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      <Form990ScheduleJPartIII>
        <Identifier>Part I, Line 1a</Identifier>
        <Explanation>Summa Health System grossed-up taxes for supplemental executive retirement programs paid to certain officers, key employees, and the highly compensated. Health and social club dues, and tax preparation services were paid on behalf of certain officers. The personal use is reflected as wages.</Explanation>
      </Form990ScheduleJPartIII>
      <Form990ScheduleJPartIII>
        <Identifier>Part I, Line 4a</Identifier>
        <Explanation>In 2011, Kathleen Rice received $481,614 in severance and benefits from a related organization.</Explanation>
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      <Form990ScheduleJPartIII>
        <Identifier>Part I, Line 4b</Identifier>
        <Explanation>Summa Health System has a 457(f) program for the executive staff which rewards certain officers, directors and key employees for meeting key long term strategic objectives of the organization. Thomas J. Strauss $79,362, Joseph Zarconi, MD $31,582, William A. Powel, III $37,018, Thomas P. O'Neill $17,532, Robert Harrigan $56,024, Martin Hauser $36,362, Gregory Kall $27,434, Unhee Kim $33,404, Kyle Klawitter $25,160, Patrice Lange $24,934, Kevin Theiss $12,544, Michael Hillman, MD $17,386, Charles Vignos $15,360, Mary H. Ward $32,354, Dale P. Murphy, MD $24,948, and Charles E. Ross, MD $17,302.</Explanation>
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      <Form990ScheduleJPartIII>
        <Identifier>Part I, Line 6</Identifier>
        <Explanation>Summa Health System management incentive program is designed to reward employees for meeting quality performance and financial targets. These include clinical quality, patient satisfaction, employee/physician satisfaction, net operating income and the strengthening of the balance sheet.</Explanation>
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    </IRS990ScheduleJ>
    <IRS990ScheduleL documentId="IRS990ScheduleL">
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          <NamePerson>OAPO LLC</NamePerson>
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        <Relationship>Part V</Relationship>
        <AmountOfTransaction>995461</AmountOfTransaction>
        <DescriptionOfTransaction>Lease payments</DescriptionOfTransaction>
        <SharingOfRevenues>false</SharingOfRevenues>
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      <Form990ScheduleLPartV>
        <Identifier>Schedule L, Part IV, Business Transactions</Identifier>
        <Explanation>The following person(s) have a financial interest in OAPO, LLC: William Ginter, director, is a principal of OAPO, LLC.</Explanation>
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    <IRS990ScheduleO documentId="IRS990ScheduleO">
      <GeneralExplanation>
        <Identifier>Form 990, Page 6, Part VI, Line 2</Identifier>
        <Explanation>Michael Bage, M.D., Robert Flora, M.D., Michael Maggio, M.D., Dale P. Murphy, M.D., Joseph Myers, M.D., Jay Williamson, M.D., and William A. Powel, III have business relationships through Summa Physicians, Inc.: Michael Bage, M.D., Robert Flora, M.D., Michael Maggio, M.D., Dale P. Murphy, M.D., and Jay Williamson, M.D. are employed by Summa Physicians, Inc.; and William A. Powel, III is a Director of Summa Physicians, Inc. Richard Marsh, Leila Vespoli, and Anthony Lockhart have a business relationship through First Energy: Leila Vespoli is employed as an officer at First Energy and Richard Marsh and Anthony Lockhart are retired officers of First Energy. Mary Ward and Thomas O'Neill have a business relationship through Crystal Clinic Orthopaedic Center, LLC: both are Directors of Crystal Clinic Orthopaedic Center, LLC. Stephen Hailer, Thomas Knoll, Thomas Strauss, William A. Powel, III have a business relationship: all are Directors of Summa Western Reserve Hospital, LLC. Greg Kall, Thomas O'Neill, Unhee Kim, and Daniel Finelli, M.D. have a business relationship through ARIS Teleradiology, LLC: all are Directors of ARIS Teleradiology, LLC.</Explanation>
