHIOHTTP://WWW.HCNO.ORG/PDF/COUNTIES/FULTON%20COUNTY%20FINAL%20REPORT%20REV%207-22-13.PDFALSO, HARD COPIES OF THE FULL REPORT WERE GIVEN TO ALL KEY LEADERS AT THE COMMUNITY EVENT. FULTON COUNTY HEALTH CENTER PART V, SECTION B, LINE 6I: ADULT SURVEY: ADULTS AGES 19 AND OVER LIVING IN FULTON COUNTY WERE USED AS THE SAMPLING FRAME FOR THE ADULT SURVEY. SINCE U.S. CENSUS BUREAU AGE CATEGORIES DO NOT CORRESPOND EXACTLY TO THIS AGE PARAMETER, THE INVESTIGATORS CALCULATED THE POPULATION OF THOSE 18 YEARS AND OVER LIVING IN FULTON COUNTY. THERE WERE 31,689 PERSONS AGES 18 AND OVER LIVING IN FULTON COUNTY. THE INVESTIGATORS CONDUCTED A POWER ANALYSIS TO DETERMINE WHAT SAMPLE SIZE WAS NEEDED TO ENSURE A 95% CONFIDENCE LEVEL WITH A CORRESPONDING CONFIDENCE INTERVAL OF 5% (I.E., WE CAN BE 95% SURE THAT THE "TRUE" POPULATION RESPONSES ARE WITHIN A 5% MARGIN OF ERROR OF THE SURVEY FINDINGS.) A SAMPLE SIZE OF AT LEAST 380 ADULTS FROM ALL RACES WERE NEEDED TO ENSURE THIS LEVEL OF CONFIDENCE. THE RANDOM SAMPLE OF MAILING ADDRESSES OF ADULTS FROM FULTON COUNTY WAS OBTAINED FROM AMERICAN CLEARINGHOUSE IN LOUISVILLE, KY.PRIOR TO MAILING THE SURVEY TO ADULTS, AN ADVANCE LETTER WAS MAILED TO 2,000 ADULTS IN FULTON COUNTY. THIS ADVANCE LETTER WAS PERSONALIZED, PRINTED ON FULTON COUNTY PARTNERS FOR HEALTH STATIONERY AND WAS SIGNED BY MIKE ORICKO, HEALTH COMMISSIONER, FULTON COUNTY HEALTH DEPARTMENT. THE LETTER INTRODUCED THE COUNTY HEALTH ASSESSMENT PROJECT AND INFORMED THE READERS THAT THEY MAY BE RANDOMLY SELECTED TO RECEIVE THE SURVEY. THE LETTER ALSO EXPLAINED THAT THE RESPONDENTS' CONFIDENTIALITY WOULD BE PROTECTED AND ENCOURAGED THE READERS TO COMPLETE AND RETURN THE SURVEY PROMPTLY IF THEY WERE SELECTED. TWO WEEKS FOLLOWING THE ADVANCE LETTER, A THREE-WAVE MAILING PROCEDURE WAS IMPLEMENTED TO MAXIMIZE THE SURVEY RETURN RATE. THE INITIAL MAILING INCLUDED A PERSONALIZED HAND SIGNED COVER LETTER (ON FULTON COUNTY PARTNERS FOR HEALTH STATIONERY) DESCRIBING THE PURPOSE OF THE STUDY; A QUESTIONNAIRE PRINTED ON COLORED PAPER; A SELF-ADDRESSED STAMPED RETURN ENVELOPE; AND A $2 INCENTIVE. APPROXIMATELY TWO WEEKS AFTER THE FIRST MAILING, A SECOND WAVE MAILING INCLUDED ANOTHER PERSONALIZED COVER LETTER ENCOURAGING THEM TO REPLY, ANOTHER COPY OF THE QUESTIONNAIRE ON COLORED PAPER, AND ANOTHER REPLY ENVELOPE. A THIRD WAVE POSTCARD WAS SENT TWO WEEKS AFTER THE SECOND WAVE MAILING. SURVEYS RETURNED AS UNDELIVERABLE WERE NOT REPLACED WITH ANOTHER POTENTIAL RESPONDENT. THE ENTIRE MAILING PROCEDURE FOR ADULTS TOOK PLACE FROM JANUARY THROUGH JUNE 2012.THE RESPONSE RATE FOR THE ENTIRE MAILING WAS 50% (N=921). THIS RETURN RATE AND SAMPLE SIZE MEANS THAT THE RESPONSES IN THE HEALTH ASSESSMENT SHOULD