2013-11-14T14:40:56-06:00 2012-12-31 351178661 BLUE & CO LLC 8800 LYRA DRIVE SUITE 450 COLUMBUS OH 43240 990 2012-01-01 344430716 FISHER-TITUS MEDICAL CENTER FISH 4196688101 272 BENEDICT AVENUE NORWALK OH 44857 DUANE WOODS JR 4196688101 2013-11-14 1 ROBERT M MORELAND P00418596 6148852583 2013-11-14 2012 2016-02-24 21:20:13Z ROSS MATLACK 272 BENEDICT AVENUE NORWALK OH 44857 132045872 0 X WWW.FTMC.COM X 1911 OH SEE SCHEDULE O 11 7 1074 289 1135265 108049 103445 36739 113348908 113659343 989771 570568 1083121 1058327 115525245 115324977 173780 289673 0 0 58358974 58430475 0 0 0 52898605 52373485 111431359 111093633 4093886 4231344 186179952 193347072 67931873 71718381 118248079 121628691 X PROVIDE QUALITY HEALTHCARE IN A COST EFFECTIVE MANNER, WHILE RESPECTING THE DIGNITY AND UNIQUENESS OF EACH INDIVIDUAL WE SERVE. 0 0 90807687 289673 105363051 SEE SCHEDULE O 4943270 0 7161027 SEE SCHEDULE O 95750957 1 1 0 1 0 0 0 0 0 0 1 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 1 0 0 0 0 0 1 0 0 1 1 1 0 0 0 1 1 1 1 0 0 1 119 0 1 1074 1 1 1 0 0 0 0 0 0 0 0 0 X 11 7 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 1 1 OH X DAVID WILSON MBACMA 4196688101 272 BENEDICT AVENUE NORWALK OH 44857 JOHN D PAYNE CPA 10.00 X 0 0 0 LESLIE D STONEHAM 15.00 X X 0 0 0 CHARLES F FUREY 8.00 X X 0 0 0 GLENN TRIPPE MD 8.00 X 0 0 0 WILLIAM B CORNELL MD 8.00 X 0 0 0 VIRGINIA H POLING 6.00 X 0 0 0 ERIC SCHMIDT MD 4.00 X 0 0 0 THOMAS C BLEILE 8.00 X 0 0 0 REV FRED WIECHERS 8.00 X X 0 0 0 MATT GROSS 12.00 X X 0 0 0 PATRICK J MARTIN 53.00 12.00 X X 1444319 0 229863 DUANE WOODS 44.50 5.50 X 235250 0 63839 LORNA STRAYER 50.00 X 200830 0 74117 CHERIE M SPRAGG 50.00 X 208080 0 84413 JOHN BRITTON 45.00 X 190435 0 15297 GARY MOOREMAN 45.00 X 324074 0 23009 PHILLIP J ANNARINO 45.00 X 183758 0 56848 JOHN K HUGHES 40.00 X 116269 117551 32872 GEORGE B ELMER 40.00 10.00 X 171041 0 26527 CHRISTINA CANFIELD 40.00 X 97570 90685 13972 JOSEPH E CENTA 40.00 X 114282 114579 28137 KATHLEEN A MEEHAN - DE LA CRUZ 40.00 X 102936 88656 25667 3388844 411471 674561 29 0 1 0 THE ROBINS & MORTON GROUP 5500 MARYLAND WAY SUITE 100 BRENTWOOD TN 37027 BUILDING CONTRACTOR 3457363 CERNER CORPORATION 2800 ROCKCREEK PARKWAY KANSAS CITY MO 64117 HEALTHCARE INFORMATION TECHNOLOGY 2714418 HOSPITAL MEDICINE ASSOCIATES OF OHIO PO BOX 634850 CINCINNATI OH 45263 HOSPITALIST 1425318 BOSTWICK DESIGN PARTNERSHIP 2729 PROSPECT AVE CLEVELAND OH 44115 ARCHITECTS 1227906 LABORATORY CORP OF AMERICA PO BOX 12140 BURLINGTON NC 27216 BLOOD ADMIN & LAB TESTING 645611 17 681 36058 36058 36739 NET PATIENT SERVICES 622110 105363051 105363051 NET NURSING HOME & ASSISTED LIVIN 623000 7161027 7161027 MEDICAL LABORATORY 621500 1126418 1126418 HEALTH AND ALLIED SERVICES 621990 8847 8847 113659343 384507 384507 145 145 16873536 33275 16139162 581733 734374 -548458 185916 185916 CAFETERIA SALES 722210 472962 472962 OTHER HOSPITAL REVENUE 900099 322249 322249 AUXILIARY SALES 453220 263116 263116 1058327 115324977 112524078 1135265 1628895 289673 289673 3334132 2235549 1098583 39668151 34437576 5230575 3851821 3343926 507895 8200606 7135683 1064923 3375765 2952928 422837 231872 173904 57968 112868 56434 56434 9117145 6252453 2864692 466670 458642 8028 3781376 2563173 1218203 3538675 2861776 676899 1884273 1231721 652552 112765 97476 15289 297544 101076 196468 1325071 1253587 71484 7697376 7281065 416311 677625 488236 189389 UBI INCOME TAX 67459 67459 MEDICAL SUPPLIES 14317695 14316661 1034 BAD DEBT EXPENSES 5642815 5642815 OHIO HOSPITAL TAX & SNF 1752197 1752197 1350059 756947 593112 111093633 95750957 15342676 0 5225 5225 18518902 8946760 14202026 12665479 245321 222121 586299 1534477 1934718 2163680 1999792 2040024 153145317 64651944 78382933 88493373 67547461 74581195 245374 245374 348961 229542 2162940 2219822 186179952 193347072 34681434 39791474 314054 292163 32760000 31515000 176385 119744 67931873 71718381 X 118229778 121610373 18301 18318 118248079 121628691 186179952 193347072 X 4231344 4615062 -5465794 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 1 0 1 8098 8098 0 EXPLANATION OF LOBBYING ACTIVITIES: PART II-B, LINE 1: EXECUTIVE MEMBERS OF THE ORGANIZATION, ON AN OCCASIONAL BASIS, MAY WRITE OR SPEAK TO LEGISLATIVE MEMBERS CONCERNING PROPOSED LEGISLATION THAT MIGHT IMPACT THE LOCAL DELIVERY OF HEALTHCARE SERVICES. THE MEDICAL CENTER HAS MEMBERSHIPS IN VARIOUS HEALTHCARE RELATED ASSOCIATIONS, WHICH PROVIDE STATE AND NATIONAL LEADERSHIP ON LEGAL, REGULATORY, QUALITY AND ACCREDITATION ISSUES. AS A PART OF THAT LEADERSHIP ROLE THESE ORGANIZATIONS DO CONTACT LEGISLATORS TO EXPRESS THEIR ASSOCIATION'S POSITIONS ON MATTERS IMPORTANT TO THEIR MEMBERSHIP. THE FOLLOWING ORGANIZATIONS LISTED BELOW SHOW THE PERCENTAGE OF THE DUES THAT REFLECT LOBBYING AS DETERMINED BY THE IRS: OHIO HEALTH CARE ASSOCIATION - 18.41% OF DUES; OHIO HOSPITAL ASSOCIATION - 5.3% OF DUES AND AMERICAN HOSPITAL ASSOCIATION - 23.98% OF DUES. 1487279 1487279 102036940 38949221 63087719 43180189 23398255 19781934 6440909 2304468 4136441 88493373 X 117947372 4615062 -1730209 2884853 115062519 262457 262457 115324976 113490524 2586243 2586243 110904281 189352 189352 111093633 PART XI, LINE 2D - OTHER ADJUSTMENTS: TRANSFER TO AFFILIATED ENTITY NORWALK AREA HEALTH SYSTEMS -1,517,500. FASB 158 PROVISIONS -4,650,739. HEALTH PROMOTIONS OF NORWALK REVENUE 565,446. FISHER-TITUS PAIN MANAGEMENT LLC REVENUE 3,872,584. PART XI, LINE 4B - OTHER ADJUSTMENTS: HOSPITAL AUXIIARY REVENUE 263,823. HOSPITAL EXPENSE ADJUSTMENTS TO REVENUES -1,366. PART XII, LINE 2D - OTHER ADJUSTMENTS: HEALTH PROMOTIONS OF NORWALK EXPENSES 474,962. FISHER-TITUS PAIN MANAGEMENT LLC EXPENSES 2,111,281. PART XII, LINE 4B - OTHER ADJUSTMENTS: HOSPITAL AUXILIARY EXPENSES 190,719. HOSPITAL EXPENSE ADJUSTMENTS TO REVENUES -1,367. PART X LINE 2 - MANAGEMENT HAS ANALYZED THE TAX POSITIONS TAKEN BY THESE ENTITIES, AND HAS CONCLUDED THAT AS OF DECEMBER 31, 2012 AND 2011, THERE ARE NO UNCERTAIN POSITIONS TAKEN OR EXPECTED TO BE TAKEN THAT WOULD REQUIRE, RECOGNITION OF A LIABILITY OR DISCLOSURE IN THE ACCOMPANYING CONSOLIDATED FINANCIAL STATEMENTS. FISHER-TITUS MEDICAL CENTER INDIVIDUAL ACCRUED UNCERTAIN TAX POSITION WAS $0.00 1 1 X 1 X 1 X 1 1 1 0 1 1 1 1689 1723183 541623 1181560 0.01120 1 23597 13520355 8176000 5344355 0.05070 0 0 2 25286 15243538 8717623 6525915 0.06190 39 67124 805534 51166 754368 0.00720 2 158 73026 11325 61701 0.00060 4 1087955 214522 873433 0.00830 3 1935 492278 492278 0.00470 48 69217 2458793 277013 2181780 0.02080 50 94503 17702331 8994636 8707695 0.08270 1 656 16546 16546 0.00020 1 3680 3680 3680 0.00000 2 4336 20226 20226 0.00020 1 5642815 1692845 23354802 30743129 -7388327 X 1 1 1 NORTH CENTRAL CARENET PHYSICIAN-HOSPITAL ORGANIZATION 0.50000 0.06380 0.43620 2 FISHER-TITUS PAIN MANAGEMENT LLC PAIN MANAGEMENT 0.51000 0.49000 1 1 FISHER-TITUS MEMORIAL HOSPITAL

272 BENEDICT AVENUE NORWALK OH 44857

X X X FISHER-TITUS MEMORIAL HOSPITAL 1 1 X X X X X X X X X 11 1 1 1 X X X X X X X X X X X 0 0 1 1 150.000000000000 1 200.000000000000 1 X X X X X 1 1 X X X X X 1 1 X X X X 1 X 0 1 2 NORWALK MEMORIAL HOME

272 BENEDICT AVENUE NORWALK OH 44857

