2013-11-15T09:20:02-06:00 2012-12-31 381357951 PLANTE & MORAN PLLC 65 EAST STATE STREET SUITE 600 COLUMBUS OH 43215 990 2012-01-01 344441792 H B MAGRUDER MEMORIAL HOSPITAL HBMA 4197343131 615 FULTON STREET PORT CLINTON OH 43452 JON TODD ALMENDINGER 4197343131 2013-11-13 1 BERNIE OSTROWSKI P00366367 6148493000 2012 2016-02-25 16:41:14Z MAGRUDER HOSPITAL JON TODD ALMENDINGER 615 FULTON STREET PORT CLINTON OH 43452 53247390 0 X WWW.MAGRUDERHOSPITAL.COM X 1940 OH MAGRUDER HOSPITAL SHALL PROVIDE COMPASSIONATE CARE WITH EXCELLENT OUTCOMES. 14 13 434 120 0 0 158405 132591 49814762 48112866 184639 150874 1019379 4372184 51177185 52768515 12400 7000 0 0 21418595 21746040 0 0 0 26834882 26897789 48265877 48650829 2911308 4117686 44578147 47800167 9664454 8483634 34913693 39316533 X SEE SCHEDULE OMAGRUDER SHALL:-PROVIDE QUALITY AND COMPASSIONATE MEDICAL CARE AND TREATMENT-PROMOTE HEALTH EDUCATION AND PREVENTATIVE CARE-IMPROVE THE COMMUNITY'S HEALTH STATUS-WORK COLLABORATIVELY AND COOPERATIVELY WITH AREA HEALTH PROVIDERS-STRIVE FOR CONTINUAL QUALITY IMPROVEMENT-BE COST-EFFECTIVE IN HOSPITAL OPERATIONS-ACHIEVE ALIGNMENT WITH THE GOALS AND OBJECTIVES OF THE STAFF PHYSICIANS 0 0 43397497 7000 49208822 SEE SCHEDULE OFOUNDED IN 1940, H B MAGRUDER MEMORIAL HOSPITAL (MAGRUDER) IS A 25 BED, MEDICARE DESIGNATED CRITICAL ACCESS TAX EXEMPT HEALTHCARE FACILITY, LOCATED IN PORT CLINTON, OHIO. THE HOSPITAL PROVIDES DIRECT HEALTHCARE SERVICES TO THE RESIDENTS IN THE COMMUNITIES OF OTTAWA COUNTY THAT INCLUDE BOTH INPATIENT AND OUTPATIENT SERVICES INCLUDING EMERGENCY SERVICES 24 HOURS PER DAY, 7 DAYS PER WEEK. PATIENTS ARE ACCEPTED REGARDLESS OF NATIONAL ORIGIN, AGE, RACE, CREED, SEX, OR ABILITY TO PAY.IN 2012, MAGRUDER EXPERIENCED A TOTAL OF 2913 INPATIENT DAYS, INCLUDING 2245 DAYS TO MEDICARE PATIENTS AND 70 DAYS TO MEDICAID PATIENTS. THE HOSPITAL EXPERIENCED 15,968 VISITS TO THE EMERGENCY DEPARTMENT, AND TREATED A TOTAL OF 75,746 OUTPATIENTS.WHILE MEDICARE, MEDICAID, AND PRIVATE INSURANCE PLANS AND PROGRAMS PAID FOR THE SERVICES OF MOST PATIENTS TREATED AND RELEASED AT MAGRUDER, UNCOMPENSATED CARE WAS PROVIDED BY THE HOSPITAL TO PATIENTS WHO WERE EITHER UNABLE OR UNWILLING TO PAY. THIS REFLECTED THE HOSPITAL'S MISSION TO CARE FOR PATIENTS EVEN IF UNABLE OR UNWILLING TO PAY FOR SERVICES NOT OTHERWISE COVERED BY PRIVATE INSURANCE AND/OR GOVERNMENTAL PROGRAMS.MAGRUDER CONTINUES ITS COMMITMENT TO SERVING THE PUBLIC HEALTH PREVENTION AND HEALTH EDUCATION NEEDS IN THE COMMUNITIES OF OTTAWA COUNTY. MAGRUDER CONTINUES TO KEEP AN ACTIVE ROLE IN THE OTTAWA