2012-11-13T12:52:54-06:00 2011-12-31 990 2011-01-01 340718390 LODI COMMUNITY HOSPITAL LODI 3309485501 225 ELYRIA STREET LODI OH 44254 SUE J MCCARTHY 3309485501 2012-11-13 2011 2016-02-24 21:20:13Z THOMAS WHELAN 225 ELYRIA STREET LODI OH 44254 18084168 0 X WWW.LODIHOSPITAL.COM X 1920 OH TO IMPROVE THE HEALTH AND LIVES OF THE PEOPLE AND COMMUNITIES WE SERVE. 15 12 185 51 0 0 6672 349425 17198910 17608762 4444 8283 340 89551 17210366 18056021 4000 348823 0 0 8390231 8429058 0 0 0 7877161 8501065 16271392 17278946 938974 777075 9968451 10258336 1578588 1653508 8389863 8604828 LODI COMMUNITY HOSPITAL'S MISSION IS TO IMPROVE THE HEALTH AND LIVES OF THE PEOPLE AND COMMUNITIES WE SERVE. 0 0 3476159 3730847 LODI COMMUNITY HOSPITAL IS A 25 BED HOSPITAL OFFERING INPATIENT SERVICES FOR MEDICAL AND SURGICAL PATIENTS. 12915449 343021 13862035 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. 15082 5802 16187 LODI COMMUNITY HOSPITAL OFFERS COMMUNITY HEALTH AND EDUCATIONAL SERVICES TO THE LOCAL AND SURROUNDING COMMUNITIES. 16406690 1 1 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 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 18 0 1 185 1 0 0 0 0 0 0 0 0 0 0 0 0 X 15 12 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 400 WABASH AVENUE AKRON OH 44307 X RORY O'NEIL 1.00 X 0 0 0 HAROLD YOUNG 0.80 X 0 0 0 BETSY GILDER 0.50 X 0 0 0 JOHN BAKER 0.40 X 0 0 0 JIM RICE 1.20 X X 0 0 0 JIM COLEMAN 1.00 X 0 0 0 THOMAS PICKERING 1.40 X 0 0 0 STEPHEN SEARS 0.60 X 0 0 0 JIM SHEPARD 0.80 X 0 0 0 THOMAS WHELAN 53.00 X X 214547 0 35094 VINCENT J MCCORKLE 0.30 X 0 1238616 24447 MARLENE BARKHEIMER 0.40 X X 0 0 0 JOE REMINGTON 1.90 X 0 0 0 DAVID BROCKMAN 0.80 X 0 0 0 THERESA CARTER 0.60 X 0 0 0 BRET TREIER 0.20 X 0 0 0 WILLIAM FRANTZ 0.70 X 0 0 0 MARY BETH C CARROLL 1.50 X 0 0 0 WILLIAM STEERE 1.10 X 0 0 0 WILLIAM BABCOX 1.90 X 0 0 0 ROBERT KAMIENSKI MD 5.00 X 0 309357 22947 JUSTIN LAVIN MD 1.10 X 0 0 0 ALAN PAPA 0.40 X 0 483121 42535 JOSEPH MELI MD 0.10 X 0 287405 28975 ALAN A GANCI 40.50 X 93840 0 9906 CRAIG BABBITT 1.00 X 0 350783 35029 STEPHEN GARY 1.00 X 0 365876 13563 BARBARA VIMONT 1.00 X 0 135551 28410 STEPHANIE KOCSIS 44.00 X 102008 0 10016 ALAN J BLEYER 0.00 X 0 543563 6165 410395 3714272 257087 2 1 1 0 EPMG OF OHIO INC PA 2000 GREEN RD SUITE 300 ANN ARBOR MI 481051571 ER PHYSICIANS 564620 AKRON GENERAL HEALTH SYSTEM 400 WABASH AVE AKRON OH 44307 MANAGEMENT FEE 470724 RESPIRATORY SUPPORT SERVICES 328 BOSTON MILLS ROAD HUDSON OH 44236 CARDIOPULMONARY SERVICES 388392 AKRON GENERAL MEDICAL CENTER 400 WABASH AVE AKRON OH 44307 LAB PURCHASED SERVICES 161450 ALLIANCE HEALTHCARE SERVICES PO BOX 96485 CHICAGO IL 606936485 MRI SERVICES 138050 6 6000 343425 349425 NET PATIENT REVENUE 