INTERMEDIATE & SKILLED NURSING FACILITY THE CARRIAGE HOUSE OF FISHER-TITUS

175 SHADY LANE DRIVE NORWALK OH 44857

ASSISTED LIVING FACILITY PART I, LINE 7: THE COSTING METHODOLOGY USED FOR THE CHARITY CARE SEGMENT OF THE LINE 7 TABLE WAS THE IRS WORKSHEET 1 "CHARITY CARE AT COSTS" IN THE INSTRUCTIONS. COST TO CHARGE RATIOS WERE CARRIED OVER FROM THE IRS WORKSHEET 2 AS A BASIS TO ESTIMATE EXPENSES AND WAS APPLIED TO THE GROSS PATIENT CHARITY CARE CHARGES RECORDED IN 2012. THE COSTING METHODOLOGY USED FOR THE UNREIMBURSED MEDICAID SEGMENT OF THE LINE 7 TABLE WERE CALCULATED USING A COST TO CHARGE RATIO EXTRACTED FROM THE MEDICAID COST REPORT DATA. THE COSTING METHODOLOGY USED FOR "OTHER BENEFITS" SEGMENT OF THE LINE 7 TABLE WERE CALCULATED USING A COMBINATION OF DIRECT COSTS AND OUR COST ACCOUNTING SYSTEM, WHICH TAKES INTO CONSIDERATION ALL PATIENT TYPES AND SEGMENTS. 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 $ 5642815. PART II: IN 2012, FISHER-TITUS'S COMMUNITY BUILDING ACTIVITIES AND BENEFITS PROVIDED $15.9 MILLION TO SUPPORT PROGRAMS THAT IMPACTED THE OVERALL HEALTH OF OUR COMMUNITIES AND THE QUALITY OF LIFE OF OUR RESIDENTS. WHILE HOSPITAL-BASED MEDICAL SERVICES ARE THE MOST OBVIOUS WAY WE HELP, FTMC FULFILLS THE HEALTH-CARE NEEDS OF OUR AREA WITH COMMUNITY HEALTH SCREENINGS, EDUCATION CLASSES, PATIENT ASSISTANCE PROGRAMS AND SUPPORT OF HEALTH-RELATED ACTIVITIES. FTMC EMPLOYEES SERVE ON COMMUNITY AND CIVIC BOARDS, HEALTH-ORIENTED ORGANIZATIONS AND ARE INVOLVED IN ECONOMIC DEVELOPMENT ACTIVITIES THROUGHOUT THE COUNTY. FTMC ALSO WORKS WITH SCHOOLS; WORK SITES AND SAFETY NET PROVIDERS TO PROMOTE HEALTH AND WELLNESS AND PREVENT DISEASE. FISHER-TITUS IS A LEADER IN ENVIRONMENTAL STEWARDSHIP, HAVING EARNED NUMEROUS STATE AND NATIONAL AWARDS. PART III, LINE 4: THE COSTING METHODOLOGY USED FOR COMPLETING THE SCHEDULE H PART III, LINE 2 WAS THE IRS WORKSHEET A "ESTIMATED BAD DEBT EXPENSE (AT COST)" IN THE INSTRUCTIONS. COST TO CHARGE RATIOS WERE CARRIED OVER FROM IRS WORKSHEET 2 "RATIO OF PATIENT CARE COSTS TO CHARGES" AS A BASIS TO ESTIMATE EXPENSE AND WAS APPLIED TO THE BAD DEBT EXPENSE RECORDED IN 2012. CHARITY IN BAD DEBT EXPENSE: PART III, LINE 3 AS A TAX-EXEMPT HOSPITAL, WE MUST PROVIDE NECESSARY MEDICAL CARE REGARDLESS OF THE PATIENT'S ABILITY TO PAY FOR THE SERVICES PROVIDED. AS A NOT-FOR-PROFIT, PATIENT CARE IS PROVIDED TO ALL, REGARDLESS OF THE PATIENT'S ABILITY TO PAY FOR CARE. MAKING QUALITY PATIENT CARE AVAILABLE TO ALL IN OUR COMMUNITY, REGARDLESS OF THEIR ECONOMIC MEANS, QUALIFIES BAD DEBTS AS COMMUNITY BENEFIT. THE IDENTIFICATION OF PATIENTS ELIGIBLE FOR CHARITY CARE IS SOLELY BASED ON THE COOPERATION OF THE PATIENT TO PROVIDE THE ORGANIZATION ENOUGH FAMILY AND FINANCIAL INFORMATION TO DETERMINE ELIGIBILTY TO MATCH OUR PROGRAMS. HISTORICALLY, IN ADDITION TO THE INTERNALLY IDENTIFIED CHARITY, 13-15% OF THE ACCOUNT BALANCES TURNED TO COLLECTION WERE SUBSEQUENTLY IDENTIFIED BY THE AGENCY AS CHARITY AND RETURNED. THIS CHARITY IS RECORDED ONLY WHEN IT HAS BEEN IDENTIFIED THROUGH VERIFICATION OF INABILITY TO PAY. WE DO BELIEVE THERE IS A SECOND, RELATIVELY EQUAL SEGMENT OF THE BAD DEBT THAT WOULD QUALIFY FOR CHARITY. PATIENTS WITH POOR CREDIT RATINGS AND MULTIPLE CREDITORS MAKING COLLECTION EFFORT FINDS LITTLE VALUE IN COMPLETING THE CHARITY APPLCIATION PROCESS TO ONLY ELIMINATE ONE CREDITOR AND HAVE NO IMPROVEMENT TO THEIR FINANCIAL STATUS.WE ESTIMATE THAT UNDER THE CURRENT ECONOMIC CONDITIONS UNIDENTIFIED CHARITY IN BAD DEBT EXPENSE IS ESTIMATED TO BE AN ADDITIONAL $1,692,845 OR 30% OF BAD DEBT. SINCE THIS CALCUALTION IS ON AN ACCRUAL BASIS, WE BELEIVE ESTIMATING 15% FOR CHARITY TO BE IDENTIFIED IN FUTURE YEARS AND AN ADDITIONAL 15% FOR BALANCES NEVER IDENTIFIED AS CHARITY IS A VERY CONSERVATIVE AND REASONABLE ESTIMATE OF THIS CHARITY CARE VALUE. FOOTNOTE "ALLOWANCES FOR UNCOLLECTIBLE ACCOUNTS": PART III, LINE 4 THE PROVISION FOR BAD DEBTS IS BASED UPON MANAGEMENT'S ASSESSMENT OF HISTORICAL AND EXPECTED NET COLLECTIONS CONSIDERING BUSINESS AND ECONOMIC CONDITIONS, TRENDS IN THE HEALTHCARE COVERAGE AND OTHER COLLECTION INDICATORS. PERIODICALLY THROUGHOUT THE YEAR, MANAGEMENT ASSESSES THE ADEQUACY OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS BASED UPON SPECIFIC ACCOUNTS, HISTORICAL WRITE OFF EXPERIENCE AND CURRENT MARKET CONDITIONS. THE RESULTS OF THIS REVIEW ARE THEN USED TO MAKE ANY MODIFICATIONS TO THE PROVISION FOR BAD DEBTS TO ESTABLISH THE MOST UP TO DATE APPROPRIATE ALLOWANCE FOR UNCOLLECTIBLE RECEIVABLES. PART III, LINE 8: FISHER-TITUS MEDICAL CENTER'S MEDICARE ALLOWABLE COSTS WERE CALCULATED USING A COST TO CHARGE RATIO EXTRACTED FROM THE MEDICARE COST REPORT DATA. THE MEDICAL CENTER BELIEVES THAT ALL OF THE $7.4 MILLION DOLLAR SHORTFALL SHOULD BE CONSIDERED AS COMMUNITY BENEFIT, BECAUSE OUR MISSION IS TO PROMOTE HEALTH IN THE COMMUNITY AND WE DO NOT LIMIT THE CARE AVAILABLE TO ANY PATIENTS, INCLUDING THOSE COVERED BY MEDICARE. THE IRS COMMUNITY BENEFIT STANDARD INCLUDES THE PROVISION OF CARE TO THE ELDERLY. THIS YEAR, MEDICARE ACCOUNTED FOR 44% OF HOSPITAL REVENUES AND THESE MEDICARE BENEFICIARIES WERE PROVIDED CARE IN SPITE OF THIS SHORTFALL. CARING FOR THE MEDICARE BENEFICIARIES RELIEVES THE FEDERAL GOVERNMENT OF THE BURDEN OF PAYING THE TRUE COST FOR THEIR CARE AS THESE PATIENTS TYPICALLY HAVE LOW AND/OR FIXED INCOMES. TAX EXEMPT HOSPITALS ARE ALSO EXPECTED TO PARTICIPATE IN THE MEDICARE PROGRAM. MEDICARE SHORTFALLS MUST BE ABSORBED BY THE MEDICAL CENTER IN ORDER TO CONTINUE TREATING THE ELDERLY IN OUR COMMUNITY. PART III, LINE 9B THE CHARITY POLICY IS A SUBSET OF THE OVERALL COLLLECTION POLICY. WHEN PATIENTS ARE IDENTIFIED AS QUALIFYING FOR ANY OF THE CHARITY CATEGORIES WE SEARCH ACCOUNTS RECEIVABLE AND ACCOUNTS PLACED WITH COLLECTION AGENCIES AND PACKAGE THEM WITH THE APPLICATION. IN ADDITION, CHARITY INFORMATION IS SHARED WITH OUR RELATED ORGANIZATIONS AND FORMS THE BASIS FOR THEIR CHARITY ADJUSTMENTS. IN ADDITION, WITH PATIENT APPROVAL, WE MAY CONTACT LOCAL PHYSICIAN PRACTICES WITH THE INFORMATION AS MANY WILL ADJUST THEIR BALANCES BASED UPON THE INFORMATION PROVIDED. FISHER-TITUS MEMORIAL HOSPITAL PART V, SECTION B, LINE 3: HURON 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 PROJECT COORDINATOR FROM THE HOSPITAL COUNCIL OF NW OHIO CONDUCTED A SERIES OF MEETINGS WITH THE PLANNING COMMITTEE FROM HURON COUNTY. DURING THESE MEETINGS, BANKS OF POTENTIAL SURVEYQUESTIONS FROM THE BEHAVIORAL RISK FACTOR SURVEILLANCE AND YOUTH RISK BEHAVIOR SURVEILLANCE WERE REVIEWED AND DISCUSSED. BASED ON INPUT FROM THE HURON COUNTY PLANNING COMMITTEE, THE PROJECT COORDINATOR COMPOSED DRAFTS OF SURVEYS CONTAINING 115 ITEMS FOR THE ADULT SURVEY AND 75 ITEMS FOR THE ADOLESCENT SURVEY. THE DRAFTS WERE REVIEWED AND APPROVED BY THE HEALTH RESEARCHERS AT THE UNIVERSITY OF TOLDEO. 