2013-11-13T13:58:07-06:00 2012-12-31 990 2012-01-01 344428218 FIRELANDS REGIONAL MEDICAL CENTER FIRE 4195577400 1111 HAYES AVENUE SANDUSKY OH 448703323 DANIEL J MONCHER 4195577400 2013-11-12 2012 2016-02-24 21:20:13Z DANIEL J MONCHER 1111 HAYES AVE SANDUSKY OH 448703323 280554790 0 X WWW.FIRELANDS.COM X 1919 OH OUR MISSION IS TO BE THE HEALTHCARE PROVIDER OF CHOICE FOR PHYSICIANS, THEIR PATIENTS, OUR VOLUNTEERS AND EMPLOYEES AS WE STRIVE TOGETHER TO IMPROVE THE HEALTH OF THOSE WE SERVE. 37 37 2224 276 0 0 684591 769282 219898079 226656601 2837530 3581223 6986446 7063000 230406646 238070106 1024500 282958 0 0 96496084 98742566 0 0 243691 121321617 119980001 218842201 219005525 11564445 19064581 394859699 415796088 276375870 267959407 118483829 147836681 X OUR MISSION IS TO BE THE HEALTHCARE PROVIDER OF CHOICE FOR PHYSICIANS, THEIR PATIENTS, OUR VOLUNTEERS AND EMPLOYEES AS WE STRIVE TOGETHER TO IMPROVE THE HEALTH OF THOSE WE SERVE. 0 0 175812385 282958 226656601 SEE SCHEDULE OFIRELANDS REGIONAL MEDICAL CENTER IS A 400-BED FACILITY SERVING THE GREATER ERIE COUNTY REGION WITH TOP QUALITY HEALTHCARE SERVICES DESIGNED TO HELP THE PEOPLE IN OUR COMMUNITIES LIVE HEALTHIER, HAPPIER LIVES. AS A NON-PROFIT ORGANIZATION, FIRELANDS IS COMMITTED TO ITS MISSION OF IMPROVING THE HEALTH OF THOSE WE SERVE. FIRELANDS IS DEDICATED TO PROVIDING CARE TO ALL THOSE IN OUR COMMUNITY REGARDLESS OF ABILITY TO PAY.A RESULT OF COMBINING THREE ORIGINAL HOSPITALS: GOOD SAMARITAN HOSPITAL AND MEMORIAL HOSPITAL IN 1985 AND THEN ADDING PROVIDENCE HOSPITAL IN 2001, TODAY'S FIRELANDS REGIONAL MEDICAL CENTER CARRIES ON THE PROUD TRADITION OF DELIVERING A FULL RANGE OF ALLOPATHIC AND OSTEOPATHIC MEDICAL SERVICES TO NEARLY 300,000 RESIDENTS IN THE FIVE-COUNTY AREA.AS THE LARGEST YEAR-ROUND EMPLOYER IN ERIE COUNTY, FIRELANDS REGIONAL MEDICAL CENTER PLAYS AN IMPORTANT ROLE IN THE LOCAL COMMUNITY. WITH OVER 2,168 INDIVIDUALS EMPLOYED IN THE HEALTH SYSTEM IN 2012, $900,502 WAS PAID IN CITY AND SCHOOL PAYROLL TAXES IN 2012, AND $9.2 MILLION OF GOODS AND SERVICES WERE PURCHASED FROM BUSINESSES IN FIRELANDS' SERVICE AREA.IN TERMS OF HEALTHCARE SERVICES PROVIDED IN 2012, INPATIENT CARE WAS GIVEN TO 9,393 INDIVIDUALS, AND THE HOSPITAL PROVIDED CARE THROUGH 231,686 OUTPATIENT VISITS. THROUGH THE EMERGENCY ROOM, INCLUDING EMERGENCY QUICKCARE, SENIOR ER AND URGENT CARE, 52,056 PERSONS WERE TREATED. FIRELANDS HAD 732 BIRTHS IN 2012.CONSISTENT WITH OUR COMMITMENT TO PROVIDE CARE TO ALL, REGARDLESS OF ABILITY TO PAY, FIRELANDS GAVE THE COMMUNITY BACK $14 MILLION OF SERVICES IN FREE OR DISCOUNTED PROGRAMS OR SERVICES. ADDITIONAL CHARITY CARE WAS PROVIDED BY INDEPENDENT PHYSICIANS WHO ARE ON THE MEDICAL STAFF OF FIRELANDS.SPECIFICALLY, IN TERMS OF FREE OR DISCOUNTED CARE PROVIDED, FIRELANDS SERVED THE FOLLOWING NUMBER OF PERSONS WITHIN EACH CATEGORY, AMOUNTING TO SIGNIFICANT DOLLARS INVESTED IN THE COMMUNITY FOR WHICH FIRELANDS DID NOT RECEIVE COMPENSATION.FOR EXAMPLE, 25,033 PERSONS WERE SERVED WHERE THE COSTS OF SERVICES WERE NOT COVERED BY MEDICARE OR MEDICAID. THE COST TO FIRELANDS OF PROVIDING THIS CARE WAS $6,623,644. FOR HEALTH EDUCATION AND OUTREACH, 25,579 PERSONS WERE SERVED, AND THE COST OF PROVIDING THIS CARE WAS $182,865. MEDICAL EDUCATION PROGRAMS SERVED 131 PEOPLE AT A COST OF $2,111,202. THE HOSPITAL ALSO PROVIDED CHARITY CARE TO 12,545 PEOPLE, AT A COST OF $5,018,436. FINALLY, IN-KIND DONATIONS TOTALED $103,064.FIRELANDS' COMMUNITY OUTREACH DEPARTMENT IS DEDICATED TO PROVIDING SCREENINGS, COMMUNITY EDUCATION PROGRAMS, AND PREVENTIVE SERVICES ALL DESIGNED TO IMPROVE THE HEALTH OF THE COMMUNITIES SERVED BY FIRELANDS. THESE SERVICES ARE PROVIDED AT FREE OR DISCOUNTED RATES. ADDITIONALLY IN 2012 SEVERAL INITIATIVES WERE LAUNCHED TO SPECIFICALLY ADDRESS THE ISSUE OF CHILDHOOD OBESITY, WHICH WAS IDENTIFIED AS A PROBLEM IN ERIE COUNTY IN A COMMUNITY NEEDS ASSESSMENT RELEASED IN 2012 IN CONJUNCTION WITH THE COUNTY HEALTH DEPARTMENT. THESE INITIATIVES WERE LED BY THE POPULATION HEALTH EFFORTS OF THE MEDICAL CENTER. FIRELANDS ALSO WORKS IN CONJUNCTION WITH OTHER HEALTHCARE FACILITIES TO BRING SPECIALIZED PEDIATRIC CLINICS TO THE AREA, SUCH AS