900099 14240657 14240657 MEDICARE/MEDICAID PAYM 900099 3351918 3351918 COMMUNITY HEALTH/EDUCA 900099 16187 16187 17608762 6236 6236 25015 27523 -2508 -2508 -2508 2047 0 2047 2047 2047 931 624 307 307 CAFETERIA 900099 78535 78535 ALL OTHER REVENUE 900099 13217 13217 91752 18056021 17609069 0 97527 345323 345323 3500 3500 353388 353388 6559567 6559567 75778 75778 1004629 1004629 435696 435696 29181 29181 708 708 2216671 1879023 337648 124682 124682 525621 504596 21025 202385 194290 8095 817552 784850 32702 45948 44110 1838 6447 6189 258 7840 7840 667720 641011 26709 107136 102851 4285 PROVISION FOR BAD DEBTS 2569541 2569541 MEDICAL SUPPLIES 710940 710940 MGMT FEE TO AGHS 409069 409069 DUES 31350 10399 20951 28274 646 27628 17278946 16406690 872256 0 753699 1497761 2360318 1971931 51982 56160 221235 194033 13207083 7664894 5919727 5542189 661490 996262 9968451 10258336 1034445 1201457 544143 452051 1578588 1653508 X 8053061 7921524 336802 683304 8389863 8604828 9968451 10258336 X 777075 -562110 X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 1 708 0 0 0 708 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 (LISTED ABOVE) IS USED BY OHA FOR LOBBYING ACTIVITIES. 336802 343021 3481 683304 132986 200000 3816 336802 148776 15790 132986 155416 6640 148776 1.00000 0 1 1 98793 98793 7921536 3987475 3934061 4718396 3361172 1357224 468358 316247 152111 5542189 INTEREST IN FOUNDATION NET ASSETS 996262 996262 ESTIMATED MEDICARE SETTLEMENT DUE 130650 ACCRUED SELF INSURANCE CLAIMS PAYABLE 150191 ASSET RETIREMENT OBLIGATION 171210 452051 18056021 17278946 777075 -11729 -11729 765346 14820723 -2920424 -2920424 17741147 314874 314874 18056021 14055377 83613 83613 13971764 3307182 3307182 17278946 PART XI, LINE 8 - OTHER ADJUSTMENTS: CHANGE IN INTEREST IN FOUNDATION UNRESTRICTED NET ASSETS -11,729. PART XII, LINE 2D - OTHER ADJUSTMENTS: MANAGEMENT FEE TO AFFILIATE -409,069. GRANTS & OTHER ASSISTANCE TO GOVERNMENTS & ORGANIZATIONS IN THE U.S. -2,302. NET ASSETS RELEASED FROM RESTRICTIONS FOR OPERATIONS 55,466. CHANGE IN INTEREST IN FOUNDATION UNRESTRICTED NET ASSETS -11,729. PROVISION FOR BAD DEBTS -2,569,541. OTHER PURCHASED SERVICES REPAID 11,220. PURCHASE DISCOUNTS 5,171. U.S. TREASURY HIRE ACT REFUND 360. PART XII, LINE 4B - OTHER ADJUSTMENTS: COST OF GOODS SOLD FOR SALE OF SUPPLIES -624. RENTAL EXPENSES -27,523. ESTATE OF BONNY KAHL CONTRIBUTIONS 343,021. PART XIII, LINE 2D - OTHER ADJUSTMENTS: COST OF GOODS SOLD FOR SALE OF SUPPLIES 624. NET ASSETS RELEASED FROM RESTRICTIONS FOR OPERATIONS 55,466. RENTAL EXPENSES 27,523. PART XIII, LINE 4B - OTHER ADJUSTMENTS: MANAGEMENT FEE TO AFFILIATE 409,069. GRANTS & OTHER ASSISTANCE TO GOVERNMENTS & ORGANIZATIONS IN THE U.S. 2,302. OTHER PURCHASED