2013-11-11T16:40:59-06:00 2012-12-31 381357951 PLANTE & MORAN PLLC 65 EAST STATE ST STE 600 COLUMBUS OH 43215 990 2012-01-01 341883284 LIMA MEMORIAL JOINT OPERATING COMPANY LIMA 4192283335 1001 BELLEFONTAINE AVENUE LIMA OH 45804 ERIC D POHJALA 4192283335 2013-10-25 1 BERNIE OSTROWSKI P00366367 6148493000 2012 2016-02-24 21:20:13Z LIMA MEMORIAL HEALTH SYSTEM MICHAEL SWICK 1001 BELLEFONTAINE AVENUE LIMA OH 45804 174780232 0 X WWW.LIMAMEMORIAL.ORG X 1999 OH WE ARE HERE TO IMPROVE THE QUALITY OF LIFE IN OUR COMMUNITIES THROUGH COMPREHENSIVE HEALTH SERVICES. 12 10 1684 10 1163213 -48351 259882 55854 156231426 171576480 585912 954395 847070 2121616 157924290 174708345 6923116 421361 0 0 68609202 72417822 0 4705 180542 78513770 88135063 154046088 160978951 3878202 13729394 218263113 241603603 80976539 83792469 137286574 157811134 X AS ONE OF THE LARGEST NOT-FOR-PROFIT HEALTH CARE ORGANIZATIONS IN WEST CENTRAL OHIO, LIMA MEMORIAL HEALTH SYSTEM IS COMMITTED TO IMPROVING THE QUALITY OF LIFE IN OUR COMMUNITIES THROUGH COMPREHENSIVE HEALTH SERVICES. LIMA MEMORIAL IS CONTINUALLY IMPROVING ITS SERVICES AND FACILITIES BY KEEPING UP WITH THE LATEST TECHNOLOGIES, PROVIDING CONTINUING EDUCATION TO OUR HEALTH CARE TEAM AND UPDATING OUR FACILITIES. OUR PATIENT SATISFACTION NUMBERS CONTINUE TO IMPROVE AND WE CONTINUALLY ACHIEVE QUALITY SCORES THAT ARE BETTER THEN THE STATE AND NATIONAL AVERAGES. 0 0 134494089 421361 172534883 SEE SCHEDULE OAS ONE OF THE LARGEST NOT-FOR-PROFIT HEALTH CARE ORGANIZATIONS IN WEST CENTRAL OHIO, LIMA MEMORIAL HEALTH SYSTEM IS COMMITTED TO IMPROVING THE QUALITY OF LIFE IN OUR COMMUNITIES THROUGH COMPREHENSIVE HEALTH SERVICES. LIMA MEMORIAL IS CONTINUALLY IMPROVING ITS SERVICES AND FACILITIES BY KEEPING UP WITH THE LATEST TECHNOLOGIES, PROVIDING CONTINUING EDUCATION TO OUR HEALTHCARE TEAM AND UPDATING OUR FACILITIES. OUR PATIENT SATISFACTION NUMBERS CONTINUE TO IMPROVE AND WE CONTINUALLY ACHIEVE QUALITY SCORES THAT ARE BETTER THEN THE STATE AND NATIONAL AVERAGES.THE HEALTH SYSTEM PROVIDES COMPREHENSIVE HEALTHCARE THAT ALLOWS US TO CARE FOR OUR PATIENTS FROM BIRTH THROUGH ELDER YEARS. THESE SERVICES INCLUDE, BUT ARE NOT LIMITED TO: - CHEST PAIN CENTER WITH CYCLE III ACCREDITATION - 24-HOUR EMERGENCY SERVICES INCLUDING LEVEL II TRAUMA - FAMILY MEDICINE - THE HEART AND VASCULAR INSTITUTE - HOME HEALTH CARE - INPATIENT AND OUTPATIENT REHABILITATION SERVICES - LABORATORY - LEVEL II NEONATAL NURSERY - NEUROLOGY - OBSTETRICS AND PEDIATRICS - OCCUPATIONAL HEALTH - ONCOLOGY SERVICES - ORTHOPEDICS - RADIOLOGY - RENAL SERVICES - WALK IN CARE - WELLNESS SERVICES - WOMEN'S HEALTH CENTERIN 2012, LIMA MEMORIAL CONTRIBUTED MORE THAN AN ESTIMATED $30 MILLION IN COMMUNITY VALUE IN TERMS OF COMMUNITY BENEFIT EXPENDITURES, GOVERNMENT-SPONSORED HEALTHCARE AND NEARLY $6.5 MILLION IN CHARITY CARE. THIS NUMBER NOT ONLY INDICATES OUR COMMITMENT TO OUR COMMUNITIES, BUT ALSO FULFILLS OUR PURPOSE AS A NOT-FOR-PROFIT ORGANIZATION BY POSITIVELY IMPACTING THE MEMBERS OF OUR COMMUNITIES. THOUSANDS OF PEOPLE HAVE BENEFITED FROM THE COMPASSION, CARE AND EXPERTISE OF OUR PHYSICIANS, NURSES, ASSOCIATES AND VOLUNTEERS.EXAMPLES OF PROGRAMS BENEFITING THE BROADER COMMUNITY INCLUDE, BUT ARE NOT LIMITED TO:KIDS CLINICCHILDREN'S DEVELOPMENTAL CENTERCHEST PAIN CENTERBONE DENSITY SCREENINGSVASCULAR SCREENINGSVEIN SCREENINGSPROSTATE SCREENINGSCANCER RESOURCE CENTERMEDICARE ELIGIBILITY PROGRAMBREAST CANCER SURVIVOR SUPPORT GROUPFAMILY BIRTH CLINICSWOMEN'S RESOURCE CENTERTV AND RADIO PSASBREAST FEEDING CLASS AND CLINICBLOOD DRIVESAS HEALTHCARE CONTINUES TO CHANGE, LIMA MEMORIAL HEALTH SYSTEM WILL CONTINUE TO PROVIDE THE HIGHEST QUALITY OF CARE TO OUR PATIENTS. WE DO THIS BY CONTINUALLY ADVANCING OUR SERVICES AND MODERNIZING OUR FACILITIES. LIMA MEMORIAL HEALTH SYSTEM WILL SUPPORT OUR COMMUNITIES THROUGH COMPREHENSIVE HEALTHCARE AND OUTREACH ACTIVITIES SUCH AS HEALTHCARE AWARENESS AND PREVENTION PROGRAMS, FREE PUBLIC HEALTH SCREENINGS, FINANCIAL SUPPORT FOR COMMUNITY ORGANIZATIONS, AND OUTREACH TO THE THOSE IN NEED.COMMUNITY BENEFIT DEFINITIONSLIMA MEMORIAL HEALTH