BE REPRESENTATIVE OF THE ENTIRE COUNTY.ADOLESCENT SURVEY: THE PROJECT COORDINATOR MET WITH ALL SCHOOL DISTRICT SUPERINTENDENTS AND OBTAINED APPROVAL FOR THE SURVEY. SCHOOLS AND GRADES WERE RANDOMLY SELECTED. EACH STUDENT IN THAT GRADE HAD TO HAVE AN EQUAL CHANCE OF BEING IN THE CLASS THAT WAS SELECTED, SUCH AS A GENERAL ENGLISH OR HEALTH CLASS. CLASSROOMS WERE CHOSEN BY THE SCHOOL PRINCIPAL. PASSIVE PERMISSION SLIPS WERE MAILED HOME TO PARENTS OF ANY STUDENT WHOSE CLASS WAS SELECTED TO PARTICIPATE. THE RESPONSE RATE WAS 92% (N=469). THE SURVEY CONTAINED 81 QUESTIONS AND HAD A MULTIPLE CHOICE RESPONSE FORMAT. THE STUDENTS WERE SURVEYED IN SEPTEMBER 2012. FULTON COUNTY HEALTH CENTER PART V, SECTION B, LINE 7: RESOURCE RESTRICTIONS DO NOT ALLOW THE HOSPITAL TO ADDRESS ALL OF THE NEEDS IDENTIFIED THROUGH THE HEALTH ASSESSMENT. OF THE PRIORITY NEEDS IDENTIFIED BY THE COMMUNITY PLANNING PROCESS, THE HOSPITAL IS NOT DIRECTLY ADDRESSING ALL OF THE ISSUES OF YOUTH AND ADULT OBESITY RELATED BEHAVIORS, CARDIOVASCULAR HEALTH, YOUTH AND ADULT DEPRESSION AND SUICIDE, AND YOUTH BULLYING. THIS IS BECAUSE MANY COMMUNITY AGENCIES ACROSS FULTON COUNTY ARE ADDRESSING THESE ISSUES THROUGH THE FOLLOWING ACTION STEPS: -THE FULTON COUNTY HEALTH DEPARTMENT WILL WORK TO EXPAND THE GROW IT, TRY IT, LIKE IT! PROGRAM TO PRESCHOOLS AND THE C.A.T.C.H. PROGRAM IN SCHOOLS. THEY WILL INITIATE FORMALIZED BREASTFEEDING POLICIES FOR EMPLOYERS. ALONG WITH FULTON COUNTY HEALTH CENTER AND HELP ME GROW THEY WILL IMPLEMENT GO, SLOW, WHOA PROGRAM. LASTLY, THEY ARE GOING TO IMPLEMENT MILLION HEARTS INITIATIVE.-HELP ME GROW WILL IMPLEMENT GO, SLOW, WHOA PROGRAM ALONG WITH THE FULTON COUNTY HEALTH DEPARTMENT AND FULTON COUNTY HEALTH CENTER. -FULTON COUNTY PARTNERS FOR HEALTH WILL CREATE A BRANDED LOGO WITH A CONSISTENT MESSAGE TO INCREASE ADULT CARDIOVASCULAR HEALTH.-FOUR COUNTY ADAMHS BOARD WILL CREATE A MENTAL HEALTH DETOXIFICATION UNIT, AND WILL EXPAND EVIDENCE-BASED PROGRAMS TARGETING YOUTH. THEY WILL ALSO, INCREASE THE NUMBER PRIMARY CARE PHYSICIANS SCREENING FOR DEPRESSION DURING OFFICE VISITS (PQH2 AND PQH9).-FOUR COUNTY FAMILY CENTER WILL ASSIST FOUR COUNTY ADAMHS BOARD IN EXPANDING EVIDENCE-BASED PROGRAMS TARGETING YOUTH, AND INCREASE THE NUMBER PRIMARY CARE PHYSICIANS SCREENING FOR DEPRESSION DURING OFFICE VISITS (PQH2 AND PQH9). -PIKE DELTA YORK SCHOOLS WILL IMPLEMENT THE OLWEUS PREVENTION PROGRAM IN FULTON COUNTY SCHOOLS.-CENTER FOR CHILD AND FAMILY ADVOCACY WILL WORK WITH PIKE DELTA YORK SCHOOLS TO IMPLEMENT THE OLWEUS PREVENTION PROGRAM IN FULTON COUNTY SCHOOLS.