PULMONARY, PSYCHIATRY, EPILEPSY, PHYSIATRY, CARDIOLOGY, NEUROLOGY, GASTROENTEROLOGY, AND ORTHOPEDICS. FIRELANDS' COMMITMENT TO PROVIDE HEALTHCARE TO THE UNDERSERVED IS EVIDENT IN ITS 2012 FUNDING OF $408,790 IN SUPPORT OF FAMILY HEALTH SERVICES, A CLINIC FOR LOW INCOME FAMILIES. FAMILY HEALTH SERVICES PROVIDES ACCESS TO PRIMARY CARE PHYSICIANS FOR THOSE WHO OTHERWISE WOULD NOT BE ABLE TO AFFORD A PHYSICIAN. THE CLINIC PROVIDES WELL-CHILD CARE, WOMEN'S HEALTHCARE AND PAP TESTS, TREATMENT OF ACUTE PROBLEMS LIKE COLDS AND FLU, AND MANAGEMENT OF CHRONIC CONDITIONS SUCH AS DIABETES, HIGH BLOOD PRESSURE, DEPRESSION, EMPHYSEMA AND ARTHRITIS. THE CLINIC PROVIDES A MORE APPROPRIATE PLACE OF SERVICE THAN AN EMERGENCY ROOM VISIT, AND AT A MUCH LOWER COST. FIRELANDS IS COMMITTED TO PROVIDING THE BEST QUALITY OF HEALTHCARE TO THE LOCAL COMMUNITY, REGARDLESS OF A PERSON'S ABILITY TO PAY. FIRELANDS HAS SEEN SIGNIFICANT GROWTH IN BRINGING ADVANCED PROCEDURES TO THE LOCAL COMMUNITY SO THAT PERSONS RESIDING IN THE FIVE-COUNTY AREA CAN STAY CLOSE TO HOME FOR ADVANCED CARE SUCH AS HEART SURGERIES AND INTERVENTIONAL PROCEDURES, ADVANCED CARE IN MEDICAL ONCOLOGY AND RADIATION ONCOLOGY SERVICES, THE ADDITION OF NEW TECHNOLOGICALLY ADVANCED EQUIPMENT IN THE RADIOLOGY DEPARTMENT AND WOMEN'S HEALTH AND WELLNESS CENTER, AND THE ADDITION OF MANOMETRY EQUIPMENT TO THE DIGESTIVE HEALTH CENTER. THE MEDICAL CENTER ALSO PROVIDES THE AREA'S ONLY ENDOCRINOLOGIST, WHICH PROVIDES LOCAL CARE TO THOSE IN THE REGION WITH DIABETES AND OTHER ENDOCRINE CONDITIONS. DURING 2012, FIRELANDS ALSO EXPANDED SERVICE HOURS FOR NUMEROUS PROGRAMS AND OPENED SATELLITE FACILITIES IN SURROUNDING RURUAL AREAS TO PROVIDE PHYSICAL THERAPY SERVICES, LAB SERVICES, AND DIALYSIS SERVICES.NEW IN 2012, FIRELANDS REGIONAL MEDICAL CENTER ADDED AN URGENT CARE FACILITY TO SERVE THE REGION, A SENIOR ER, AN ADDITIONAL WOMEN'S IMAGING LOCATION, AND A MEDICATION MANAGEMENT CLINIC WHICH PROVIDES PATIENTS WITH ASSISTANCE IN MANAGING THEIR MEDICATION FOR CHRONIC MEDICAL CONDITIONS. 175812385 1 1 0 1 0 0 0 0 0 1 1 0 0 0 1 0 0 1 0 0 0 0 0 0 1 0 1 1 1 1 1 1 0 0 0 0 0 0 0 1 1 1 0 0 0 0 0 1 0 1 0 1 147 0 1 2224 1 0 0 0 0 0 0 0 0 0 0 0 0 0 X 37 37 0 0 0 0 0 0 0 1 1 0 0 0 1 1 1 1 1 1 1 1 1 OH X DENNIS J KOPCO 4195577094 1111 HAYES AVE SANDUSKY OH 448703323 J WILLIAM SPRINGER 2.00 0.00 X 0 0 0 JOHN O BACON 2.00 0.00 X 0 0 0 THOMAS AYLWARD 1.00 0.00 X 0 0 0 WILLIAM K BALZER PHD 1.00 0.00 X 0 0 0 KAMAL CHABAN MD 1.00 0.00 X 0 0 0 VINCENTA GASPAR-YOO MD 1.00 0.00 X 0 0 0 MARK GROSS 1.00 0.00 X 0 0 0 ROGER M GUNDLACH 1.00 0.00 X 0 0 0 FREDRIC ITZKOWITZ DO 1.00 0.00 X 0 0 0 BRIAN KASPER 1.00 0.00 X 0 0 0 THEODORE A KASTOR 1.00 0.00 X 0 0 0 DANIEL KELLER 1.00 0.00 X 0 0 0 RICHARD R KELLER MD 1.00 0.00 X 0 0 0 M LEE MCDERMOND JR 1.00 0.00 X 0 0 0 CAROL A WOLFE 1.00 0.00 X 0 0 0 PATRICK MCGUINN MD 1.00 0.00 X 0 0 0 DUFFIELD E MILKIE 1.00 0.00 X 0 0 0 JAMES MILLER 1.00 0.00 X 0 0 0 ALLEN R NICKLES 1.00 0.00 X 0 0 0 KARL OBERER DO 1.00 0.00 X 0 0 0 DEAN J REICHENBACH MD 1.00 0.00 X 0 0 0 CAROL B STEUK 2.00 0.00 X 0 0 0 JAMES V STOUFFER JR 1.00 0.00 X 0 0 0 DAVID A VOIGHT SR 1.00 0.00 X 0 0 0 ELAINE WATERFIELD 1.00 0.00 X 0 0 0 JAMES O WIBLE 1.00 0.00 X 0 0 0 CARL E WILL 1.00 0.00 X 0 0 0 LEON J WIEBER 2.00 0.00 X 0 0 0 GEORGE L MYLANDER 2.00 0.00 X 0 0 0 CARLOS LOWELL DO 1.00 0.00 X 0 0 0 JAMES E PRESTON DO 1.00 0.00 X 0 0 0 PAULA J RENGEL 1.00 0.00 X 0 0 0 THOMAS M ROUTH 1.00 0.00 X 0 0 0 JOHN WALDOCK JR 1.00 0.00 X 0 0 0 GERALD GUERRA 1.00 0.00 X 0 0 0 MARTIN E TURSKY 40.00 0.00 X X 282816 0 55334 STEVE LICHTCSIEN 1.00 0.00 X 0 0 0 DOUGLAS PHARES 1.00 0.00 X 0 0 0 JOHN HOTY 1.00 0.00 X 0 0 0 DANIEL J MONCHER 40.00 0.00 X 481471 0 59556 TAMARA L JACKSON 40.00 0.00 X 429446 0 72914 ROBERT M MOORE 40.00 0.00 X 254197 0 54240 ERIC MAST 40.00 0.00 X 235792 0 29217 SCHRICKEL BEV 40.00 0.00 X 202531 0 61041 JIM SENNISH 40.00 0.00 X 204860 0 47508 MIKE CANFIELD 40.00 0.00 X 217452 0 28203 CHARLES A STARK 40.00 0.00 X 145507 0 10892 RYAN CHANDLER 40.00 0.00 X 165486 0 15083 2619558 0 433988 10 1 1 0 UNIVERSITY HOSPITALS HEALTH SYSTEM PO BOX 70328 CLEVELAND OH 44190 PHYSICIAN STAFF 2864496 PREMIER