      </GeneralExplanation>
      <GeneralExplanation>
        <Identifier>Form 990, Page 6, Part VI, Line 7a</Identifier>
        <Explanation>Summa Health System (i) The medical staff of Summa Akron City and St. Thomas Hospitals elects six (6) physicians to be directors of Summa Health System. These are the President of the Medical Staff, Vice President of the Medical Staff, Immediate Past President of the Medical Staff, and three (3) other members of the medical staff. (ii) The Board of Directors of Cuyahoga Falls General Hospital elects two (2) directors. (iii) The Board of Directors of Summa Barberton Citizens Hospital elects one (1) director. (iv) The Board of Directors of Summa Wadsworth-Rittman Hospital elects one (1) director.</Explanation>
      </GeneralExplanation>
      <GeneralExplanation>
        <Identifier>Form 990, Page 6, Part VI, Line 11b</Identifier>
        <Explanation>The return was reviewed in detail by a committee consisting of internal and external legal counsel, financial management, and an external auditor. The review committee included the System Vice President, Finance &amp; CFO and the System Vice President, Legal Services &amp; General Counsel. This detailed review occurred in October 2012. Following this review and incorporation of changes recommended by this committee, the return was provided to the Summa Health System Committee on Governance prior to its October 2012 meeting for further review. The Committee on Governance is a standing committee appointed by the Summa Health System Board of Directors and includes members of the Board of Directors. After this review by the Committee on Governance, and prior to filing with the IRS, an email was sent to each voting member of the Board of Directors. This email included instructions and a link to a password-protected web site on which the entire Form 990 was available for viewing.</Explanation>
      </GeneralExplanation>
      <GeneralExplanation>
        <Identifier>Form 990, Page 6, Part VI, Line 12c</Identifier>
        <Explanation>Conflict of Interest Process Summary: A Conflict of Interest Questionnaire is sent annually to all Summa Health System entities Boards of Directors, Key Employees, Senior Managers, Medical Directors, Employed Physicians, Contracted Physicians, Administrative Directors, Executive Directors, Department Heads, Managers, Supervisors, and Members of Purchasing Committees for completion. Responses are individually reviewed for determination of potential conflicts. Those responses deemed to present potential conflicts are then presented to the Governance Committee (Sub-Committee of the Summa Health System Board of Directors). The Governance Committee reviews each response that presents a potential conflict and determines whether additional action is required to eliminate or mitigate the potential conflict. This annual conflict of interest questionnaire process is managed by the Corporate Compliance Department pursuant to the Summa Health System Policy on Conflict of Interest as approved by the Summa Health System Board of Directors. In addition to the annual Conflict of Interest Questionnaire, the Conflict of Interest Policy imposes a duty to disclose conflicting interests on an ongoing basis. Disclosure Procedure: Any person with a conflicting interest in any transaction or arrangement is required to disclose the conflicting interest to the Board or committee considering such transaction or arrangement prior to or at the beginning of any meeting at which such transaction or arrangement is under consideration. The person with a conflicting interest is prohibited from using his/her personal influence on the matter but may briefly state his/her position on the transaction or arrangement and answer questions