COUNTY HEALTH PARTNERS, WHICH COMPLETED A COMMUNITY HEALTH NEEDS ASSESSMENT IN 2012. RESULTS WERE ROLLED OUT IN OCTOBER 2012.OUR OUTREACH PROGRAMS CONTINUE TO TOUCH HUNDREDS OF LIVES IN OUR COMMUNITIES. -REDUCED FEE CHOLESTEROL SCREENING FOR THE COMMUNITY EACH MONTH (158 PARTICIPANTS)-ANNUAL FREE WOMEN'S HEALTH DAY EDUCATION PROGRAM (85 PARTICIPANTS)-ADMINISTERED FLU SHOTS AT BUSINESSES, HEALTH FAIRS AND PUBLIC CLINICS (300 PARTICIPANTS)-MEDICARE EDUCATION FOR THE COMMUNITY (IN ADDITION TO A LARGE PUBLIC EDUCATIONAL SESSION (67), WE HAD STAFF THROUGHOUT THE END OF THE YEAR OFFERING ONE ON ONE APPOINTMENTS FOR PART D COMPARISONS AND OTHER RESOURCES.)-KIWANIS LAB SCREENING TEST FOR 7 DIFFERENT MEDICAL CONDITIONS (177 PARTICIPANTS)-FREE SKIN CANCER SCREENING TO THE COMMUNITY (81 PARTICIPANTS)-FREE PROSTATE CANCER SCREENING TO THE COMMUNITY (61 PARTICIPANTS)-FREE COLORECTAL HEALTH SCREENING KITS TO THE COMMUNITY (63)-CANCER SUPPORT GROUP (57 PARTICIPANTS)-REDUCED FEE WELLNESS CLASSES FOR THE COMMUNITY (1,076 PARTICIPANTS)-GENERAL HEALTH SCREENINGS (USUALLY BLOOD PRESSURE & BLOOD SUGAR) AT COMMUNITY EVENTS (203 PARTICIPANTS)-BOARD INVOLVEMENT IN: AMERICAN CANCER SOCIETY, 3 LOCAL SCHOOL WELLNESS COMMITTEES, COUNCIL OF HEALTH & SOCIAL CONCERNS, SALVATION ARMY & AMERICAN HEART ASSOCIATION-MAGRUDER SPONSORED 3 BLOOD DRIVES IN 2012 WHICH INCLUDES NOT ONLY THE SPACE AND PROMOTION FOR THE EVENT BUT ALSO ALLOWED 46 EMPLOYEES TO DONATE ON WORK TIME.-EDUCATION PROGRAMS (OVER 1,000 PARTICIPANTS) -COMMUNITY EVENTS: DIABETES, HEART HEALTH, WOMEN'S HEALTH, MEDICAL INFORMATION NOTEBOOK, YOUTH NUTRITION -MONTHLY LUNCHEONS: CHRONIC PAIN, SELF CARE, UROLOGIC ISSUES, AUTISM, STROKES, SLEEP -"TIME FOR HEALTH" TV SHOW: STREET DRUGS, VERTIGO, NUTRITION, CPR, ELDER ABUSE, FLU, ALLERGIES, SUPPORT GROUPS-MAGRUDER HOSPITAL ALSO SPONSORS OR PARTICIPATES IN THE FOLLOWING COMMUNITY BUILDING ACTIVITIES: -CASA (COURT APPOINTED SPECIAL ADVOCATES) -JOYFUL CONNECTIONS (SUPERVISED VISITATION AND EXCHANGE) -HABITAT FOR HUMANITY -JUVENILE DIABETES -SUSAN G KOMEN -EASTER SEALS -TEEN PEP (PEERS EDUCATING PEERS) -AMERICAN RED CROSSOPPORTUNITIES ARE PROVIDED TO ASSIST IN THE DELIVERY OF HEALTHCARE AT THE HOSPITAL THROUGH VOLUNTEER SERVICE COORDINATED BY THE H B MAGRUDER MEMORIAL HOSPITAL AUXILIARY (AUXILIARY). THE AUXILIARY OPERATES THE HOSPITAL'S GIFT SHOP, AND PROVIDES VOLUNTEERS THAT WORK IN VARIOUS HOSPITAL DEPARTMENTS, INCLUDING: TRANSPORT, RADIOLOGY, NURSING, FOOD SERVICE, HEALTH INFORMATION SERVICES, LAB AND THE BUSINESS OFFICE. 