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. IN ADDITION, THE ORGANIZATIONS THAT SERVE THESE POPULATIONS PARTICIPATED IN THE HEALTH ASSESSMENT PROCESS. THE PARTICIPANTS WHO HAVE A (PH) AFTER THEIR NAME INDICATES THEY WORK IN THE PUBLIC HEALTH FIELD. THE PARTICIPANTS INCLUDED: TIMOTHY HOLLINGER (PH), ANGELA SMITH (PH) AND KATIE SPAAR (PH) ALL FROM HURON COUNTY GENERAL HEALTH DISTRICT; ANNE WAGONER (PH) AND EMILY HUESTISS (PH) BOTH FROM MERCY WILLARD HOSPITAL; LORNA STRAYER (PH) FISHER-TITUS MEDICAL CENTER; JEAN KING (PH) HURON COUNTY ADAMHS BOARD; KARI SMITH (PH) HURON COUNTY BOARD OF DEVELOPMENT DISABILITIES; RENEE GEROME (PH) FIRELANDSCOUNSELING & RECOVERY SERVICES; DEBRA FISHER (PH) ERIE-HURON COUNTIES, CAC; CHARLOTTE WAGNER, NORTH POINT EDUCATIONAL SERVICE CENTER DIRECTOR; KIM SCHUBERT, BELLEVUE CITY SCHOOLS SUPERINTENDENT; DAVID STUBBLEBINE, MONROEVILLE LOCAL SCHOOLS SUPERINTENDENT; CAROL GIRTON, NEW LONDON LOCAL SCHOOLS SUPERINTENDENT; DENNIS DOUGHTY, NORWALK CITY SCHOOLS SUPERINTENDENT; BENJAMIN CHAFFEE JR, SOUTH CENTRAL SCHOOLS SUPERINTENDENT; RODGE WILSON, WESTERN RESERVE LOCAL SCHOOLS SUPERINTENDENT AND DAN DANHOFF WILLARD CITY SCHOOLS SUPERINTERDENT. FISHER-TITUS MEMORIAL HOSPITAL PART V, SECTION B, LINE 4: MERCY HOSPITAL OF WILLARD, THE BELLEVUE HOSPITAL AND FIRELANDS REGIONALHOSPITAL (COUNSELING & RECOVERY CENTER) FISHER-TITUS MEMORIAL HOSPITAL PART V, SECTION B, LINE 5C: THE ASSESSMENT IS AVAILABLE ON THE HOSPITAL'S WEBSITE AT HTTP://WWW.FISHER-TITUS.ORG/IMAGES/STORIES/PDFS/HURONCOHEALTHASSESSMENTFINALREPORT 2011.PDF.THE ASSESSMENT IS ALSO AVAILABLE ON THE FOLLOWING ADDITIONAL WEBSITES: HURON COUNTY GENERAL HEALTH DISTRICT - HTTP://WWW.HURONCOHEALTH.COM/HEALTH-ASSESSMENT#!_HEALTH-ASSESSMENT AND THE HOSPITAL COUNCIL OF NORTHWEST OHIO - HTTP://WWW.HCNO.ORG/COMMUNITY/REPORTS.HTML FISHER-TITUS MEMORIAL HOSPITAL PART V, SECTION B, LINE 7: EACH OF THE HEALTH NEEDS LISTED BELOW IS IMPORTANT AND IS BEING ADDRESSED BY NUMEROUS PROGRAMS AND INITIATIVES SUPPORTED BY FISHER-TITUS MEDICAL CENTER AND OTHER COMMUNITY PARTNERS OF THE HOSPITAL. THE MEDICAL CENTER DOES NOT ADDRESS THESE NEEDS LISTED BELOW AS PART OF THIS IMPLEMENTATION PLAN DUE TO LIMITED FINANCIAL AND HUMAN RESOURCES AND THE NEED TO ALLOCATE SIGNIFICANTRESOURCES ON THE THREE PRIORITY HEALTH NEEDS LISTED IN THE IMPLENTATION PLAN. NEEDS NOT ADDRESSED: 1. 12% OF HURON COUNTY ADULTS WERE WITHOUT HEALTH CARE COVERAGE; 2. 22 % OF HURON COUNTY ADULTS AREDIAGNOSED WITH ARTHRITIS; 3. 10% OF HURON COUNTY ADULTS AND 18% OF YOUTHS WERE DIAGNOSED WITH ASTHMA;4. INSECTS AND MOLD WERE REPORTED AS THE TWO MOST THREATENING ENVIRONMENTAL HEALTH ISSUES BY RESPONDENTS AND 5. 45% OF ADULTS HAD NOT VISITED A DENTIST OR DENTAL CLINIC IN THE PAST YEAR. FISHER-TITUS MEMORIAL HOSPITAL PART V, SECTION B, LINE 17E: AS PART OF ITS FINANCIAL ASSISTANCE POLICY, FISHER TITUS MEDICAL CENTER (THE HOSPITAL) MAKES A CONCERTED EFFORT TO DETERMINE IF AN INDIVIDUAL IS ELIGIBLE FOR FINANCIAL ASSISTANCE PRIOR TO PROCEEDING WITH COLLECTION ACTIVITIES BY THE HOSPITAL OR BY ENGAGING A THIRD PARTY. THESE EFFORTS INCLUDE NOTIFYING THE INDIVIDUAL OF THE FINANCIAL ASSISTANCE POLICY (FAP) ON ADMISSION, INCLUDING INFORMATION ABOUT THE FAP IN COMMUNICATIONS ABOUT THE INDIVIDUAL'S BILLS AND DOCUMENTING THE HOSPITAL'S DETERMINATION OF AN INDIVIDUAL'S ELIGIBILITY TO RECEIVE ASSISTANCE UNDER THE FAP. IF THE RESULT OF THESE EFFORTS IS UNSUCCESSFUL, THE HOSPITAL WILL PROCEED WITH COLLECTIONS ACTIVITY. THESE ACTIVITIES INCLUDE REPORTING THE INDIVIDUAL TO THE APPROPRIATE CREDIT AGENCY, LEGAL ACTIONS OR LIENS AS DEEMED NECESSARY. IF IT IS DETERMINED THAT AN INDIVIDUAL IS ELIGIBLE UNDER THE FAP SUBSEQUENT TO COLLECTION ACTIVITY BEGINNING, ALL COLLECTION ACTIVITY WILL CEASE. PART V, SECTION B 19(D) THE DISCOUNT RATE FOR SELF-PAY PATIENTS WAS SET TO MATCH THE RATE OF OUR TWO PREDOMINANT COMMERCIAL INSURANCE CONTRACTS WHICH MAKE UP 2/3RDS OF OUR POPULATION COVERED BY THIRD PARTY INSURANCE. PART V, SECTION B 20, 21 & 22 FISHER TITUS MEDICAL CENTER INITIALLY CHARGES ALL CLASSES OF PATIENTS THE SAME GROSS CHARGE FOR ANY PARTICULAR SERVICE AND IS REFLECTED AS SUCH ON ALL INITIAL BILLS. AT THE TIME OF ADMISSION, FTMC ATTEMPTS TO COLLECT INFORMATION ON THE INTENDED MEANS OF PAYING FOR SERVICES, INCLUDING DISTRIBUTING INFORMATION ON APPLYING FOR FINANCIAL ASSISTANCE, BUT DO NOT RESTRICT ACCESS BASED ON WHETHER THE INTENDED MEANS OF PAYING FOR SERVICES IS PROVIDED. PATIENTS WHO APPLY FOR FINANCIAL ASSISTANCE, EITHER AT THE TIME OF SERVICE OR SUBSEQUENT TO THE SERVICES BEING PROVIDED, HAVE THEIR BILLS PUT ON A "HOLD" STATUS AS SOON AS PATIENTS MAKE ANY CONTACT WITH OUR FINANCIAL COUNSELING STAFF. UPON REVIEW AND APPROVAL OF APPLICATIONS AND ANY DISCUSSION WITH OUR FINANCIAL COUNSELORS GROSS CHARGES ARE THEN ADJUSTED ACCORDING TO FTMC CHARITY POLICY BEFORE ANY FURTHER BILLING PROCESSES ARE RESUMED. PART V, SECTION B LINE 6 THE ADOPTED IMPLEMENTATION STRATEGY CAN BE FOUND ON THE MEDICAL CENTER'S WEBSITE AT: HTTP://WWW.FISHER-TITUS.ORG/IMAGES/IMPLEMENTATION_STRATEGIES_FOR_2011_CHNA.PDF PART VI, LINE 2: FISHER-TITUS SPONSORED AND COLLABORATED WITH THE HURON COUNTY GENERAL HEALTH DISTRICT AND OTHER HEALTH-RELATED ORGANIZATIONS (CALLED HURON COUNTY HEALTH PARTNERS) TO DEVELOP AND FUND THE HURON COUNTY HEALTH NEEDS ASSESSMENT IN 2011. LOCAL COMMUNITY AGENCIES WERE INVITED TO PARTICIPATE IN THE HEALTH ASSESSMENT PROCESS, INCLUDING CHOOSING QUESTIONS FOR THE SURVEYS, PROVIDING LOCAL DATA, REVIEWING DRAFT REPORTS AND PLANNING THE COMMUITY RELEASE OF THE DATA AND SETTING PRIORITIES. THERE WERE OVER 50 KEY LEADERS FROM THE COMMUNITY THAT REPRESENTED PUBLIC HEALTH, LAW ENFORCEMENT, SCHOOLS, CHURCHES, LOCAL OFFICIALS, SOCIAL AGENCIES AND OTHER VARIOUS COMMUNITY MEMBERS IN ATTENDANCE AT THE PUBLIC RELEASE OF THECOMMUNITY HEALTH NEEDS ASSESSMENT. AT THE EVENT, PARTICIPANTS, PARTICIPATED IN FOCUS GROUPS AND PRIORITIES WERE CHOOSEN FOR HURON COUNTY TO FOCUS ON OVER THE NEXT FEW YEARS. FTMC ALSO USES THIS INFORMATION TO ADD AND EXPAND SERVICES AND TO RECRUIT PHYSICIANS TO MEET THE THEN IDENTIFIED MEDICAL NEEDS OF OUR COMMUNITY. FROM THESE PRIOTIES, FTMC HAS DEVELOPED NUMEROUS PROGRAMS TARGETING THE HURON COUNTY'S HIGH RATE OF OBESITY, DIABETES AND CARDIOVASCULAR ISSUES. PROGRAMS INCLUDING DIABETESSCREENINGS AT HISPANIC HEALTH FAIRS AND VARIOUS LOCATIONS IN THE COUNTY, NUTRITION AND FITNESS FOR SCHOOL CHILDREN, DEVELOPING A COMMUNITY GARDEN AND A COUNTY-WIDE WALKING PROGRAM IN PARTNERSHIP WITH THE AMERICAN HEART ASSOCIATION AND LOCAL PHYSICIANS AND BUSINESSES. PART VI, LINE 3: PATIENTS ARE INTERVIEWED AFTER REGISTRATION TO ASSIST THEM IN DETERMINING EACH PATIENT'S ELIGIBILITY FOR FINANCIAL ASSISTANCE PROGRAMS AVAILABLE INTERNALLY AND EXTERNALLY. FTMC HAS BILINGUAL SIGNAGE POSTED IN THE ADMITTING/REGISTRATION AREAS, BILLING OFFICE AND FINANCIAL COUNSELING OFFICES, AND IN THE INPATIENT GUIDES IN ALL PATIENT ROOMS. THE FTMC WEBSITE HAS A SECTION ABOUT THE FINANCIAL ASSISTANCE PROGRAM AND CONTRACT INFORMATION. A MESSAGE ABOUT FINANCIAL ASSISTANCE AND CHARITY CARE ALSO IS INCLUDED ON THE BILLS THAT ARE SENT TO THE PATIENTS. MANY MATERIALS ARE BILINGUAL AND INTERPRETATION SERVICES ARE AVAILABLE. THE MEDICAL CENTER SUPPORTS AN OUTSIDE COUNSELOR DEDICATED TO HELPING PATIENTS BECOME QUALIFIED FOR MEDICAID OR OTHER GOVERNMENT PROGRAMS. THEY ALSO REFER PATIENTS WHO DON'T QUALIFY FOR THOSE PROGRAMS TO OUR FTMC