2013-11-12T13:06:04-06:00 2012-12-31 990 2012-01-01 340718390 LODI COMMUNITY HOSPITAL LODI 3309485501 225 ELYRIA STREET LODI OH 44254 SUE J MCCARTHY 3309485501 2013-11-12 2012 2016-03-07 17:11:31Z THOMAS WHELAN 225 ELYRIA STREET LODI OH 44254 19278856 0 X WWW.LODIHOSPITAL.COM X 1920 OH TO IMPROVE THE HEALTH AND LIVES OF THE PEOPLE AND COMMUNITIES WE SERVE. 13 9 171 43 0 0 349425 0 17608762 19127924 8283 215 89551 116193 18056021 19244332 348823 4268 0 0 8429058 7895004 0 0 0 8501065 9198385 17278946 17097657 777075 2146675 10258336 9718029 1653508 2802911 8604828 6915118 LODI COMMUNITY HOSPITAL'S MISSION IS TO IMPROVE THE HEALTH AND LIVES OF THE PEOPLE AND COMMUNITIES WE SERVE. 0 0 3114409 4253125 LODI COMMUNITY HOSPITAL IS A 25 BED HOSPITAL OFFERING INPATIENT SERVICES FOR MEDICAL AND SURGICAL PATIENTS. 10881072 14859501 LODI COMMUNITY HOSPITAL OFFERS A VARIETY OF OUTPATIENT SERVICES. OUTPATIENT SERVICES OFFERED TO PATIENTS INCLUDE RADIOLOGY, PHYSICAL THERAPY, CARDIAC, SURGERY, MAMMOGRAPHY, SLEEP CENTER, LAB SERVICES AND EMERGENCY SERVICES. 11203 4268 15298 LODI COMMUNITY HOSPITAL OFFERS COMMUNITY HEALTH AND EDUCATIONAL SERVICES TO THE LOCAL AND SURROUNDING COMMUNITIES. 14006684 1 0 0 1 0 0 0 0 0 1 1 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 15 0 1 171 1 0 0 0 0 0 0 0 0 0 0 X 13 9 0 0 0 0 1 1 1 1 1 0 1 1 1 1 1 1 1 1 1 1 0 OH X DEBBIE GORBACH 3303446603 1 AKRON GENERAL AVENUE AKRON OH 44307 X ALAN PAPA 62.90 1.00 X 0 482128 106869 DAVID PETER MD 0.50 54.50 X 0 381250 40850 JOSEPH MELI MD 0.10 55.00 X 0 280878 36349 JUSTIN LAVIN MD 0.50 49.50 X 0 134292 10496 ROBERT KAMIENSKI MD 1.30 55.00 X 0 411900 37319 THOMAS STOVER MD 0.50 51.60 X 0 891568 105284 TODD BREAUX MD 1.30 X 0 0 0 VINCENT J MCCORKLE 0.00 40.00 X 0 269282 10398 HAROLD YOUNG 0.30 X 0 0 0 JOHN BAKER 0.40 X 0 0 0 JIM RICE 0.00 X 0 0 0 MARLENE BARKHEIMER 0.70 X 0 0 0 DAVID BROCKMAN 0.20 2.60 X 0 0 0 THERESA CARTER 1.40 X X 0 0 0 BRET TREIER 0.40 0.20 X 0 0 0 WILLIAM FRANTZ 0.70 0.10 X X 0 0 0 MARY BETH C CARROLL 1.50 X 0 0 0 WILLIAM BABCOX 1.90 2.90 X X 0 0 0 SONJA ALEMAGNO 1.50 X 0 0 0 ALAN A GANCI 40.00 X 59871 39914 10436 CRAIG BABBITT 1.90 60.40 X 0 398704 72714 DEBBIE L GORBACH 0.70 59.30 X 0 266199 108520 STEPHEN GARY 0.80 61.00 X 0 323318 19801 SUE MCCARTHY 1.10 55.00 X 0 161792 3174 THOMAS WHELAN 55.00 X 250300 0 63732 KATHIE PACK 40.00 X 104425 0 20243 STEPHANIE KOCSIS 44.00 X 134187 0 5259 ALAN J BLEYER 0.00 X 0 25803 53742 548783 4067028 705186 3 1 1 0 EPMG OF OHIO INC PA 2000 GREEN RD SUITE 300 ANN ARBOR MI 481051571 ER PHYSICIANS 530762 RESPIRATORY SUPPORT SERVICES 328 BOSTON MILLS ROAD HUDSON OH 44236 CARDIOPULMONARY SERVICES 428605 ALLIANCE HEALTHCARE SERVICES PO BOX 96485 CHICAGO IL 606936485 MRI SERVICES 156325 WESTLAKE REED LESKOSKY LTD 925 EUCLID ANVENUE SUITE 1900 CLEVELAND OH 44115 ARCHITECTS 123469 ARAMARK 115 NORTH FIRST STREET BURBANK CA 91502 LINEN SERVICES 103702 5 NET PATIENT REVENUE 900099 15760708 15760708 MEDICARE/MEDICAID PAYM 900099 3351918 3351918 COMMUNITY HEALTH/EDUCA 900099 15298 15298 19127924 215 215 22665 34524 -11859 -11859 -11859 CAFETERIA 900099 60592 60592 CHANGE IN INTEREST-FOU 900099 50762 50762 16698 16698 128052 19244332 19127924 0 116408 1768 1768 2500 2500 380165 380165 6078404 5431976 646428 76783 65286 11497 973877 887566 86311 385775 344843 40932 33104 33104 653 653 2519613 2035921 483692 67413 67413 545021 334777 210244 201154 171034 30120 638538 542926 95612 49126 34866 14260 4933 23 4910 8211 6982 1229 639650 304269 335381 52833 44922 7911 PROVISION FOR BAD DEBTS 3085501 3085501 MEDICAL SUPPLIES 636530 636530 MGMT FEE TO AGHS 427930 427930 OHIO FRANCHISE FEE 255909 255909 32266 7581 24685 17097657 14006684 3090973 0 1497761 648572 1971931 2331618 56160 51001 194033 156391 13695410 8308457 5542189 5386953 996262 1143494 10258336 9718029 1201457 1520669 452051 1282242 1653508 2802911 X 7921524 6135344 683304 779774 8604828 6915118 10258336 9718029 X 2146675 -3836385 X 0 1 X 1 0 X 0 0 0 0 0 1 653 0 0 0 653 0 PART IV, SUPPLEMENTAL INFORMATION: PART II-B, LINE 1 (F), GRANTS TO OTHER ORGANIZATIONS FOR LOBBYING PURPOSES: LODI COMMUNITY HOSPITAL IS A DUES PAYING MEMBER OF THE OHIO HOSPITAL ASSOCIATION (OHA). A PORTION OF OUR DUES ($653) IS USED BY OHA FOR LOBBYING ACTIVITIES. 