ANESTHESIA OF SANDUSKY PO BOX 638144 CINCINNATI OH 45263 ANESTHESIOLOGY SVCS 1386871 BRIDGE HOMECARE PARTNERS 5335 FAR HILLS AVE DAYTON OH 45429 HOME CARE MANAGEMENT 1282946 PHILLIPS MEDICAL SYSTEMS PO BOX 100355 ATLANTA GA 30384 MEDICAL EQUIP MAINTENANCE 822115 LABORATORY CORPORATION OF AMERICA PO BOX 12140 BURLINGTON NC 27216 LABORATORY SERVICES 749203 71 5685 44692 718905 769282 NET PATIENT SERVICE REVENUE 623000 221514872 221514872 SCHOOL OF NURSING 611600 754968 754968 PROGRAM SERVICE INVESTMENTS 525990 162043 162043 4224718 4224718 226656601 2891872 2891872 42670459 342188 41823310 499986 847149 -157798 689351 689351 275711 5685 161388 114323 114323 EMPLOYEE PHARMACY 446110 3672753 3672753 DIETARY SERVICES 722210 1463852 1463852 OFFICE RENTS 531190 1419996 1419996 392076 392076 6948677 238070106 226656601 0 10644223 253588 253588 29370 29370 3053546 1493007 1560539 74833431 55447742 19275140 110549 5710130 4221494 1488636 9580191 7095041 2471331 13819 5565268 4074307 1482504 8457 1045494 581609 463885 220257 220257 134575 134575 368550 368550 20450025 13489889 6946017 14119 684698 2301 665229 17168 40101993 39374732 694635 32626 2763786 2763786 4766659 1442398 3324261 592770 189590 395538 7642 48083 48083 5188063 5188063 14886922 14886922 2981764 2422387 559377 CHARITY CARE 14216532 14216532 BAD DEBTS 6860071 6860071 FRANCHISE TAX 2361321 2361321 PHYSICIAN RECRUITMENT 723762 723762 1584676 1458259 87106 39311 219005525 175812385 42949449 243691 7329 7829 3794294 10865815 268356 135424 29474123 28128523 2814479 2853757 3483459 7183093 321751738 147297076 180829051 174454662 155593962 171823173 590524 632567 15316293 17321378 1493821 1280418 1194008 1109449 394859699 415796088 73612428 69602704 163570684 156212152 39192758 42144551 276375870 267959407 X 106518694 134639821 8356679 9319298 3608456 3877562 118483829 147836681 394859699 415796088 X 19064581 18385757 -8097486 X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 1 2837 0 0 2837 0 PART IV, SUPPLEMENTAL INFORMATION: PART II-B LINE 1F- FIRELANDS REGIONAL MEDICAL CENTER PAID MEMBERSHIP DUES TO THE OHIO HOSPITAL ASSOCIATION OF WHICH 5.3% OR $2,837 WAS USED FOR LOBBYING ACTIVITIES. 11090402 1591037 339359 83612 12258468 12085032 -581145 334843 78642 11090402 10976812 1502602 323668 70714 12085032 9189157 2221977 364993 69329 10976812 13829380 -4095231 467639 77353 9189157 1.00000 1 0 11446489 11446489 146908256 45593712 101314544 2432526 1094637 1337889 154910387 97400720 57509667 6054080 3208007 2846073 174454662 CAPITAL LEASE 841488 SELF-INSURANCE RESERVE 5000000 ACCRUED POST-RETIREMENT AND PENSION 32126671 DEFERRED INCOME GUARANTEE 4158176 DUE TO RELATED PARTIES 18216 42144551 DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: PART V, LINE 4: ENDOWMENT FUND EXPENDITURES FOR FACILITIES AND PROGRAMS ARE USED TO PROMOTE PHYSICAL AND MENTAL WELL-BEING IN THE COMMUNITY. PART XI - FINANCIAL STATEMENTS FOR FIRELANDS REGIONAL MEDICAL CENTER ARE PART OF THE CONSOLIDATED AND AUDITED FINANCIAL STATEMENTS OF FIRELANDS REGIONAL HEALTH SYSTEM. RECONCILIATION IS NOT REQUIRED FOR PART XI. PART XII - FINANCIAL STATEMENTS FOR FIRELANDS REGIONAL MEDICAL CENTER ARE PART OF THE CONSOLIDATED AND AUDITED FINANCIAL STATEMENTS OF FIRELANDS REGIONAL HEALTH SYSTEM. RECONCILIATION IS NOT REQUIRED FOR PART XII. FASHION SHOW 130765 3857 126908 0 38142 1538 13745 4733 14018 GOLF OUTING 54947 656 54291 334 5147 9620 5685 2112 913 2 95684 1172 94512 0 3970 1500 23049 4970 31912 281396 5685 275711 334 47259 12658 42479 11815 46843 161388 114323 1 1 1 X 1 X 1 1 0 1 1 5018436 0 5018436 0.02540 19059213 12435569 6623644 0.03350 0 0 0.00000 24077649 12435569 11642080 0.05890 274938 101565 173373 0.00090 5073569 2962367 2111202 0.01070 0 0 0.00000 0 0 0.00000 103064 0 103064 0.00050 5451571 3063932 2387639 0.01210 29529220 15499501 14029719 0.07100 1 4 2010 2010 0.00000 1 12500 12500 0.00010 8 9493 9493 0.00000 1 10434 528108 119318 408790 0.00190 11 10438 552111 119318 432793 0.00200 0 2421605 756508 78490808 99724358 -21233550 X 1 1 1 NORTHERN OHIO SURGICAL PROPERTIES PROPERTY OWNERSHIP/MANAGEMENT 0.50000 0.00000 0.50000 1 1 FIRELANDS REGIONAL MEDICAL CENTER