FINANCIAL COUNSELORS FOR ASSISTANCE WITH H.C.A.P., FISHER-TITUS CHARITY AND FISHER-TITUS COMMUNITY ASSISTANCE PROGRAMS. OUR SOCIAL SERVICES DEPARTMENT REGULARLY REFERS PATIENTS IN NEED TO OUR FINANCIAL COUNSELORS FOR ASSISTANCE. WE ALSO TAKE REFERRALS FROM THE LOCAL COUNTY HUMAN SERVICES AGENCIES, VICTIMS OF VIOLENT CRIMES, LOCAL HEALTH DEPARTMENTS, LOCAL LAW ENFORCEMENT AGENCIES, CHURCHES, ETC. FTMC IS VERY PROACTIVE IN TAKING THE MESSAGE TO OUR COMMUNITY. BROCHURES ARE AVAILABLE AT COMMUNITY OUTREACH EVENTS HELD IN THE HOSPITAL AND AT OUTSIDE COMMUNITY EVENTS. FTMC COMMUNICATES THE INFORMATION ABOUT CHARITY CARE PROGRAMS THROUGH ITS COMMUNITY NEWSLETTER AND LOCAL NEWS MEDIA. PART VI, LINE 4: THE FISHER-TITUS MEDICAL CENTER PROVIDES COMPREHENSIVE STATE-OF-THE ART HEALTH CARE SERVICES TO THE RESIDENTS OF HURON, ERIE AND THE ADJACENT SURROUNDING COMMUNITIES WITH THE LATEST MEDICAL ADVANCEMENTS. THE PRIMARY AREA IS THE GREATER HURON COUNTY AREA IN NORTH CENTRAL OHIO, WHICH IS HOME TO AROUND 60,000 RESIDENTS. FTMC'S 50 ACRE CAMPUS IS IN THE COUNTY SEAT OF NORWALK, WHICH IS THE LARGEST CITY IN THE COUNTY WITH OVER 17,000 RESIDENTS. FTMC HAS NUMEROUS MEDICAL OFFICES THROUGHOUT THE COUNTYIN SMALLER CITIES TO PROVIDE EASIER ACCESS TO PHYSICIANS FOR COMMUNITY MEMBERS. THE COUNTY IS HOME TO SEVERAL LARGE MANUFACTURERS WHO HAVE EXPERIENCED MAJOR JOB LOSSES OVER THE PAST 10 YEARS. HURON COUNTYHAD THE TENTH HIGHEST UNEMPLOYMENT RATE IN OHIO IN 2012 WITH AN ANNUAL AVERAGE OF 10.2%. THE LARGEST PERCENTAGE OF RESIDENTS ARE CHILDREN UNDER 18 WITH THOSE 65 AND OLDER MAKING UP THE 2ND LARGEST PERCENTAGE. 91% OF THE RESIDENTS ARE CAUCASIAN WITH A GROWING HISPANIC POPULATION OF 5.9%. THE MEDIAN HOUSEHOLD INCOME IN HURON COUNTY (IN 2010 INFLATION-ADJUSTED DOLLARS) WAS $62,033 WITH 12.9% OF THE FAMILIES LIVING BELOW THE POVERTY LEVEL AND 26.3% LIVING BELOW 200% OF THE POVERTY RATE IN 2010. 12% OFHURON COUNTY ADULTS WERE WITHOUT HEALTH COVERAGE. THE OVERALL TRENDS INDICATE A DECLINE IN EMPLOYMENT-BASED MEDICAL INSURANCE AND INCREASING UNINSURED AND RELIANCE ON GOVERNMENT PROGRAMS. PART VI, LINE 5: THE BOARD OF DIRECTORS IS COMPOSED OF AREA RESIDENTS INCLUDING BUSINESS AND COMMUNITY LEADERS, PHYSICIANS AND OTHER INTERESTED PERSONS. THESE VOLUNTEERS GIVE COUNTLESS HOURS OF SERVICE TO THE MEDICAL CENTER IN THEIR OVERSIGHT ROLE. THEY ARE INVOLVED IN THE COMMUNITY NEEDS ASSESSMENT PROCESS, IN FUNDRAISING, AND IN GENERAL STEWARDHSIP. FTMC'S MEDICAL STAFF IS OPEN AND PRIVILEGES ARE GRANTED TO ALL QUALIFIED PHYSICIANS WHO APPLY AND MEET THE STANDARDS OF THE MEDICAL CENTER PRIVILEGING PROCESS. THE MEDICAL CENTER UTILIZES SURPLUS FUNDS TO MAINTAIN ACCESS TO PATIENT SERVICES AND TO EXPAND ACCESS POINTS OF CARE TO PATIENTS THROUGHOUT THE COMMUNITY INCLUDING, BUT NOT LIMITED TO THE FOLLOWING:1. EDUCATIONAL PROGRAMS THAT PROVIDE CLASSES AND INFORMATION ON TOBACCO CESSATION, HEALTHY AGINING, CHILDBIRTH, INFANT CARE, EARLY PREGNANCY AND MORE2. FREE BLOOD PRESSURE AND DIABETES SCREENINGS, AND MAMMOGRAMS TO QUALIFYING INDIVIDUALS, FREE OR LOW-COST SCREENINGS FOR BREAST, PROSTATE, SKIN AND COLORECTAL CANCERS ANS WELL AS OSTEOPOROSIS ASSESSMENTS. 1 SERVICES FOR AGING INC 130 SHADY LANE DR NORWALK OH 44857 341108780 501(C)(3) 12500 HELP ASSIST SENIORS IN THE LOCAL COMMUNITY IN GETTING LOW-COST HEALTHCARE SERVICES. HURON COUNTY HEALTH DEPARTMENT 180 MILAN AVE NORWALK OH 44857 115 10000 DONATION FOR THE HURON COUNTY HEALTH DEPARTMENT CLINIC AND SERVICES NORWALK AREA UNITED FUND 10 WEST MAIN ST NORWALK OH 44857 340906312 501(C)(3) 20000 CONTRIBUTE TO THE UNITED WAY PACESETTER CAMPAIGN TO HELP THE LOCAL COMMUNITY NORWALK ECONOMIC DEVELOPMENT FUND 10 1/2 WEST MAIN ST NORWALK OH 44857 341787391 501(C)(3) 5000 CONTRIBUTION TO THE NORWALK ECONOMIC DEVELOPMENT CORP TO HELP THE LOCAL COMMUNITY AMERICAN RED CROSS 300 CENTRAL AVENUE SANDUSKY OH 44870 530196605 501(C)(3) 15897 CONTRIBUTIONS TO THE RED CROSS FOR RELIEF EFFORTS DUE TO THE HURRICANE STORM SANDY. AMERICAN HEART ASSOCIATION 5455 N HIGH STREET COLUMBUS OH 43215 135613797 501(C)(3) 17500 CORPORATE SPONSORSHIP FOR THE HURON COUNTY HEART WALK SHELBY CHRISTIAN AND MISSIONARY ALLIANCE CHURCH 105 SMILEY AVENUE SHELBY OH 44875 341354574 501(C)(3) 134637 FMV MISCELLANEOUS OPERATING ROOM MEDICAL SUPPLIES DONATED MISCELLANEOUS MEDICAL SUPPLIES AND OPERATING SUPPLIES TO CHURCH THIRD WORLD MISSION. SHELBY CHRISTIAN AND MISSIONARY ALLIANCE CHURCH 105 SMILEY AVENUE SHELBY OH 44875 341354574 501(C)(3) 74139 FMV MISCELLANEOUS CATH LAB MEDICAL SUPPLIES DONATED MISCELLANEOUS CATH LAB MEDICAL SUPPLIES TO CHURCH THIRD WORLD MISSION. 8 0 PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, PART I, LINE 2: THE MEDICAL CENTER REVIEWS EACH GRANT OR DONATION REQUEST BEFORE IT IS MADE. X X X X X X 0 1 0 0 0 0 0 0 0 PATRICK J MARTIN 480756 0 147352 0 816211 0 211011 0 18852 0 1674182 0 793635 0 DUANE WOODS 195162 0 39642 0 446 0 48939 0 14900 0 299089 0 0 0 LORNA STRAYER 160569 0 39698 0 563 0 47835 0 26282 0 274947 0 0 0 CHERIE M SPRAGG 171841 0 35146 0 1093 0 75034 0 9379 0 292493 0 0 0 JOHN BRITTON 158572 0 31662 0 201 0 15297 0 0 0 205732 0 0 0 GARY MOOREMAN 295344 0 26913 0 1817 0 14525 0 8484 0 347083 0 0 0 PHILLIP J ANNARINO 151434 0 31362 0 962 0 39696 0 17152 0 240606 0 0 0 JOHN K HUGHES 113121 115005 0 0 3148 2546 4815 3685 12186 12186 133270 133422 0 0 GEORGE B ELMER 150658 0 19412 0 971 0 3245 0 23282 0 197568 0 0 0 CHRISTINA CANFIELD 76033 76399 21253 14050 284 236 0 0 6986 6986 104556 97671 0 0 JOSEPH E CENTA 114181 114180 0 0 101 399 2910 2945 11141 11141 128333 128665 0 0 KATHLEEN A MEEHAN - DE LA CRUZ 94346 83949 3321 0 5269 4707 4256 3685 8863 8863 116055 101204 0 0 SUPPLEMENTAL INFORMATION PART III PART I LINE 4B & PART II, LINE 1 - INCLUDED IN MR. MARTIN'S TOTAL W-2 COMPENSATION OF $1,444,319 IS $793,635 WHICH REPRESENTS THE CURRENT YEAR PAYMENT OF DEFERRED COMPENSATION FROM A NON-QUALIFIED RETIREMENT PLAN WHICH WAS DEFERRED ON PRIOR FORM 990'S. INCLUDED IN MR. MARTIN'S TOTAL W-2 COMPENSATION OF $1,444,319 IS $201,868 WHICH REPRESENTS THE PORTION OF MR. MARTIN'S SALARY ALLOCABLE TO THE NORWALK MEMORIAL HOME, A DIVISION OF FISHER-TITUS MEDICAL CENTER. INCLUDED IN THE TOTAL CONTRIBUTION TO DEFERRED COMPENSATION OF $211,011 IN COLUMN C IS $119,007 OF VESTED DEFERRED WAGES AND QUALIFIED RETIREMENT PLAN CONTRIBUTIONS AND $92,004 FOR THE CURRENT YEAR ACCRUAL OF A NON-VESTED, NON-QUALIFIED RETIREMENT PLAN. THIS PLAN PROVIDES AN ADDITIONAL RETIREMENT BENEFIT BASED ON YEARS OF ELIGILE SERVICE AND VESTED STATUS AND REMAINS SUBJECT TO A SUBSTANTIAL RISK OF FORFEITURE. PART I LINE 4B & PART II, LINE 3 - INCLUDED IN DUANE WOOD'S TOTAL W-2 COMPENSATION OF $235,250 IS $35,237 WHICH REPRESENTS THE PORTION OF MR. WOOD'S S SALARY ALLOCABLE TO THE NORWALK MEMORIAL HOME, A DIVISION OF FISHER-TITUS MEDICAL CENTER. INCLUDED IN THE TOTAL CONTRIBUTION TO DEFERRED COMPESATION OF $48,939 IN COLUMN C IS $8,500 OF DEFERRED WAGES AND QUALIFIED RETIREMENT PLAN CONTRIBUTIONS AND $40,939 FOR THE CURRENT YEAR AND PRIOR YEAR ACCRUAL OF A NON-VESTED, NON-QUALIFIED RETIREMENT PLAN. THIS PLAN PROVIDES AN ADDITIONAL RETIREMENT