43397497 1 1 0 1 0 0 0 0 0 0 1 0 0 0 1 1 1 0 0 0 0 0 0 0 1 0 1 1 0 1 1 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 1 97 0 1 434 1 0 0 0 0 0 1 1 0 0 0 0 X 14 13 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 0 0 1 0 1 0 OH X TONI MAGSIG ACCOUNTING DIRECTOR 4197343131 615 FULTON STREET PORT CLINTON OH 43452 PAUL DRUCKENMILLER 1.00 0.00 X X 0 0 0 BRUCE SMITH 1.00 0.00 X X 0 0 0 NANCY OSBORN 1.00 0.00 X X 0 0 0 DAVID SODERBERG 1.00 0.00 X X 0 0 0 DANIEL ALMENDINGER 1.00 0.00 X X 0 0 0 JOHN BODIE MD 1.00 0.00 X 0 0 0 EMIL CELLIER 1.00 0.00 X 0 0 0 DOUGLAS FOCHT 1.00 0.00 X 0 0 0 MARK HABLITZEL DDS 1.00 0.00 X 0 0 0 RON MILLER 1.00 0.00 X 0 0 0 KEVIN SNEIDER DPM 1.00 0.00 X 0 0 0 LOCKWOOD ZEIS 1.00 0.00 X 0 0 0 SUE CROSSER 1.00 0.00 X 0 0 0 GREG DEERHAKE 1.00 0.00 X 0 0 0 JON TODD ALMENDINGER 40.00 0.00 X 174615 0 30246 ISIDRO AMIGO 40.00 0.00 X 360317 0 43312 LEONARDO QUE 40.00 0.00 X 310979 0 0 DANIEL CADIGAN 40.00 0.00 X 213450 0 32863 CHRISTOPHER STRANATHAN 40.00 0.00 X 206281 0 29959 KAREN KLAEGE 40.00 0.00 X 193718 0 31794 MICHAEL E LONG 40.00 0.00 X 217660 0 31584 1677020 0 199758 25 1 1 0 CERNER CORPORATION 2800 ROCKCREEK PARKWAY KANSAS CITY MO 64117 COMPUTER SUPPORT 2192755 PORT CLINTON EMERGENCY PHYSICIANS INC 3914 MEMORIAL SHOREWAY LAKESIDEMARBLEHEAD OH 43440 EMERGENCY PHYSICIANS 1908194 ADVANCED HEALTH LTD 2500 W STRUB RD STE 150 SANDUSKY OH 44870 PHYSICAL THERAPY 1335119 ABAN AFFAN MD 4446 MARIN HARBOR UNIT C PORT CLINTON OH 43452 ANESTHESIOLOGIST 570726 FOCHT CONSTRUCTION 2040 STATE RD PORT CLINTON OH 43452 CONSTRUCTION 541029 22 605 34872 2182 94932 132591 HEALTHCARE SERVICES 622110 48112866 48112866 48112866 150874 150874 392691 456343 -63652 -63652 -63652 24745 34872 22532 2213 2213 EHR INCENTIVE PAYMENTS 900099 3111420 3111420 FLOW THROUGH INCOME 900099 585770 585770 MOBILE MEALS/FOOD SVC 900099 369581 369581 366852 140605 226247 4433623 52768515 49208822 0 3427102 X 7000 7000 204861 204861 15555071 13455136 2099935 932810 806881 125929 3833953 3316369 517584 1219345 1054733 164612 132943 132943 93193 93193 10675418 10171933 503485 234805 234805 1366317 1067651 298666 1126877 980383 146494 1335884 1140564 195320 69234 34617 34617 2048509 2048509 377396 377396 MEDICAL SUPPLIES 6061598 6061598 BAD DEBT EXPENSE 2478655 2478655 NON-CONTRACTED PHYSICIA 700000 700000 PHYSICIAN RECRUITMENT 134705 118069 16636 62255 43198 19057 48650829 43397497 5253332 0 98722 2350 7641744 9596147 6366083 6737526 548645 516787 394231 357461 531872 719914 56901788 32800121 23699783 24101667 4731442 5372979 565625 395336 44578147 47800167 5400296 4813778 1704948 497452 2559210 3172404 9664454 8483634 X 34881732 39281885 31961 34648 34913693 39316533 44578147 47800167 X 4117686 342096 -56942 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 1233 1233 0 EXPLANATION OF LOBBYING ACTIVITIES: PART II-B, LINE 1: A PORTION OF DUES PAID TO THE OHIO HOSPITAL ASSOCIATION RELATES TO LOBBYING. 