1111 HAYES AVENUE SANDUSKY OH 44870

X X X X FIRELANDS REGIONAL MEDICAL CENTER 1 1 1 200.000000000000 1 300.000000000000 1 X X 1 1 X X X X 1 0 1 X 0 0 18 FIRELANDS REG MED CTR SURGERY CENTER

2800 HAYES AVE BLD E SANDUSKY OH 44870

OUTPATIENT SURGERY FIRELANDS REG MED CTR OUTPAT DIALYSIS

904 PIERCE ST SANDUSKY OH 44870

OUTPATIENT DIALYSIS FIRELANDS REG MED CTR OUTPAT DIALYSIS

290 PROGRESS DR STE A BELLEVUE OH 44811

OUTPATIENT DIALYSIS FIRELANDS REG MED CTR HOME HEALTH

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OP MENTAL HEALTH & CD FIRELANDS COUNS & REC SVCS OF HURON CO

292 BENEDICT AVE NORWALK OH 44857

OP MENTAL HEALTH & CD FIRELANDS COUNS & REC SVCS OF HURON CO

290 PROGRESS DR STE B BELLEVUE OH 44811

OP MENTAL HEALTH & CD FIRELANDS COUNS & REC SVCS OF HURON CO

390 E HOWARD ST STE B WILLARD OH 44890

OP MENTAL HEALTH & CD FIRELANDS COUNS & REC SVCS OF SENECA CO

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101 S WASHINGTON ST CASTALIA OH 44824