BENEFIT BASED ON YEARS OF ELIBIGLE SERVICE AND VESTED STATUS AND REMAINS SUBJECT TO A SUBSTANTIAL RISK OF FORFEITURE. PART I LINE 4B & PART II, LINE 6 - INCLUDED IN MR. ANNARINO'S TOTAL CONTRIBUTIONS TO DEFERRED COMPENSATION OF $39,696 IS $7,206 OF DEFERRED WAGES AND QUALIFIED RETIREMENT PLAN CONTRIBUTIONS AND $32,490 FOR THE CURRENT YEAR AND PRIOR YEAR ACCRUAL OF A NON-VESTED, NON-QUALIFIED RETIREMENT PLAN. THIS PLAN PROVIDES AN ADDITIONAL RETIREMENT BENEFIT BASED ON YEARS OF ELIGIBLE SERVICE AND VESTED STATUS AND REMAINS SUBJECT TO A SUBSTANTIAL RISK OF FORFEITUE. PART II LINE 8 THRU 11 - JOSEPH CENTA, JOHN HUGHES M.D., KATHLEEN MEEHAN-DELA CRUZ AND CHRISTINA CANFIELD ALL RECEIVED THEIR COMPENSATION FROM FTMC MEDICAL CARE LLC. FTMC MEDICAL CARE LLC WAS A WHOLLY OWNED DISREGARDED ENTITY OF FISHER-TITUS MEDICAL CENTER FROM JANUARY 1ST THRU JUNE 30TH 2012 BEFORE BEING TRANSFERRED ON JULY 1ST 2012 TO OUR PARENT COMPANY, NORWALK AREA HEALTH SYSTEMS, INC. COMPENSATION IS FOR PHYSICIAN SERVICES. PART I LINE 3 - RESPONSIBILITY FOR DETERMINING AND RECOMMENDING EXECUTIVE COMPENSATION RESTS WITH THE JOINT PERSONNEL COMMITTEE OF THE FISHER-TITUS MEDICAL CENTER AND NORWALK AREA HEALTH SYSTEMS, INC. BOARDS. THE COMMITTEE RETAINS AN INDEPENDENT EXECUTIVE COMPENSATION CONSULTANT TO HELP ESTABLISH CASH COMPENSATION TARGET RANGES AND IDENTIFY REASONABLE AND CUSTOMARY BENEFIT PROGRAMS FOR EXECUTIVES. THE INDEPENDENT CONSULTANT REPORTS TO THE JOINT PERSONNEL COMMITTEE ON REVELANT PEER GROUPS, CASH COMPENSATION REPORTED IN AVAILABLE SALARY SURVEYS FOR THE PEER GROUP AND TRENDS IN BENEFITS AND PERQUISITE PROGRAMS CUSTOMARILY AVAILABLE AMONG THE PEER GROUP FOR EXECUTIVES. RECOMMENDATIONS BY THE CONSULTANT ARE PRESENTED TO THE JOINT PERSONNEL COMMITTEE WHICH PREPARES MINUTES OF ITS DELIBERATIONS REGARDING EXECUTIVE COMPENSATION INCLUDING RECOMMENDATIONS THAT ARE PROVIDED TO EACH OF THE DIRECTORS OF FTMC AND NAHS. THE RECOMMENDATIONS TO BE ACTED ON MUST BE APPROVED FIRST BY THE JOINT PERSONNEL COMMITTEE AND THEN BY THE MEDICAL CENTER'S BOARD OF DIRECTORS BEFORE FINALLY BEING CONSIDERED BY THE SYSTEM'S BOARD OF DIRECTORS. THE MINUTES OF EACH BOARD MEETING WHERE ACTION IS TAKEN REFLECT SUCH ACTION. THE PROCESS IS PERFORMED ANNUALLY IN THE SPRING AND WAS LAST DONE IN MAY 2012. A COUNTY OF HURON OHIO 346400672 447540CC7 2007-06-28 28622597 SEE PART V BELOW 0 0 0 B COUNTY OF HURON OHIO 346400672 447540BN4 2003-01-08 30000000 SEE PART V BELOW 0 0 0 A 28838308 564200 7215711 21058397 2008 1 0 1 1 B 30714144 524983 263425 27308799 2616937 2005 1 0 1 1 A 0 0 0 1 1 0 0 0 B 0 0 0 1 1 0 0 0 A 0 0 1 0 0 0 0 0 1 B 0 0 1 0 1 0 0 0 1 A 0 B 0 PART I, LINE A SERIES 2007A BONDS - PURPOSE WAS TO ACQUIRE, CONSTRUCT AND INSTALL A VASCULAR HEART ADDITION TO THE HOSPITAL'S MAIN CAMPUS AS WELL AS SUPPORT SERVICES AND THE RENOVATION OF THE EXISTING EMERGENCY ROOM. PART I, LINE B SERIES 2003A BONDS - PURPOSE WAS TO ACQUIRE, CONSTRUCT AND INSTALL A MULTI-STORY ADDITION TO THE HOSPITAL'S MAIN CAMPUS DEVOTED TO INPATIENT SERVICES AS WELL AS SUPPORT SERVICES AND THE RENOVATION OF SEVERAL AREAS OF THE EXISTING FACILITY. PART II, LINE 3, COLUMN A INCLUDED IN THE TOTAL PROCEEDS OF $28,838,308 IS INVESTMENT EARNINGS OF $215,711. PART II, LINE 11, COLUMN A $21,058,397 OF THE PROCEEDS WERE USED TO REFUND THE HOSPITAL'S COUNTY OF HURON REVENUE BONDS, SERIES 1996B AND A PORTION OF SERIES 2003A BONDS. PART II, COLUMN B, LINE 3 INCLUDED IN THE TOTAL PROCEEDS OF $30,714,144 IS INVESTMENT EARNINGS OF $714,144. PART II, COLUMN B, LINE 11 $2,616,937 OF THE PROCEEDS WERE USED TO REFUND THE HOSPITAL'S COUNTY OF HURON REVENUE BONDS, SERIES 1995A BONDS. CHRISTINA CANFIELD PRIVATE PRACTICE OPERATING LOANS X 373304 222121 0 1 1 222121 MRS JOHN BRITTON SPOUSE OF KEY EMPLOYEE 50615 EMPLOYEMENT 0 BAYLESS PATHMARK SEE PART V 130000 INDEPENDENT CONTRACTOR 0 MS SCHWAB FAMILY MEMBER OF OFFICER, LORNA STRAYER 68498 EMPLOYMENT 0 MS RILEY FAMILY MEMBER OF DIRECTOR, MATT GROSS 64234 EMPLOYMENT 0 PART II LINE 1 PART II LINE 1 - PURPOSE OF LOAN: PRIVATE PRACTICE OPERATING LOANS BEFORE PRACTICE ACQUISTION. BEGINNING IN 1998 AND CONTINUING THROUGH 2005, FISHER-TITUS MEDICAL CENTER ADVANCED FUNDS TO DR. CHRISTINA CANFIELD AND IN THREE INSTANCES, TO DR. CANFIELD AND HER PROFESSIONAL CORPORATION, "WAKEMAN AREA FAMILY CARE CENTER, INC." (THE CORPORATION). THE CORPORATION IS AN OHIO PROFESSIONAL CORPORATION THAT WAS FORMED IN 1998. DR. CANFIELD IS THE SOLE SHAREHOLDER. THE FUNDS WERE PRIMARILY ADVANCED UNDER INTEREST BEARING LINES OF CREDIT TO FACILIATATE DR. CANFIELD'S INITIAL ESTABLISHMENT AND CONTINUATION OF A FAMILY MEDICAL PRACTICE IN WAKEMAN, OH. WAKEMAN, OHIO IS WITHIN THE SERVICE AREA OF FISHER-TITUS MEDICAL CENTER AND IS AN UNDERSERVED AREA, WITH NO OTHER PROVIDERS AND A HIGHER PROPORTION OF UNINSURED. THE ADVANCES ALSO WERE INTENDED TO ASSIST DR. CANFIELD'S PRACTICE WITH OPERATIONAL EXPENSES INCLUDING TRANSITION FROM A THIRD-PARTY BILLING SERVICE TO AN IN-HOUSE BILLING AND COLLECTION OPERATION AND EXPENSES ASSOCIATED WITH ATTEMPTS TO ADD ADDITIONAL PHYSICIANS TO THE MEDICAL PRACTICE. THE MEDICAL CENTER PROVIDED THE ADVANCES UNDER THE LINES OF CREDIT TO ENHANCE THE ABILITY OF DR. CANFIELD AND HER CORPORATION TO PROVIDE QUALITY MEDICAL SERVICES TO THE RESIDENTS OF WAKEMAN, OHIO. PRIOR TO THE OPENING, DR. CANFIELD'S PRACTICE, RESIDENTS OF WAKEMAN NEEDING MEDICAL CARE WERE REQUIRED TO TRAVEL 10-15 MILES TO OTHER COMMUNITIES TO RECEIVE CARE AS THERE WERE NO PHYSICIANS IN THE WAKEMAN COMMUNITY. THE ADVANCES WERE NECESSARY TO IMPROVE THE QUALITY OF HEALTHCARE IN THE WAKEMAN AREA AND PROVIDE ACCESS TO NEEDED HEALTH SERVICES, BOTH BEING CONSISTENT WITH THE MEDICAL CENTER'S EXEMPT PURPOSE OF PROVIDING MEDICAL CARE AND PROMOTING HEALTH IN ITSSERVICE AREA. SUBSEQUENT TO THE LINE OF CREDIT ADVANCES, DR. CANFIELD AND HER CORPORATIONSOLD THE CORPORATION'S ASSETS AND ACCOUNTS RECEIVABLE TO FTMC MEDICAL CARE LLC, WHICH IS AN OHIO LIMITED LIABILTY COMPANY.FISHER-TITUS MEDICAL CENTER WAS THE SOLE MEMBER OF THE LLC THRU JUNE-30-2012, AT WHICH TIME THE LLC WAS TRANSFERRED TO THE PARENT COMPANY NORWALK AREA HEALTH SYSTEMS. THE ASSET PURCHASE AGREEMENT PROVIDED THAT AFTER PAYMENT OF TRADE PAYABLES OF THE PRACTICE, THE PURCHASE PRICE WOULD BE USED TO PAY OFF THE CORPORATION'S OBLIGATIONS ON THE LINES OF CREDIT, AND TO THE EXTEND PURCHASE PRICE PROCEEDS WERE STILL AVAILABLE, WOULD BE DISTRIBUTED TO DR. CANFIELD WHO WAS REQUIRED TO USE THEM TO PAY BALANCES STILL OUTSTANDING ON LINES OF CREDIT ON WHICH SHE WAS PERSONALLY OBLIGATED. DR. CANFIELD SIMULTANEOUSLY BECAME AN EMPLOYEE OF THE LLC. THE EMPLOYMENT AGREEMENT ALSO PROVIDED FOR A DEDUCTION AGAINST HER COMPENSATION TO BE APPLIED TO OUTSTANDING BALANCES ON THE LINES OF CREDIT. BOTH TRANSACTIONS WERE INTENDED TO FACILITATE REPAYMENT OF THE ADVANCES TO FISHER-TITUS MEDICAL CENTER.PART IV LINE 2 - RELATIONSHIP OF INTERESTED PARTY: FAMILY MEMBER OF OFFICER, LORNA STRAYERPART IV LINE 3 - RELATIONSHIP OF INTERESTED PARTY: FAMILY MEMBER OF DIRECTOR, MATT GROSSPART IV LINE 4 - RELATIONSHIP OF INTERESTED PARTY: DR. WILLIAM CORNELL, M.D. IS A PARTNER OF BAYLESS