SERVICES REPAID -11,220. PURCHASE DISCOUNTS -5,171. PROVISION FOR BAD DEBTS 2,569,541. U.S. TREASURY HIRE ACT REFUND -360. ESTATE OF BONNY KAHL CONTRIBUTIONS TRANSFERRED TO AKRON GENERAL FOUNDATION 343,021. LODI COMMUNITY HOSPITAL ADOPTED FIN48 IN 2007 AS REQUIRED. NO FOOTNOTE DISCLOSURES WERE REQUIRED UNDER GAAP AS PARTNERS PHYSICIAN GROUP DOES NOT HAVE ANY MATERIAL TAX CONTINGENCIES THAT REQUIRED SUCH DISCLOSURES. 1 1 X 1 X 1 X 1 1 1 0 0 475235 0 475235 0.03230 2462687 1191481 1271206 0.08640 2937922 1191481 1746441 0.11870 282063 47128 234935 0.01600 100975 100975 0.00690 372834 343021 29813 0.00200 755872 390149 365723 0.02490 3693794 1581630 2112164 0.14360 16229 16229 16229 16229 1 1031350 4040609 3928903 111706 X 1 1 1 1 LODI COMMUNITY HOSPITAL

225 ELYRIA ST LODI OH 44254

X X X X LODI COMMMUNITY HOSPITAL 1 0 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 6A: LODI COMMUNITY HOSPITAL IS A MEMBER OF AKRON GENERAL HEALTH SYSTEM. AKRON GENERAL HEALTH SYSTEM PREPARES AN ANNUAL COMMUNITY BENEFIT REPORT THAT INCLUDES THE ACTIVITIES OF LODI COMMUNITY HOSPITAL. 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 $2,569,541 - 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, LCH 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 LCH. 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 13G: 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 $55,811. 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 6.0% THE SURROUNDING COUNTIES' RATES ARE HIGHER; LORAIN IS 8.0%, WAYNE IS 6.3% AND ASHLAND IS 7.4% WITH THE STATE OF OHIO AT 7.4%. 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 - 16 IN 2011 - 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 ROSE LANE HEALTH CENTER; AND AKRON GENERAL DEVELOPMENT 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. 1 AKRON GENERAL FOUNDATION 400 WABASH AVENUE AKRON OH 44307 341127047 501 (C) (3) 343021 REHAB SERVICES 1 0 PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, PART I, LINE 2: ASSISTANCE IS OCCASIONALLY PROVIDED TO COMMUNITY BASED NON-PROFIT ORGANIZATIONS OR LOCAL GOVERNMENT EVENTS. GENERALLY, ASSISTANCE IS LIMITED TO SPECIFIC EVENTS/PURPOSES WHERE THE ASSISTANCE IS SPENT IMMEDIATELY BY THE DONEE. ON RARE OCCASIONS-SUCH AS THE DONATIONS TO AKRON GENERAL FOUNDATION MADE IN 2011-THE ASSISTANCE RESULTS IN A FUND BALANCE WITH THE DONEE. HERE THE FUND BALANCE IS FOR THE BENEFIT OF THE LODI COMMUNITY FOR REHABILITATION SERVICES. LODI COMMUNITY HOSPITAL HAS DIRECT ACCESS TO MONTHLY REPORTS ON THE FUND BALANCES AND ALL USES OF THE FUND BALANCES. X X 1 1 X X X X X 0 1 0 0 0 0 0 0 0 THOMAS WHELAN 174410 0 0 0 40137 0 15480 0 19614 0 249641 0 0 0 VINCENT J MCCORKLE 0 791084 0 179219 0 268313 0 9800 0 14647 0 