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OP PHYSICAL THERAPY FIRELANDS REG MED CTR OP THERAPY

1605 STATE ROUTE 60 VERMILION OH 44089

OP PHYSICAL THERAPY PART I, LINE 3C: FIRELANDS REGIONAL MEDICAL CENTER DOES USE FEDERAL POVERTY GUIDELINES TO DETERMINE ELIGIBILITY FOR FREE OR DISCOUNTED CARE.PART I, LINE 6A: FIRELANDS REGIONAL MEDICAL CENTER PREPARES AN ANNUAL COMMUNITY BENEFIT REPORT. PART I, LINE 7: TO DERIVE COSTS OF CHARITY CARE AND OTHER COMMUNITY BENEFITS, A COMBINATION OF COST ACCOUNTING SYSTEM AND COST-TO-CHARGE RATIOS WAS USED. THE LATTER WAS DERIVED FROM WORKSHEET 2, RATIO OF PATIENT CARE COST-TO-CHARGES. OUR COST ACCOUNTING SYSTEM ADDRESSES ALL PATIENT TYPES AND PAYER SOURCES. PART II: SEE NARRATIVE UNDER PART VI, LINE 5 PART III LINE 2: THE RATIO DERIVED ON WORKSHEET 2, RATIO OF PATIENT CARE COST-TO-CHARGES WAS USED TO COMPUTE THE COST ASSOCIATED WITH BAD DEBT EXPENSE PART III LINE 3: FOR ESTIMATING THE AMOUNT OF BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER ITS FINANCIAL ASSISTANCE POLICY, FIRELANDS REGIONAL MEDICAL CENTER UTILIZED A COMBINATION OF HISTORICAL PATIENT VISIST AND THIRD-PARTY DATA BASED ON ESTIMATED FAMILY SIZE, INCOME AND OTHER DEMOGRAPHICS. ALL ACCOUNTS PLACED INTO BAD DEBT DURING THE YEAR WITH NO PAYMENT ACTIVITY WERE SCORED BASED ON THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY, AND ALL WHO MET THE INCOME CRITEREIA BASED ON FAMILY SIZE WERE ASSUMED TO BE CHARITY ELIGIBLE AND THUS TREATABLE AS A COMMUNITY BENEFIT. PART III, LINE 4: 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 SYSTEM'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 PAYERS BASED ON CURRENT REIMBURSEMENT METHODOLOGIES. THIS AMOUNT ALSO INCLUDES AMOUNTS RECEIVED AS INTERIM PAYMENTS AGAINST UNPAID CLAIMS BY CERTAIN PAYERS. PART III, LINE 8: FIRELANDS REGIONAL MEDICAL CENTER'S COST ACCOUNTING SYSTEM WAS USED TO DETERMINE MEDICARE COSTS REFLECTED IN PART III, LINE 6. THE ORGANIZATION BELIEVES THAT ALL OF THE MEDICARE SHORTFALL SHOULD BE TREATED AS A COMMUNITY BENEFIT SINCE THESE SERVICES ARE RENDERED IN CONJUNCTION WITH THE ORGANIZATION'S CHARITABLE TAX-EXEMPT PURPOSES AND PROMOTE THE WELL-BEING OF THE COMMUNITY. FURTHERMORE, IT RELIEVES THE BURDEN ON LOCAL GOVERNMENTS. PART III, LINE 9B: WHEN A PATIENT IS UNINSURED OR INSURANCE PAYMENTS HAVE BEEN RECEIVED AND APPLIED, THEY ARE CLASSIFIED AS SELF PAY. OVER A 90-DAY PERIOD EACH PATIENT RECEIVES A MINIMUM OF 2 BALANCE DUE STATEMENTS AND 1 FINAL STATEMENT. DURING THAT PERIOD THE PATIENT HAS THE OPPORTUNITY TO PAY THE ACCOUNT IN FULL, SET UP PAYMENT ARRANGEMENTS, OR APPLY FOR FINANCIAL AID. IN THE EVENT THE PATIENT DOES NOT PAY THE ACCOUNT IN FULL, SET UP PAYMENT ARRANGEMENTS, APPLY FOR FINANCIAL AID, OR MAKE AN EFFORT TO CONTACT THE FACILITY WITH SPECIAL CIRCUMSTANCES CONCERNING THE UNPAID BALANCE, THE ACCOUNT IS PLACED IN BAD DEBT COLLECTION AT OR ABOUT 120 DAYS FROM THE FIRST STATEMENT OR LAST PAYMENT.SHOULD AN ACCOUNT BE PLACED IN COLLECTION, THE PATIENT HAS AN ADDITIONAL OPPORTUNITY TO APPLY FOR FINANCIAL AID, SET UP PAYMENT ARRANGEMENTS, OR SUPPLY ADDITIONAL INFORMATION RELATED TO THE ACCOUNT. IF ANY OF THESE EVENTS OCCUR, THE COLLECTION ACCOUNT IS EITHER PLACED ON HOLD, BILLED TO INSURANCE, UPDATED WITH THE PAYMENT ARRANGEMENT, OR TAKEN OUT OF BAD DEBT AND ADJUSTED ACCORDING TO FINANCIAL AID GUIDELINES.PART V: DIALYSIS CENTER - FIRELANDS REGIONAL MEDICAL CENTER DIALYSIS PROVIDES INDIVIDUALIZED IN-CENTER HEMODIALYSIS TREATMENTS AND MEDICAL CARE TO ADULT PATIENTS THAT ARE DIAGNOSED WITH END STAGE RENAL DISEASE. THE NURSING CARE DELIVERY SYSTEM IN THE DIALYSIS UNIT IS HOLISTIC AND FAMILY CENTERED, WITH PRIMARY NURSING CARE BEING ENCOURAGED. THIS RESULTS IN GREATER CONTINUITY OF CARE FOR THE DIALYSIS PATIENT AND FAMILY MEMBERS. FIRELANDS REGIONAL MEDICAL CENTER HOME HEALTH SERVICES PROVIDES CARE TO PERSONS LIVING WITHIN ERIE COUNTY AND 12 SURROUNDING COUNTIES. HOME CARE SERVICES ARE PROVIDED ON AN INTERMITTENT BASIS TO PATIENTS IN THEIR PLACE OF RESIDENCE AND INCLUDE SKILLED NURSING, PHYSICAL THERAPY, OCCUPATIONAL THERAPY, SPEECH THERAPY, HOME HEALTH AIDE , AND MEDICAL SOCIAL SERVICE. FIRELANDS COUNSELING AND RECOVERY SERVICES PROVIDES A CONTINUUM OF CARE OF OUTPATIENT AND INPATIENT MENTAL HEALTH SERVICES FOR CHILDREN, ADOLESCENTS, ADULTS AND OLDER ADULTS. ALL COUNSELING SERVICES ARE PROVIDED BY APPROPRIATELY CREDENTIALED OR LICENSED PROFESSIONALS. SERVICES ARE ALSO AVAILABLE TO PROVIDE TREATMENT IN A SUPPORTIVE AND THERAPEUTIC ENVIRONMENT FOR INDIVIDUALS EXPERIENCING ADDICTION TO ALCOHOL AND/OR OTHER DRUGS WHICH MAY RESULT IN THE LOSS OF THE INDIVIDUAL'S FAMILY, JOB, HEALTH, FRIENDS, MONEY, SELF-ESTEEM, OR EVEN LIFE ITSELF. CHEMICAL DEPENDENCY SERVICES ARE OFFERED FOR ADULTS, ADOLESCENTS, AND THEIR FAMILIES. FIRELANDS COUNSELING AND RECOVERY SERVICES ARE AVAILABLE IN THE CITIES OF SANDUSKY, NORWALK, WILLARD, BELLEVUE, TIFFIN, FOSTORIA, FREMONT, UPPER SANDUSKY, PORT CLINTON