PATHMARK. X 1 7525 FAIR MARKET VALUE X MEDICAL EQUIPMENT 2 28533 FAIR MARKET VALUE 0 1 0 MISSION STATEMENT PART I, LINE 1 PROVIDE QUALITY HEALTHCARE IN A COST EFFECTIVE MANNER WHILE RESPECTING THE DIGNITY AND UNIQUENESS OF EACH INDIVIDUAL WE SERVE. STATEMENT OF PROGRAM SERVICE ACCOMPLISHMENTS PART III, LINE 4A/4B FISHER-TITUS MEDICAL CENTER (FTMC) IS AN INDEPENDENT NON-PROFIT COMMUNITY HEALTHCARE ORGANIZATION GOVERNED BY A BOARD OF DIRECTORS COMPOSED OF AREA RESIDENTS INCLUDING BUSINESS AND COMMUNITY LEADERS, PHYSICIANS AND OTHER INTERESTED INDIVIDUALS. FTMC IS COMPOSED OF THE FOLLOWING FOUR OPERATING DIVISIONS: FISHER-TITUS MEMORIAL HOSPITAL THE HOSPITAL PROVIDES INPATIENT AND OUTPATIENT HEALTHCARE SERVICES TO THE RESIDENTS OF HURON, ERIE AND THE ADJACENT COUNTIES OF SANDUSKY, CRAWFORD, LORAIN, ASHLAND AND RICHLAND. IN 2012, THE HOSPITAL PROVIDED 13,381 DAYS OF INPATIENT CARE TO 3,724 PATIENTS. THE HOSPITAL ALSO PROVIDED 90,925 PATIENTS WITH 136,430 OUTPATIENT AND 27,601 EMERGENCY ROOM VISITS DURING THE YEAR. THE NORWALK MEMORIAL HOME THE NORWALK MEMORIAL HOME PROVIDES SKILLED AND LONG-TERM CARE IN ITS TRANSITIONAL AND EXTENDED CARE UNITS. DURING 2012, THE HOME SERVED 386 RESIDENTS AND PROVIDED 24,111 DAYS OF CARE. THE HOME HEALTH CENTER HOME HEALTH AGENCY THE HOME HEALTH CENTER PROVIDED 12,218 HOME VISITS TO 330 DIFFERENT PATIENTS IN 2012. THE CARRIAGE HOUSE OF FISHER-TITUS OPENED IN 1998, THE CARRIAGE HOUSE IS A 48-UNIT ASSISTED LIVING FACILITY, WHICH PROVIDED 16,447 DAYS OF ASSISTED LIVING CARE TO 61 RESIDENTS IN 2012. PROGRAM EXPANSIONS, IMPROVEMENTS, AND ACCREDITATIONS AMONG HEALTHCARE'S MOST WIRED HOSPITALS IN THE NATION IN 2012 FISHER-TITUS WAS NAMED ONE OF HEALTHCARE'S TOP 100 MOST WIRED U.S. HOSPITALS TO RECOGNIZE ITS ACCOMPLISHMENTS AS THE NATION'S FIRST ALL-DIGITAL SMART COMMUNITY HOSPITAL AND CONTINUED ADVANCEMENTS IN PATIENT-FOCUSED TECHNOLOGY AIMED AT PROVIDING THE HIGHEST LEVEL OF CLINICAL QUALITY, PATIENT SAFETY, AND COORDINATION OF CARE. AS A CERNER CORPORATION SHOWCASE SITE, FISHER-TITUS HAS HOSTED HOSPITALS FROM ALL OVER THE WORLD INCLUDING THE CLEVELAND CLINIC, THE VETERANS ADMINISTRATION, AND BRAZIL'S HOSPITAL ALBERT EINSTEIN TO SEE THIS FULLY INTEGRATED ELECTRONIC HEALTH RECORD SYSTEM AND INTERACTIVE PATIENT-ROOM TECHNOLOGY IN ACTION. ELECTRONIC MEDICAL RECORDS - FISHER TITUS MEDICAL CENTER ACHIEVED THE HEALTH INFORMATION AND MANAGEMENT SYSTEMS SOCIETY, HIMSS LEVEL 6 (THE HIGHEST LEVEL BEING LEVEL 7) FOR ELECTRONIC MEDICAL RECORD (EMR) ADOPTION. FACILITY AND PROGRAM EXPANSIONS NEW EMERGENCY DEPARTMENT / REGISTRATION-ADMITTING / AND OUTPATIENT LABORATORY SERVICES IN JUNE 2012, FISHER-TITUS GREETED THE FIRST PATIENTS TO A NEW AND EXPANDED $12.5 MILLION EMERGENCY DEPARTMENT, REGISTRATION/ADMITTING AREA, AND OUTPATIENT LABORATORY SERVICES. THIS 29,500 SQUARE-FOOT EXPANSION HAS ALLOWED FISHER-TITUS MEDICAL CENTER TO RE-ENGINEER THE ER PATIENT PROCESS FROM ADMISSION AND REGISTRATION TO THE DELIVERY OF CARE TO ENSURE THE BEST OUTCOMES AND THE BEST OVERALL EXPERIENCE FOR PATIENTS AND THEIR FAMILIES. IMAGING SERVICES DEPARTMENT / INFUSION SERVICES / PRE-ADMISSION TESTING. IMMEDIATELY FOLLOWING THE OPENING OF THE NEW ER IN JUNE 2012, CONSTRUCTION BEGAN TO RENOVATE THE VACATED SPACE FOR A NEW IMAGING SERVICES DEPARTMENT. COMPLETED IN APRIL OF 2013, THE $11.7 MILLION CONSTRUCTION PROJECT REPOSITIONED THE DEPARTMENT TO ALLOW QUICKER ACCESS FOR EMERGENCY PATIENTS, A MORE COMFORTABLE RECEPTION AREA AND ADDITIONAL PRIVACY FOR OUTPATIENTS RECEIVING DIAGNOSTIC TESTS. WHILE MOST OF THE EXISTING STATE-OF-THE-ART IMAGING EQUIPMENT WAS MOVED, A NEW OPEN MRI WAS PURCHASED TO MEET THE NEEDS OF CLAUSTROPHOBIC AND BARIATRIC PATIENTS. THE EXPANSION ALSO INCLUDED AN INFUSION CENTER AS WELL AS A NEW PRE-ADMISSION TESTING AREA. FISHER-TITUS ADDS ROBOTIC-ASSISTED SURGERY IN DECEMBER 2012, FISHER-TITUS MEDICAL CENTER WAS FIRST IN THE REGION TO ACQUIRE DAVINCI ROBOTIC-ASSISTED SURGICAL TECHNOLOGY. ROBOTIC-ASSISTED PROCEDURES PROVIDER BENEFITS FOR PATIENTS INCLUDING SMALLER INCISIONS, LESS PAIN, FASTER RECOVERIES AND QUICKER RETURN TO DAILY ACTIVITIES FOR PATIENTS. THE TECHNOLOGY IS APPROVED FOR 140 SURGICAL PROCEDURES INCLUDING GENERAL SURGERY, GYNECOLOGICAL, UROLOGICAL, THORACIC AND ENT PROCEDURES. MULTIPURPOSE MEDICAL OFFICE BUILDING ANNOUNCED IN LATE 2012, FISHER-TITUS INVESTED $1.75 MILLION IN THE PURCHASE OF PROPERTY ON SR 250 NORTH. A FACILITY SCHEDULED FOR CONSTRUCTION IN LATE 2013 WILL HOUSE AN URGENT/AFTER HOURS CLINIC, INDUSTRIAL HEALTH SERVICES, REHABILITATION, LABORATORY SERVICES AND NORTHERN OHIO FOOT & ANKLE SPECIALISTS, PROVIDING EASIER ACCESS TO THESE SERVICE TO RESIDENTS AND BUSINESSES. FISHER-TITUS FIRST IN REGION TO INVEST IN MOST ADVANCED WEAPON IN THE FIGHT AGAINST HOSPITAL INFECTIONS TO KEEP PATIENTS EVEN SAFER FROM INFECTIONS, "TITUS" THE GERM ZAPPER JOINED THE HOSPITAL'S ENVIRONMENTAL SERVICES DEPARTMENT. THE HIGH-TECH ROBOT "PULSES" ULTRAVIOLET LIGHT THAT PENETRATES CELL WALLS OF MICRO-ORGANISMS KILLING THE ORGANISM TO PROVIDE AN EXTRA LAYER OF INFECTION CONTROL FOR PATIENTS. EDUCATION AND RESEARCH - TO ENSURE THAT WE HAVE THE QUALITY WORKFORCE WE NEED TO CARE FOR OUR COMMUNITY IN THE FUTURE, WE ARE COMMITTED TO THE EDUCATION OF CURRENT AND FUTURE CAREGIVERS, AND WE WORK WITH EHOVE CAREER CENTER, FIRELANDS BOWLING GREEN STATE UNIVERSITY CAMPUS, LORAIN COUNTY COMMUNITY COLLEGE, NORTH CENTRAL STATE COLLEGE, TERRA COMMUNITY COLLEGE, THE OHIO STATE UNIVERSITY, AND OHIO UNIVERSITY TO PROVIDE INTERNSHIPS, INSTRUCTORS, CLASSROOM SPACE, AND CLINICAL TRAINING. WE ARE PLEASED TO BE ABLE TO OFFER A COMPREHENSIVE LEARNING EXPERIENCE UTILIZING OUR STATE-OF-THE-ART FACILITIES AND ADVANCED TECHNOLOGY. AWARDS AND ACCREDITATIONS - THROUGHOUT THE YEARS FISHER-TITUS HAS BEEN HIGHLY SUCCESSFUL IN MEETING THE CHALLENGES OF AN INCREASINGLY COMPLEX HEALTH-CARE INDUSTRY AND HAS PROVIDED EXCEPTIONAL SERVICE QUALITY TO MEMBERS OF THE SURROUNDING COMMUNITIES. IN 2012, FISHER-TITUS EARNED A THREE-YEAR ACCREDITATION BY THE HEALTHCARE FACILITIES ACCREDITATION PROGRAM (HFAP). FISHER-TITUS ALSO EARNED RE-DESIGNATION AS A LEVEL 3 TRAUMA CENTER BY OHIO DEPARTMENT OF HEALTH AND THE OHIO DEPARTMENT OF PUBLIC TRANSPORTATION. FISHER-TITUS WAS THE FIRST AREA HOSPITAL TO EARN THAT DESIGNATION IN 2009. FISHER-TITUS WAS ALSO ONE OF 15% U.S. HOSPITALS TO EARN AN A HOSPITAL SAFETY SCORE BY THE LEAPFROG GROUP ON ITS NATIONAL REPORT CARD ON PREVENTABLE MEDICAL ERRORS, INJURIES, ACCIDENTS, AND INFECTIONS. THE MEDICAL CENTER'S FOCUS ON QUALITY CARE AND EXCEPTIONAL SERVICE IS EVIDENCED BY THE MANY DEPARTMENTAL ACCREDITATIONS AND AWARDS AND RECOGNITIONS RECEIVED BY THE MEDICAL CENTER IN 2012: -OHIO DEPARTMENT OF HEALTH MAMMOGRAPHY QUALITY STANDARDS -AMERICAN COLLEGE OF RADIOLOGY (ACR) 3-YEAR ACCREDITATION IN MAGNETIC RESONANCE IMAGING -AMERICAN COLLEGE OF RADIOLOGY (ACR) 3-YEAR ACCREDITATION IN COMPUTED TOMOGRAPHY -AMERICAN ASSOCIATION OF RESPIRATORY CARE, QUALITY RESPIRATORY CARE AWARD -AMERICAN HEART ASSOCIATION GET WITH THE GUIDELINES STROKE SILVER PLUS QUALITY ACHIEVEMENT AWARD -AMERICAN DIABETES ASSOCIATION EDUCATION