683304 34659 21197 -40614 779774 336802 343021 3481 683304 132986 200000 3816 336802 148776 15790 132986 155416 6640 148776 1.00000 0 1 1 98793 98793 7935297 4243437 3691860 4983449 3722867 1260582 677871 342153 335718 5386953 INTEREST IN FOUNDATION NET ASSETS 1143494 1143494 ESTIMATED MEDICARE SETTLEMENT DUE 959786 ACCRUED SELF INSURANCE CLAIMS PAYABLE 143035 ASSET RETIREMENT OBLIGATION 179421 1282242 18857115 -421741 -421741 19278856 -34524 -34524 19244332 16710440 34524 34524 16675916 421741 421741 17097657 PART XI, LINE 2D - OTHER ADJUSTMENTS: MANAGEMENT FEE -427,930. EXPENSES RECORDED IN REVENUE 6,189. PART XI, LINE 4B - OTHER ADJUSTMENTS: RENTAL EXPENSES -34,524. PART XII, LINE 2D - OTHER ADJUSTMENTS: RENTAL EXPENSES 34,524. PART XII, LINE 4B - OTHER ADJUSTMENTS: MANAGEMENT FEE 427,930. EXPENSES RECORDED IN REVENUE -6,189. LODI COMMUNITY HOSPITAL ADOPTED FIN 48 (ASC 740) IN 2007 AS REQUIRED. NO FOOTNOTE DISCLOSURES WERE REQUIRED UNDER GAAP AS LODI COMMUNITY HOSPITAL DOES NOT HAVE ANY MATERIAL TAX CONTINGENCIES THAT REQUIRED SUCH DISCLOSURES. 1 1 X 1 X 1 X 1 1 1 0 0 398879 398879 0.02850 2422733 1265986 1156747 0.08260 2821612 1265986 1555626 0.11110 244594 36510 208084 0.01490 90796 90796 0.00650 12277 12277 0.00090 347667 36510 311157 0.02230 3169279 1302496 1866783 0.13340 23115 23115 23115 23115 1 1105118 3840049 3775939 64110 X 1 1 1 1 LODI COMMUNITY HOSPITAL

225 ELYRIA ST LODI OH 44254

X X X X LODI COMMMUNITY HOSPITAL 1 1 1 200.000000000000 1 400.000000000000 1 X 1 1 X X X X X X X 1 0 1 X 0 0 2 LODI COMMUNITY CARE CENTER

402 HIGHLAND LODI OH 44254

PHYSICIANS OFFICE LODI COMMUNITY CARE CENTER

221 ELYRIA ST LODI OH 44254

PHYSICIANS OFFICE PART I, LINE 7: COLUMN (F): IN CALCULATING THE PERCENTAGE OF TOTAL EXPENSE REPORTED IN COLUMN (F), TOTAL EXPENSES AS REPORTED ON FORM 990, PART IX, LINE 25, COLUMN (A) WERE REDUCED BY $3,085,501 - THE AMOUNT OF BAD DEBT EXPENSE INCLUDED ON THAT LINE. PART III, LINE 4: THE PROVISION FOR BAD DEBTS IS BASED UPON MANAGEMENT'S ASSESSMENT OF HISTORICAL AND EXPECTED NET COLLECTIONS CONSIDERING HISTORICAL BUSINESS AND ECONOMIC CONDITIONS, TRENDS IN HEALTH CARE COVERAGE AND OTHER COLLECTION INDICATORS. PERIODICALLY THROUGHOUT THE YEAR, MANAGEMENT ASSESSES THE ADEQUACY OF THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS BASED UPON HISTORICAL WRITE-OFF EXPERIENCE BY PAYOR CATEGORY. THE RESULTS OF THIS REVIEW ARE THEN USED TO MAKE ANY MODIFICATIONS TO THE PROVISION FOR BAD DEBTS TO ESTABLISH AN APPROPRIATE ALLOWANCE FOR UNCOLLECTIBLE RECEIVABLES.AFTER SATISFACTION OF AMOUNTS DUE FROM INSURANCE, LODI COMMUNITY HOSPITAL FOLLOWS ESTABLISHED GUIDELINES FOR PLACING CERTAIN PAST-DUE PATIENT BALANCES WITH COLLECTION AGENCIES, SUBJECT TO THE TERMS OF CERTAIN RESTRICTIONS ON COLLECTION EFFORTS AS DETERMINED BY LODI COMMUNITY HOSPITAL. PART III, LINE 9B: LODI COMMUNITY HOSPITAL'S BAD DEBT COLLECTION POLICY ADDRESSES HOW TO IDENTIFY AND PROCESS PATIENTS' ACCOUNTS FOR QUALIFICATION AS CHARITY CARE OR OTHER FINANCIAL ASSISTANCE. AT REGISTRATION/ADMISSION A SCREENING PROCESS IDENTIFIES THOSE PATIENTS WITHOUT INSURANCE. THOSE PATIENT ACCOUNTS ARE AUTOMATICALLY CHECKED FOR POSSIBLE MEDICAID OR OTHER FINANCIAL ASSISTANCE ELIGIBILITY. WHERE ELEGIBILITY IS ESTABLISHED, THE PATIENT RECEIVES ASSISTANCE AFTER COMPLETING ANY REQUIRED APPLICATIONS. PATIENTS WHO QUALIFY FOR 100% CHARITY CARE WILL HAVE THEIR CHARGES WRITTEN OFF AS SUCH AND NO COLLECTION EFFORTS WILL FOLLOW. PATIENTS THAT QUALIFY FOR A SLIDING SCALE DISCOUNT THROUGH CHARITY CARE WILL HAVE THEIR STATEMENT ADJUSTED ACCORDINGLY. IF THE ADJUSTED BALANCE IS UNPAID, THE ADJUSTED BALANCE GOES TO COLLECTIONS IN ACCORDANCE WITH POLICY FOR ALL BAD DEBT ACCOUNTS. LODI COMMMUNITY HOSPITAL PART V, SECTION B, LINE 14G: FOR UNINSURED AND UNDERINSURED PATIENTS, OUR FINANCIAL COUNSELORS OR ELIGIBILITY VENDOR STAFF REACH OUT UPON ADMISSION, OR AS SOON AS POSSIBLE THEREAFTER, TO EXPLAIN THE PROGRAMS FOR FREE OR DISCOUNTED CARE AND TO ASSESS ELIGIBILITY FOR MEDICAID AND OTHER VARIOUS PROGRAMS (VETERAN'S ADMINISTRATION, COBRA, OTHER LOCAL PROGRAMS, ETC.).FOR SCHEDULED OUTPATIENT SERVICES, FINANCIAL COUNSELORS ATTEMPT TO CONTACT THE PATIENT PRIOR TO SERVICE TO SCREEN UNINSURED PATIENTS FOR POSSIBLE ASSISTANCE/PAYMENT SOLUTIONS. IF UNABLE TO CONTACT PATIENT PRIOR TO THE SERVICE, WE ATTEMPT TO SCREEN ON THE DAY OF SERVICE OR AS SOON THEREAFTER AS POSSIBLE.FOR UNSCHEDULED EMERGENCY SERVICES, SCREENING MAY BE COMPLETED DURING THE VISIT WHEN PATIENT IS ABLE. OTHERWISE, ATTEMPTS TO CONTACT THE PATIENT ARE MADE BY THE FINANCIAL COUNSELING STAFF.IN EITHER CASE, IF WE ARE UNABLE TO CONTACT THE PATIENT, THE FINANCIAL ASSISTANCE INFORMATION IS ON EACH BILLING STATEMENT SENT TO THE PATIENT.IF THE PATIENT IS DETERMINED TO BE LIKELY ELIGIBLE FOR MEDICAID, THE ELIGIBILITY VENDOR STAFF ASSIST AND REPRESENT THE PATIENT THROUGHOUT THE APPLICATION PROCESS (UPON APPROVAL FROM THE PATIENT). IN ADDITION TO SIGNAGE, BROCHURES EXPLAINING OUR PROGRAMS ARE IN ALL OF OUR REGISTRATION AREAS. OUR WELCOME PACKETS ALSO INCLUDE INFORMATION AS DOES OUR WEBSITE. ALL STATEMENTS MAILED