SYSTEM'S 2012 COMMUNITY BENEFIT REPORT WAS PREPARED IN ACCORDANCE WITH THE REPORTING GUIDELINES PUBLISHED BY THE CATHOLIC HEALTH ASSOCIATION. COMMUNITY BENEFITS REPORTED BY THE HEALTH SYSTEM RESPOND TO AN IDENTIFIED COMMUNITY NEED AND MEET AT LEAST ONE OF THE FOLLOWING CRITERIA:- GENERATE A LOW OR NEGATIVE MARGIN;- RESPOND TO THE NEEDS OF SPECIAL POPULATIONS, SUCH AS MINORITIES, FRAIL, ELDERLY, POOR PERSONS WITH DISABILITIES, THE CHRONICALLY MENTALLY ILL, AND PERSONS WITH AIDS; AND- SUPPLY SERVICES OR PROGRAMS THAT WOULD LIKELY BE DISCONTINUED IF THE DECISION WERE MADE ON A PURELY FINANCIAL BASIS.THESE SERVICES INCLUDE: - COMMUNITY HEALTH SERVICES - HEALTH PROFESSIONS EDUCATION - SUBSIDIZED HEALTH SERVICES - RESEARCH ACTIVITIES - FINANCIAL CONTRIBUTIONS - COMMUNITY BUILDING ACTIVITIES - COMMUNITY BENEFIT OPERATIONS - COST OF CHARITY CARE - GOVERNMENT SPONSORED HEALTHCARE 134494089 1 1 0 1 0 0 0 0 0 0 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 274 0 1 1684 1 1 1 0 0 0 0 0 0 0 0 0 X 12 10 0 0 0 0 1 0 0 1 1 0 0 1 1 1 1 1 1 1 1 1 1 OH X MERI FOSTER 4192265197 121 W HIGH ST LIMA OH 45801 JOHN H JOHNSON 1.00 1.00 X X 0 0 0 BARBARA STEELE 1.00 0.00 X X 0 0 0 JACK RANDOLPH 1.00 0.00 X X 0 0 0 KERMIT STROH 1.00 2.00 X X 0 0 0 BILL ROBINSON 1.00 1.00 X 0 0 0 BARRETT RYDELL 1.00 1.00 X 0 0 0 GARY AKENBERGER 1.00 0.00 X 0 0 0 LAWRENCE D BELL MD 1.00 39.00 X 0 527766 22956 DEBRA MCCURDY PHD 1.00 1.00 X 0 0 0 ROBERT L THOMPSON 1.00 0.00 X 0 0 0 KHA H TRAN MD 1.00 39.00 X 0 179028 26854 PHILLIP R BUELL 1.00 1.00 X 0 0 0 MICHAEL SWICK 34.00 6.00 X 840521 0 204759 ROBERT E ARMSTRONG JR 30.00 10.00 X 449901 0 100067 ERIC D POHJALA 34.00 6.00 X 397376 0 94904 CHARLES LYNN THOMPSON MD 20.00 20.00 X 416248 0 105275 ANN-MARIE JEAN POHL 40.00 0.00 X 180980 0 32515 ANITA GOOD 40.00 0.00 X 132518 0 21213 MARK RECKER 40.00 0.00 X 133513 0 12638 LYNN CARPENTER 4.00 36.00 X 144174 0 25875 CHERYL HOMAN 40.00 0.00 X 129139 0 21126 JUDY RECKER 40.00 0.00 X 126487 0 12983 2950857 706794 681165 34 0 1 0 LIMA ANESTHESIA & PAIN TREATMENT PC PO BOX 33058 PALM BEACH GARDENS FL 33420 MEDICAL SERVICES 3664358 MAYO COLLABORATIVE SERVICES 200 FIRST ST ROCHESTER MN 55905 MEDICAL SERVICES 1072785 APOGEE MEDICAL MANAGEMENT INC 2525 E CAMELBACK RD PHOENIX AZ 85016 MEDICAL SERVICES 1003617 NORTH CENTRAL OHIO PHYSICIAN SERVICES 1005 BELLEFONTAINE AVE LIMA OH 45804 MEDICAL SERVICES 837500 MORRISON MANAGEMENT SPECIALISTS PO BOX 102289 ATLANTA GA 30368 FOOD SERVICES 777822 35 55770 84 55854 PATIENT SERVICE REV 621110 170862698 170862698 RENT FROM AFFILIATE 900099 713782 713782 171576480 1026282 1026282 71887 -71887 -71887 -71887 REFERENCE LAB 541380 1163213 1163213 EDUCATIONAL SERVICES 621110 30119 30119 HEALTH PERFORMANCE K-1 525990 -8249 -8249 936533 936533 2121616 174708345 172534883 1163213 954395 X 409861 409861 11500 11500 2093087 2093087 55311751 44120273 11030068 161410 1409114 1127291 281823 9526778 7621422 1905356 4077092 3261674 815418 697283 557826 139457 92925 74340 18585 4705 4705 25001831 20001464 5000367 739601 590729 147682 1190 7096330 5669074 1417269 9987 2204933 1763946 440987 430219 342496 85624 2099 2081712 1665370 416342 9722439 7777951 1944488 1120464 896371 224093 MEDICAL SUPPLIES 26480605 26480605 BAD DEBT EXPENSE 10441716 10441716 RECRUITING 1221939 1038648 183291 EDUCATION & REWARDS 438198 349731 87433 1034 364868 291801 72950 117 160978951 134494089 26304320 180542 10343207 8239350 6012460 6308008 23192073 23787677 1653935 4147448 4582296 3495729 3373502 3266442 218252713 123613414 84769081 94639299 25984842 30458030 1894312 1703202 56457405 65558418 218263113 241603603 12870023 14956552 46055000 44433750 383847 2790032 21667669 21612135 80976539 83792469 X 137252469 157730557 34105 80577 137286574 157811134 218263113 241603603 X 13729394 866019 -9 5929156 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 10939 10939 0 EXPLANATION OF LOBBYING ACTIVITIES: PART II-B, LINE 1: LOBBYING EXPENSES ARE INCURRED IN CONNECTION WITH THE DUES PAID TO THE OHIO HOSPITAL ASSOCIATION AND THE AMERICAN HOSPITAL ASSOCIATION. 