raised by members of the Board or committee. The person with a conflicting interest is prohibited from otherwise participating in the decision and may be required to leave the meeting during the discussion and vote on the transaction or arrangement. In addition, if appropriate, a non-interested person or committee may be appointed to investigate alternatives to the proposed transaction or arrangement. The minutes of Board meetings and committee meetings reflect whether any conflicting interests were disclosed, the nature of the conflicting interests, and the names of persons who were present for discussion and votes relating to the transaction or arrangement.</Explanation>
      </GeneralExplanation>
      <GeneralExplanation>
        <Identifier>Form 990, Page 6, Part VI, Line 15</Identifier>
        <Explanation>Executive Compensation: The Compensation Committee of the Summa Health System Board of Directors meets at least twice each year to review and approve base compensation and total remuneration for executive staff. Each voting member of the Compensation Committee is an independent director and is not affiliated with management. The Compensation Committee engages outside consulting support to provide independent market data, advice and counsel to the Compensation Committee. For the past two years, the Compensation Committee has used Hay Group, a nationally recognized consulting firm, to assist their efforts. The Hay Group provides the following services to the Compensation Committee: (a) education of Committee members regarding executive compensation trends and best practices in healthcare organizations; (b) assessment of the market competitiveness and reasonableness of Summa's executive compensation programs including base salary, incentive compensation, core and executive benefits, as well as their alignment with the mission and future performance expectations; (c) written, detailed evaluation of the market reasonableness of Summa's executive compensation and benefits program; and (d) ongoing support and independent advice to the Compensation Committee on matters related to executive compensation. Each year the Compensation Committee reviews and approves the compensation for the following positions: Summa Health System President &amp; CEO System Vice President, Finance &amp; CFO System Vice President, Legal Services &amp; General Counsel System Vice President, IT&amp;S &amp; CIO System Vice President, Service Lines, Ambulatory &amp; Ancillary System Vice President, Planning &amp; Marketing System Vice President &amp; Chief Nursing Officer System Vice President, Human Resources System Vice President, Quality &amp; Medical Affairs</Explanation>
      </GeneralExplanation>
      <GeneralExplanation>
        <Identifier>Form 990, Page 6, Part VI, Line 19</Identifier>
        <Explanation>Summa Health System makes its Conflicts of Interest Policy available on its website (www.summahealth.org). The Articles of Incorporation of Summa Health System and its related entities are available on the website of the Ohio Secretary of State (www.sos.state.oh.us). The financial statements are available through the Electronic Municipal Market Access (www.emma.msrb.org).</Explanation>
      </GeneralExplanation>
      <GeneralExplanation>
        <Identifier>Form 990, Page 5, Part V, Line 2a</Identifier>
        <Explanation>Summa Akron City and St. Thomas Hospitals (SACSTH) 34-0714755 is the paymaster for Summa Health System. All wages of Summa Health System have been appropriately included in the payroll related reporting and tax filings of SACSTH. Summa Health System employees are included as part of the SACSTH payroll tax filings, the employees and related expenses are shown on the Summa Health System form 990.</Explanation>
      </GeneralExplanation>
      <GeneralExplanation>
        <Identifier>Form 990, Page 12, Part XI, Line 5</Identifier>