-THE BOARD OF COMMISSIONERS, AGING CONSORTIUM, AND JOB AND FAMILY SERVICES ARE GOING TO IMPLEMENT A TRANSPORTATION SYSTEM. FULTON COUNTY HEALTH CENTER PART V, SECTION B, LINE 14G: FCHC HAS SIGNS POSTED AT EACH PLACE THAT REGISTERS PATIENTS TO INFORM THEM OF FINANCIAL ASSISTANCE AVAILABLE. ALSO, EACH BILLING STATEMENT SENT TO THE PATIENT PROVIDES INFORMATION ON WHO THE PATIENT MAY CONTACT FOR INFORMATION REGARDING FINANCIAL ASSISTANCE. IN ADDITION, FINANCIAL COUNSELORS VISIT CERTAIN PATIENTS IN THE EMERGENCY DEPARTMENT AND ON THE INPATIENT FLOORS TO DISCUSSS THE FINANCIAL ASSISTANCE AVAILABLE TO THEM. FINALLY, FCHC PUBLICIZED THEIR POLICY THROUGH THE FOLLOWING WAYS: POSTED ON THE HOSPITAL FACILITY'S WEBSITE, ATTACHED TO BILLING INVOICES, POSTED IN THE HOSPITAL FACILITY'S EMERGENCY ROOMS AND WAITING ROOMS, POSTED IN THE HOSPITAL FACILITY'S ADMISSIONS OFFICES, PROVIDED IN WRITING TO PATIENTS ON ADMISSION TO THE HOSPITAL FACILITY, AND MADE AVAILABLE UPON REQUEST. 2 FULTON MANOR 725 SOUTH SHOOP AVENUE WAUSEON OH 43567 SKILLED NURSING FACILITY FCHC MEDICAL CARE 725 SOUTH SHOOP AVENUE WAUSEON OH 43567 PHYSICIAN PRACTICES PART I, LINE 6A: NOT APPLICABLE PART I, LINE 7: COST OF CHARITY CARE IS CALCULATED USING COST-TO-CHARGE RATIO FROM WORKSHEET 2. COST OF MEDICAID IS PER THE MEDICAID COST REPORT. THE REMAINING ITEMS ARE CALCULATED BASED ON ACTUAL COSTS OF SPECIFIC PROGRAMS WITHOUT THE USE OF A COST ACCOUNTING SYSTEM. PART I, LN 7 COL(F): THE AMOUNT OF BAD DEBT EXPENSE THAT WAS REMOVED FROM THE CALCULATION IN PART I LINE 7 COLUMN (F) TOTALED $2,604,887. PART II, COMMUNITY BUILDING ACTIVITIES: N/A PART III, LINE 2: FCHC CALCULATES BAD DEBT EXPENSE PER THE FINANCIAL STATEMENTS PART III, LINE 3: FCHC USED A 3% CALCULATION OF TOTAL BAD DEBT PER THE FINANCIAL STATEMENTS IN ORDER TO ESTIMATE THE AMOUNT OF BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENTS WHO WOULD HAVE BEEN ELIGIBLE UNDER THE ORGANIZATION'S FINANCIAL ASSISTANCE POLICY PART III, LINE 4: FINANCIAL STATEMENT FOOTNOTE REGARDING BAD DEBT: ACCOUNTS RECEIVABLE FOR PATIENTS, INSURANCE COMPANIES, AND GOVERNMENTAL AGENCIES ARE BASED ON GROSS CHARGES. AN ALLOWANCE FOR CONTRACTUAL ADJUSTMENTS AND INTERIM PAYMENT ADVANCES IS BASED ON EXPECTED PAYMENT RATES FROM PAYORS BASED ON CURRENT REIMBURSEMENT METHODOLOGIES. THIS AMOUNT ALSO INCLUDES AMOUNTS RECEIVED AS INTERIM PAYMENTS UNPAID CLAIMS BY CERTAIN PAYORS. ACCOUNTS RECEIVABLE ARE REDUCED BY AN ALLOWANCE FOR DOUBTFUL ACCOUNTS.IN EVALUATING THE COLLECTIBILITY OF ACCOUNTS RECEIVABLE, THE HOSPITAL ANALYZES ITS PAST HISTORY AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYOR SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND PROVISION FOR BAD DEBTS. MANAGEMENT REGULARLY REVIEWS DATA ABOUT THESE MAJOR PAYOR SOURCES OR REVENUE IN EVALUATING THE SUFFICIENCY OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS.FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY COVERAGE, THE HOSPITAL ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS AND A PROVISION FOR BAD DEBTS, IF NECESSARY (FOR EXAMPLE, FOR EXPECTED UNCOLLECTIBLE DEDUCTIBLES AND COPAYMENTS ON ACCOUNTS FOR WHICH THE THIRDPARTY PAYOR HAS NOT YET PAID, OR FOR PAYORS WHO ARE KNOWN TO BE HAVING FINANCIAL DIFFICULTIES THAT MAKE THE REALIZATION OF AMOUNTS DUE UNLIKELY). FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS (WHICH INCLUDES BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND COPAYMENT BALANCES DUE FOR WHICH THIRD-PARTY COVERAGE EXISTS FOR PART OF THE BILL), THE HOSPITAL RECORDS A SIGNIFICANT PROVISION FOR BAD DEBTS IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST EXPERIENCE, WHICH INDICATES THAT MANY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. THE DIFFERENCE BETWEEN THE STANDARD RATES (OR THE DISCOUNTED RATES IF NEGOTIATED) AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS IN THE PERIOD THEY ARE DETERMINED TO BE UNCOLLECTIBLE.ANY BAD DEBT EXPENSE THAT IS ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S CHARITY FINANCIAL ASSISTANCE POLICY WOULD BE RECLASSIFIED FROM BAD DEBT TO CHARITY CARE ONCE IT IS IDENTIFIED. THE ENTIRE AMOUNT OF THE BAD DEBT EXPENSE IS REVERSED AND ASSIGNED TO CHARITY CARE. PART III, LINE 8: MEDICARE ALLOWABLE COSTS WERE CALCULATED USING A COST TO CHARGE RATIO. PART III, LINE 9B: THE PRACTICES FULTON COUNTY HEALTH CENTER UTILIZES TO COLLECT FROM PATIENTS INCLUDES: PATIENTS ARE SENT STATEMENTS FOR OUTSTANDING BALANCES FOR A PERIOD OF TIME NOT LESS THAN 105 DAYS, AFTER AN EFFORT HAS BEEN MADE TO COLLECT THE BALANCE OR PLAN A PATIENT-PAY ACCOUNT PAYMENT PLAN THROUGH A SERIES OF 4 LETTERS AND 2 TELEPHONE CONTACTS DURING THE AFOREMENTIONED 105 DAY PERIOD, THE ACCOUNT IS TURNED OVER TO A COLLECTION AGENCY FOR FURTHER COLLECTION EFFORTS OR LEGAL ACTION. COLLECTION EFFORTS ARE NOT ENFORCED FOR BALANCES KNOWN TO QUALIFY UNDER CHARITY CARE OR OTHR FINANCIAL ASSISTANCE CRITERIA. PART VI, LINE 2: EVERY THREE YEARS, THE ORGANIZATION PERFORMS A COMMUNITY HEALTH NEEDS ASSESSMENT TO DETERMINE THE CURRENT HEALTH NEEDS WITHIN THE COMMUNITY. IN ADDITION, THE MEDICAL STAFF PROVIDES THE HOSPITAL WITH HEALTH CARE NEEDS WITHIN THE COMMUNITY BASED ON THEIR OWN PATIENT HEALTH CARE NEEDS. PART VI, LINE 3: FCHC HAS SIGNS POSTED AT EACH PLACE THAT REGISTERS PATIENTS TO INFORM THEM OF FINANCIAL ASSISTANCE AVAILABLE. ALSO, EACH BILLING STATEMENT SENT TO THE PATIENTS PROVIDES INFORMATION ON WHO THE PATIENT MAY CONTACT FOR INFORMATION REGARDING FINANCIAL ASSISTANCE. IN ADDITION, FINANCIAL COUNSELORS VISIT CERTAIN PATIENTS IN THE EMERGENCY