TO PATIENTS INCLUDE A NOTICE THAT OUR FINANCIAL ASSISTANCE APPLICATIONS ARE ON THE BACK OF THE STATEMENT. PHONE NUMBERS ARE PROVIDED FOR ASSISTANCE.FOR SCHEDULED OUTPATIENT SERVICES, FINANCIAL COUNSELORS ATTEMPT TO CONTACT THE PATIENT PRIOR TO SERVICE TO SCREEN UNINSURED PATIENTS FOR POSSIBLE ASSISTANCE/PAYMENT SOLUTIONS. IF UNABLE TO CONTACT PATIENT PRIOR TO THE SERVICE, WE ATTEMPT TO SCREEN ON THE DAY OF SERVICE OR AS SOON THEREAFTER AS POSSIBLE. PART VI, LINE 2: THERE ARE A VARIETY OF NEEDS ASSESSMENT METHODS EMPLOYED BY LODI COMMUNITY HOSPITAL IN DETERMINING THE HEALTH NEEDS OF THE COMMUNITY IT SERVES. FOR MEDICAL STAFFING AND SERVICES, A COMBINATION OF FACTORS INCLUDING THE COMMUNITY'S DEMOGRAPHICS AND HEALTH NEEDS, THE DEMOGRAPHICS OF MEDICAL STAFF (PHYSICIAN AGE, SPECIALTY, ETC...) ARE WEIGHED TO DETERMINE WHERE RESOURCES SHOULD BE CONCENTRATED IN ORDER TO MEET CURRENT AND FUTURE HEALTHCARE NEEDS OF THE COMMUNITY. LODI COMMUNITY HOSPITAL PARTICIPATES IN HEALTHCARE INITIATIVES OF STATE AND LOCAL HEALTH DEPARTMENTS, EITHER SOLELY OR IN CONCERT WITH OTHER HEALTHCARE PROVIDERS, DEPENDING ON THE INITIATIVE. LODI COMMUNITY HOSPITAL HAS WORKED WITH LOCAL CHURCHES AND SOCIAL WELFARE ORGANIZATIONS TO IDENTIFY AND SERVICE HEALTHCARE NEEDS OF PERSONS WHO ARE UNDERSERVED BY GOVERNMENT PROGRAMS OR WHO HAVE FALLEN COMPLETELY THROUGH GOVERNMENT SAFETY NETS. PART VI, LINE 3: FINANCIAL ASSISTANCE APPLICATIONS ARE ON THE BACK OF EVERY PATIENT STATEMENT AS WELL AS MESSAGES INFORMING PATIENTS THAT ASSISTANCE IS AVAILABLE - VIA WEBSITE, AUTOMATED ATTENDANT OR CUSTOMER SERVICE LINE, SUCH MESSAGES ALSO ARE CONSPICUOUSLY POSTED IN PATIENT AREAS AND THROUGHOUT OUR FACILITIES. PART VI, LINE 4: LODI COMMUNITY HOSPITAL IS LOCATED IN SOUTHERN MEDINA COUNTY AND SERVES THE POPULATION OF 174,035 PEOPLE IN MEDINA. THE MEDIAN AGE OF RESIDENTS IN MEDINA IS 36.6 AND THE MEDIAN HOUSEHOLD INCOME IS AROUND $55,000. THE DOMINANT INDUSTRIES IN THE AREA ARE AGRICULTURE, MANUFACTURING, RETAIL AND GOVERNMENT. LODI COMMUNITY HOSPITAL ALSO SERVES A LARGE AMISH POPULATION. WHILE MEDINA COUNTY'S UNEMPLOYMENT RATE IS AT 6.1% THE SURROUNDING COUNTIES' RATES ARE HIGHER; LORAIN IS 8.2%, WAYNE IS 6.4% AND ASHLAND IS 7.4% WITH THE STATE OF OHIO AT 7.3%. PART VI, LINE 5: IN ORDER TO ENSURE THE FURTHERANCE OF LODI COMMUNITY HOSPITAL'S EXEMPT PURPOSE, ITS BOARD OF DIRECTORS CONSISTS OF COMMUNITY MEMBERS - THE MAJORITY OF WHOM ARE INDEPENDENT. THE SIZE OF THE BOARD - 13 IN 2012 - IS DESIGNED TO BE LARGE ENOUGH TO PROVIDE SUFFICIENT EXPERTISE AND DIVERSITY FOR AN ORGANIZATION OF THIS SIZE WITHOUT BEING TOO LARGE TO MANAGE ITSELF. THE BOARD, AS WELL AS SENIOR MANAGEMENT AND MEDICAL STAFF LEADERS, ARE CHARGED BY POLICY WITH THE EXPECTATION THAT PERSONS IN SUCH POSITIONS WILL ADVOCATE STRONG TIES BETWEEN THE ORGANIZATION AND THE COMMUNITY IT SERVES. AMONG OTHER THINGS THE POLICY CITES THE ASSUMPTION OF BOARD POSITIONS WITH SERVICE ORGANIZATIONS AND COMMUNITY AGENCIES AS WAYS TO PROMOTE SUCH TIES. THROUGH THE HEALTH SYSTEM'S COMMUNITY HEALTH COMMITTEE, LODI COMMUNITY HOSPITAL RECEIVES CONSIDERABLE SUPPORT IN MAINTAINING CONTACTS WITH A DIVERSE CROSS SECTION OF ITS COMMUNITY. THE COMMUNITY HEALTH COMMITTEE SUPPORTS INITIATIVES DESIGNED TO MEET THE NEEDS OF VULNERABLE, DISADVANTAGED POPULATIONS AND THOSE WHO LACK ACCESS TO QUALITY HEALTH CARE. THE MAJORITY OF THE COMMUNITY MEMBERS ARE INDEPENDENT ARE INDEPENDENT COMMUNITY MEMBERS WHOSE FOCUSED MISSION PROVIDES AN IMPORTANT ACCESS POINT FOR GROUPS WITHIN THE COMMUNITY.LODI COMMUNITY HOSPITAL ALSO MAINTAINS AN OPEN MEDICAL STAFF.LODI COMMUNITY HOSPITAL IS BOUND BY LAW TO REINVEST ANY SURPLUS FROM OPERATIONS INTO ITS FACILITIES AND PROGRAMS IN FURTHERANCE OF ITS EXEMPT PURPOSE, PROMOTING THE HEALTH OF THE COMMUNITY IT SERVES. PART VI, LINE 6: AKRON GENERAL HEALTH SYSTEM IS A NOT-FOR-PROFIT HEALTHCARE ORGANIZATION WITH THE MISSION OF IMPROVING THE HEALTH AND LIVES OF PATIENTS AND THE COMMUNITY, AKRON GENERAL HEALTH SYSTEM INCLUDES: AKRON GENERAL MEDICAL CENTER, A 537-BED TEACHING AND RESEARCH MEDICAL CENTER, AND EDWIN SHAW REHAB, THE AREA'S LARGEST PROVIDER OF REHABILITATION SERVICES: AKRON GENERAL PARTNERS, WHICH INCLUDES PARTNERS PHYSICIAN GROUP, THE AKRON GENERAL HEALTH & WELLNESS CENTERS, LODI COMMUNITY HOSPITAL, COMMUNITY HEALTH CENTERS AND OTHER COMPANIES; AKRON GENERAL COMMUNITY HEALTH VENTURES, WHICH INCLUDES VISITING NURSE SERVICE AND AFFILIATES, THE LARGEST AND MOST COMPREHENSIVE PROVIDER OF HOME HEALTHCARE SERVICES IN OHIO, AND THE AKRON GENERAL FOUNDATION.AKRON GENERAL HEALTH SYSTEM BRINGS TOGETHER A NETWORK OF HEALTH CARE FACILITIES AND STAFF WITH A RICH HERITAGE OF EXCEPTIONAL CARE. IT IS AN INTEGRATED