1263063 0 0 ROBERT KAMIENSKI MD 0 274231 0 26515 0 8611 0 9800 0 13147 0 332304 0 0 ALAN PAPA 0 308218 0 30000 0 144903 0 22942 0 19593 0 525656 0 0 JOSEPH MELI MD 0 270076 0 15000 0 2329 0 12071 0 16904 0 316380 0 0 CRAIG BABBITT 0 278986 0 0 0 71797 0 16269 0 18760 0 385812 0 0 STEPHEN GARY 0 296353 0 0 0 69523 0 0 0 13563 0 379439 0 0 BARBARA VIMONT 0 131683 0 0 0 3868 0 14256 0 14154 0 163961 0 0 ALAN J BLEYER 0 18173 0 0 0 525390 0 6165 0 0 0 549728 0 543563 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 2011, 1 EMPLOYEE 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 2011, 1 EMPLOYEE RECEIVED THIS BENEFIT. NOTE THAT, TAX INDEMNIFICATION IS NOT OFFERED AS A BENEFIT. PART I, LINE 4B ALAN BLEYER SEPARATED FROM SERVICE DURING 2009. UNDER THE TERMS OF HIS SEVERANCE AGREEMENT, MR. BLEYER RECEIVED PAYMENTS TOTALING $543,563 IN 2011. AT 12/31/2011 THE BALANCE OF THE ACCRUED LIABILITY FOR THE REMAINDER OF MR. BLEYER'S SEVERANCE AGREEMENT TOTALED $135,536. 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 2011. THOMAS WHELAN - $21,600 VINCENT MCCORKLE - $117,995 STEPHEN GARY - $18,047 ALAN J. BLEYER - $126,748 ALAN PAPA - $29,856 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 BARBARA VIMONT STEPHEN M. GARY FORM 990, PART VI, SECTION A, LINE 6 LODI COMMUNITY HOSPITAL HAS ONE MEMBER, AKRON GENERAL PARTNERS. AKRON GENERAL PARTNERS 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 PARTNERS IS NOT A PRIVATE FOUNDATION. FORM 990, PART VI, SECTION A, LINE 7A AKRON GENERAL PARTNERS IS THE SOLE MEMBER OF LODI COMMUNITY HOSPITAL. AKRON GENERAL HEALTH SYSTEM IS THE SOLE MEMBER OF AKRON GENERAL PARTNERS. 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 PARTNERS IS THE SOLE MEMBER OF LODI COMMUNITY HOSPITAL. AKRON GENERAL HEALTH SYSTEM IS THE SOLE MEMBER OF AKRON GENERAL PARTNERS. 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 SAFEGUARD 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 TEH 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 DEPARTMENT ANNUALLY IN JANUARY. 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 DEPARTMENT. ANY SUBSEQUENTLY REPORTED ITEMS ARE SUBJECT TO THE AFORMENTIONED 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 THE COMPENSATION OF THE REPORTING ORGANIZATION'S TOP MANAGEMENT PERSONNEL THAT IS BASED ON THE SAFE HARBOR DESCRIBED BY 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 THE COMPENSATION COMMITTEE OF THE REPORTING ORGANIZATION'S BOARD OF DIRECTORS. THE COMPENSATION 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 2008. 