        <Explanation>Reduction in liability $2,000,000 Prior period adjustment $ 50,000 Unrealized gain $ 96,460</Explanation>
      </GeneralExplanation>
      <GeneralExplanation>
        <Identifier>Form 990, Page 6, Part VI, Line 18</Identifier>
        <Explanation>This Form 990 is posted on the organization's website at www.summahealth.org.</Explanation>
      </GeneralExplanation>
      <GeneralExplanation>
        <Identifier>HOURS DEVOTED FOR RELATED ORGANIZATION</Identifier>
        <ReturnReference>FORM 990 PART VII</ReturnReference>
        <Explanation>NAME:Michael Bage, MD TITLE:Director HOURS:48</Explanation>
      </GeneralExplanation>
      <GeneralExplanation>
        <Identifier>HOURS DEVOTED FOR RELATED ORGANIZATION</Identifier>
        <ReturnReference>FORM 990 PART VII</ReturnReference>
        <Explanation>NAME:Robert Flora, MD TITLE:Director HOURS:48</Explanation>
      </GeneralExplanation>
      <GeneralExplanation>
        <Identifier>HOURS DEVOTED FOR RELATED ORGANIZATION</Identifier>
        <ReturnReference>FORM 990 PART VII</ReturnReference>
        <Explanation>NAME:Michael Maggio, MD TITLE:Director HOURS:48</Explanation>
      </GeneralExplanation>
      <GeneralExplanation>
        <Identifier>HOURS DEVOTED FOR RELATED ORGANIZATION</Identifier>
        <ReturnReference>FORM 990 PART VII</ReturnReference>
        <Explanation>NAME:Dale Murphy, MD TITLE:Director HOURS:48</Explanation>
      </GeneralExplanation>
      <GeneralExplanation>
        <Identifier>HOURS DEVOTED FOR RELATED ORGANIZATION</Identifier>
        <ReturnReference>FORM 990 PART VII</ReturnReference>
        <Explanation>NAME:Joseph Myers, MD TITLE:Director HOURS:48</Explanation>
      </GeneralExplanation>
      <GeneralExplanation>
        <Identifier>HOURS DEVOTED FOR RELATED ORGANIZATION</Identifier>
        <ReturnReference>FORM 990 PART VII</ReturnReference>
        <Explanation>NAME:Joseph Zarconi, MD TITLE:Director HOURS:48</Explanation>
      </GeneralExplanation>
      <GeneralExplanation>
        <Identifier>HOURS DEVOTED FOR RELATED ORGANIZATION</Identifier>
        <ReturnReference>FORM 990 PART VII</ReturnReference>
        <Explanation>NAME:Thomas Strauss TITLE:Director &amp; System Pres/CEO HOURS:48</Explanation>
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      <GeneralExplanation>
        <Identifier>HOURS DEVOTED FOR RELATED ORGANIZATION</Identifier>
        <ReturnReference>FORM 990 PART VII</ReturnReference>
        <Explanation>NAME:Bernett Williams TITLE:Director (term 01/2011) HOURS:</Explanation>
      </GeneralExplanation>
      <GeneralExplanation>
        <Identifier>HOURS DEVOTED FOR RELATED ORGANIZATION</Identifier>
        <ReturnReference>FORM 990 PART VII</ReturnReference>
        <Explanation>NAME:William Powel, III TITLE:Secretary HOURS:48</Explanation>
      </GeneralExplanation>
      <GeneralExplanation>
        <Identifier>HOURS DEVOTED FOR RELATED ORGANIZATION</Identifier>
        <ReturnReference>FORM 990 PART VII</ReturnReference>
        <Explanation>NAME:Brian Derrick TITLE:System CFO HOURS:48</Explanation>
      </GeneralExplanation>
      <GeneralExplanation>
        <Identifier>HOURS DEVOTED FOR RELATED ORGANIZATION</Identifier>
        <ReturnReference>FORM 990 PART VII</ReturnReference>
        <Explanation>NAME:Thomas O'Neill TITLE:Asst Treasurer HOURS:48</Explanation>
      </GeneralExplanation>
      <GeneralExplanation>
        <Identifier>HOURS DEVOTED FOR RELATED ORGANIZATION</Identifier>
        <ReturnReference>FORM 990 PART VII</ReturnReference>
        <Explanation>NAME:C. Michael Rutherford TITLE:System CFO (term 01/2011) HOURS:48</Explanation>
      </GeneralExplanation>
      <GeneralExplanation>
        <Identifier>HOURS DEVOTED FOR RELATED ORGANIZATION</Identifier>
        <ReturnReference>FORM 990 PART VII</ReturnReference>
        <Explanation>NAME:Charles Ross, MD TITLE:Chief Medical Officer HOURS:48</Explanation>
      </GeneralExplanation>