RECOGNITION CERTIFICATE -HOMECARE ELITE TOP 100 AGENCY (FISHER-TITUS HOME HEALTH CENTER) -AMERICAN ASSOCIATION OF CARDIOVASCULAR AND PULMONARY REHABILITATION, CARDIAC REHABILITATION -LABORATORY SERVICES CAP ACCREDITATION -BLOOD GAS LABORATORY CAP ACCREDITATION -OHIO HOSPITAL ASSOCIATION SAFETY AWARD -OHIO HOSPITAL ASSOCIATION HEALTH CARE WORKER OF THE YEAR AWARDED TO FISHER-TITUS NURSE SHERRY FISHBAUGH FTMC EMPLOYS 950 AREA RESIDENTS AND IS THE SECOND LARGEST EMPLOYER IN HURON COUNTY AND IS PROUD TO HAVE BEEN NAMED AMONG THE TOP 100 BEST PLACES TO WORK IN HEALTHCARE BY MODERN HEALTHCARE MAGAZINE THREE OF THE FIVE PAST YEARS. FISHER-TITUS ALSO IS A AMERICAN HEART ASSOCIATION FIT-FRIENDLY FACILITY WITH PLATINUM-LEVEL STATUS RECOGNITION FOR ITS COMMITMENT TO PROVIDE VALUE-ADDED BENEFITS TO IMPACT THE OVERALL HEALTH AND FITNESS OF ITS EMPLOYEES INCLUDING WEIGHT WATCHERS, A FULLY OUTFITTED EMPLOYEE FITNESS CENTER, SMOKING CESSATION PROGRAMMING AND WALKING PROGRAMS. PART III, LINE 4A/4B CONTINUED EXCELLENT PHYSICIANS: FISHER-TITUS IS COMMITTED TO RECRUITING PHYSICIANS TO SERVE THE UNIQUE HEALTH-CARE NEEDS OF OUR COMMUNITY MEMBERS. IN 2012, MAHER SALAM, MD, GASTROENTEROLOGIST; ABIGAIL CHUDZINSKI,D.O., PEDIATRICIAN; UPDENDER GEHLOT, M.D., PSYCHIATRY; NICHOLAS BROWN, D.P.M., PODIATRIST; VITAILIY PISCHIK, M.D., HEMATOLOGY/ONCOLOGY; KAMAL CHABAN, M.D., PULMONARY CRITICAL CARE; LEANNE STRACK, D.O., PULMONARY CRITICAL CARE; CHRISTOPHER AVENDANO, M.D., PULMONARY CRITICAL CARE; KERIN KURTZ, D.O., EMERGENCY; RICARDO MACHADO, M.D., EMERGENCY; KHALAD YASSINE, M.D., NEUROLOGY; AND TONY LEE, D.O., EMERGENCY. NEW MEMBERS TO THE FISHER-TITUS HOSPITALISTS TEAM, INTERNAL MEDICINE PHYSICIANS WHO SERVE PATIENTS IN THE HOSPITALS, INCLUDED SHANKAR KURRA, M.D., DIRECTOR; RYAN NAGY, M.D.; AND HASAN AMIR, M.D. COMMUNITY HEALTH AND OUTREACH PROGRAMS FTMC COMMUNITY BENEFITS EXTEND OUTSIDE OUR WALLS TO FAMILIES, BUSINESS, SCHOOLS, CHURCHES AND NEIGHBORHOODS THROUGH OUTREACH PROGRAMS AND OTHER COORDINATED CARE ACTIVITIES THAT MAKE OUR COMMUNITIES HEALTHIER PLACES TO LIVE, WORK AND WORSHIP. OUR GOAL IS TO HELP ALL RESIDENTS EQUALLY ACCESS THE CARE THEY NEED, AND HELP THEM LEARN TO MANAGE THEIR CONDITIONS AND LIVE HEALTHIER SAFER LIVES. FISHER-TITUS HAS PROVIDED LEADERSHIP AND FUNDING FOR THE HURON COUNTY HEALTH ASSESSMENT ISSUED IN LATE 2011 AND IN ADDRESSING THE NEEDS IDENTIFIED IN THE HEALTH ASSESSMENT. THE PRIORITIES OF FISHER-TITUS COMMUNITY OUTREACH AND COMMUNITY BENEFIT PROGRAMS IN 2012 WERE ALIGNED WITH THE GOALS IDENTIFIED BY THE HURON COUNTY HEALTH PARTNERS WITH FISHER-TITUS HEALTH PROFESSIONALS LEADING AND SERVING ON COMMUNITY-WIDE TASK FORCES THAT ARE ADDRESSING OBESITY, RISKY BEHAVIORS AMONG YOUTH, AND MENTAL HEALTH RESOURCES. FTMC SUPPORTS OTHER AREA NON-PROFIT COMMUNITY ORGANIZATIONS THAT ARE COMMITTED TO COMMUNITY HEALTH IMPROVEMENT THROUGH FINANCIAL INVESTMENTS, IN-KIND SERVICE AND EMPLOYEE VOLUNTEERISM. MANY OF OUR COMMUNITY BENEFIT PROGRAMS ARE ORGANIZED TO WORK COLLABORATIVELY WITH COMMUNITY GROUPS, SCHOOLS AND GOVERNMENT ORGANIZATIONS TO EFFECTIVELY LEVERAGE RESOURCES AND ADDRESS IDENTIFIED COMMUNITY NEEDS. IN 2012, WE OFFERED COMMUNITY HEALTH EDUCATION PROGRAMS, INCLUDING SCHOOL-BASED PROGRAMS, SUPPORT GROUPS, COMMUNITY-BASED HEALTH FAIRS AND SCREENINGS, AND WALKING AND FITNESS PROGRAMS THAT IMPACTED OUR RESIDENTS THROUGH 69,217 ENCOUNTERS. AUXILIARY AND VOLUNTEER SERVICE: - DURING 2012, OUR 279 CARING VOLUNTEERS DONATED 51,702 HOURS OF AUXILIARY AND VOLUNTEER SERVICES TO THE MEDICAL CENTER. VOLUNTEERS PROVIDE A VARIETY OF SERVICES INCLUDING HELPING FAMILY MEMBERS, PROVIDING TRANSPORTATION, ASSISTING AT COMMUNITY HEALTH PROGRAMS, DELIVERING REFRESHMENTS, MAIL AND FLOWERS TO HOSPITAL PATIENTS AND RESIDENTS OF THE NORWALK MEMORIAL HOME PLUS ESCORTING PATIENTS THROUGHOUT THE BUILDING. THEY ALSO PERFORM CLERICAL DUTIES, STAFF THE MEDICAL CENTER'S GIFT SHOP AND ORGANIZE SEVERAL FUND-RAISING EVENTS THROUGHOUT THE YEAR. VOLUNTEER "AMBASSADORS" HAVE INSTRUCTED PATIENTS SINCE APRIL, 2010 ON THE USE OF THE TELEVISION/COMPUTER SCREENS LOCATED IN EACH PATIENT ROOM. VOLUNTEERS WORKING IN THIS CAPACITY ARE AT FISHER-TITUS MEDICAL CENTER SEVEN DAYS PER WEEK EACH MORNING FOR 2 HOURS. AMONG THE ITEMS PATIENTS ARE INSTRUCTED ON ARE HOW TO ACCESS THE DAY'S MENU, MEDICAL INFORMATION PERTAINING TO THE PERSON'S HEALTH PROBLEMS, ACCESSING THE INTERNET, PLAYING GAMES, OBTAINING THE NAMES OF CAREGIVERS AS THEY ENTER THE PATIENT'S ROOM, CHOOSING MOVIES, ETC. THE PATIENT THEN MAY USE A REMOTE CONTROL OR A WIRELESS KEYBOARD TO ACCESS THIS INFORMATION. INFORMATION SERVICES PROVIDES ALL COMPUTER TRAINING FOR VOLUNTEERS THAT WORK IN THIS CAPACITY. IN APPRECIATION FOR THEIR WORK IN 2012, THE MEDICAL CENTER PROVIDED 13,449 FREE MEALS TO THE VOLUNTEER STAFF AT A COST OF $86,074. COMMUNITY HEALTH IMPROVEMENT SERVICES: NUMEROUS HEALTH SCREENINGS ARE OFFERED THROUGHOUT THE YEAR AT THE MEDICAL CENTER AND AT VARIOUS COMMUNITY LOCATIONS AND EVENTS THROUGHOUT OUR SERVICE AREA. THESE PROGRAMS INCLUDE SCREENING FOR BLOOD PRESSURE, BLOOD GLUCOSE, CHOLESTEROL LEVELS, SKIN CANCER, PROSTATE CANCER, OSTEOPOROSIS AND SCREENING MAMMOGRAMS. IN ADDITION, THE MEDICAL CENTER SPONSORS NUMEROUS SUPPORT GROUPS TO PROVIDE EDUCATION, CARE AND EMOTIONAL SUPPORT TO INDIVIDUALS AND FAMILIES AFFECTED BY DISABILITIES AND CHRONIC MEDICAL CONDITIONS. FTMC'S HEALTH MINISTRY PROGRAM, FORMED IN 2000, HAS BEEN A VERY EFFECTIVE GRASSROOTS INITIATIVE TO GATHER INFORMATION AND PROVIDE HEALTH PROGRAMS THROUGHOUT HURON COUNTY. CURRENTLY 50 AREA CONGREGATIONS ARE MEMBERS OF THE FTMC HEALTH MINISTRY PROGRAM WHICH PROVIDES HEALTH AND WELLNESS INFORMATION AND PROGRAMS IN AREA CHURCHES. THE MEDICAL CENTER IN PARTNERSHIP WITH ITS PHYSICIANS AND OTHER COMMUNITY ORGANIZATIONS PROVIDES PUBLIC FORUMS AND EDUCATIONAL SESSIONS ON A VARIETY OF TOPICS, WHICH ARE SOMETIMES HELD IN TANDEM WITH THE HEALTH SCREENINGS PROVIDED. WE ALSO PROVIDE NUMEROUS HEALTH FAIRS DURING THE YEAR IN SEVERAL LOCATIONS THROUGHOUT THE COUNTY AND SURROUNDING COMMUNITIES IN OUR SERVICE AREA. THESE COMMUNITY HEALTH IMPROVEMENT SERVICES BENEFITED 67,124 PEOPLE IN 2012 AT A COST OF $754,368. PROFESSIONAL MEDICAL EDUCATION: THE MEDICAL CENTER SUPPORTS THE FAMILY PRACTICE RESIDENCY PROGRAM AT FIRELANDS REGIONAL MEDICAL CENTER TO ENHANCE THE AVAILABILITY OF FAMILY PRACTICE PHYSICIANS WITHIN THE LOCAL COMMUNITY. FTMC FUNDS THE COST OF A FAMILY PRACTICE RESIDENT THAT SHARES TIME BETWEEN THE HOSPITAL'S EMERGENCY ROOM AND THE COUNTY HEALTH DEPARTMENT CARING FOR THE UNDERSERVED. IN ADDITION, FTMC SUPPORTS AND STAFFS SEVERAL CLASSES FOR HEALTH PROFESSIONALS INCLUDING HEALTHCARE PROVIDER CPR, ADVANCED CARDIAC LIFE SUPPORT, BASIC LIFE SUPPORT INSTRUCTOR COURSE AND PEDIATRIC ADVANCE LIFE SUPPORT. THE TOTAL COST OF PROFESSIONAL MEDICAL EDUCATION PROVIDED TO 158 PARTICIPANTS WAS $61,701. SUBSIDIZED HEALTH SERVICES: THE MEDICAL CENTER ALSO SUBSIDIZES CERTAIN HEALTH SERVICES AND PROCESSES IN ORDER TO ADDRESS SPECIFIC HEALTH ISSUES IN THE COMMUNITY, PROVIDE CARE TO THE UNDERSERVED, OR ENHANCE THE OVERALL QUALITY OF HEALTHCARE WITHIN THE