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 VINCENT J. MCCORKLE - MR. MCCORKLE SERVED AS MEMBER EX OFFICIO OF THE BOARD OF DIRECTORS FOR THE REPORTING ORGANIZATION. MR. MCCORKLE ALSO SERVED AS CEO AND MEMBER EX-OFFICIO OF THE BOARD OF DIRECTORS FOR AKRON GENERAL HEALTH SYSTEM, AVERAGING 55.0 PER WEEK ON THOSE DUTIES. IN ADDITION, MR. MCCORKLE SERVED AS MEMBER EX-OFFICIO OF THE BOARD OF DIRECTORS OF THE FOLLOWING RELATED ORGANIZATIONS, AVERAGE HOURS PER WEEK CORRESPONDING: AKRON GENERAL PARTNERS - .3 COMMNUITY HEALTH VENTURES, INC. - .3 AKRON GENERAL MEDICAL CENTER - 2.0 AKRON GENERAL FOUNDATION - .3 NHV PHYSCIANS PROFESSIONAL CORPORATION - .3 VISITING NURSE SERVICE - .3 VISITING HOURS, INC. - .3 HOSPICE CARE OHIO - .3 MARLENE BARKHEIMER - SERVED AS DIRECTOR AND VICE CHAIR OF THE BOARD OF DIRECTORS OF LODI COMMUNITY HOSPITAL THROUGH OCTOBER 31, 2011. ON OCTOBER 31, 2011 LODI COMMUNITY HOSPITAL'S CODE OF REGULATIONS WAS AMENDED MAKING THE AKRON GENERAL HOSPITALS BOARD OF DIRECTORS THE GOVERNING BODY OF LODI COMMUNITY HOSPITAL. MS. BARHEIMER WAS APPOINTED TO THAT BODY ON OCTOBER 31, 2012. HAROLD YOUNG - SERVED AS A MEMBER OF THE BOARD OF DIRECTORS OF LODI COMMUNITY HOSPITAL THROUGH OCTOBER 31, 2011. ON OCTOBER 31, 2011 LODI COMMUNITY HOSPITAL'S CODE OF REGULATIONS WAS AMENDED MAKING THE AKRON GENERAL HOSPITALS BOARD OF DIRECTORS THE GOVERNING BODY OF LODI COMMUNITY HOSPITAL. MR. YOUNG WAS APPOINTED TO THAT BODY ON OCTOBER 31, 2012. JOHN BAKER - SERVED AS A MEMBER OF THE BOARD OF DIRECTORS OF LODI COMMUNITY HOSPITAL THROUGH OCTOBER 31, 2011. ON OCTOBER 31, 2011 LODI COMMUNITY HOSPITAL'S CODE OF REGULATIONS WAS AMENDED MAKING THE AKRON GENERAL HOSPITALS BOARD OF DIRECTORS THE GOVERNING BODY OF LODI COMMUNITY HOSPITAL. MR. BAKER WAS APPOINTED TO THAT BODY ON OCTOBER 31, 2012. JIM RICE - SERVED AS A MEMBER OF THE BOARD OF DIRECTORS OF LODI COMMUNITY HOSPITAL THROUGH OCTOBER 31, 2011. ON OCTOBER 31, 2011 LODI COMMUNITY HOSPITAL'S CODE OF REGULATIONS WAS AMENDED MAKING THE AKRON GENERAL HOSPITALS BOARD OF DIRECTORS THE GOVERNING BODY OF LODI COMMUNITY HOSPITAL. MR. RICE WAS APPOINTED TO THAT BODY ON OCTOBER 31, 2012. THOMAS WHELAN - MR. WHELAN SERVED AS PRESIDENT OF LODI COMMUNITY HOSPITAL FOR THE ENTIRE YEAR, AVERAGING 53.0 HOURS PER WEEK ON THOSE DUTIES. MR. WHELAN ALSO SERVED AS A MEMBER EX OFFICIO OF THE BOARD OF DIRECTORS OF THE REPORTING ORGANIZATION THROUGH OCTOBER 31, 2011. EFFECTIVE OCTOBER 31, 2011, THE ARTICLES OF LODI COMMUNITY HOSPITAL WERE AMENDED MAKING THE BOARD OF DIRECTORS OF AKRON GENERAL MEDICAL CENTER THE GOVERNING BODY OF LODI COMMUNITY HOSPITAL. WILLIAM BABCOX - ON OCTOBER 31, 2011 LODI COMMUNITY HOSPITAL'S CODE OF REGULATIONS WAS AMENDED MAKING THE AKRON GENERAL HOSPITALS BOARD OF DIRECTORS THE GOVERNING BODY OF LODI COMMUNITY HOSPITAL. MR. BABCOX ALREADY WAS A MEMBER OF THAT BODY ON OCTOBER 31, 2011. 