DEPARTMENT AND ON THE INPATIENT FLOORS TO DISCUSS THE FINANCIAL ASSISTANCE AVAILABLE TO THEM. FINALLY, FCHC PUBLICIZES THEIR POLICY THROUGH THE FOLLOWING WAYS: POSTED ON THE HOSPITAL FACILITY'S WEBSITE, ATTACHED TO BILLING INVOICES, POSTED IN THE HOSPITAL FACILITY'S EMERGENCY ROOMS AND WAITING ROOMS, POSTED IN THE HOSPITAL FACILITY'S ADMISSIONS OFFICES, PROVIDED IN WRITING TO PATIENTS ON ADMISSION TO THE HOSPITAL FACILITY, AND MADE AVAILABLE UPON REQUEST. PART VI, LINE 4: FCHC SERVES FULTON COUNTY, OHIO AS THE PRIMARY SERVICE AREA, AS WELL AS PORTIONS OF HENRY & WILLIAMS COUNTIES IN OHIO AND MORENCI, MICHIGAN AS THE SECONDARY SERVICE AREA. THE POPULATION THAT THE HOSPITAL SERVICES RANGES FROM 40,000 TO 45,000. THERE ARE NO OTHER HOSPITALS IN FULTON COUNTY. THE PERCENTAGE OF PERSONS BELOW THE POVERTY LEVEL IS APPROXIMATELY 9-11%. THE AVERAGE MEDIAN HOUSEHOLD INCOME IS APPROXIMATELY $59,000. APPROXIMATELY 9% OF FULTON COUNTY RESIDENTS ARE UNINSURED. ALMOST 73% OF RESIDNETS ARE ADULTS OVER THE AGE OF 19, 11% ARE YOUTH AGES 12-18 YEARS AND 16% ARE ADOLESCENTS UNDER THE AGE OF 11. THE MARJORITY (95%) OF THE POPULATION ARE CAUCASIAN. HISPANICS (8%), AFRICAN AMERICANS (<1%), ASIAN (<1%) AND TWO OR MORE RACES (2%) COMPRISE THE REST OF THE POPULATION. PART VI, LINE 5: ALL OF THE ORGANIZATION'S BOARD MEMBERS RESIDE IN THE SERVICE AREA OF THE HOSPITAL. BOARD MEMBERS REPRESENT AND LIVE IN THE CITIES AND VILLAGES OF FULTON COUNTY AND ARE NEITHER EMPLOYEES NOR INDEPENDENT CONTRACTORS OF THE ORGANIZATION. THE ORGANIZATION EXTENDS MEDICAL STAFF PRIVILEGES TO ALL QUALIFIES PHYSICIANS IN ITS COMMUNITY THAT MEET THE MEDICAL STAFF BYLAW REQUIREMENTS. THE ORGANIZATION REINVESTS SURPLUS FUNDS INTO THE ORGANIZATION IN THE FORM OF NEW EQUIPMENT, RENOVATIONS, AND ADDITIONAL SERVICES. THE ORGANIZATION HAD 14% OF ITS REVENUE SOURCED FROM MEDICAID AND UNINSURED PATIENTS. FCHC INCURRED $80,457 EXPENSES RELATED TO RECRUITING AND MAINTAINING QUALIFIED PHYSICIANS AND SPECIALISTS TO THE HOSPITAL. THESE PHYSICIANS AND SPECIALISTS ARE CRITITICAL TO ENHANCING THE HEALTH AND LEVEL OF CARE PROVIDED TO THE COMMUNITY. WITHOUT FCHC RECRUITING AND MAINTAINING THESE PHYSICIANS, THE COMMUNITY WOULD NOT HAVE ACCESS TO THESE DOCTORS. AS SUCH, FCHC CONSIDERS THESE PHYSICIAN RECRUITMENT COSTS TO BE A COMMUNITY BENEFIT SERVICE. PART VI, LINE 6: N/A 1 PART I, LINE 2: FCHC REVIEWS MANY GRANT REQUESTS THROUGHOUT THE YEAR. ALL GRANTS ARE AT THE DISCRETION OF THE EXECUTIVE DIRECTOR AND BOARD MEMBERS WHO DETERMINE THE AMOUNT OF GRANTS BASED ON THE NEEDS OF THE COMMUNITY. FCHC ROUTINELY ISSUES DONATIONS TO LOCAL NONPROFIT ORGANIZATIONS AND CHARITIES. EMPLOYEES AND BOARD MEMBERS OF FCHC ARE ABLE TO INDIRECTLY