4222316 4222316 137666365 89098351 48568014 75287244 33851451 41435793 1076788 663612 413176 94639299 BOND ISSUE COSTS 442599 INVESTMENTS IN AFFILIATED ORG. 65115819 65558418 ACCRUED PENSION LIABILITY 2063911 PROFESSIONAL LIABILITY RESERVE 489000 FIN 47 ASBESTOS LIABILITY 2856947 THIRD PARTY PAYOR SETTLEMENTS 3694248 MINORITY INTEREST IN CONSOLIDATED SUBS 213811 FAIR VALUE OF INTEREST RATE SWAP AG 12294218 21612135 X 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. 1 1 X 1 X 1 X 1 1 1 0 1 1 6648120 1653889 4994231 0.03320 22032553 12925811 9106742 0.06050 28680673 14579700 14100973 0.09370 6571047 6571047 0.04370 231500 231500 0.00150 6802547 6802547 0.04520 35483220 14579700 20903520 0.13890 0 10441716 935578 41540137 48243714 -6703577 X 1 1 1 HEALTH PERFORMANCE MANAGEMENT COMPANY LLC CARDIOLOGY CO-MANAGEMENT 0.25000 0.75000 2 LMHS WOMEN'S HEALTH CO-MANAGEMENT COMPANY LLC CO-MANAGEMENT 0.50000 0.50000 1 1 LIMA MEMORIAL HEALTH SYSTEM

1001 BELLEFONTAINE AVE LIMA OH 45804

X X X LIMA MEMORIAL HEALTH SYSTEM 1 1 1 200.000000000000 1 300.000000000000 1 X X X X X X 1 1 X X X X 1 0 1 X 0 0 2 MEDICAL PARK

525 EASTOWN RD LIMA OH 45807

MRI, CT YMCA - WELLNESS CENTER

345 S ELIZABETH ST LIMA OH 45801

WELLNESS CENTER PART I, LINE 7: COLUMN C, LINE 7A & 7B: THE HOSPITAL USED A COST-TO-CHARGE COSTING METHODOLOGY TO CALCULATE THE AMOUNTS REPORTED IN LINE 7. THE HOSPITAL DERIVED THE COST-TO-CHARGE RATIO FROM THE USE OF WORKSHEET 2.PART I, LINE 7E:IN ADDITION TO LIMA MEMORIAL JOINT OPERATING COMPANY'S COMMUNITY HEALTH IMPROVEMENT SERVICES AND COMMUNITY BENEFIT OPERATIONS, THIS LINE AMOUNT ALSO INCLUDES COMMUNITY BENEFIT PROVIDED BY LIMA MEMORIAL PROFESSIONAL CORPORATION, WHICH IS A RELATED ENTITY, IN AS MUCH AS LIMA MEMORIAL PROFESSIONAL CORPORATION'S ACTIVITY, ARE CARRIED ON IN A MANNER CONSISTENT WITH AND DIRECTLY IN CONNECTION WITH THE TAX EXEMPT PURPOSE OF LIMA MEMORIAL JOINT OPERATING COMPANY. PART I, L7 COL(F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 24B, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE OF THIS COLUMN IS $10,441,716. PART II: BEYOND THE NUMBERS: KEY COMMUNITY BENEFITS ACTIVITIES OF 2012 - LIMA MEMORIAL DEVELOPS PROGRAMS AND SERVICES TO ADDRESS COMMUNITY HEALTH NEEDS AND MAKES INVESTMENTS IN INITIATIVES THAT ALIGN WITH THE HEALTH SYSTEM'S MISSION, VISION, AND VALUES. THE MAJORITY OF LIMA MEMORIAL'S COMMUNITY BENEFIT INVESTMENT WAS IN THE AREA OF CHARITABLE CARE TO ENSURE THAT THOSE WITHOUT INSURANCE OR WITH LIMITED INSURANCE HAVE ACCESS TO NEEDED MEDICAL CARE. BEYOND THAT FOCUS ARE PROGRAMS AND SERVICES THAT BENEFIT EVERY RESIDENT AND SUPPORT THE FAR REACHING GOAL OF A HEALTHIER WEST CENTRAL OHIO. LIMA MEMORIAL HEALTH SYSTEM CANNOT MEET ALL OF THE HEALTHCARE NEEDS WITHOUT THE ENGAGEMENT AND SUPPORT OF KEY STAKEHOLDERS INCLUDING OUR MEDICAL STAFF, AS WELL AS OTHER COMMUNITY ORGANIZATIONS. COMMUNITY HEALTH SERVICESIN 2012, LIMA MEMORIAL HEALTH SYSTEM PROVIDED AND/OR PARTICIPATED NUMEROUS COMMUNITY HEALTH SERVICE PROGRAMS. INCLUDED IN THIS CATEGORY ARE HEALTH AND WELLNESS EDUCATION, HEALTH SCREENINGS, COMMUNITY DEVELOPMENT, AND SERVICES TO HELP PEOPLE ADOPT HEALTHY LIFE-STYLE CHANGES. ALSO INCLUDED ARE THE MYRIAD OF SUPPORT GROUP ACTIVITIES THAT HELP PATIENTS AND THEIR FAMILIES MANAGE CHRONIC HEALTH CONDITIONS. KEY INITIATIVES THIS PAST YEAR INCLUDE DIAGNOSTIC HEART AND VASCULAR SCREENINGS FOR AT-RISK ADULTS, CHILDHOOD DIABETES EDUCATION IN AREA SCHOOLS, INJURY PREVENTION AND AWARENESS, AND HEALTHY EATING EVENTS.A THIRD SUBSET OF THIS CATEGORY INCLUDES HEALTH CARE SUPPORT SERVICES, OR THOSE SERVICES THAT ARE PROVIDED TO ASSIST COMMUNITY MEMBERS IN ACCESSING BOTH INFORMATION AND THE MEDICAL CARE THAT THEY NEED. CHIEF AMONG THE HEALTH SYSTEM'S SUPPORT INITIATIVES ARE THE FINANCIAL COUNSELORS THAT ENSURE THAT PATIENTS WHO ARE STRUGGLING FINANCIALLY AND/OR LACK MEDICAL INSURANCE ARE AFFORDED THE CARE THAT THEY NEED.HEALTH PROFESSIONS EDUCATIONLIMA MEMORIAL HEALTH SYSTEM BELIEVES THAT HAVING HIGHLY TRAINED MEDICAL PERSONNEL BENEFITS EVERYONE IN THE COMMUNITY. BEYOND ON-GOING EDUCATION FOR PHYSICIANS, NURSES, TECHNICIANS, AND