686533 686533 31933020 15606156 16326864 626816 590062 36754 23465735 16603903 6861832 189684 189684 24101667 ESTIMATED 3RD PARTY PAYOR SETTLEMENTS 2759828 ACCRUED POST-RETIREMENT BEN. OBLIGATION 412576 3172404 X 50502542 342096 -3081769 -2739673 53242215 -473700 -473700 52768515 46006805 478875 478875 45527930 3122899 3122899 48650829 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X, LINE 2: ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA REQUIRE MANAGEMENT TO EVALUATE TAX POSITIONS TAKEN BY THE HOSPITAL AND RECOGNIZE A TAX LIABILITY IF THE HOSPITAL HAS TAKEN AN UNCERTAIN POSITION THAT MORE LIKELY THAN NOT WOULD NOT BE SUSTAINED UPON EXAMINATION BY 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, 2012, THERE ARE NO UNCERTAIN POSITIONS TAKEN OR EXPECTED TO BE TAKEN THAT WOULD REQUIRE RECOGNITION OF A LIABILITY OR DISCLOSURE IN THE 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 2009. PART XI, LINE 2D - OTHER ADJUSTMENTS: POSTRETIREMENT RELATED COSTS 41,130. BAD DEBT EXPENSES -2,478,655. RECLASS OF CARDIAC SALARY OFFSET 55,756. NON-CONTRACTED PHYSICIAN PAYMENTS -700,000. PART XI, LINE 4B - OTHER ADJUSTMENTS: RECLASS SPECIAL EVENT EXPENSES -22,532. RECLASS RENTAL EXPENSES -456,343. BOOK TO TAX DIFFERENCES FROM FLOW THROUGH INVESTMENTS 73,334. AUXILIARY NET LOSS -68,159. PART XII, LINE 2D - OTHER ADJUSTMENTS: RECLASS RENTAL EXPENSES 456,343. RECLASS SPECIAL EVENT EXPENSES 22,532. PART XII, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT EXPENSES 2,478,655. RECLASS OF CARDIAC SALARY OFFSET -55,756. NON-CONTRACTED PHYSICIAN PAYMENTS 700,000. CHARITY BALL 35917 23857 12060 10558 GOLF OUTING 23700 11015 12685 11974 59617 34872 24745 22532 22532 2213 1 1 X 1 X 1 X 1 1 0 1 1 1537686 572673 965013 0.02120 4815179 1673110 3142069 0.06910 6352865 2245783 4107082 0.09030 8 2720 31428 6082 25346 0.00060 4 20 18064 18064 0.00040 12 2740 49492 6082 43410 0.00100 12 2740 6402357 2251865 4150492 0.09130 28 9174 9174 0.00020 4469 4469 0.00010 28 13643 13643 0.00030 0 2478655 123933 14886168 14738775 147393 X 1 1 2 OTTAWA COUNTY CARENET GROUP CONTRACTING 0.50000 0.50000 3 MAGRUDER PAIN MANAGEMENT LLC PAIN MANAGEMENT SERVICES 0.51000 0.49000 1 1 HB MAGRUDER MEMORIAL HOSPITAL