AND AMHERST. PART V: PATIENTS WHOSE FAMILY INCOME FALLS AT 200% OR LESS THAN THE FEDERAL POVERTY GUIDELINES (FPG) ARE ELIBGIBLE FOR FREE CARE. THOSE WHOSE FAMILY INCOME FALLS BETWEEN 201-300% OF THE FPG ARE PROVIDED A 25% DICOUNT OFF BILLED CHARGES. PART VI, LINE 2: FIRELANDS REGIONAL MEDICAL CENTER USES SEVERAL RESOURCES TO DETERMINE THE HEALTHCARE NEEDS OF THE COMMUNITY IN WHICH IT SERVES. IT WORKS IN CONJUNCTION WITH THE LOCAL HEALTH DEPARTMENT AND HELPS TO FUND A COMMUNITY NEEDS ASSESSMENT WHICH IS DONE EVERY FEW YEARS. RESULTS OF THE ASSESSMENT ARE ANALYZED AND USED TO DETERMINE THE NEED FOR NEW PROGRAMS, SERVICES, EDUCATIONAL PROGRAMS, AND ACCESS NEEDS. THE MEDICAL CENTER ALSO COMMISSIONS A PHYSICIAN NEEDS STUDY EVERY FEW YEARS TO DETERMINE THE TYPES AND NUMBERS OF PHYSICIANS NEEDED TO ADEQUATELY MEET THE NEEDS OF THE COMMUNITY. ADDITIONALLY, EVERY THREE YEARS A COMMUNITY RESEARCH STUDY IS PERFORMED WHICH ASKS LOCAL RESIDENTS THEIR PERCEPTIONS OF HEALTHCARE SERVICES IN THE AREA AND DETERMINES IF ADDITIONAL SERVICES ARE NEEDED. SECONDARY DATA OF THE REGION IS ANALYZED ANNUALLY TO DETERMINE UTILIZATION OF SPECIFIC SERVICES, OUTMIGRATION OF LOCAL RESIDENTS TO RECEIVE SERVICES, ETC. PROJECTED UTILIZATION STUDIES ENSURE THAT ANY NEW PROGRAMS OR SERVICES EXPLORED MEET THE NEEDS OF THE COMMUNITY. PART VI, LINE 3: HOSPITAL CARE ASSURANCE PROGRAM SIGNS ARE POSTED IN ALL REGISTRATION AND EMERGENCY AREAS. BILLING AND FINANCIAL ASSISTANCE BROCHURES ARE AVAILABLE WITH INSTRUCTIONS ON WHOM TO CONTACT AND HOW TO APPLY FOR SERVICES. FINANCIAL ASSISTANCE GUIDELINES AND APPLICATIONS ARE ALSO AVAILABLE ON OUR WEBSITE (WWW.FIRELANDS.COM). EVERY PATIENT STATEMENT CONTAINS CHARITY GUIDELINES AND AN APPLICATION.SELF-PAY INPATIENTS ARE SEEN ON-SITE BY A CONTRACTED AGENCY THAT DISCUSSES AND ASSISTS PATIENTS WITH APPLICATIONS FOR MEDICAID OR DISABILITY. THESE PATIENTS ARE ALSO SEEN BY A FINANCIAL COUNSELOR WHO EXPLAINS THE HOSPITAL CHARITY POLICY, ASSISTS WITH THE APPLICATION AND/OR SUPPLIES THEM WITH A CONTACT IF QUESTIONS SHOULD ARISE AFTER DISCHARGE. SELF-PAY INPATIENT ACCOUNTS ARE MONITORED DAILY TO IDENTIFY PATIENTS THAT ARE ELIGIBLE FOR MEDICAID AND HAVE NO PRIOR INSURANCE COVERAGE.ALL SELF-PAY OUTPATIENT ACCOUNTS WITH A BALANCE OF $1,500 OR MORE ARE SCREENED BY A THIRD PARTY AND A MEDICAID APPLICATION IS STARTED FOR THOSE THAT MEET ELIGIBILITY GUIDELINES. DURING THE SCHEDULING PROCESS, IF THE PATIENT STATES THAT THEY HAVE NO INSURANCE OR ARE CONCERNED ABOUT THEIR FINANCIAL LIABILITY, THE PATIENT CALL IS FORWARDED TO A FINANCIAL COUNSELOR WHO WILL EXPLAIN OUR CHARITY PROGRAM AND OFFER TO ASSIST WITH AND/OR MAIL THE FINANCIAL ASSISTANCE APPLICATION.A FINANCIAL COUNSELOR IS AVAILABLE DURING THE FIRST SHIFT IN THE EMERGENCY DEPARTMENT TO ASSIST PATIENTS WITH CHARITY CARE APPLICATIONS. REGISTRATION STAFF SUPPLIES THE PATIENT WITH A BROCHURE AND APPLICATION IF A FINANCIAL COUNSELOR IS NOT AVAILABLE UPON DISCHARGE. FINANCIAL COUNSELING STAFF IS AVAILABLE MONDAY THROUGH FRIDAY FROM 7:30 AM TO 5:00 PM. PART VI, LINE 4: FIRELANDS REGIONAL MEDICAL CENTER SERVES A FIVE-COUNTY AREA OF APPROXIMATELY 300,000 RESIDENTS. THE PRIMARY SERVICE AREA IS ERIE COUNTY, WHICH HAS A POPULATION OF NEARLY 79,000 PERSONS AND IS LOCATED ON THE SOUTHERN SHORELINE OF LAKE ERIE, HALFWAY BETWEEN CLEVELAND, OH AND TOLEDO, OH. BASED UPON THE LATEST CENSUS DATA, THE MAJORITY OF THE POPULATION'S RACE IS CAUCASIAN, WITH 7.3% MINORITY. SIXTY-ONE (61)% OF THE POPULATION HAS A HIGH SCHOOL EDUCATION OR SOME COLLEGE. THE COUNTY'S MEDIAN AGE IS 43.4 AND THE MEDIAN HOUSEHOLD INCOME IS $46,593. APPROXIMATELY 72% OF THE COUNTY'S RESIDENTS OWN THEIR OWN HOME, WITH THE MEDIAN HOME VALUE OF $138,100.SECONDARY SERVICE AREAS CONSIST OF THE CONTIGUOUS COUNTIES OF OTTAWA, HURON AND SANDUSKY, WHICH HAVE A COMBINED POPULATION OF APPROXIMATELY 155,000 INDIVIDUALS. FIRELANDS COUNSELING AND RECOVERY SERVICES REACHES EVEN FURTHER, SERVING 7 SURROUNDING COUNTIES INCLUDING THE COUNTIES OF ERIE, HURON, OTTAWA, SANDUSKY, SENECA, WYANDOT AND LORAIN. HOME HEALTH SERVICES PROVIDED BY THE MEDICAL CENTER REACHES INTO 13 DIFFERENT COUNTIES. DEMOGRAPHICS OF THE COUNTIES ARE SIMILAR TO THE PRIMARY SERVICE AREA OF ERIE COUNTY. PART VI, LINE 5: FIRELANDS REGIONAL MEDICAL CENTER ESTABLISHED THE FIRELANDS GARDEN DISTRICT PLAN IN 2007 WITH THE GOAL OF ENHANCING AND REVITALIZING THE MEDICAL CENTER'S NEIGHBORHOOD IN TERMS OF ATTRACTIVENESS, CHARM AND SAFETY. THIS REVITALIZATION IS ACCOMPLISHED THROUGH A PROGRAM PROVIDING FIRELANDS' EMPLOYEES THE RESOURCES NEEDED TO MAKE A DOWN PAYMENT FOR THE PURCHASE OR RESTORATION OF HOMES FOR OCCUPANCY.FIRELANDS PARTICIPATES IN THE NORTHWEST OHIO PUBLIC INFORMATION OFFICER COMMITTEE TO BRING ADDITIONAL SKILLS TO THE AREA REGARDING DISASTER READINESS. IN ADDITION TO MEETING THE REQUIRED INCIDENT COMMAND TRAINING COURSES, THE MEDICAL CENTER HAS GONE ABOVE AND BEYOND BY ATTENDING REGIONAL MEETINGS, COMPLETING CRISIS