OTHER CLINICIANS, THE HEALTH SYSTEM SUPPORTED NUMEROUS SPECIAL INITIATIVES IN 2012 TO FURTHER THE CAPABILITIES OF AREA MEDICAL PERSONNEL.OUR SCHOOLS OF NURSING PROGRAM PROVIDED A TRAINING SITE FOR OVER 450 NURSING STUDENTS IN 2012. LIMA MEMORIAL PROVIDES EDUCATION OUTREACH BEYOND THE WALLS OF THE HOSPITAL TO SUPPORT MEDICAL EDUCATION IN THE COMMUNITY BY PROVIDING HUNDREDS OF HOURS OF TRAINING FOR AREA EMTS AND PARAMEDICS. FINANCIAL CONTRIBUTIONSLIMA MEMORIAL PROVIDES BOTH CASH AND IN-KIND SUPPORT TO INDIVIDUALS AND OTHER COMMUNITY ORGANIZATIONS. THE SPONSORSHIP FUND PROVIDES FUNDING SUPPORT TO WEST-CENTRAL OHIO PROGRAMS THAT ADDRESS IDENTIFIED COMMUNITY NEEDS AND SERVE VULNERABLE POPULATIONS. IN 2012, LIMA MEMORIAL CONTRIBUTED TO MORE THAN 55 ORGANIZATIONS INCLUDING THE EQUESTRIAN THERAPY PROGRAM, YMCA OF LIMA, AMERICAN CANCER SOCIETY, THE ALLEN COUNTY SHERIFFS DEPARTMENT, THE UNITED WAY, AND THE AMERICAN RED CROSS. COMMUNITY BENEFIT OPERATIONSFOR 2012, THE COMMUNITY BENEFITS EXPENSE RECORDED INCLUDES THE SOFTWARE RENEWAL AND REPORT ON THE HEALTH SYSTEMS COMMUNITY BENEFIT INVESTMENT AS WELL AS THE STAFF EXPENSE TO TRACK AND INPUT THE INFORMATION. THE APPLICABLE COSTS FOR STAFF ENGAGING IN ACTUAL COMMUNITY BENEFIT SERVICES AND PROGRAMMING ARE REPORTED WITHIN SPECIFIC INITIATIVES AND ACTIVITIES. CHARITY CAREIN ACCORDANCE WITH REPORTING REQUIREMENTS, LIMA MEMORIAL'S CHARITY CARE EXPENSE IS BASED UPON COSTS VERSUS CHARGES. CHARITY CARE INCLUDES LIMA MEMORIAL'S TRADITIONAL INPATIENT AND EMERGENCY SERVICES. WHEN A PATIENT IS APPROVED TO RECEIVE FINANCIAL ASSISTANCE, THAT APPROVAL IS FOR A SIX-MONTH PERIOD AND INCLUDES ALL HOSPITAL CARE. THIS APPROACH ENSURES THAT ASSISTANCE IS PORTABLE AND THAT PATIENTS HAVE ACCESS TO NEEDED MEDICAL SERVICES BY MAKING A SINGLE APPLICATION.A KEY GOAL IS TO IDENTIFY COMMUNITY MEMBERS IN NEED SOONER. THE RESULT IS MORE CHARITY CARE AND FEWER BAD DEBTS.GOVERNMENT SPONSORED HEALTHCAREPAYMENT SHORTFALLS FOR PUBLIC INSURANCE PROGRAMS, INCLUDING MEDICAID AND MEDICARE, WERE $15,810,319 IN 2012. PART III, LINE 4: SECTION A: 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 AGAINST UNPAID CLAIMS BY CERTAIN PAYORS. THE ALLOWANCE FOR CONTRACTUAL ADJUSTMENTS IS REPORTED AS PART OF THE PATIENT ACCOUNTS RECEIVABLE AMOUNT ON THE CONSOLIDATED BALANCE SHEET. 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.PART III, SECTION A, LINE 3: BAD DEBT ATTRIBUTABLE TO PATIENTS IDENTIFIED UNDER CHARITY CARE WAS ESTIMATED BY A THIRD PARTY THROUGH THE SCREENING OF BAD DEBT PATIENTS AT POVERTY LEVEL. THE HOSPITAL APPLIES ANY DISCOUNTS/PAYMENTS RECEIVED AGAINST PATIENT ACCOUNTS BEFORE DETERMINING BAD DEBT EXPENSE. PART III, LINE 8: SECTION B: BASED ON A COST TO CHARGE RATIO DETERMINED IN ACCORDANCE WITH MEDICARE COST REPORT REQUIREMENTS, THE COSTS OF PROVIDING CARE TO THE MEDICARE POPULATION IN 2012 WAS $48,243,714. THE PAYMENTS RELATED TO THESE SERVICES WERE $41,540,137. LEAVING A MEDICARE SHORTFALL OF $6,703,577 FOR THE YEAR. THE MEDICARE SHORTFALL IS A COMMUNITY BENEFIT BECAUSE PROVIDING SERVICES TO THE ELDERLY IS A TAX EXEMPT PURPOSE CONSISTENT WITH LIMA MEMORIAL JOINT OPERATING COMPANY'S OVERALL EXEMPT STATUS, AND THE HOSPITAL ACCEPTS THESE PATIENTS REGARDLESS OF ITS IMPACT ON OVERALL PROFITABILITY. PART III, LINE 9B: SECTION C: PATIENTS DO NOT RECEIVE ANY NOTICE FROM LMH UNTIL BALANCES ARE DETERMINED TO BE THE PATIENT'S RESPONSIBILITY. PRIMARY SELF-PAY ACCOUNTS ARE REFERRED TO AN OUTSIDE AGENCY AS AN EXTENSION OF THE BUSINESS OFFICE AT DAY 45. ACCOUNTS REMAIN WITH THE AGENCY UNTIL IT IS AT A ZERO BALANCE OR 150 DAYS. AT 150 DAYS THE ACCOUNT IS CLOSED BACK AND GIVEN TO THE SUBSEQUENT AGENCY FOR REGULAR COLLECTION FOLLOW UP. BALANCE AFTER INSURANCE ACCOUNTS ARE REFERRED TO AN OUTSIDE AGENCY ONCE ANY MONEY IS MOVED INTO SELF PAY. THE ACCOUNT IS KEPT FOR A MINIMUM OF 90 DAYS AND THEN REFERRED TO A COLLECTION AGENCY. LIMA MEMORIAL HEALTH SYSTEM PART V, SECTION B, LINE 20D: ALL PATIENTS REGARDLESS OF THEIR ABILITY TO PAY ARE CHARGED THE SAME AMOUNT. THE FACILITY ATTEMPTS TO SCREEN ALL SELFPAY PATIENTS AND PROVIDES