615 FULTON STREET PORT CLINTON OH 43452

X X X HB MAGRUDER MEMORIAL HOSPITAL 1 1 1 100.000000000000 1 400.000000000000 1 X 1 1 X X X X X 1 0 1 X 0 0 7 PHYSICIAN OFFICE

611 E 6TH STREET PORT CLINTON OH 43452

PHYSICIAN OFFICE PHYSICIAN OFFICE

621 FULTON STREET PORT CLINTON OH 43452

PHYSICIAN OFFICE PHYSICAL THERAPY

7725 W STATE ROUTE 163 OAK HARBOR OH 43449

PHYSICAL THERAPY PHYSICIAN OFFICE

11697 W STATE ROUTE 163 OAK HARBOR OH 43449

PHYSICIAN OFFICE PHYSICAL THERAPY

4058 E HARBOR RD PORT CLINTON OH 43452

PHYSICAL THERAPY PHYSICIAN OFFICE

1297 W MAIN STREET LAKESIDE MARBLEHEAD OH 43440

PHYSICIAN OFFICE PHYSICIAN OFFICE

2861 EAST HARBOR ROAD PORT CLINTON OH 43452

PHYSICIAN OFFICE PART I, LINE 7: TOTAL COMMUNITY BENEFIT EXPENSE RELATED TO CHARITY CARE WAS CALCULATED USING A COST-TO-CHARGE RATIO. TOTAL COMMUNITY BENEFIT RELATED TO MEDICAID WAS CALCULATED FROM THE MEDICAID COST REPORT. THE COST-TO-CHARGE RATIO WAS DERIVED FROM WORKSHEET 2. PART I, LINE 7, COLUMN (F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $ 2478655. PART II: THE COMMUNITY BUILDING ACTIVITIES THAT MAGRUDER HOSPITAL SUPPORTS ENCOURAGE EXERCISE (AREA SCHOOL ATHLETIC BOOSTERS), EDUCATION (AREA SCHOOLS HONOR BANQUETS), SAFETY (OFFICER PHIL), AND OTHER HEALTH-RELATED ORGANIZATIONS (EMS, EASTER SEALS, HOSPICE). PART III, LINE 4: ACCOUNTS RECEIVABLE FOR PATIENTS, INSURANCE COMPANIES, AND GOVERNMENTAL AGENCIES ARE BASED ON GROSS CHARGES. AN ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS IS ESTABLISHED ON AN AGGREGATE BASIS BY USING HISTORICAL WRITE-OFF RATE FACTORS APPLIED TO UNPAID ACCOUNTS BASED ON AGING. LOSS RATE FACTORS ARE BASED ON HISTORICAL LOSS EXPERIENCE AND ADJUSTED FOR ECONOMIC CONDITIONS AND OTHER TRENDS AFFECTING THE HOSPITAL'S ABILITY TO COLLECT OUTSTANDING AMOUNTS. UNCOLLECTIBLE AMOUNTS ARE WRITTEN OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS IN THE PERIOD THEY ARE DETERMINED TO BE UNCOLLECTIBLE. 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 AGAINST UNPAID CLAIMS BY CERTAIN PAYORS.THE AMOUNT OF BAD DEBT EXPENSE REPORTED IN PART III, LINES 2 AND 3 IS BASED DIRECTLY ON THE BAD DEBT EXPENSE REPORTED IN THE AUDITED FINANCIAL STATEMENTS, WITH LINE 3 BEING ESTIMATED AS 5% OF THE TOTAL BAD DEBT EXPENSE REPORTED IN LINE 2. THE ENTIRE BAD DEBT EXPENSE RELATES SOLELY TO PATIENT ACCOUNTS. MAGRUDER