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        <Identifier>HOURS DEVOTED FOR RELATED ORGANIZATION</Identifier>
        <ReturnReference>FORM 990 PART VII</ReturnReference>
        <Explanation>NAME:Robert Harrigan TITLE:System COO HOURS:48</Explanation>
      </GeneralExplanation>
      <GeneralExplanation>
        <Identifier>HOURS DEVOTED FOR RELATED ORGANIZATION</Identifier>
        <ReturnReference>FORM 990 PART VII</ReturnReference>
        <Explanation>NAME:Gregory Kall TITLE:VP, CIO HOURS:48</Explanation>
      </GeneralExplanation>
      <GeneralExplanation>
        <Identifier>HOURS DEVOTED FOR RELATED ORGANIZATION</Identifier>
        <ReturnReference>FORM 990 PART VII</ReturnReference>
        <Explanation>NAME:Martin Hauser TITLE:President, SummaCare HOURS:48</Explanation>
      </GeneralExplanation>
      <GeneralExplanation>
        <Identifier>HOURS DEVOTED FOR RELATED ORGANIZATION</Identifier>
        <ReturnReference>FORM 990 PART VII</ReturnReference>
        <Explanation>NAME:Kyle Klawitter TITLE:VP, System HR HOURS:48</Explanation>
      </GeneralExplanation>
      <GeneralExplanation>
        <Identifier>HOURS DEVOTED FOR RELATED ORGANIZATION</Identifier>
        <ReturnReference>FORM 990 PART VII</ReturnReference>
        <Explanation>NAME:Unhee Kim TITLE:VP, Clinical Services HOURS:48</Explanation>
      </GeneralExplanation>
      <GeneralExplanation>
        <Identifier>HOURS DEVOTED FOR RELATED ORGANIZATION</Identifier>
        <ReturnReference>FORM 990 PART VII</ReturnReference>
        <Explanation>NAME:Patrice Lange TITLE:VP, System Marketing HOURS:48</Explanation>
      </GeneralExplanation>
      <GeneralExplanation>
        <Identifier>HOURS DEVOTED FOR RELATED ORGANIZATION</Identifier>
        <ReturnReference>FORM 990 PART VII</ReturnReference>
        <Explanation>NAME:Mary Ward TITLE:VP, Chief Nursing Officer HOURS:48</Explanation>
      </GeneralExplanation>
      <GeneralExplanation>
        <Identifier>HOURS DEVOTED FOR RELATED ORGANIZATION</Identifier>
        <ReturnReference>FORM 990 PART VII</ReturnReference>
        <Explanation>NAME:Michael Hillman, MD TITLE:VP, Chief Med/Qual Officer HOURS:48</Explanation>
      </GeneralExplanation>
      <GeneralExplanation>
        <Identifier>HOURS DEVOTED FOR RELATED ORGANIZATION</Identifier>
        <ReturnReference>FORM 990 PART VII</ReturnReference>
        <Explanation>NAME:Jay Williamson, MD TITLE:Interim Pres., SPI HOURS:48</Explanation>
      </GeneralExplanation>
      <GeneralExplanation>
        <Identifier>HOURS DEVOTED FOR RELATED ORGANIZATION</Identifier>
        <ReturnReference>FORM 990 PART VII</ReturnReference>
        <Explanation>NAME:T. Clifford Deveny, MD TITLE:President, SPI (term 04/2011) HOURS:48</Explanation>
      </GeneralExplanation>
      <GeneralExplanation>
        <Identifier>HOURS DEVOTED FOR RELATED ORGANIZATION</Identifier>
        <ReturnReference>FORM 990 PART VII</ReturnReference>
        <Explanation>NAME:Kevin Theiss TITLE:VP, System Revenue Cycle HOURS:48</Explanation>
      </GeneralExplanation>
      <GeneralExplanation>
        <Identifier>HOURS DEVOTED FOR RELATED ORGANIZATION</Identifier>
        <ReturnReference>FORM 990 PART VII</ReturnReference>
        <Explanation>NAME:Kathleen Rice TITLE:Former Officer HOURS:</Explanation>
      </GeneralExplanation>
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        <ShareOfEOYAssets>41387</ShareOfEOYAssets>
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      </Form990ScheduleRPartIV>
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          <City>Grand Cayman</City>
          <ProvinceOrState>Cayman Islands</ProvinceOrState>
          <Country>CJ</Country>
        </AddressForeign>
        <EIN>980405096</EIN>
        <PrimaryActivity>Self Insuranc</PrimaryActivity>
        <LegalDomicileForeignCountry>CJ</LegalDomicileForeignCountry>
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</Return>