INFORMATION TO THEM CONCERNING CHARITY POLICIES. AT TIMES, PATIENTS ARE REQUESTED TO PROVIDE PROOF OF INCOME. OF THOSE PATIENTS THAT ARE NOT SCREENED AND DO NOT RETURN THE REQUIRED PAPERWORK, THEY ARE CHARGED FULL PRICE FOR THEIR SERVICE UNTIL PROOF OR A COMPLETED AND SIGNED APPLICATION IS RECEIVED. THE LEAST DISCOUNT RECEIVED IS 40% WHICH IS LARGER THAN THE AVERAGE COMMERICAL CSA. PART VI, LINE 2: LIMA MEMORIAL HEALTH SYSTEM REGULARLY PARTICIPATES IN COMPREHENSIVE COMMUNITY HEALTH NEEDS ASSESSMENTS TO IDENTIFY FAR-REACHING HEALTH NEEDS FACED BY PEOPLE IN THE COMMUNITIES SERVED BY THE HOSPITAL. ASSESSMENT RESULTS ARE EVALUATED OVER TIME AND SERVE AS THE BASIS TO DEVELOP NEW OR EXPANDED PLANS TO ADDRESS SERVICES IN RESPONSE TO NEED.LIMA MEMORIAL HEALTH SYSTEM JOINED OTHER AREA ORGANIZATIONS TO DEVELOP, IMPLEMENT AND UTILIZE THE 2009 ALLEN COUNTY COMMUNITY HEALTH NEEDS ASSESSMENT. THE NEEDS ASSESSMENT COLLECTED DATA FOR ALLEN COUNTY ADULTS (AGES 19 YEARS OF AGE AND OLDER) AND YOUTH (AGES 12 THROUGH 18) WHO PARTICIPATED IN A COUNTY-WIDE ASSESSMENT SURVEY DURING 2009. THE FINDINGS ARE BASED ON SELF-ADMINISTERED SURVEYS USING A STRUCTURED QUESTIONNAIRE. THE QUESTIONS WERE MODELED AFTER THE SURVEY INSTRUMENTS USED BY THE CENTERS FOR DISEASE CONTROL AND PREVENTION FOR THEIR NATIONAL AND STATE BEHAVIORAL RISK FACTOR SURVEILLANCE SYSTEM AND YOUTH RISK BEHAVIOR SURVEILLANCE SYSTEM. THE SURVEY ASSESSED THE FOLLOWING AREAS: COMMUNITY CONCERNS AND SERVICES, PHYSICAL HEALTH ISSUES AND BEHAVIORAL HEALTH ISSUES. FOR AREAS OUTSIDE OF ALLEN COUNTY, LIMA MEMORIAL UTILIZES DATA FROM ADDITIONAL COUNTY-BASED NEEDS ASSESSMENT WHEN AVAILABLE. THE RESULTS OF THIS SURVEY ARE BEING USED TO SHAPE LIMA MEMORIAL COMMUNITY OUTREACH EFFORTS.IN 2012, LMHS ALSO PARTICIPATED AND HELPED FUND THE PIONEERING HEALTHY COMMUNITIES IN CONJUNCTION WITH THE CITY OF LIMA AND THE ALLEN COUNTY YMCA. AS PART OF THE PROGRAM, NEED AND RISKS OF THE ALLEN COUNTY AREA WERE LOOKED AT. OBESITY, ESPECIALLY CHILDHOOD OBESITY, WAS DETERMINED TO BE A SIGNIFICANT HEALTH RISK. ALSO LMHS IS PART OF THE COMMUNITY SUSTAINABILITY ADVISORY COMMITTEE, WHICH IS ADDRESSING A VARIETY OF HEALTH-RELATED NEEDS IN THE COMMUNITIES WE SERVE. THIS COMMITTEE'S GOAL IS TO INCREASE THE NUMBER OF ADULTS WHO ARE AT A HEALTHY WEIGHT BY AT LEAST TWO PERCENTAGE POINTS BY 2020.ASSESSMENT SUMMARYWHEN ASKED TO RANK COMMUNITY PROBLEMS FROM A PREPARED LIST, 43% OF RESPONDENTS NOTED UNEMPLOYMENT AS THE SINGLE MOST IMPORTANT PROBLEM FACING LOCAL FAMILIES. RESIDENTS IDENTIFY JOB TRAINING & EMPLOYMENT SERVICES AS THE SINGLE MOST IMPORTANT SERVICE NEED IN THE COUNTY IN 2009. CRIME PREVENTION SERVICES WAS RANKED THE SECOND MOST IMPORTANT/MOST NEEDED SERVICE IN 2009.OTHER IMPORTANT AND EMERGING COMMUNITY PROBLEMS ARE FAMILY ISSUES OF DOMESTIC VIOLENCE, QUALITY OF LIFE, AND PARENTING. OTHER IMPORTANT SERVICES INCLUDED HEALTH CARE SERVICES, YOUTH PROGRAMS AND CARE OF THE ELDERLY. ALMOST ONE-QUARTER (24%) OF ALLEN COUNTY ADULTS REPORTED IN 2009 THAT THEY HAD ATTEMPTED TO GET ASSISTANCE FROM A SOCIAL SERVICE AGENCY. 58% OF THOSE ADULTS DID RECEIVE ASSISTANCE AND ONLY 1% OF ADULTS REPORTED THEY DID NOT KNOW WHERE TO LOOK FOR ASSISTANCE.PREVIOUS ASSESSMENTS BROUGHT TO LIGHT SOME OF THE PHYSICAL HEALTH CHALLENGES ALLEN COUNTY RESIDENTS FACED AND HIGH RATES OF CHRONIC DISEASE. ALTHOUGH ALLEN COUNTY DEATH RATES FOR HEART DISEASE, CANCER, STROKE, AND DIABETES HAVE DECREASED, THE NUMBER OF ADULTS WHO REPORT HAVING CLINICAL INDICATORS AND LIFESTYLE CHARACTERISTICS ASSOCIATED WITH THEM HAS INCREASED IN SEVERAL AREAS. TWO AREAS THAT HAVE INCREASED SINCE A 2002 SURVEY ARE CONSIDERABLY ABOVE STATE AND NATIONAL RATES ARE HIGH BLOOD PRESSURE AND EXCESSIVE BODY WEIGHT. ABOUT 3 OUT OF 4 ALLEN COUNTY ADULTS ARE CONSIDERED OVERWEIGHT OR OBESE BY BODY MASS INDEX STANDARDS(BMI). SOME POSITIVE CHANGES WERE NOTED - FEWER ADULTS REPORT NO LEISURE TIME ACTIVITY, INDICATING THEY ARE MORE ACTIVE THAN PREVIOUS ASSESSMENTS FOUND, AND CIGARETTE SMOKING IS DOWN IN ALLEN COUNTY, THOUGH STILL SLIGHTLY HIGHER THAN STATE AND NATIONAL RATES.HEALTH CARE WAS