HOSPITAL DOES NOT BELIEVE BAD DEBT SHOULD BE INCLUDED AS A COMMUNITY BENEFIT. PART III, LINE 8: BASED ON A COST TO CHARGE RATIO CALCULATED AS REQUIRED UNDER MEDICARE RULES, THE COSTS OF PROVIDING CARE TO THE MEDICARE POPULATION IN 2012 WAS $14,738,775. THE PAYMENTS RELATED TO THESE SERVICES WERE $14,886,168, LEAVING A MEDICARE SURPLUS OF $147,393 FOR THE YEAR. PART III, LINE 9B: ALL COLLECTION EFFORTS ARE PLACED ON HOLD UNTIL FINANCIAL ASSISTANCE IS PROCESSED. IF APPROVED, THE BALANCES ARE WRITTEN OFF. HB MAGRUDER MEMORIAL HOSPITAL PART V, SECTION B, LINE 20D: ALL PATIENTS ARE CHARGED AT GROSS CHARGES PER THE CHARGEMASTER. THOSE APPROVED FOR FINANCIAL ASSISTANCE ARE THEN GIVEN THE APPROPRIATE ALLOWANCE AND BILLED ANY REMAINING AMOUNT. PART VI, LINE 2: MAGRUDER IS PART OF A GROUP CALLED OTTAWA COUNTY COMMUNITY HEALTH PARTNERS, WHICH IS LEAD BY THE OTTAWA COUNTY HEALTH DEPARTMENT. OTHER MEMBERS INCLUDE: MENTAL HEALTH, NURSING FACILITIES, UNITED WAY, BOARD OF DEVELOPMENTAL DISABILITIES, JOB & FAMILY SERVICES AND SEVERAL SCHOOL DISTRICTS. MOST RECENTLY WE HAVE COMPLETED COMMUNITY HEALTH NEEDS ASSESSMENTS IN 2001 AND 2006. THE HOSPITAL COUNCIL OF NORTHWEST OHIO AND THE UNIVERSITY OF TOLEDO CARRY OUT THE ASSESSMENTS AND PROVIDE DATA BACK TO THE OTTAWA COUNTY COMMUNITY HEALTH PARTNERS. THE ASSESSMENT CONSISTS OF SELF-ADMINISTERED SURVEYS OF ADULTS (AGE 19 AND OLDER) AND ALSO YOUTH (AGES 12-18). THE QUESTIONS ARE MODELED AFTER THE SURVEY INSTRUMENTS USED BY THE CDC FOR THEIR NATIONAL AND STATE BEHAVIORAL RISK FACTOR SURVEILLANCE SYSTEM AND YOUTH RISK BEHAVIOR SURVEILLANCE SURVEY. THE RESULTS WERE ROLLED OUT TO THE COMMUNITY IN OCTOBER OF 2006 AND THE COMMUNITY HEALTH PARTNERS NARROWED DOWN A FOCUS OF OBESITY AND ALCOHOL USE (FOR YOUTH) AND ABUSE (FOR ADULTS). THEY DID A COMMUNITY RESOURCE ASSESSMENT AS WELL AS A GAP ANALYSIS AND CAME UP WITH SOME PLANS TO ADDRESS OBESITY AND ALCOHOL. THE GROUP HAS MET SEVERAL TIMES TO REVIEW PROGRAMS AND TACTICS BEING CARRIED OUT THROUGHOUT THE COUNTY TO ADDRESS THOSE ISSUES. PART VI, LINE 3: PATIENTS RECEIVE INFORMATION AT REGISTRATION, IN THEIR FIRST STATEMENT, AND OFFERED ON FOLLOW-UP PHONE CALLS. THERE ARE BROCHURES AT OUR PHYSICIAN OFFICES AND THROUGHOUT THE HOSPITAL. PART VI, LINE 4: MAGRUDER HOSPITAL IS A CRITICAL ACCESS HOSPITAL LOCATED IN PORT CLINTON, OHIO SERVING THE HEALTHCARE