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 - 1.0 AKRON GENERAL MEDICAL CENTER - 1.9 DAVID BROCKMAN - ON OCTOBER 31, 2011 LODI COMMUNITY HOSPITAL'S CODE OF REGULATIONS WAS AMENDED MAKING THE AKRON GENERAL HOSPITALS BOARD OF DIRECTORS THE GOVERNING BODY OF LODI COMMUNITY HOSPITAL. MR. BROCKMAN ALREADY WAS A MEMBER OF THAT BODY ON OCTOBER 31, 2011. MR. BROCKMAN ALSO SERVED AS A MEMBER OF THE BOARD OF DIRECTORS OF THE FOLLOWING RELATED ORGANIZATION, AVERAGE HOURS PER WEEK CORRESPONDING: AKRON GENERAL MEDICAL CENTER - .8 AKRON GENERAL FOUNDATION - .5 THERESA CARTER - ON OCTOBER 31, 2011 LODI COMMUNITY HOSPITAL'S CODE OF REGULATIONS WAS AMENDED MAKING THE AKRON GENERAL HOSPITALS BOARD OF DIRECTORS THE GOVERNING BODY OF LODI COMMUNITY HOSPITAL. MS. CARTER ALREADY WAS A MEMBER OF THAT BODY ON OCTOBER 31, 2011. MS. CARTER ALSO SERVED AS A MEMBER OF THE BOARD OF DIRECTORS OF THE FOLLOWING RELATED ORGANIZATION, AVERAGE HOURS PER WEEK CORRESPONDING: AKRON GENERAL MEDICAL CENTER - .6 BRET TREIER - ON OCTOBER 31, 2011 LODI COMMUNITY HOSPITAL'S CODE OF REGULATIONS WAS AMENDED MAKING THE AKRON GENERAL HOSPITALS BOARD OF DIRECTORS THE GOVERNING BODY OF LODI COMMUNITY HOSPITAL. MR. TREIER ALREADY WAS A MEMBEER OF THAT BODY ON OCTOBER 31, 2011. MR. TREIER ALSO SERVED AS A MEMBER OF THE BOARD OF DIRECTORS OF THE FOLLOWING RELATED ORGANIZATION, AVERAGE HOURS PER WEEK CORRESPONDING: AKRON GENERAL MEDICAL CENTER - .2 AKRON GENERAL PARTNERS - .2 WILLIAM FRANTZ - ON OCTOBER 31, 2011 LODI COMMUNITY HOSPITAL'S CODE OF REGULATIONS WAS AMENDED MAKING THE AKRON GENERAL HOSPITALS BOARD OF DIRECTORS THE GOVERNING BODY OF LODI COMMUNITY HOSPITAL. MR. FRANTZ ALREADY WAS A MEMBER OF THAT BODY ON OCTOBER 31, 2011. MR. FRANTZ ALSO SERVED AS A MEMBER OF THE BOARD OF DIRECTORS OF THE FOLLOWING RELATED ORGANIZATION, AVERAGE HOURS PER WEEK CORRESPONDING: AKRON GENERAL MEDICAL CENTER - .7 MARY BETH C CARROLL - ON OCTOBER 31, 2011 LODI COMMUNITY HOSPITAL'S CODE OF REGULATIONS WAS AMENDED MAKING THE AKRON GENERAL HOSPITALS BOARD OF DIRECTORS THE GOVERNING BODY OF LODI COMMUNITY HOSPITAL. MS. CARROLL ALREADY WAS A MEMBER OF THAT BODY ON OCTOBER 31, 2011. MS. CARROLL ALSO SERVED AS A MEMBER OF THE BOARD OF DIRECTORS OF THE FOLLOWING RELATED ORGANIZATION, AVERAGE HOURS PER WEEK CORRESPONDING: AKRON GENERAL MEDICAL CENTER - 1.5 WILLIAM STEERE - ON OCTOBER 31, 2011 LODI COMMUNITY HOSPITAL'S CODE OF REGULATIONS WAS AMENDED MAKING THE AKRON GENERAL HOSPITALS BOARD OF DIRECTORS THE GOVERNING BODY OF LODI COMMUNITY HOSPITAL. MR. STEERE ALREADY WAS A MEMBER OF THAT BODY ON OCTOBER 31, 2011. MR. STEERE ALSO SERVED AS A MEMBER OF THE BOARD OF DIRECTORS OF THE FOLLOWING RELATED ORGANIZATION, AVERAGE HOURS PER WEEK CORRESPONDING: AKRON GENERAL