IDENTIFIED AS ONE OF THE TOP THREE MOST IMPORTANT SERVICES IN ALLEN COUNTY AND THE MAJORITY OF ADULTS (86%) REPORT HAVING HEALTH CARE COVERAGE. DESPITE THIS, FEWER WOMEN ARE PARTICIPATING IN SCREENINGS FOR EARLY DETECTION OF CANCER. A NOTABLE IMPROVEMENT FROM 2002 WAS THE PERCENTAGE OF ADULTS WHO HAVE VISITED A DENTIST IN THE PAST YEAR, THOUGH REPORTED DENTAL VISITS WITHIN THE PAST YEAR ARE STILL LOWER IN ALLEN COUNTY COMPARED TO STATE AND NATIONAL RATES. LIFESTYLE CHARACTERISTICS THAT CORRESPOND WITH REDUCED RISK FOR CHRONIC DISEASE INCLUDE A HEALTHY BODY WEIGHT, ADEQUATE FRUIT AND VEGETABLE CONSUMPTION, REGULAR LEISURE-TIME PHYSICAL ACTIVITY, AND NOT SMOKING, YET ONLY 0.8% OF ALLEN COUNTY ADULTS ENGAGE IN ALL FOUR HEALTHY LIFESTYLE CHARACTERISTICS.SOME OF THE HEALTH ISSUES FACING ALLEN COUNTY YOUTH INCLUDE EARLY SEXUAL ACTIVITY AND TEEN PREGNANCY, BULLYING, AND LACK OF SAFETY HABITS SUCH AS WEARING HELMETS WHEN RIDING BICYCLES AND ATVS, AND LACK OF REGULAR SEATBELT USE. PART VI, LINE 3: ALL PATIENTS OF LIMA MEMORIAL HOSPITAL ARE EDUCATED ON THE HOSPITAL'S CHARITY CARE PROGRAM DURING THE REGISTRATION PROCESS VIA WALL-POSTED STATEMENTS, HOSPITAL PERSONNEL INQUIRIES, ETC. INFORMATION REGARDING THE HOSPITAL'S CHARITY CARE IS ALSO FOUND ON LIMA MEMORIAL HOSPITAL'S WEBSITE. STATEMENTS GOING TO PATIENTS ALSO IDENTIFY THIS PROGRAM. PART VI, LINE 4: LIMA MEMORIAL HEALTH SYSTEM SERVES A 10 COUNTY AREA THAT INCLUDES MORE THAN 475,000 PEOPLE. THE COUNTIES INCLUDE ALLEN, AUGLAIZE, PUTNAM, HANCOCK, MERCER, HARDING, LOGAN, SHELBY, PAULDING, AND VAN WERT. THE MEDIUM HOUSEHOLD INCOME FOR THE REGION IS $44,300. 24% OF RESIDENTS ARE UNDER 18 YEARS-OLD, WHILE 14.5% OF RESIDENTS ARE 65 YEARS-OLD OR OLDER. 95.4% OF OUR ENTIRE SERVICE AREA IS CAUCASIAN, WHILE 2.75% ARE AFRICAN AMERICAN. IN OUR PRIMARY SERVICE AREA OF ALLEN COUNTY 85.6% ARE CAUCASIAN, WHILE 11.7% ARE AFRICAN AMERICAN.THE REGION IS PRIMARILY RURAL WITH SMALL COMMUNITIES. THE LARGEST CITY IN THE REGION IS LIMA WITH A POPULATION OF MORE THAN 38,000. PART VI, LINE 5: LIMA MEMORIAL HEALTH SYSTEM TAKES PART IN NUMEROUS HEALTH-RELATED COMMUNITY ACTIVITIES. HEALTH FAIRS IN OUR SERVICE AREA, FREE AND REDUCED MAMMOGRAMS, SPECIAL DISCOUNTS FOR LAB SERVICES FOR FREQUENTLY NEEDED TESTS ALL HELP LMHS ADDRESS THE NEEDS OF THE UNINSURED AND UNDERINSURED IN OUR AREA. PART VI, LINE 6: LIMA MEMORIAL HEALTH SYSTEM DEVELOPS PROGRAMS AND SERVICES TO ADDRESS COMMUNITY HEALTH NEEDS TO SUPPORT THE GOAL OF A HEALTHIER WEST CENTRAL OHIO. REPORTS FILED WITH STATES PART VI, LINE 7 OH 1 TOLEDO CHILDREN'S HOSPITAL FOUNDATION 2142 N COVE BLVD TOLEDO OH 43606 341901463 501(C)6 10000 COMMUNITY DEVELOPMENT/HEALTH AND WELLNESS EQUESTRIAN THERAPY PROGRAM 22532 BOWSHER RD CRIDERSVILLE OH 45806 341376159 501(C)3 5000 THERAPY PROGRAM FOR CHILDREN WITH DISABILITIES LIMA AREA FAMILY YMCA 345 S ELIZABETH ST LIMA OH 45801 344431173 501(C)3 262994 COMMUNITY DEVELOPMENT/HEALTH AND WELLNESS LIMA SYMPHONY ORCHESTRA 133 N ELIZABETH ST LIMA OH 45807 344465022 501(C)3 6800 COMMUNITY DEVELOPMENT SUPPORTING ARTS AMERICAN RED CROSS 610 S COLLET ST LIMA OH 45805 530196605 501(C)3 10000 COMMUNITY DEVELOPMENT/HEALTH AND WELLNESS LIMA MEMORIAL FOUNDATION 1001 BELLEFONTAINE AVE LIMA OH 45804 341707570 501(C)3 10000 HEALTH INITIATIVE THE LIMA NEWS 3515 ELIDA RD LIMA OH 45807 344466918 5000 COMMUNITY HEALTH EDUCATION WTLW 44 1844 BATY RD ELIDA OH 45807 341315196 501(C)3 16667 COMMUNITY DEVELOPMENT/HEALTH AND WELLNESS LIMA AREA CHAMBER OF COMMERCE 144 S MAIN ST LIMA OH 45801 344179070 501(C)3 5000 COMMUNITY DEVELOPMENT/HEALTH AND WELLNESS 7 2 PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, PART I, LINE 2: IN MOST CASES THE EFFECTIVE USE OF FUNDS IS EVIDENT THROUGH THE POSITIVE RESULTS OF THE PROGRAMS WE FUND. IN ADDITION, LIMA MEMORIAL HAS BOARD REPRESENTATION ON MOST OF THE ORGANIZATIONS WE SUPPORT. IF THIS IS NOT THE CASE WE DO ASK FOR THEIR BUSINESS PLAN AND A LIST OF EXPENDITURES. PART II LIMA ALLEN COUNTY REGIONAL PLANNING COMMISSION IS A GOVERNMENTAL ENTITY. X 1 1 X X X X X 0 1 0 0 0 0 0 0 0 LAWRENCE D BELL MD 0 522766 0 5000 