HEALTH SYSTEM THAT PROVIDES HIGH-QUALITY HEALTHCARE FOR PATIENTS AND COMMUNITY THROUGHOUT THEIR ENTIRE LIFE - BIRTHS, INPATIENT AND OUTPATIENT SERVICES FOR ADULTS, EMERGENCY CARE, HOME CARE, WELLNESS, DURABLE MEDICAL EQUIPMENT AND HOSPICE SERVICES. X X 1 1 X X X X X 0 1 0 0 0 0 0 0 0 ALAN PAPA 0 346324 0 36867 0 98937 0 81298 0 25571 0 588997 0 0 DAVID PETER MD 0 303006 0 7054 0 71190 0 26111 0 14739 0 422100 0 0 JOSEPH MELI MD 0 250458 0 25000 0 5420 0 21690 0 14659 0 317227 0 0 ROBERT KAMIENSKI MD 0 312980 0 84774 0 14146 0 23960 0 13359 0 449219 0 0 THOMAS STOVER MD 0 648164 0 125000 0 118404 0 86553 0 18731 0 996852 0 0 VINCENT J MCCORKLE 0 173368 0 0 0 95914 0 7575 0 2823 0 279680 0 0 CRAIG BABBITT 0 277576 0 59875 0 61253 0 53395 0 19319 0 471418 0 0 DEBBIE L GORBACH 0 181791 0 45996 0 38412 0 84528 0 23992 0 374719 0 0 STEPHEN GARY 0 186255 0 0 0 137063 0 10819 0 8982 0 343119 0 0 SUE MCCARTHY 0 100704 0 40000 0 21088 0 91 0 3083 0 164966 0 0 THOMAS WHELAN 189793 0 16335 0 44172 0 43968 0 19764 0 314032 0 0 0 ALAN J BLEYER 0 0 0 0 0 25803 0 20280 0 33462 0 79545 0 59265 PART I, LINE 1A THE EXPENSES INDICATED IN PART I, LINE 1 ARE TAXABLE BENEFITS. AS SUCH THEY ARE PART OF TOTAL COMPENSATION. TOTAL COMPENSATION IS TESTED FOR REASONABLENESS AS DESCRIBED IN SCHEDULE O FOR FORM 990, PART VI, SECTION B, LINES 15A AND B. DISCRETIONARY SPENDING ACCOUNT A PORTION OF THE EMPLOYEES' TAXABLE INCOME IS DESIGNATED AS A DISCRETIONARY SPENDING ACCOUNT BENEFIT. THE RECIPIENTS ARE TAXED ON THE ENTIRE VALUE OF THE BENEFIT. THE NET AMOUNT MAY THEN BE APPLIED TO ONE OR MORE OF A LIMITED NUMBER OF CHOICES AVAILABLE UNDER THIS BENEFIT. IF ANY OF THE NET AMOUNT REMAINS AFTER CHOOSING FROM SUCH OPTIONS, IT IS APPLIED TOWARD THE RECIPIENT'S NON-QUALIFIED RETIREMENT BENEFIT. THIS BENEFIT WAS OFFERED TO EMPLOYEES AT THE VICE PRESIDENT LEVEL AND ABOVE. IN 2012, 2 EMPLOYEES CHOSE THIS BENEFIT. TAX INDEMNIFICATION AND GROSS-UP PAYMENTS SUPPLEMENTAL RETIREMENT IS GROSSED-UP FOR TAX PURPOSES. THE GROSS-UP AND THE BENEFIT BOTH ARE TAXED AND ARE INCLUDED IN TOTAL COMPENSATION. TOTAL COMPENSATION IS TESTED FOR REASONABLENESS AS DESCRIBED IN SCHEDULE O FOR FORM 990, PART VI, SECTION B, LINES 15A AND B. THIS BENEFIT WAS OFFERED TO EMPLOYEES AT THE VICE PRESIDENT LEVEL AND ABOVE. IN 2012, 10 EMPLOYEES RECEIVED THIS BENEFIT. NOTE THAT, TAX INDEMNIFICATION IS NOT OFFERED AS A BENEFIT. PART I, LINE 4B ALAN BLEYER SEPARATED FROM SERVICE IN 2009. UNDER THE TERMS OF HIS SEVERANCE AGREEMENT, MR. BLEYER RECEIVED PAYMENTS TOTALING $25,803 IN 2012. AT 12/31/2012 THE BALANCE OF THE ACCRUED LIABILITY FOR THE REMAINDER OF MR. BLEYER'S SEVERANCE AGREEMENT TOTALED $75,289. IN 2012, VINCENT MCCORKLE SEPARATED FROM SERVICE WITH AKRON GENERAL HEALTH SYSTEM. DURING 2012, MR. MCCORKLE RECEIVED A SEPARATION PAYMENT OF $67,000. IN 2012, STEVE GARY SEPARATED FROM SERVICE WITH AKRON GENERAL HEALTH SYSTEM. DURING 2012, MR. GARY RECEIVED SEPARATION PAYMENTS TOTALING $78,462. LINE 4B: THE FOLLOWING EMPLOYEES RECEIVED EMPLOYER CONTRIBUTIONS TO A NONQUALIFIED TAXABLE PLAN. THE BENEFIT IS PAID BY AKRON GENERAL HEALTH SYSTEM (RELATIONSHIP DESCRIBED BELOW). THE CONTRIBUTIONS WERE TAXABLE TO THE EMPLOYEES IN 2012. THOMAS WHELAN - $23,493 CRAIG BABBITT - $18,000 DEBBIE GORBACH - $17,280 STEPHEN M. GARY - $15,300 SUE J. MCCARTHY - $6,093 TIM STOVER, M.D. - $40,200 VINCENT MCCORKLE - $30,000 ALAN PAPA - $45,000 DAVID PETER, M.D. - $19,500 DANA KOCSIS - $5,193 SUPPLEMENTAL INFORMATION PART III RELATED ORGANIZATION COMPENSATION AKRON GENERAL HEALTH SYSTEM (FEIN 34-1546466) IS THE SOLE MEMBER OF AKRON GENERAL MEDICAL CENTER (FEIN 34-0714478). AKRON GENERAL MEDICAL CENTER IS THE SOLE MEMBER OF LODI COMMUNITY HOSPITAL. THE INDIVIDUALS LISTED BELOW ARE (OR WERE) FULL TIME PAID EMPLOYEES OF AKRON GENERAL HEALTH SYSTEM. THE AMOUNTS SHOWN IN SCHEDULE J PART II REFLECT COMPENSATION FOR SERVICES TO THAT ORGANIZATION. VINCENT J. MCCORKLE ALAN J. BLEYER (FORMER) CRAIG M. BABBITT STEPHEN M. GARY TIM STOVER, M.D. SUE J. MCCARTHY AKRON GENERAL HEALTH SYSTEM (FEIN 34-1546466) IS THE SOLE MEMBER OF AKRON GENERAL MEDICAL CENTER (FEIN 34-0714478). AKRON GENERAL MEDICAL CENTER IS THE SOLE MEMBER OF LODI COMMUNITY HOSPITAL. THE INDIVIDUALS LISTED BELOW ARE (OR WERE) FULL TIME PAID EMPLOYEES OF AKRON GENERAL MEDICAL CENTER. THE AMOUNTS SHOWN IN SCHEDULE J PART II REFLECT COMPENSATION FOR SERVICES TO THAT ORGANIZATION. ALAN PAPA DAVID PETER, M.D. JUSTIN LAVIN, M.D. AKRON GENERAL HEALTH SYSTEM (FEIN 34-1546466) IS THE SOLE MEMBER OF AKRON GENERAL MEDICAL CENTER. IT IS ALSO THE SOLE MEMBER OF AKRON GENERAL PARTNERS (FEIN 20-1801493) WHICH IN TURN IS THE SOLE MEMBER OF PARTNERS PHYSICIAN GROUP (FEIN 34-1843403) WHICH IN TURN IS THE SOLE MEMBER OF NHV PHYSICIANS PROFESSIONAL CORPORATION (FEIN 34-1818688). THE INDIVIDUALS LISTED BELOW ARE PAID AS EMPLOYEES OF NHV PHYSICIANS PROFESSIONAL CORPORATION. JOSEPH MELI, M.D. ROBERT KAMIENSKI, M.D. FORM 990, PART VI, SECTION A, LINE 6 LODI COMMUNITY HOSPITAL HAS ONE MEMBER, AKRON GENERAL MEDICAL CENTER. AKRON GENERAL MEDICAL CENTER IS ORGANIZED IN OHIO AS A NON-PROFIT ORGANIZATION AND IS RECOGNIZED AS EXEMPT FROM FEDERAL INCOME TAX UNDER IRC 501(C)(3). AKRON GENERAL MEDICAL CENTER IS NOT A PRIVATE FOUNDATION. FORM 990, PART VI, SECTION A, LINE 7A AKRON GENERAL MEDICAL CENTER IS THE SOLE MEMBER OF LODI COMMUNITY HOSPITAL. AKRON GENERAL HEALTH SYSTEM IS THE SOLE MEMBER OF AKRON GENERAL MEDICAL CENTER. THE ORGANIZATION FOLLOWS THE PRACTICE UNDER WHICH LODI COMMUNITY HOSPITAL CURRENT BOARD SUGGESTS CANDIDATES FOR OPENINGS ON ITS BOARD, THAT ARE THEN REVIEWED FOR APPROVAL BY AKRON GENERAL HEALTH SYSTEM'S BOARD. FORM 990, PART VI, SECTION A, LINE 7B AKRON GENERAL MEDICAL CENTER IS THE SOLE MEMBER OF LODI COMMUNITY HOSPITAL. AKRON GENERAL HEALTH SYSTEM IS THE SOLE MEMBER OF AKRON GENERAL MEDICAL CENTER. AKRON GENERAL HEALTH SYSTEM'S RESPONSIBILITIES INCLUDE PROVIDING LONG TERM PLANNING, ESTABLISHING SYSTEM POLICIES AND PROCEDURES, FINANCIAL MANAGEMENT, AND ASSISTING ORGANIZATIONS WITHIN THE SYSTEM IN CARRYING OUT THIER EXEMPT PROGRAMS. GENERALLY, AKRON GENERAL HEALTH SYSTEM LIMITS ITS POWER OF APPROVAL OVER DECISIONS MADE BY THE BOARD OF LODI COMMUNITY HOSPITAL TO THOSE CONCERNING MEMBERSHIP OF THAT BOARD AND THAT ORGANIZATION'S ANNUAL BUDGET. FORM 990, PART VI, SECTION B, LINE 11 LODI COMMUNITY HOSPITAL IS A MEMBER OF THE AKRON GENERAL HEALTH SYSTEM. LODI COMMUNITY HOSPITAL PREPARES ITS FORM 990 INTERNALLY. THE RETURN IS SUBJECT TO FINANCIAL REVIEW BY THE CHIEF FINANCIAL OFFICER OF AKRON GENERAL HEALTH SYSTEM, THE VICE PRESIDENT OF ACCOUNTING AND FINANCE OF AKRON GENERAL HEALTH SYSTEM, AND REVIEWED FOR COMPLIANCE WITH THE REPORTING REQUIREMENTS OF FORM 990 BY THE DIRECTOR OF CORPORATE TAX FOR AKRON GENERAL HEALTH SYSTEM. FORM 990, PART VI, SECTION B, LINE 12C LODI COMMUNITY HOSPITAL IS A MEMBER OF THE AKRON GENERAL HEALTH SYSTEM (SYSTEM). AKRON GENERAL HEALTH SYSTEM IS THE PARENT ORGANIZATION OF THE SYSTEM AND AS SUCH IT DETERMINES CERTAIN POLICIES AND PROCEDURES APPLICABLE TO ALL MEMBER ORGANIZATIONS. IN THE CASE OF CONFLICT OF INTEREST REPORTING, AKRON GENERAL HEALTH SYSTEM NOT ONLY DETERMINES THE POLICY AND THE PROCEDURE, IT CARRIES OUT THE PROCEDURE FOR ALL SYSTEM ORGANIZATIONS ITSELF. A CONFLICT OF INTEREST QUESTIONNAIRE IS DISTRIBUTED TO ALL BOARD MEMBERS, MANAGEMENT PERSONNEL, EMPLOYED PHYSICIANS AND ANY OTHER PERSONNEL THAT HAVE BEEN DESIGNATED BY MANAGEMENT. THE DISTRIBUTION COVERS ALL SYSTEM ORGANIZATIONS. ALL RESPONSES THAT INDICATE A PERCEIVED CONFLICT OF INTEREST ARE TURNED OVER TO THE GOVERNANCE AND COMPLIANCE COMMITTEE (THE COMMITTEE) OF AKRON GENERAL HEALTH SYSTEM FOR REVIEW. THE COMMITTEE MAKES A DETERMINATION AS TO WHETHER THE PERCEIVED CONFLICT IS LIKELY TO BE AN ACTUAL CONFLICT, THE MATERIALITY OF ANY ACTUAL CONFLICTS AND THE EXTENT OF SAFEGUARDS REQUIRED FOR ANY ACTUAL CONFLICTS. SAFEGUARDS INCLUDE, BUT ARE NOT LIMITED TO, REQUIRING, IN THE CASE OF A BOARD MEMBER, THAT THE PERSON RECUSE HIMSELF OR HERSELF FROM ANY DISCUSSIONS OR VOTING THAT MAY BE AFFECTED BY THE CONFLICT, REQUIRING THE PERSON TO DISENGAGE FROM THE CONDUCT CREATING THE CONFLICT OR REQUIRING THE PERSON TO RESIGN FROM THE POSITION AFFECTED BY THE CONFLICT. THIS PROCESS IS CONDUCTED BY AKRON GENERAL HEALTH SYSTEM'S LEGAL SERVICES DEPARTMENT ANNUALLY. THE CONFLICT OF INTEREST LETTER PUTS THE RECIPIENT ON NOTICE THAT HE OR SHE IS UNDER AN ONGOING DUTY TO REPORT ANY POTENTIAL CONFLICTS THAT MAY ARISE SUBSEQUENT TO THIS FORMAL PROCESS. SUBSEQUENT EVENT REPORTING IS MONITORED BY AKRON GENERAL HEALTH SYSTEM'S LEGAL SERVICES DEPARTMENT. ANY SUBSEQUENT REPORTED ITEMS ARE SUBJECT TO THE AFOREMENTIONED REVIEW PROCESS BY AKRON GENERAL HEALTH SYSTEM'S GOVERNANCE AND COMPLIANCE COMMITTEE. FORM 990, PART VI, SECTION B, LINE 15 THE REPORTING ORGANIZATION IS A MEMBER OF THE AKRON GENERAL HEALTH SYSTEM. THE EXEMPT PURPOSE OF THE SYSTEM PARENT, AKRON GENERAL HEALTH SYSTEM (AGHS), IS TO SUPPORT THE MEMBERS OF THAT SYSTEM. ONE OF THE SUPPORT SERVICES THAT AGHS PROVIDES IS DETERMINING THE COMPENSATION OF THE TOP MANAGEMENT PERSONNEL OF THE REPORTING ORGANIZATION. AGHS FOLLOWS A PROCESS FOR DETERMINING COMPENSATION OF THE ORGANIZATION'S CEO AND OTHER TOP MANAGEMENT PERSONNEL THAT IS MODELED AFTER THE REQUIREMENTS FOUND IN INTERNAL REVENUE CODE SECTION 4958 FOR ESTABLISHING THE PRESUMPTION OF