MONITOR THE NONPROFITS IN WHICH THEY DONATE TO DUE TO THE NATURE OF THE SMALL COMMUNITY WHERE THE HOSPITAL RESIDES. IN 2013, THERE WAS NO INDIVIDUAL GRANT GREATER THAN $5,000. X X 0 0 0 0 0 0 0 0 0 PATRICIA A FINN CHIEF EXECUTIVE OFFICER 187002 0 0 0 0 0 9691 0 21038 0 217731 0 0 0 DANIEL MCKERNAN PHYSICIAN 792954 0 0 0 0 0 0 0 19566 0 812520 0 0 0 CHRISTOPHER SPIELES PHYSICIAN 642944 0 0 0 0 0 0 0 19566 0 662510 0 0 0 SEMEGHAGHA FOFUNG PHYSICIAN 274267 0 0 0 0 0 0 0 7698 0 281965 0 0 0 ALAN RIVERA HOSPITALIST 237491 0 0 0 0 0 0 0 0 0 237491 0 0 0 RONALD MUSIC PHYSICIAN 167955 0 0 0 0 0 0 0 19566 0 187521 0 0 0 A COUNTY OF FULTON OHIO 346400540 2011-10-20 28755000 SEE PART VI 0 0 0 A 28755000 318130 28436870 2009 1 0 1 1 A 0 0 1 1 1 1 0.00000 0.00000 0.00000 0 0 1 A 0 0 1 0 1 0 0 0 1 A 1 FORM 990, SCHEDULE K, PART III, LINE 3A: FOOTNOTE: UNDER THE SAFE-HARBOR PROVISIONS OF REVENUE PROCEDURE 97-13, THE MANAGEMENT CONTRACTS DO NOT RESULT IN PRIVATE BUSINESS USES. FORM 990, SCHEDULE K, PART III, LINE 3C: FOOTNOTE: FULTON COUNTY HEALTH CENTER'S ONCOLOGY DEPARTMENT PARTICIPATES IN THE TOLEDO ONCOLOGY CANCER DRUG RESEARCH PROGRAM. RESEARCH AGREEMENTS RELATED TO THIS PROGRAM DO NOT RESULT IN PRIVATE BUSINESS USE. FORM 990, SCHEDULE K, PART I, LINE A, COLUMN (F): FOOTNOTE: CURRENT REFUNDING OF $28,500,000 FULTON COUNTY HEALTH CENTER, COUNTY OF FULTON, OHIO, ADJUSTABLE RATE DEMAND REVENUE BOND SERIES 2005, ISSUED DECEMBER 1, 2005. FORM 990, SCHEDULE K, PART II, LINE 11: FOOTNOTE: PROCEEDS USED TO REFUND BONDS DESCRIBED IN PART I, LINE A, COLUM (F), AS REFERRED TO IN PART II, LINE 14. THE ORGANIZATION ENTERED INTO A QUALIFIED HEDGE WITH RESPECT TO THE REFUNDED BOND ISSUE. PURSUANT TO TREASURY REGULATIONS SECTION 1.48-4(H)(3)(IV)(A), THE HEDGE WAS DEEMED TERMINATED UPON ISSUANCE OF THE 2011 REFUNDING BONDS. UNDER TREASURY REGULATIONS SECTION 1.148-4(H)(3)(IV)(C), FOR REBATE PURPOSES THE DEEMED TERMINATION OF THE HEDGE RESULTS IN A DEEMED TERMINATION PAYMENT THAT IS ALLOCATED TO THE 2011 REFUNDING ISSUE. AS A RESULT OF THIS PROVISION, FOR REBATE PURPOSES A PORTION OF THE PROCEEDS OF THE 2011 REFUNDING ISSUE IS DEEMED TO CONSTITUTE A PAYMENT TO THE HEDGE PROVIDER. THE ORGANIZATION HAS REPORTED THE MANNER IN WHICH THE PROCEEDS WERE ACTUALLY SPENT IN PART II, LINES 1-11. FORM 990, SCHEDULE K, PART IV, LINE 4A: FOOTNOTE: AS DISCUSSED IN THE SUPPLEMENTAL INFORMATION PROVIDED IN PART II, LINE 11, THE ORGANIZATION ENTERED INTO A QUALIFIED HEDGE WITH RESPECT TO THE BONDS THAT ARE DESCRIBED IN PART I, LINE A, COLUMN (F), WHICH WERE REFUNDED BY THE 2011 REFUNDING ISSUE. THE QUALIFIED HEDGE WAS DEEMED TERMINATED PURSUANT TO TREASURY REGULATIONS SECTION 1.148-4(H)(3)(IV)(A). THE