AND EMERGENCY RISK COMMUNICATION TRAINING, PUBLIC INFORMATION OFFICER TRAINING THROUGH THE OHIO EMERGENCY MANAGEMENT AGENCY AND THROUGH THE DEPARTMENT OF HOMELAND SECURITY, AS WELL AS INCORPORATING SOCIAL MEDIA IN ITS CRISIS COMMUNICATION METHODS.MANAGEMENT STAFF OF FIRELANDS REGIONAL MEDICAL CENTER IS ENCOURAGED TO PARTICIPATE IN LOCAL AND REGIONAL BOARDS AND ACTIVITIES THAT IMPROVE THE LOCAL COMMUNITY. ADVOCACY INCLUDES SUCH ACTIVITIES AS FINANCIAL SUPPORT TO A LOCAL CLINIC THAT SERVES UNINSURED AND UNDERINSURED ALONG WITH EFFORTS TO ORGANIZE A FEDERALLY QUALIFIED HEALTH CENTER FOR THE COMMUNITY, BOARD LEVEL WORK FOR COMMUNITY HEALTH EDUCATION ENTITIES AND AREA NON-PROFIT ORGANIZATIONS WHICH WORK TO IMPROVE THE HEALTH OF THE COMMUNITY. 1 FAMILY HEALTH SERVICES OF ERIE COUNTY 1912 HAYES AVE SANDUSKY OH 44870 263607741 501(C)(3) 253588 0 GENERAL SUPPORT 1 0 SCHOLARSHIPS TO BEGIN OR CONTINUE COURSE WORK 24 29370 0 PART II LINE 1. TO EXPAND THE DELIVERY OF HEALTH CARE SERVICES AND PROMOTE A HEALTHY QUALITY OF LIFE FOR THE MEDICALLY UNDERSERVED PERSONS OF ERIE COUNTY, OHIO. FIRELANDS REGIONAL MEDICAL CENTER SUPPORTS THE MISSION OF FAMILY HEALTH SERVICES OF ERIE COUNTY TO ATTAIN THE DESIGNATION OF FEDERALLY QUALIFIED HEALTH CENTER AND DELIVER ITS INTENDED SERVICES. THE USE OF FUNDS CONTRIBUTED IS MONITORED BY THE REVIEW OF FINANCIAL AND PERFORMANCE REPORTS. PART III LINE 1. SCHOLARSHIPS - TO BE ELIGIBLE FOR THE "EDUCATION PAYMENT PROGRAM", A CANDIDATE MUST BE A QUALIFIED FAMILY MEMBER OF A CURRENT ACTIVE EMPLOYEE AND BE SPONSORED BY THEIR FIRELANDS-EMPLOYED FAMILY MEMBER; BE A HIGH SCHOOL GRADUATE (OR EQUIVALENT) OR A HIGH SCHOOL SENIOR PLANNING TO BEGIN OR CONTINUE COURSE WORK AT AN ACCREDITED EDUCATIONAL INSTITUTION WITHIN ONE YEAR OF SUBMITTING A PROGRAM APPLICATION; AND HAVE A CUMMULATIVE ACADEMIC AVERAGE OF "C" OR BETTER. PART III LINE 1. AWARD RECIPIENTS ARE SELECTED BASED ON APPLICATION, PAST ACADEMIC PERFORMANCE, FIELD OF STUDY, EDUCATIONAL INSTITUTION, ECONOMIC NEED AND AVAILABILITY OF FUNDS. THIS PROGRAM IS ADMINISTERED WITHOUT REGARD TO RACE, COLOR, RELIGION, SEX, AGE, ANCESTRY, NATIONAL ORIGIN OR DISABILITY. FUNDS ARE PAID DIRECTLY TO THE SCHOOL ON BEHALF OF THE RECIPIENT. X 1 1 X X X X X 0 1 0 0 0 1 0 0 0 MARTIN E TURSKY 233085 0 25000 0 24731 0 22917 0 32417 0 338150 0 0 0 DANIEL J MONCHER 305227 0 144643 0 31601 0 30000 0 29556 0 541027 0 0 0 TAMARA L JACKSON 230970 0 115000 0 83476 0 48000 0 24914 0 502360 0 0 0 ROBERT M MOORE 211478 0 40000 0 2719 0 32000 0 22240 0 308437 0 0 0 ERIC MAST 230314 0 5000 0 478 0 7244 0 21973 0 265009 0 0 0 SCHRICKEL BEV 159784 0 30000 0 12747 0 43000 0 18041 0 263572 0 0 0 JIM SENNISH 167343 0 30000 0 7517 0 26000 0 21508 0 252368 0 0 0 MIKE CANFIELD 184038 0 33000 0 414 0 6524 0 21679 0 245655 0 0 0 CHARLES A STARK 76762 0 0 0 68745 0 0 0 10892 0 156399 0 0 0 RYAN CHANDLER 99066 0 55000 0 11420 0 0 0 15083 0 180569 0 0 0 PART I, LINE 6 PART I LINE 6A - BONUS AND INCENTIVE COMPENSATION LISTED IN PART II IS PRIMARILY BASED ON A SUCCESS SHARING PLAN MEASURED BY BOTH OPERATING RESULTS COMPARED TO BUDGET AND PATIENT SATISFACTION. PART II LINE 1- MARTIN E TURSKY ACCEPTED THE POSITION OF PRESIDENT AND CEO ON 6/18/12. PART II LINE 9- CHARLES STARK RESIGNED HIS POSITION AS PRESIDENT AND CEO ON 2/08/12. PART II LINE 10- RYAN CHANDLER RESIGNED HIS POSITION AS VP OPERATIONS ON 6/23/12. PART 1 LINE 4B- FIRELANDS REGIONAL MEDICAL CENTER CONTRIBUTED $22,917 TO A SUPPLEMENTAL NONQUALIFIED 457F RETIREMENT PLAN ON BEHALF OF MARTIN TURSKY. A COUNTY OF ERIE OHIO 346400428 29514PAV4 2006-06-01 65951557 SEE PART VI 0 0 0 B COUNTY OF ERIE OHIO 346400428 29514PAW2 2006-06-01 15000000 SEE PART VI 0 0 0 C COUNTY OF ERIE OHIO 346400428 2008-04-29 20000000 SEE PART VI 0 0 0 D COUNTY OF ERIE OHIO 346400428 29514BPD3 2012-08-15 72711827 SEE PART VI 0 0 0 A 4475573 68365573 3359060 580938 64416279 2008 0 0 1 1 B 15492204 134063 15358141 2008 0 0 1 1 C 18546238 20000000 40000 19960000 2008 0 0 1 1 D 72717104 3047291 264264 6947432 2013 1 0 0 1 A 0 0 1 1 0 0.00000 0.00000 0.00000 0 0 0 B 0 0 1 1 0 0.00000 0.00000 0.00000 0 0 0 C 0 0 1 1 0 0.00000 0.00000 0.00000 0 0 0 D 0 0 0 0 0.00000 0.00000 0.00000 0 0 0 A 0 0 0 1 0 0 0 0 0 B 0 0 0 1 0 0 0 NA 0 0 0 C 0 1 0 0 0 0 0 NA 0 0 0 D 0 1 0 0 1 0 0 NA 0 0 0 A 0 B 0 C 0 D 0 SCHEDULE K SUPPLENTAL INFORMATION PART I LINE A- ERIE COUNTY BOND 29514PAV4 WAS ISSUED TO ACQUIRE, CONSTRUCT, FURNISH AND EQUIP ADDITIONS AND IMPROVEMENTS TO HOSPITAL FACILITIES. PART I LINE B- ERIE COUNTY BOND 29514PAW2 WAS ISSUED TO ACQUIRE, CONSTRUCT, FURNISH AND EQUIP ADDITIONS AND IMPROVEMENTS TO HOSPITAL FACILITIES. PART 1 LINE C- ERIE COUNTY BOND ISSUED 4/29/08 WAS ISSUED TO EQUIP ADDITIONS AND IMPROVEMENTS MADE TO HOSPITAL FACILITIES. PART 1 LINE D- CURRENT REFUNDING ISSUE- ERIE COUNTY BOND 29514BPD3 WAS ISSUED FOR THE PURPOSE OF REFUNDING SERIES 2002 BONDS AND THE FINANCING OF TECHNOLOGY IMPROVEMENTS, EQUIPMENT AND RENOVATIONS MADE