REASONABLE COMPENSATION. THEREFORE, THE PROCESS CALLS FOR RECOMMENDATIONS - DEVELOPED BY AN INDEPENDENT COMPENSATION CONSULTANT, BASED ON COMPARABLE MARKET DATA FROM PUBLISHED SURVEYS AND THE FORMS 990 OF COMPARABLE ORGANIZATIONS - THAT ARE WITHIN THE RANGE OF THE COMPENSATION OF SIMILARLY SITUATED PERSONS AT SIMILARLY SITUATED ORGANIZATIONS. THESE RECOMMENDATIONS ARE REVIEWED BY A COMMITTEE OF THE REPORTING ORGANIZATION'S BOARD OF DIRECTORS. THE COMMITTEE IS COMPRISED OF INDEPENDENT PERSONS AND THE DELIBERATIONS ARE DOCUMENTED, CONTEMPORANEOUSLY, IN THE COMMITTEE'S MINUTES. THE COMPENSATION FOR ALL TOP MANAGEMENT WAS REVIEWED FOR REASONABLENESS USING THIS PROCESS IN 2011. FORM 990, PART VI, SECTION C, LINE 19 CURRENTLY, LODI COMMUNITY HOSPITAL DOES NOT MAKE ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, OR ITS FINANCIAL STATEMENTS GENERALLY AVAILABLE TO THE PUBLIC. LODI COMMUNITY HSOPITAL DOES MAKE THESE DOCUMENTS AVAILABLE ON A CASE BY CASE BASIS. TITLE AND HOURS FOR RELATED ORGANIZATION FORM 990, PART VII, COLUMNS A AND B ALAN PAPA ALAN PAPA SERVED AS PRESIDENT AND CHIEF OPERATING OFFICER, AND MEMBER OF THE BOARD OF DIRECTORS OF THE REPORTING ORGANIZATION, AVERAGING 62.9 HOURS PER WEEK ON THOSE DUTIES MR. PAPA MEETS THE DEFINITION OF KEY EMPLOYEE WITH RESPECT TO AKRON GENERAL HEALTH SYSTEM, A RELATED TAX EXEMPT ORGANIZATION, AVERAGING .9 HOURS PER WEEK ON THOSE DUTIES. IN ADDITION, MR. PAPA SERVED AS A MEMBER OF THE BOARD OF DIRECTORS OF THE FOLLOWING RELATED ORGANIZATION, AVERAGE HOURS PER WEEK CORRESPONDING: PARTNERS PHYSICIAN GROUP - .1 DAVID PETER, M.D. DR. PETER SERVED AS A MEMBER OF THE BOARD OF DIRECTORS. DR. PETER ALSO SERVED AS SENIOR VICE PRESIDENT AND CHIEF MEDICAL OFFICER OF AKRON GENERAL MEDICAL CENTER, A RELATED TAX EXEMPT ORGANIZATION, SPENDING AN AVERAGE OF 54.5 HOURS PER WEEK ON THOSE DUTIES. JOSEPH MELI, M.D. DIRECTOR FOR THE REPORTING ORGANIZATION. DR. MELI IS ALSO A FULL TIME EMPLOYEE OF NHV PHYSICIANS PROFESSIONAL CORPORATION, A RELATED ORGANIZATION, AVERAGING 55.0 HOURS PER WEEK ON THOSE DUTIES. JUSTIN LAVIN, M.D. DR. LAVIN SERVED AS A MEMBER OF THE BOARD OF THE REPORTING ORGANIZATION THROUGH APRIL OF 2012. DR. LAVIN ALSO SERVED AS THE CHAIRMAN OF THE OB/GYN DEPARTMENT OF AKRON GENERAL MEDICAL CENTER, A RELATED TAX EXEMPT ORGANIZATION, SPENDING AN AVERAGE OF 49.5 HOURS PER WEEK ON THOSE DUTIES. ROBERT KAMIENSKI, M.D. DIRECTOR FOR THE REPORTING ORGANIZATION. DR. KAMIENSKI IS ALSO A FULL TIME EMPLOYEE OF NHV PHYSICIANS PROFESSIONAL CORPORATION, A RELATED ORGANIZATION, AVERAGING 55 HOURS PER WEEK ON THOSE DUTIES. TIM STOVER, M.D. BEGINNING FEBRUARY 3, 2012, DR. STOVER SERVED AS A MEMBER OF THE THE BOARD OF DIRECTORS OF THE REPORTING ORGANIZATION, AVERAGING .5 HOURS PER WEEK ON THESE DUTIES. THROUGH FEBRUARY 3, 2012, DR. STOVER SERVED AS PRESIDENT OF OUTPATIENT SERVICES FOR AKRON GENERAL HEALTH SYSTEM, A RELATED ORGANIZATION. BEGINNING FEBRUARY 3, 2012, DR. STOVER SERVED AS PRESIDENT, CHIEF EXECUTIVE OFFICER AND MEMBER OF THE BOARD OF DIRECTORS OF AKRON GENERAL HEALTH SYSTEM, AVERAGING 50.8 PER WEEK ON THESE DUTIES. DR. STOVER SERVED AS PRESIDENT AND EX OFFICIO MEMBER OF THE BOARD OF DIRECTORS OF THE FOLLOWING RELATED ORGANIZATIONS, AVERAGE HOURS PER WEEK CORRESPONDING: AKRON GENERAL PARTNERS, INC. - .2 DR. STOVER ALSO SERVED AS A MEMBER OF THE BOARD OF DIRECTORS OF THE FOLLOWING RELATED ORGANIZATIONS: PARTNERS PHYSICIAN GROUP - .2 NHV PHYSICIANS PROFESSIONAL CORPORATION - 0 BEGINNING FEBRUARY 3, 2012, DR. STOVER SERVED AS A MEMBER OF THE BOARD OF DIRECTORS OF THE FOLLOWING RELATED ORGANIZATIONS, AVERAGE HOURS PER WEEK CORRESPONDING: AKRON GENERAL FOUNDATION - .2 COMMUNITY HEALTH VENTURES - .1 VISITING NURSE SERVICE - 0 VISITING HOURS, INC. - 0 HOSPICE CARE OHIO - .1 VINCENT J. MCCORKLE THROUGH FEBRUARY 3, 2012, MR. MCCORKLE SERVED AS A MEMBER OF THE BOARD OF DIRECTORS FOR THE REPORTING ORGANIZATION. THROUGH FEBRUARY 3, 2012, MR. MCCORKLE SERVED AS CEO AND MEMBER OF THE BOARD OF DIRECTORS FOR AKRON GENERAL HEALTH SYSTEM, A RELATED ORGANIZATION, AVERAGING 55.0 PER WEEK ON THOSE DUTIES. THROUGH FEBRUARY 3, 2012, MR. MCCORKLE SERVED AS A MEMBER OF THE BOARD OF DIRECTORS OF THE FOLLOWING RELATED ORGANIZATIONS, AVERAGE HOURS PER WEEK CORRESPONDING: AKRON GENERAL PARTNERS - .30 COMMUNITY HEALTH VENTURES, INC. - .30 AKRON GENERAL FOUNDATION - .30 NHV PHYSCIANS PROFESSIONAL CORPORATION - .30 VISITING NURSE SERVICE - .30 VISITING HOURS, INC. - .30 HOSPICE CARE OHIO - .30 DAVID BROCKMAN THROUGH APRIL 2012, MR. BROCKMAN SERVED AS A MEMBER OF THE BOARD OF DIRECTORS OF THE REPORTING ORGANIZATION, AVERAGING .2 HOURS PER WEEK ON THOSE DUTIES. BEGINNING IN APRIL OF 2012, MR. BROCKMAN SERVED AS