PAYMENTS ON THE HEDGE DO NOT CLOSELY CORRESPOND TO THE PRINCIPAL PAYMENTS ON THE 2011 REFUNDING ISSUE AND THE HEDGE HAS THEREFORE NOT BEEN IDENTIFIED AS A QUALIFYING HEDGE WITH RESPECT TO THE 2011 REFUNDING ISSUE. FORM 990, SCHEDULE K, PART III, LINE 7: FOOTNOTE: FULTON COUNTY HEALTH CENTER DOES NOT BELIEVE THAT THE BOND ISSUE MEETS THE PRIVATE SECURITY OR PAYMENT TEST, BUT BECAUSE THERE IS NO PRIVATE BUSINESS USE OF THE BOND-FINANCED FACILITIES, IT HAS NOT FORMALLY CALCULATED WHETHER THE PRIVATE SECURITY OR PAYMENT TEST HAS BEEN MET. JANET M BUEHRER EMPLOYEE OF FCHC/SISTER TO SHARON GILLEPSIE (BOARD MEMBER) 47011 W-2 WAGES 0 DAWN M KOLB EMPLOYEE OF FCHC/WIFE TO BRETT KOLB (BOARD MEMBER) 45804 W-2 WAGES 0 FORM 990, PART III, LINE 2 IN OCTOBER OF 2013 A PEDIATRIC OFFICE WAS OPENED TO PROVIDE PEDIATRIC CARE. FORM 990, PART VI, SECTION B, LINE 11 A COPY OF THE FORM 990 IS PROVIDED TO AND REVIEWED BY EACH OF THE ORGANIZATION'S BOARD OF DIRECTORS, DIRECTOR OF FINANCE - DARRELL TOPMILLER, AND CHIEF EXECUTIVE OFFICER - PATRICIA A. FINN, BEFORE THE FORM IS FILED. FORM 990, PART VI, SECTION B, LINE 12C CONFLICT OF INTEREST QUESTIONNAIRES ARE DISTRIBUTED ANNUALLY TO THE BOARD OF DIRECTORS AND DEPARTMENT HEADS. NEW BOARD MEMBERS ARE INTERVIEWED BY THE ADMINISTRATOR AND AT THAT TIME, DISCUSS WHETHER ANY CONFLICTS OF INTEREST EXIST. THE BOARD MEMBER IS PRESENTED TO THE EXECUTIVE COMMITTEE WHO REVIEWS ALL PERTINENT INFORMATION TO DETERMINE IF THERE IS A CONFLICT OF INTEREST AND WHETHER THAT PERSON CAN SERVE AS A BOARD MEMBER. VENDORS ARE REVIEWED REGULARLY BY DEPARTMENT HEADS TO DETERMINE IF ANY RELATIONSHIPS EXIST PER THE CONFLICT OF INTEREST QUESTIONNAIRES. AN OFFICER, DIRECTOR, OR KEY EMPLOYEE WHO HAS A CONFLICT OF INTEREST SHALL DISCLOSE THE CONFLICT OF INTEREST WHEN IT ARISES, AND BEFORE ACTION ON THE TRANSACTION OR CLAIM IN QUESTION. DISCLOSURE IS REQUIRED EVEN IF A DECISION CONCERNING THE TRANSACTION OR CLAIM IS NOT SUBJECT TO APPROVAL BY THE OFFICER, DIRECTOR, OR KEY EMPLOYEE OR THE BOARD OR COMMITTEE ON WHICH THE OFFICER, DIRECTOR, OR KEY EMPLOYEE SERVES. THE POLICY PROVIDES A PROCEDURE FOR REPORTING POTENTIAL CONFLICTS WHEN THEY ARISE AND BEFORE ACTION TO APPROVE OR AUTHORIZE THE TRANSACTION IS TAKEN. THE POLICY COVERS DIRECTORS, OFFICERS, EMPLOYEES OR AGENTS OF FULTON COUNTY HEALTH CENTER AND MEMBERS OF COMMITTEES AUTHORIZED TO APPROVE TRANSACTIONS OR ASSERT CLAIMS ON BEHALF OF THE FULTON COUNTY HEALTH CENTER. THE BOARD OF DIRECTORS, OTHER THAN ANY BOARD MEMBER DIRECTLY INVOLVED WITH THE CONFLICT, DETERMINES WHETHER A CONFLICT OF INTEREST INVOLVING AN INDIVIDUAL COVERED BY THE POLICY EXISTS AND REVIEWS ACTUAL CONFLICTS. INDIVIDUALS WITH CONFLICTS ARE NOT PERMITTED