TO HOSPITAL FACILITIES. PART IV LINE 2C- THE REBATE COMPUTATION WAS PERFORMED BY JULY 15, 2011. CHABAN KAMAL MD BOARD MEMBER 357472 EMPLOYMENT 0 ITZKOWITZ FREDERICK DO BOARD MEMBER 251956 CONTRACTED MEDICAL SERVICES 0 MCGWINN PATRICK MD BOARD MEMBER 210688 CONTRACTED LAB SERVICES 0 SPRINGER ALICE WIFE OF BOARD MEMBER 60872 EMPLOYMENT 0 STAUFFER MELVYN J DIRECTOR EMERITI 34895 CONTRACTED LEGAL SERVICES 0 PART IV LINE 1 DR. CHABAN IS EMPLOYED BY RELATED ORGANIZATION NORTH COAST PROFESSIONAL CORP AS A PULMONARY, CRITICAL CARE AND SLEEP MEDICINE SPECIALIST. PART IV LINE 2 FREDERICK ITZKOWITZ, DO IS A PARTNER IN AN INDEPENDENTLY CONTRACTED COMPANY THAT PROVIDES TRAUMA COVERAGE FOR FIRELANDS REGIONAL MEDICAL CENTER AND IS ALSO COMPENSATED FOR HIS TIME SPENT AS AN ACTING MEDICAL DIRECTOR. PART IV LINE 3 PATRICK MCGWINN, MD IS A MEMBER OF AN INDEPENDENTLY CONTRACTED COMPANY THAT PROVIDES CATH LAB COVERAGE FOR FIRELANDS REGIONAL MEDICAL CENTER. PART IV LINE 4 ALICE SPRINGER IS THE WIFE OF BOARD MEMBER J WILLIAM SPRINGER. SHE IS EMPLOYED BY FIRELANDS REGIONAL MEDICAL CENTER AS DIRECTOR OF DEVELOPMENT. PART IV LINE 5 MELVYN J STAUFFER IS AN ATTORNEY IN AN INDEPENDENTLY CONTRACTED LAW FIRM THAT PROVIDES LEGAL SERVICES TO FIRELANDS REGIONAL MEDICAL CENTER AS NEEDED. FORM 990, PART VI, SECTION B, LINE 11 THE AUDIT AND CORPORATE COMPLIANCE COMMITTEE HAS BEEN DELEGATED THE AUTHORITY BY THE FIRELANDS REGIONAL HEALTH SYSTEM BOARD OF DIRECTORS TO REVIEW AND APPROVE ALL FORM 990'S FOR ALL COMPANIES IN THE SYSTEM. THE FINAL VERSION OF THE RESPECTIVE FORM 990 IS MADE AVAILABLE TO ALL MEMBERS OF THE AUDIT AND CORPORATE COMPLIANCE COMMITTEE FOR REVIEW AND APPROVAL PRIOR TO THE FORM 990 BEING SUBMITTED TO THE INTERNAL REVENUE SERVICE. FORM 990, PART VI, SECTION B, LINE 12C THE AUDIT AND CORPORATE COMPLIANCE COMMITTEE ANNUALLY REVIEWS ALL CONFLICT OF INTEREST STATEMENTS FOR ALL APPROPRIATE INDIVIDUALS TO ASSURE PERSONS IDENTIFIED IN THE CONFLICT OF INTEREST POLICY ARE IN COMPLIANCE. FORM 990, PART VI, SECTION B, LINE 15 THE PROCESS FOR DETERMINING COMPENSATION IS DELEGATED BY THE BOARD OF DIRECTORS TO THE EXECUTIVE COMMITTEE. THE EXECUTIVE COMMITTEE APPOINTS A COMPENSATION SUB-COMMITTEE WHICH UTILIZES AN INDEPENDENT THIRD PARTY TO EVALUATE THE APPROPRIATE PAY RANGE FOR THE CEO AND OTHER KEY MANAGEMENT POSITIONS AT LIKE-SIZED AND SIMILAR HOSPITALS IN THE SAME GEOGRAPHIC REGION OF THE UNITED STATES. THIS SUB-COMMITTEE MAKES A RECOMMENDATION TO THE EXECUTIVE COMMITTEE BASED ON THEIR RESEARCH AND FINDINGS. THE EXECUTIVE COMMITTEE APPROVES THE ANNUAL SALARIES OF THE CEO AND ALL VICE PRESIDENTS. THIS PROCESS IS DONE ANNUALLY AND WAS COMPLETED DURING 2012. FORM 990, PART VI, SECTION C, LINE 19 FINANCIAL STATEMENTS OF THE ORGANIZATION ARE MADE AVAILABLE VIA A QUARTERLY "REPORT TO BOND HOLDERS" WHICH IS SENT TO ANY CONSTITUENTS, BOND HOLDERS, OR INTERESTED PARTIES WHO REQUEST TO BE ON THE DISTRIBUTION LIST. QUARTERLY REPORTS ALONG WITH THE AUDITED CONSOLIDATED FINANCIAL STATEMENTS ARE ALSO POSTED TIMELY AT HTTP://WWW.MSRB.ORG/ UTILIZING THE EMMA SYSTEM. GOVERNING DOCUMENTS AND THE CONFLICT OF INTEREST POLICY ARE AVAILABLE TO THE PUBLIC BY SPECIAL REQUEST. FORM 990 PART XI LINE 9: OTHER CHANGES IN NET ASSETS INCLUDE THE FOLLOWING: TRANSFER TO AFFILIATES $(3,826,374), PENSION ADJUSTMENTS $(4,299,383), SCHOOL OF NURSING FUNDING $28,783, MCS RECLASS $(512). TOTAL OTHER CHANGES IN NET ASSETS= $(8,097,486). CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 9: SCHOOL OF NURSING FUNDING 28,783. PENSION ADJUSTMENTS -4,299,383. TRANSFER (TO) FROM AFFILIATES -3,826,374. FUND BALANCE RE-CLASS -512. ROUNDING FIRELANDS REGIONAL HEALTH SYSTEM 1111 HAYES AVE SANDUSKY OH 44870 341401659 HOSPITAL SUPPORT OH 501(C)(3) 11-I N/A 0 THE FOUNDATION FOR FIRELANDS 1111 HAYES AVE SANDUSKY OH 44870 341401660 HOSPITAL SUPPORT OH 501(C)(3) 11-I FIRELANDS REGIONAL MEDICAL CENTER 1 MARINA HOME HEALTH LLC 709 W WASHINGTON ST SANDUSKY OH 44870 262573502 MEDICAL EQUIPMENT OH N/A FIRELANDS VOCATIONAL REHAB 1111 HAYES AVE SANDUSKY OH 44870 455448705 VOC REHABILITATION OH FIRELANDS REGIONAL MEDICAL CENTER C 339 1283 1.00000 0 FIRELANDS PROF CENTER 2 CONDO 1111 HAYES AVE SANDUSKY OH 44870 203131059 CONDO ASSOCIATION OH FIRELANDS REGIONAL MEDICAL CENTER C 62213 0.69000 0 FIRELANDS PHYSICIANS REGIONAL HEALTH CARE 1111 HAYES AVE SANDUSKY OH 44870 341829898 PHO OH FIRELANDS REGIONAL MEDICAL CENTER C -1043 53212 0.51000 0 NORTH COAST PROF CO LLC 1111 HAYES AVE SANDUSKY OH 44870 341608091 PHYSICIAN PRACTICE MGT OH THE FOUNDATION FOR FIRELANDS C 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 1 1 1 0 FIRELANDS PHYSICIANS REGIONAL HEALTH CARE Q 53798 CASH BASIS NORTH COAST PROFESSIONAL COMPANY LLC Q 224081 CASH BASIS NORTH COAST PROFESSIONAL COMPANY LLC I 392538 CASH BASIS NORTH COAST PROFESSIONAL COMPANY LLC P 296011 CASH BASIS FIRELANDS REGIONAL HEALTH SYSTEM R 55000 CASH BASIS THE FOUNDATION FOR FIRELANDS R 3771374 CASH BASIS