A MEMBER OF THE BOARD OF DIRECTORS OF AKRON GENERAL HEALTH SYSTEM, A RELATED TAX EXEMPT ORGANIZATION, AVERAGING 2.3 HOURS PER WEEK ON THOSE DUTIES. MR. BROCKMAN SERVED AS A MEMBER OF THE BOARD OF DIRECTORS OF AKRON GENERAL FOUNDATION, A RELATED TAX EXEMPT ORGANIZATION, AVERAGING .2 HOURS PER WEEK ON THOSE DUTIES. THROUGH APRIL 2012, MR. BROCKMAN ALSO SERVED AS VICE CHAIRMAN OF THAT BOARD. BRET TREIER MR. TREIER SERVED AS A MEMBER OF THE BOARD OF DIRECTORS OF AKRON GENERAL MEDICAL CENTER. MR. TREIER ALSO SERVED AS A MEMBER OF THE BOARD OF DIRECTORS OF THE FOLLOWING RELATED ORGANIZATION, AVERAGE HOURS PER WEEK CORRESPONDING: AKRON GENERAL PARTNERS, INC. - .20 WILLIAM FRANTZ MR. FRANTZ SERVED AS A MEMBER OF THE BOARD OF DIRECTORS OF THE REPORTING ORGANIZATION, AVERAGING .7 HOURS PER WEEK ON THOSE DUTIES. MR. FRANTZ SERVED AS THE VICE CHAIRMAN OF THAT BOARD THROUGH APRIL OF 2012 AND AS THE CHAIRMAN FROM APRIL OF 2012. BEGINNING IN APRIL OF 2012, MR. FRANTZ SERVED ON THE BOARD OF DIRECTOR OF AKRON GENERAL HEALTH SYSTEM, AVERAGING .1 HOURS PER WEEK ON THOSE DUTIES. WILLIAM BABCOX MR. BABCOX SERVED AS CHAIRMAN AND MEMBER OF THE BOARD OF DIRECTORS OF AKRON GENERAL MEDICAL CENTER. MR. BABCOX ALSO SERVED AS A MEMBER OF THE BOARD OF DIRECTORS OF THE FOLLOWING RELATED ORGANIZATION, AVERAGE HOURS PER WEEK CORRESPONDING: AKRON GENERAL HEALTH SYSTEM - 2.9 CRAIG BABBITT MR. BABBITT SERVED AS SECRETARY FOR THE REPORTING ORGANIZATION. MR. BABBITT SPENT AN AVERAGE OF .4 HOURS PER WEEK ON THE AFOREMENTIONED DUTIES. MR. BABBITT ALSO SERVED AS EXECUTIVE VICE PRESIDENT, BUSINESS DEVELOPMENT AND CHIEF LEGAL OFFICER, AND SECRETARY FOR AKRON GENERAL HEALTH SYSTEM, AVERAGING 60.8 HOURS PER WEEK ON THOSE DUTIES. MR. BABBITT ALSO SERVED AS SECRETARY OF THE FOLLOWING RELATED ORGANIZATIONS, AVERAGE HOURS PER WEEK CORRESPONDING: AKRON GENERAL PARTNERS - .2 PARTNERS PHYSICIAN GROUP - .1 AKRON GENERAL FOUNDATION - .3 NHV PHYSICIANS PROFESSIONAL CORPORATION - 0 VISITING HOURS, INC. - 0 HOSPICE CARE OHIO - 0 MR. BABBITT ALSO SERVED AS A MEMBER OF THE BOARD OF DIRECTORS AND SECRETARY OF THE FOLLOWING RELATED ORGANIZATIONS, AVERAGE HOURS PER WEEK CORRESPONDING: COMMNUITY HEALTH VENTURES, INC. - .1 VISITING NURSE SERVICE - 0 DEBBIE GORBACH - THROUGH JULY 6, 2012, MRS. GORBACH SERVED AS ASSISTANT TREASURER OF THE REPORTING ORGANIZATION. FROM JULY 6, 2012 THROUGH SEPTEMBER 14, 2012, MRS. GORBACH SERVED AS INTERIM TREASURER FOR THE REPORTING ORGANIZATION. FROM SEPTEMBER 14, 2012, MRS. GORBACH SERVED AS ASSISTANT TREASURER OF THE REPORTING ORGANIZATION. MRS. GORBACH SPENT AN AVERAGE OF .7 HOURS PER WEEK ON THE AFOREMENTIONED DUTIES. THROUGH JULY 6, 2012 MRS. GORBACH SERVED THE AKRON GENERAL HEALTH SYSTEM, A RELATED ORGANIZATION, AS ASSISTANT TREASURER. FROM JULY 6, 2012 THROUGH SEPTEMBER 14, 2012, MRS. GORBACH SERVED AKRON GENERAL HEALTH SYSTEM AS INTERIM CHIEF FINANCIAL OFFICER AND INTERIM TREASURER. FROM SEPTEMBER 14, 2012 MRS. GORBACH SERVED AKRON GENERAL HEALTH SYSTEM AS ASSISTANT TREASURER. MRS. GORBACH WAS EMPLOYED BY AKRON GENERAL HEALTH SYSTEM AS V.P. OF ACCOUNTING AND FINANCE FOR THE ENTIRE YEAR. OVERALL, MRS GORBACH SPENT AN AVERAGE OF 57.8 HOURS PER WEEK ON THE AFOREMENTIONED DUTIES. FOR EACH OF THE FOLLOWING RELATED ORGANIZATIONS, MRS. GORBACH SERVED AS ASSISTANT TREASURER THROUGH JULY 6, 2012, AS INTERIM TREASURER FROM JULY 6, 2012 THROUGH SEPTEMBER 14, 2012 AND SERVED AS ASSISTANT TREASURER FROM SEPTEMBER 14 2012. AVERAGE HOURS PER WEEK CORRESPONDING: AKRON GENERAL FOUNDATION - .4 AKRON GENERAL PARTNERS - .4 NHV PHYSCIANS PROFESSIONAL CORPORATION - 0 VISITING NURSE SERVICE - 0 VISITING HOURS, INC. - 0 HOSPICE CARE OHIO - .1 COMMUNITY HEALTH VENTURES - .1 THROUGH JULY 6, 2012, MRS. GORBACH SERVED AS ASSISTANT TREASURER OF THE FOLLOWING RELATED ORGANIZATION. FROM JULY 6, 2012 THROUGH SEPTEMBER 14, 2012, MRS. GORBACH SERVED AS ITS INTERIM TREASURER. FROM SEPTEMBER 14, 2012, MRS. GORBACH SERVED AS ITS ASSISTANT TREASURER. MRS. GORBACH WAS A MEMBER OF ITS BOARD OF DIRECTORS FOR ALL OF 2012. AVERAGE HOURS PER WEEK CORRESPONDING: PARTNERS PHYSICIAN GROUP - .4 STEVE GARY MR. GARY SERVED AS TREASURER OF THE REPORTING ORGANIZATION THROUGH JULY 6, 2012. MR. GARY SERVED AS CHIEF FINANCIAL OFFICER AND TREASURER OF AKRON GENERAL HEALTH SYSTEM THROUGH JULY 6, 2012, AVERAGING 60.0 HOURS PER WEEK ON THOSE DUTIES. THROUGH JULY 6, 2012, MR. GARY ALSO SERVED AS TREASURER OF FOLLOWING RELATED ORGANIZATIONS, AVERAGE HOURS PER WEEK CORRESPONDING: AKRON GENERAL FOUNDATION - .20 AKRON GENERAL PARTNERS - .40 PARTNERS PHYSICIAN GROUP - .40 NHV PHYSCIANS PROFESSIONAL CORPORATION - .00 IN ADDITION, THROUGH JULY 6, 2012, MR. GARY SERVED AS A MEMBER OF THE BOARD