NEEDS OF OTTAWA COUNTY. OTTAWA COUNTY IS LOCATED ON LAKE ERIE ABOUT 15 MILES SOUTHEAST OF TOLEDO, OHIO AND IS MADE UP OF VARIOUS COMMUNITIES THAT INCLUDE SEVEN VILLAGES, TWELVE TOWNSHIPS AND THE ONLY CITY IN OTTAWA COUNTY, PORT CLINTON. THE POPULATION OF 40,000 HAS EASY ACCESS TO MAJOR STATE ARTERIES TO TOLEDO AND CLEVELAND. PART VI, LINE 5: MAGRUDER HOSPITAL ACTIVELY RECRUITS PHYSICIANS WITH THE SPECIALTIES NEEDED WITHIN THE COMMUNITY, SO THE COMMUNITY CAN ACCESS THE HEALTHCARE IT NEEDS. EXCESS FUNDS ARE PUT INTO STATE OF THE ART TECHNOLOGY TO BETTER SERVE OUR COMMUNITY. REPORTS FILED WITH STATES PART VI, LINE 7 OH 1 SCHOLARSHIPS 14 7000 PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, PART I, LINE 2: THE ROY SCHOLARSHIP IS FUNDED BY A TRUST, AND IS RELEASED ONLY TO NURSING STUDENTS PURSUING THEIR RN DEGREE BASED ON FINANCIAL NEED AS DETERMINED THROUGH AN APPLICATION PROCESS. THE AUXILIARY ALSO AWARDS SCHOLARSHIPS BASED ON AN APPLICATION PROCESS TO QUALIFIED STUDENTS PERSUING A HEALTH-RELATED DEGREE. X 1 1 X X X X 1 0 0 0 0 0 0 0 0 JON TODD ALMENDINGER 174615 0 0 0 0 0 3507 0 26739 0 204861 0 0 0 ISIDRO AMIGO 360317 0 0 0 0 0 5000 0 38312 0 403629 0 0 0 LEONARDO QUE 310979 0 0 0 0 0 0 0 0 0 310979 0 0 0 DANIEL CADIGAN 213450 0 0 0 0 0 4090 0 28773 0 246313 0 0 0 CHRISTOPHER STRANATHAN 206281 0 0 0 0 0 0 0 29959 0 236240 0 0 0 KAREN KLAEGE 193718 0 0 0 0 0 2543 0 29251 0 225512 0 0 0 MICHAEL E LONG 192275 0 0 0 25385 0 3539 0 28045 0 249244 0 0 0 PART I, LINE 1A THE CEO RECEIVES REIMBURSEMENT FOR SOCIAL CLUB DUES; REIMBURSEMENT IS TREATED AS TAXABLE COMPENSATION TO THE CEO. THE ORGANIZATION USES FACILITY FOR VARIOUS STAFF FUNCTIONS THROUGHOUT THE YEAR. THIS TRANSACTION IS ANNUALLY BOARD APPROVED. PART I, LINE 4A MICHAEL LONG WAS CEO UNTIL 10/30/12. HIS SEVERANCE PAY STARTED AFTER THAT DATE, AND WAS PAID IN ACCORDANCE WITH A WRITTEN AGREEMENT. IN 2012, HE RECEIVED SEVERANCE OF $25,385. DOUGLAS FOCHT BOARD MEMBER COMMON LEADERSHIP 541029 INDEPENDENT CONTRACTOR THROUGH FOCHT CONSTRUCTION 0 FORM 990, PART VI, SECTION B, LINE 11 THE VP OF FINANCE REVIEWED THE FORM 990 WITH THE BOARD TREASURER TO THE LEVEL OF DETAIL REQUESTED BY THE BOARD TREASURER. THE FORM 990 WAS THEN PROVIDED TO EACH MEMBER OF THE BOARD WITH A DISCUSSION OF KEY POINTS PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C WRITTEN