COMMUNITY. ALSO, THE MEDICAL CENTER SUBSIDIZED THE COST OF ELECTRONIC MEDICAL RECORD SOFTWARE USED BY PHYSICIANS IN OUR SERVICE AREA. THE SOFTWARE ENHANCES THE ACCURACY AND SPEED OF MEDICAL INFORMATION AVAILABLE TO HEALTHCARE PROVIDERS WITHIN THE AREA AND TO ASSIST THE COMMUNITY IN MOVING TOWARD A REGIONAL HEALTH INFORMATION DATABASE. THE COST ASSOCIATED WITH THE HEALTH SERVICES AND ELECTRONIC MEDICAL RECORDS SYSTEM IN 2012 WAS $873,433. DONATIONS AND COMMUNITY SUPPORT: THE MEDICAL CENTER MAKES CASH AND NON-CASH CONTRIBUTIONS ANNUALLY TO LOCAL NON-PROFIT ORGANIZATIONS THAT BENEFIT THE HEALTH AND DEVELOPMENT OF OUR LOCAL COMMUNITY AND ITS RESIDENTS. IN ADDITION, THE MEDICAL CENTER SUPPORTS AREA SCHOOLS BY AWARDING SPECIAL HEALTH EDUCATION GRANTS TO SCHOOL DISTRICTS IN OUR SERVICE TERRITORY TO FUND INNOVATIVE PROGRAMS IN THE AREAS OF SCIENCE, MATH, HEALTH AND HEALTH RELATED EDUCATION. THE TOTAL COST OF THESE DONATIONS AND SUPPORT IN 2012 WAS $283,502. FORM 990, PART VI, SECTION A, LINE 6 THE SOLE MEMBER OF FISHER-TITUS MEDICAL CENTER IS THE PARENT COMPANY NORWALK AREA HEALTH SYSTEMS, INC., AN OHIO NONPROFIT CORPORATION. FORM 990, PART VI, SECTION A, LINE 7A THE FOLLOWING POWERS ARE RESERVED EXCLUSIVELY TO THE MEMBER (NORWALK AREA HEALTH SYSTEM, INC): A) TO ELECT THE DIRECTORS OF THE CORPORATION, AND TO REMOVE THEM AT WILL OR WITHOUT CAUSE. FORM 990, PART VI, SECTION A, LINE 7B THE FOLLOWING POWERS ARE RESERVED EXCLUSIVELY TO THE MEMBER (NORWALK AREA HEALTH SYSTEM, INC): A) TO AMEND OR REPEAL THE ARTICLES OF INCORPORATION AND THE CODE OF REGULATIONS; B) TO APPROVE THE ANNUAL OPERATING AND CAPITAL BUDGETS OF THE CORPORATION; C) TO APPROVE ANY CAPITAL OR OTHER EXTRAORDINARY EXPENDITURES IN EXCESS OF THE AMOUNT PRESCRIBED FROM TIME TO TIME BY THE MEMBER, WHICH AMOUNT SHALL BE REVIEWED BY THE MEMBER ANNUALLY; D) TO APPROVE ANY BORROWING OF ANY SUM OF MONEY FOR ANY PURPOSE IN EXCESS OF THE AMOUNT PRESCRIBED FROM TIME TO TIME BY THE MEMBER, WHICH AMOUNT SHALL BE REVIEWED BY THE MEMBER ANNUALLY; E) TO APPROVE ANY MERGER OF THE CORPORATION OR ANY SALE OF SUBSTANTIALLY ALL ITS ASSETS; TO DISSOLVE OR TERMINATE THE EXSISTENCE OF THE CORPORATION AND TO DETERMINE THE DISTRIBUTION OF ASSETS UPON SUCH DISSOLUTION OR TERMINATION. FORM 990, PART VI, SECTION B, LINE 11 THE BOARD OF DIRECTORS OF THE FISHER-TITUS MEDICAL CENTER DELEGATED THE RESPONSIBILITY FOR THE REVIEW OF THE MEDICAL CENTER'S FORM 990, PLUS ALL REQUIRED SCHEDULES AND ATTACHMENTS, TO THE MEDICAL CENTER'S AUDIT COMMITTEE. THE MEMBERS OF THIS COMMITTEE HAVE A STRONG BACKGROUND IN ACCOUNTING, LEGAL, FINANCE, AND BUSINESS AND HAVE THE TECHNICAL EXPERTISE TO PERFORM A SUBSTANTIVE REVIEW. THE AUDIT COMMITTEE REVIEWED THE MEDICAL CENTER'S FORM 990 PRIOR TO FILING AND REPORTED TO THE MEDICAL CENTER'S BOARD OF DIRECTORS REGARDING THE RESULTS OF THEIR REVIEW. IN ADDITION, EACH MEMBER OF THE MEDICAL CENTER'S BOARD OF DIRECTORS HAD ACCESS TO A COPY OF THE FORM 990 FOR VIEWING PRIOR TO FILING VIA A SECURE INTERNET WEBSITE AND A PAPER COPY WAS AVAILABLE FOR REVIEW AT THE BOARD MEETINGS. FORM 990, PART VI, SECTION B, LINE 12C ALL OF OUR AFFILIATED CORPORATE BOARD MEMBERS ARE REQUIRED TO COMPLETE A CONFLICT OF INTEREST STATEMENT UPON JOINING THE BOARD AND ANNUALLY THROUGHOUT THEIR TENURE. THESE ARE RETAINED BY ADMINISTRATION. AREAS OF CONFLICT ARE REVIEWED AND ADDRESSED AS NECESSARY TO THE TRANSACTIONS OF THE BOARD. IF AN AREA OF CONFLICT ARISES, BOARD MEMBERS ARE EXCUSED AND PROHIBITED FROM PARTICIPATING IN THE BOARD'S DELIBERATIONS AND DISCUSSIONS REGARDING THE AREA OF CONFLICT. FORM 990, PART VI, SECTION B, LINE 15 RESPONSIBILITY FOR DETERMINING AND RECOMMENDING EXECUTIVE COMPENSATION RESTS WITH THE JOINT PERSONNEL COMMITTEE OF THE FISHER-TITUS MEDICAL CENTER AND NORWALK AREA HEALTH SYSTEMS, INC. BOARDS. THE COMMITTEE RETAINS AN INDEPENDENT EXECUTIVE COMPENSATION CONSULTANT TO HELP ESTABLISH CASH COMPENSATION TARGET RANGES AND IDENTIFY REASONABLE AND CUSTOMARY BENEFIT PROGRAMS FOR EXECUTIVES. THE INDEPENDANT CONSULTANT REPORTS TO THE JOINT PERSONNEL COMMITTEE ON RELEVANT PEER GROUPS, CASH COMPENSATION REPORTED IN AVAILABLE SALARY SURVEYS FOR THE PEER GROUP, AND TRENDS IN BENEFITS AND PERQUISITE PROGRAMS CUSTOMARILY AVAILABLE AMONG THE PEER GROUP FOR EXECUTIVES. RECOMMENDATIONS BY THE CONSULTANT ARE PRESENTED TO THE JOINT PERSONNEL COMMITTEE WHICH PREPARES MINUTES OF ITS DELIBERATIONS REGARDING EXECUTIVE COMPENSATION INCLUDING RECOMMENDATIONS THAT ARE PROVIDED TO EACH OF THE DIRECTORS OF FTMC AND NAHS. THE RECOMMENDATIONS TO BE ACTED ON MUST BE APPROVED FIRST BY THE JOINT PERSONNEL COMMITTEE AND THEN BY THE MEDICAL CENTER'S BOARD OF DIRECTORS BEFORE FINALLY BEING CONSIDERED BY THE SYSTEM'S BOARD OF DIRECTORS. THE MINUTES OF EACH BOARD MEETING WHERE ACTION IS TAKEN REFLECT SUCH ACTION. THE PROCESS IS PERFORMED ANNUALLY IN THE SPRING AND WAS LAST DONE IN MAY 2012. FORM 990, PART VI, SECTION C, LINE 19 WE ISSUE AN ANNUAL REPORT TO THE COMMUNITY THAT IS PLACED IN THE LOCAL NEWSPAPER AND ON OUR WEBSITE THAT PROVIDES OUR OPERATING FINANCIAL STATEMENT, COMMUNITY BENEFIT FIGURES BROKEN DOWN BY CHARITY CARE & FINANCIAL ASSISTANCE, UPAID COSTS OF MEDICAID, COMMUNITY HEALTH & OUTREACH PROGRAMS, DONATIONS & COMMUNITY SUPPORT, SUBSIDIZED HEALTH SERVICES & PROFESSIONAL MEDICAL EDUCATION, & UNPAID COSTS OF MEDICARE & BAD DEBT. AS REQUIRED, WE OFFER A TIMELY RESPONSE TO WRITTEN REQUESTS FOR COPIES OF THE 990S AS WELL AS HAVING THE 990S AVAILABLE UPON THE PREMISES FOR THE PUBLIC TO REVIEW AND ON THE GUIDESTAR INTERNET WEBSITE. ADDITIONALLY, OUR CONFLICT OF INTEREST POLICY, CODE OF REGULATIONS, AND GOVERNING DOCUMENTS ARE ALSO AVAILABLE UPON WRITTEN REQUEST. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 9: FASB #158 ADJUSTMENT -4,650,739. TRANSFER OF FUNDS TO AFFILIATED ORGANIZATION, NORWALK AREA HEALTH SYSTEMS -1,464,893. TRANSFER OF FUNDS TO AFFILIATED ORGANIZATION,FISHER-TITUS FOUNDATION -52,607. PAIN MANAGEMENT LLC DIVIDEND PAYMENT TO JOINT VENTURE MEMBER NORWALK PAIN M 702,445. NET ASSETS BALANCE SHEET CHANGE FOR HEALTH PROMOTIONS FTMC MEDICAL CARE LLC 272 BENEDICT AVENUE NORWALK OH 44857 161768258 MEDICAL CARE OH 1127017 0 FISHER TITUS MEDICAL CENTER FTMC HOLDING 265 LLC 265 BENEDICT AVENUE NORWALK OH 44857 344430716 REAL ESTATE OH 42462 1158169 FISHER TITUS MEDICAL CENTER NORTH CENTRAL HOLDING LLC 272 BENEDICT AVENUE NORWALK OH 44857 344430716 REAL ESTATE OH 0 0 FISHER TITUS MEDICAL CENTER NORWALK AREA HEALTH SYSTEMS 272 BENEDICT AVENUE NORWALK OH 44857 341476935 SYSTEM PARENT OH 501(C)(3) LINE 11C, III-FI N/A 0 FISHER-TITUS FOUNDATION 272 BENEDICT AVENUE NORWALK OH 44857 341476937 FOUNDATION OH 501(C)(3) LINE 7 NORWALK AREA HEALTH SYSTEMS 0 NORWALK AREA HEALTH SERVICES 272 BENEDICT AVENUE NORWALK OH 44857 341476934 AMBULANCE OH 501(C)(3) LINE 9 NORWALK AREA HEALTH SYSTEMS 0 FISHER-TITUS PAIN MANAGEMENT LLC 272 BENEDICT AVENUE NORWALK OH 44857 271471272 PAIN MANAGEMENT OH FISHER TITUS MEDICAL CENTER RELATED 898266 754613 0 0 0.51000 HEALTH PROMOTIONS OF NORWALK 272 BENEDICT AVENUE NORWALK OH 44857 341502102 SUPPORT PROF. 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