0 0 0 7500 0 15456 0 550722 0 0 KHA H TRAN MD 0 170563 0 8465 0 0 0 5387 0 21467 0 205882 0 0 MICHAEL SWICK 316391 0 512924 0 11206 0 183292 0 21467 0 1045280 0 352255 0 ROBERT E ARMSTRONG JR 208762 0 235423 0 5716 0 78600 0 21467 0 549968 0 153912 0 ERIC D POHJALA 201234 0 190575 0 5567 0 73437 0 21467 0 492280 0 116446 0 CHARLES LYNN THOMPSON MD 227266 0 179398 0 9584 0 88101 0 17174 0 521523 0 92250 0 ANN-MARIE JEAN POHL 156437 0 20000 0 4543 0 32515 0 0 0 213495 0 0 0 ANITA GOOD 120780 0 10500 0 1238 0 4039 0 17174 0 153731 0 0 0 LYNN CARPENTER 127193 0 11000 0 5981 0 4408 0 21467 0 170049 0 0 0 CHERYL HOMAN 117241 0 9500 0 2398 0 3952 0 17174 0 150265 0 0 0 PART I, LINE 1A LIMA MEMORIAL JOINT OPERATING COMPANY PROVIDES SOCIAL CLUB DUES TO THE CEO; THEY ARE TREATED AS TAXABLE COMPENSATION. PART I, LINE 4B THE FOLLOWING INDIVIDUALS PARTICIPATED IN AN IRC 457(F) NON-QUALIFIED DEFERRED COMPENSATION PLAN: ERIC D. PAHJALA $15,905 ROBERT ARMSTRONG $19,222 MIKE SWICK $100,473 C. LYNN THOMPSON $23,414 A CITY OF LIMA-2007 BONDS 346400789 532567DH4 2007-07-18 25000000 HOSPITAL FACILITIES 0 0 0 B CITY OF LIMA-2003 BONDS 346400789 532567DG6 2003-04-10 10000000 HOSPITAL FACILITIES 0 0 0 C VILLAGE OF FT SHAWNEE 346006426 2007-06-07 6160000 HOSPITAL FACILITIES 0 0 0 D VILLAGE OF ELIDA 346407983 2007-05-22 7040000 HOSPITAL FACILITIES 0 0 0 A 25000000 2008 0 0 1 1 B 520000 10000000 2004 0 0 1 1 C 836250 6160000 2000 1 1 1 1 D 50000 7040000 2003 1 1 1 1 A 0 0 1 1 0 0.00000 0.00000 0.00000 0 0 1 B 0 0 1 1 0 0.00000 0.00000 0.00000 0 0 1 C 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 D 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 A 0 0 1 0 1 0 0 0 1 B 0 0 1 0 1 0 0 0 1 C 0 0 1 0 0 0 0 0 1 D 1 0 0 0 0 1 A 1 B 1 C 1 D 1 FORM 990, PART VI, SECTION A, LINE 6 THE MEMBERS ARE LIMA MEMORIAL HOSPITAL AND PH VENTURES, INC., WHOSE SOLE MEMBER IS PROMEDICA HEALTH SYSTEM, BOTH OHIO NONPROFIT CORPORATIONS. FORM 990, PART VI, SECTION B, LINE 11 THE AUDIT COMMITTEE OF THE BOARD REVIEWS AND APPROVES THE FORM 990, AND A COPY OF THE FORM 990 IS PROVIDED TO THE BOARD, PRIOR TO FILING. THIS PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. FORM 990, PART VI, SECTION B, LINE 12C EACH TRUSTEE, PRINCIPAL OFFICER, AND MEMBER OF A COMMITTEE WITH BOARD-DELEGATED POWERS SHALL ANNUALLY SIGN A STATEMENT WHICH AFFIRMS THAT SUCH PERSON: 1) HAS RECEIVED A COPY OF THE CONFLICTS OF INTEREST POLICY; 2) HAS READ AND UNDERSTANDS THE POLICY; 3) HAS AGREED TO COMPLY WITH THE POLICY; AND 4) UNDERSTANDS THAT THE CORPORATION IS A CHARITABLE ORGANIZATION AND THAT IN ORDER TO MAINTAIN ITS FEDERAL TAX EXEMPTION, IT MUST ENGAGE PRIMARILY IN ACTIVITIES WHICH ACCOMPLISH ONE OR MORE OF ITS TAX-EXEMPT PURPOSES. IF THE BOARD OR COMMITTEE HAS REASONABLE CAUSE TO BELIEVE THAT A MEMBER HAS FAILED TO DISCLOSE ACTUAL OR POSSIBLE CONFLICTS OF INTEREST, IT SHALL INFORM THE MEMBER OF THE BASIS FOR SUCH BELIEF AND AFFORD THE MEMBER AN OPPORTUNITY TO EXPLAIN THE ALLEGED FAILURE TO DISCLOSE. IF, AFTER HEARING THE RESPONSE OF THE MEMBER AND MAKING SUCH FURTHER INVESTIGATION AS MAY BE WARRANTED IN THE CIRCUMSTANCES, THE BOARD OR COMMITTEE DETERMINES THAT THE MEMBER HAS IN FACT FAILED TO DISCLOSE AN ACTUAL OR POSSIBLE CONFLICT OF INTEREST, IT SHALL TAKE APPROPRIATE DISCIPLINARY AND CORRECTIVE ACTION. FORM 990, PART VI, SECTION B, LINE 15 THE PROCESS FOR DETERMINING THE ORGANIZATION'S CEO, OTHER OFFICERS AND KEY EMPLOYEES' COMPENSATION INCLUDES: 1) REVIEW AND APPROVAL BY THE COMPENSATION COMMITTEE; 2) THE UTILIZATION OF AN INDEPENDENT COMPENSATION CONSULTANT; 3) COMPARABLE DATA; AND 4) CONTEMPORANEOUS DOCUMENTATION. THIS PROCESS WAS LAST COMPLETED IN 2012. FORM 990, PART VI, SECTION C, LINE 18 FORM 990, FORM 990-T AND FORM 1023 ARE AVAILABLE UPON REQUEST. FORM 990, PART VI, SECTION C, LINE 19 THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE CURRENTLY NOT AVAILABLE TO THE PUBLIC. OTHER FEES FORM 990, PART IX, LINE 11G TRAVEL AGENCY FEE: PROGRAM SERVICE EXPENSES 44,232. MANAGEMENT AND GENERAL EXPENSES 11,058. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 55,290. PURCHASED SERVICES FEE: PROGRAM SERVICE EXPENSES 12,448,339. MANAGEMENT AND GENERAL EXPENSES 3,112,085. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 15,560,424. MAINTENANCE FEE: PROGRAM SERVICE EXPENSES 3,816. MANAGEMENT AND GENERAL EXPENSES 954. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 4,770. CONSULTING FEE: PROGRAM SERVICE EXPENSES 240,138. MANAGEMENT AND GENERAL EXPENSES 60,035. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 300,173. COLLECTIONS FEE: PROGRAM SERVICE EXPENSES 891,977. MANAGEMENT AND GENERAL EXPENSES 222,994. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,114,971. EQUIPMENT RENTAL FEE: PROGRAM SERVICE EXPENSES 1,608,180. MANAGEMENT AND GENERAL EXPENSES 402,045. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,010,225. FREIGHT: PROGRAM SERVICE EXPENSES 252,085. MANAGEMENT AND GENERAL EXPENSES 63,021. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 315,106. WASTE REMOVAL: PROGRAM SERVICE EXPENSES 29,262. MANAGEMENT AND GENERAL EXPENSES 7,315. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 36,577. COURTESY TRANSPORTATION FEE: PROGRAM SERVICE EXPENSES 185,266. MANAGEMENT AND GENERAL EXPENSES 46,317. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 231,583. LAUNDRY SERVICE FEE: PROGRAM SERVICE EXPENSES 632. MANAGEMENT AND GENERAL EXPENSES 158. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 790. CLEANING FEE: PROGRAM SERVICE EXPENSES 91,530. MANAGEMENT AND GENERAL EXPENSES 22,882. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 114,412. PHYSICIAN FEE: PROGRAM SERVICE EXPENSES 2,117,954. MANAGEMENT AND GENERAL EXPENSES 529,489. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,647,443. CORPORATE FEE: PROGRAM SERVICE EXPENSES 444,379. MANAGEMENT AND GENERAL EXPENSES 111,095. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 555,474. CONTINGENCY FEE: PROGRAM SERVICE EXPENSES 2,375. MANAGEMENT AND GENERAL EXPENSES 594. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,969. FRANCHISE FEE: PROGRAM SERVICE EXPENSES 1,641,299. MANAGEMENT AND GENERAL EXPENSES 410,325. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,051,624. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 9: IMPLEMENTATION OF NEW ACCOUNTING PRONOUNCEMENT -76,360. INVESTMENT IN HEALTH PERFORMANCE MANAGEMENT COMPANY LLC 8,249. INVESTMENT IN LMHS WOMEN'S HEALTH CO-MANAGEMENT K-1 1,784. RESTRICTED CONTRIBUTIONS 5,995,483. FORM 990, PART XII, LINE 2C EXPLANATION THE AUDIT COMMITTEE ASSUMES RESPONSIBILITY FOR THE OVERSIGHT OF THE AUDIT AND THE SELECTION OF THE INDEPENDENT ACCOUNTANT. THIS PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. LIMA MEMORIAL HOSPITAL 1001 BELLEFONTAINE AVENUE LIMA OH 45804 344434676 HEALTHCARE OH 501(C)(3) 170(B)(1)(A)(III) LIMA MEMORIAL JOINT OPERATING COMPANY 0 LIMA MEMORIAL HOSPITAL FOUNDATION 1001 BELLEFONTAINE AVENUE LIMA OH 45804 341707570 SUPPORTING ORGANIZATION FOR LIMA MEMORIAL HOSPITAL OH 501(C)(3) 509(A)(3) LIMA MEMORIAL JOINT OPERATING COMPANY 1 LIMA MEMORIAL HOSPITAL AUXILIARY 1001 BELLEFONTAINE AVENUE LIMA OH 45804 341694632 SUPPORTING ORGANIZATION FOR LIMA MEMORIAL HOSPITAL OH 501(C)(3) 509(A)(3) LIMA MEMORIAL JOINT OPERATING COMPANY 1 LIMA MEMORIAL PROFESSIONAL CORPORATION 1001 BELLEFONTAINE AVENUE LIMA OH 45804 341935236 HEALTHCARE OH 501(C)(3) 170(B)(1)(A)(III) LIMA MEMORIAL JOINT OPERATING COMPANY 1 LMHS WOMEN'S HEALTH CO-MANAGEMENT COMPANY LLC 1001 BELLEFONTAINE AVE LIMA OH 45804 271023520 WOMEN'S HEALTH CO-MANAGEMENT OH LIMA MEMORIAL JOINT OPERATING COMPANY RELATED -1784 78046 0 1 0.50000 ELM TREE FOUNDATION 1220 EAST ELM STREET LIMA OH 45804 341417720 RENTAL REAL ESTATE OH LIMA MEMORIAL JOINT OPERATING COMPANY C 733408 7413655 1.00000 1 0 0 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 LIMA MEMORIAL HOSPITAL FOUNDATION S 2149012 EQUITY TRANSFER LIMA MEMORIAL PROFESSIONAL CORPORATION R 9012536 EQUITY TRANSFER LIMA MEMORIAL PROFESSIONAL CORPORATION J 713782 LEASE CONTRACT ELM TREE FOUNDATION K 139008 LEASE CONTRACT LIMA MEMORIAL PROFESSIONAL CORPORATION P 689027 CASH TRANSACTION ELM TREE FOUNDATION Q 150000 CASH TRANSACTION