TO PARTICIPATE IN DELIBERATIONS OR VOTE TO AUTHORIZE A TRANSACTION OR ASSERTION OF A CLAIM. FORM 990, PART VI, SECTION B, LINE 15 THE COMPENSATION OF THE ORGANIZATION'S CHIEF EXECUTIVE OFFICER, PATRICIA A. FINN, IS APPROVED BY THE BOARD OF DIRECTORS. THE ORGANIZATION PARTICIPATES WITH THE OHA AND USES THEIR WAGE SURVEYS TO HELP DETERMINE THE ADMINISTRATOR'S COMPENSATION. THE ADMINISTRATOR'S COMPENSATION IS REVIEWED ANNUALLY AND DECISIONS ARE DOCUMENTED IN THE BOARD OF DIRECTOR MEETING MINUTES. THE COMPENSATION OF OFFICERS AND KEY EMPLOYEES ARE REVIEWED BY THE BOARD OF DIRECTORS. THE ORGANIZATION PARTICIPATES WITH THE OHA AND USES THEIR WAGE SURVEYS TO HELP DETERMINE OFFICER COMPENSATION. THE BOARD APPROVES THE COMPENSATION OF EMPLOYEES IN THE AGGREGATE. OFFICER COMPENSATION IS REVIEWED ANNUALLY AND DECISIONS ARE DOCUMENTED IN THE BOARD OF DIRECTOR MEETING MINUTES. THE COMPENSATION REVIEW PROCESS FOR THE CEO, OFFICERS, AND KEY EMPLOYEES WAS LAST PERFORMED IN MARCH 2012. NO INCREASES WERE GIVEN IN 2013. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS FORM 990 AVAILABLE FOR PUBLIC INSPECTION UPON REQUEST. GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND THE FINANCIAL STATEMENTS ARE NOT AVAILABLE TO THE PUBLIC. FORM 990, PART VI, LINE 9: DALE NAFZIGER 22386 COUNTY ROAD F. ARCHBOLD, OH 45302 JASON ROW 24706 CO RD E. ARCHBOLD, OH 43502 FORM 990, PART IX, LINE 11G PROFESSIONAL SERVICES: PROGRAM SERVICE EXPENSES 2,789,840. MANAGEMENT AND GENERAL EXPENSES 1,031,859. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,821,699. HUMAN RESOURCES: PROGRAM SERVICE EXPENSES 112,304. MANAGEMENT AND GENERAL EXPENSES 41,537. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 153,841. CONSULTING: PROGRAM SERVICE EXPENSES 136,570. MANAGEMENT AND GENERAL EXPENSES 50,512. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 187,082. DIRECTORSHIP/HOUSEKEEPING/OTHER SERVICES: PROGRAM SERVICE EXPENSES 912,757. MANAGEMENT AND GENERAL EXPENSES 337,595. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,250,352. BILLING & COLLECTIONS: PROGRAM SERVICE EXPENSES 1,649,980. MANAGEMENT AND GENERAL EXPENSES 610,266. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,260,246. FORM 990, PART XI, LINE 9: K-1 LOSS 20,324. CHANGE IN FAIR VALUE OF INTEREST SWAP AGREEMENTS 1,855,703. FORM 990, PART XII, LINE 2C: THE OVERSIGHT OF THE AUDIT OF THE FINANCIAL STATEMENTS HAS NOT CHANGED SINCE THE PRIOR YEAR. FCHC MEDICAL CARE LLC 725 S SHOOP AVE WAUSEON OH 435671702 010877201 PHYSICIAN BILLING AND PHYSICIAN PRACTICES OH 4611601 2014848 FULTON COUNTY HEALTH CENTER FCHC MEDICAL SERVICES LLC 725 S SHOOP AVE WAUSEON OH 435671702 010877202 HOLD LAND OH 0 380546 FULTON COUNTY HEALTH CENTER