DISCLOSURE OF CONFLICTS OF INTEREST ARE REQUESTED ANNUALLY FOR ALL BOARD MEMBERS. THE CEO REVIEWS ALL DISCLOSURES. THE CODE OF REGULATIONS ASKS FOR PROMPT DISCLOSURE IF SITUATIONS CHANGE DURING THE YEAR. ANY BOARD MEMBER WITH A CONFLICT OR POTENTIAL CONFLICT IS RESTRICTED FROM PARTICIPATING IN VOTING ON MATTERS WHERE THERE IS A CONFLICT OR POTENTIAL CONFLICT. DOUG FOCHT, DIRECTOR, IS RESTRICTED FROM PARTICIPATING IN DECISIONS IN REGARDS TO BUILDING CONSTRUCTION TRANSACTIONS (SEE SCHEDULE L, PART VI DISCLOSURE). FORM 990, PART VI, SECTION B, LINE 15A THE CEO'S COMPENSATION IS APPROVED BY THE BOARD. THE EXECUTIVE COMMITTEE REVIEWS THE OHA SALARY SURVEY FOR COMPARISON. RECOMMENDATIONS TO THE FULL BOARD ARE MADE BASED ON SALARY SURVEY FINDINGS, MARKET FINDINGS, AND PERFORMANCE REVIEW FOR EXECUTIVES; ALL OTHER EMPLOYEES' SALARIES ARE DETERMINED IN A SIMILAR FASHION EXCLUDING BOARD APPROVAL. CONTEMPORANEOUS DOCUMENTATION AND RECORDKEEPING IS COMPLETED WITH RESPECT TO THIS PROCESS. THIS PROCESS WAS LAST PERFORMED IN 2012. FORM 990, PART VI, SECTION C, LINE 18 FORM 1023 AND FORM 990 ARE AVAILABLE UPON REQUEST. FORM 990, PART VI, SECTION C, LINE 19 GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE PROVIDED TO THE PUBLIC UPON REQUEST. AN ABBREVIATED FINANCIAL STATEMENT IS INCLUDED IN THE HOSPITAL'S ANNUAL REPORT. OTHER FEES FORM 990, PART IX, LINE 11G PROFESSIONAL SERVICES : PROGRAM SERVICE EXPENSES 6,598,614. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 6,598,614. PURCHASED SERVICES : PROGRAM SERVICE EXPENSES 3,573,319. MANAGEMENT AND GENERAL EXPENSES 503,485. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 4,076,804. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 9: POST RETIREMENT RELATED COSTS 41,130. NET ASSETS RELEASED FROM RESTRICTION 2,687. AUXILIARY NET ASSETS -95,584. FLOW THROUGH BOOK TO TAX DIFFERENCES -73,334. AUXILIARY NET LOSS 68,159. FORM 990, PART XI, LINE 2C MEMBERS OF THE HOSPITAL'S BOARD OVERSEE THE AUDIT PROCESS AND THE SELECTION OF THE INDEPENDENT ACCOUNTANT. THIS PROCESS HAS NOT CHANGED SINCE THE PRIOR YEAR. PART VI, SECTION B, LINE 13 DURING 2013, THE HOSPITAL IS IN PROCESS OF DRAFTING AND ADOPTING A WRITTEN WHISTLEBLOWER POLICY. PART VI, SECTION B, LINE 14 DURING 2013, THE HOSPITAL IS IN PROCESS OF DRAFTING AND ADOPTING A WRITTEN DOCUMENT RETENTION AND DESTRUCTION POLICY.