OF DIRECTORS AND TREASURER OF THE FOLLOWING RELATED ORGANIZATIONS, AVERAGE HOURS PER WEEK CORRESPONDING: COMMNUITY HEALTH VENTURES, INC. - .00 VISITING NURSE SERVICE - .00 VISITING HOURS, INC. - .00 HOSPICE CARE OHIO - .00 THOMAS WHELAN THOMAS WHELAN SERVED AS THE PRESIDENT OF THE LODI HOSPITAL FACILITY. ALAN J. BLEYER MR. BLEYER IS A FORMER DIRECTOR EX OFFICIO OF THE REPORTING ORGANIZATION, AS WELL AS FORMER PRESIDENT. SUE MCCARTHY BEGINNING SEPTEMBER 14, 2012 MS. MCCARTHY SERVED AS TREASURER OF THE REPORTING ORGANIZATION, AVERAGING 1.1 HOURS PER WEEK ON THOSE DUTIES. BEGINNING SEPTEMBER 14, 2012 MS. MCCARTHY SERVED AS, EXECUTIVE VICE PRESIDENT, CHIEF FINANCIAL OFFICER AND TREASURER OF AKRON GENERAL HEALTH SYSTEM, AVERAGING 54.6 HOURS PER WEEK ON THOSE DUTIES. BEGINNING SEPTEMBER 14, 2012, MS. MCCARTHY SERVED AS TREASURER OF THE FOLLOWING RELATED ORGANIZATIONS, AVERAGE HOURS PER WEEK CORRESPONDING: AKRON GENERAL FOUNDATION - .1 AKRON GENERAL PARTNERS - .1 PARTNERS PHYSICIAN GROUP - .1 NHV PHYSCIANS PROFESSIONAL CORPORATION - 0 COMMNUITY HEALTH VENTURES, INC. - .1 VISITING NURSE SERVICE - 0 VISITING HOURS, INC. - 0 HOSPICE CARE OHIO - 0 OTHER FEES FORM 990, PART IX, LINE 11G PHYSICIAN PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 683,872. MANAGEMENT AND GENERAL EXPENSES 2,500. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 686,372. OTHER PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 960,460. MANAGEMENT AND GENERAL EXPENSES 6,981. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 967,441. BILLING & COLLECTION FEES: PROGRAM SERVICE EXPENSES 54,444. MANAGEMENT AND GENERAL EXPENSES 52,014. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 106,458. LICENSES & REGISTRATION: PROGRAM SERVICE EXPENSES 54,091. MANAGEMENT AND GENERAL EXPENSES 135,741. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 189,832. SECURITY SERVICES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 56,950. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 56,950. COURIER: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 53,038. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 53,038. TRANSCRIPTION: PROGRAM SERVICE EXPENSES 87,859. MANAGEMENT AND GENERAL EXPENSES 100. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 87,959. MISCELLANEOUS : PROGRAM SERVICE EXPENSES 195,195. MANAGEMENT AND GENERAL EXPENSES 176,368. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 371,563. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 9: CHANGE IN INTEREST IN FOUNDATION NET ASSETS 96,470. GRANT FUNDING FOR CAPITAL 25,703. TRANSFER TO/FROM AFFILIATES -3,958,558. AKRON GENERAL HEALTH SYSTEM 400 WABASH AVENUE AKRON OH 44307 341546466 SUPPORTING ORGANIZATION OH IRC 501(C)(3) 11C, FI NONE 0 AKRON GENERAL PARTNERS INC 400 WABASH AVENUE AKRON OH 44307 201801493 SUPPORTING ORGANIZATION OH IRC 501(C)(3) 11A AKRON GENERAL HEALTH SYSTEM 1 AKRON GENERAL FOUNDATION 400 WABASH AVENUE AKRON OH 44307 341127047 FUNDRAISING OH IRC 501(C)(3) 7 AKRON GENERAL HEALTH SYSTEM 1 COMMUNITY HEALTH VENTURES INC 1 HOME CARE PLACE AKRON OH 44320 341478435 SUPPORTING ORGANIZATION OH IRC 501(C)(3) 11C, FI AKRON GENERAL HEALTH SYSTEM 1 AKRON GENERAL MEDICAL CENTER 400 WABASH AVENUE AKRON OH 44307 340714478 HOSPITAL OH IRC 501(C)(3) 3 AKRON GENERAL HEALTH SYSTEM 1 PARTNERS PHYSICIAN GROUP 400 WABASH AVENUE AKRON OH 44307 341843403 COMMUNITY HEALTH SERVICES OH IRC 501(C)(3) 9 AKRON GENERAL PARTNERS INC 1 NHV PHYSICIANS PROFESSIONAL CORPORATION 400 WABASH AVENUE AKRON OH 44307 341818688 PRIMARY & SPECIALTY OUTPATIENT HEALTHCARE OH IRC 501(C)(3) 11A PARTNERS PHYSICIAN GROUP 1 AKRON GENERAL MEDICAL CENTER SELF INSURANCE TRUST FUND 400 WABASH AVENUE AKRON OH 44307 341243687 SUPPORTING ORGANIZATION OH IRC 501(C)(3) 11A AKRON GENERAL MEDICAL CENTER 1 VISITING NURSE SERVICE INC 1 HOME CARE PLACE AKRON OH 44320 340714779 HOME HEALTH CARE OH IRC 501(C)(3) 9 COMMUNITY HEALTH VENTURES INC 1 HOSPICE CARE OHIO INC 1 HOME CARE PLACE AKRON OH 44320 341771508 HOSPICE SERVICES OH IRC 501(C)(3) 9 COMMUNITY HEALTH VENTURES INC 1 VISITING HOURS INC 1 HOME CARE PLACE AKRON OH 44320 341347010 HOME HEALTH CARE OH IRC 501(C)(3) 9 COMMUNITY HEALTH VENTURES INC 1 ROSE LANE INC 5425 HIGH MILL AVENUE NW MASSILLON OH 44646 341527202 NURSING HOME OH IRC 501(C)(3) 9 COMMUNITY HEALTH VENTURES INC 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 0 AKRON GENERAL HEALTH SYSTEM O 913605 FAIR MARKET VALUE AKRON GENERAL HEALTH SYSTEM P 70181 FAIR MARKET VALUE AKRON GENERAL MEDICAL CENTER R 1896523 COST AKRON GENERAL MEDICAL CENTER Q 1938869 COST AKRON GENERAL MEDICAL CENTER P 92331 COST PARTNERS PHYSICIAN GROUP Q 716341 COST PARTNERS PHYSICIAN GROUP R 775399 COST