HEALTH SYSTEM - 4.8 AKRON GENERAL MEDICAL CENTER - 1.1 ROBERT KAMIENSKI, MD - ON OCTOBER 31, 2011 LODI COMMUNITY HOSPITAL'S CODE OF REGULATIONS WAS AMENDED MAKING THE AKRON GENERAL HOSPITALS BOARD OF DIRECTORS THE GOVERNING BODY OF LODI COMMUNITY HOSPITAL. DR. KAMIENSKI ALREADY WAS A MEMBER OF THAT BODY ON OCTOBER 31, 2011. DR. KAMIENSKI ALSO SERVED AS A MEMBER OF THE BOARD OF DIRECTORS OF THE FOLLOWING RELATED ORGANIZATION, AVERAGE HOURS PER WEEK CORRESPONDING: AKRON GENERAL MEDICAL CENTER - 5.0 IN ADDITION, DR. KAMIENSKI WAS EMPLOYED BY NHV PHYSICIANS PROFESSIONAL CORPORATION SPENDING AN AVERAGE OF 55 HOURS WEEKLY ON THOSE DUTIES. JUSTIN LAVIN, MD - ON OCTOBER 31, 2011 LODI COMMUNITY HOSPITAL'S CODE OF REGULATIONS WAS AMENDED MAKING THE AKRON GENERAL HOSPITALS BOARD OF DIRECTORS THE GOVERNING BODY OF LODI COMMUNITY HOSPITAL. DR. LAVIN ALREADY WAS A MEMBER OF THAT BODY ON OCTOBER 31, 2011. DR. LAVIN ALSO SERVED AS A MEMBER OF THE BOARD OF DIRECTORS OF THE FOLLOWING RELATED ORGANIZATION, AVERAGE HOURS PER WEEK CORRESPONDING: AKRON GENERAL MEDICAL CENTER - 1.1 ALAN PAPA - ON OCTOBER 31, 2011 LODI COMMUNITY HOSPITAL'S CODE OF REGULATIONS WAS AMENDED MAKING THE AKRON GENERAL HOSPITALS BOARD OF DIRECTORS THE GOVERNING BODY OF LODI COMMUNITY HOSPITAL. MR. PAPA ALREADY WAS A MEMBER OF THAT BODY ON OCTOBER 31, 2011. MR. PAPA ALSO SERVED AS PRESIDENT AND AS A MEMBER OF THE BOARD OF DIRECTORS OF AKRON GENERAL MEDICAL CENTER SPENDING AN AVERAGE OF 40.4 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 - .2 JOSEPH MELI, MD - ON OCTOBER 31, 2011 LODI COMMUNITY HOSPITAL'S CODE OF REGULATIONS WAS AMENDED MAKING THE AKRON GENERAL HOSPITALS BOARD OF DIRECTORS THE GOVERNING BODY OF LODI COMMUNITY HOSPITAL. DR. MELI ALREADY WAS A MEMBER OF THAT BODY ON OCTOBER 31, 2011. DR. MELI ALSO SERVED AS A MEMBER OF THE BOARD OF DIRECTORS OF THE FOLLOWING RELATED ORGANIZATION, AVERAGE HOURS PER WEEK CORRESPONDING: AKRON GENERAL MEDICAL CENTER - 0.1 IN ADDITION, DR. MELI WAS EMPLOYED BY NHV PHYSICIANS PROFESSIONAL CORPORATION SPENDING AN AVERAGE OF 55 HOURS WEEKLY ON THOSE DUTIES. ALAN J. BLEYER - MR. BLEYER IS A FORMER DIRECTOR EX OFFICIO OF THE REPORTING ORGANIZATION. MR. BLEYER IS THE FORMER CHIEF EXECUTIVE OFFICER OF AKRON GENERAL HEALTH SYSTEM. MR. BLEYER SEPARATED FROM SERVICE IN 2009 AND THE COMPENSATION SHOWN IS PAID BY AKRON GENERAL HEALTH SYSTEM IN ACCORDANCE WITH MR. BLEYER'S SEVERANCE AGREEMENT. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: CHANGE IN INTEREST IN FOUNDATION UNRESTRICTED NET ASSETS -11,729. CHANGE IN INTEREST IN FOUNDATION TEMPORARILY RESTRICTED NET ASSETS 3,481. GRANT FUNDING FOR CAPITAL 20,036. TRANSFER TO/FROM AFFILIATES -916,919. CONTRIBUTIONS FROM ESTATE OF BONNY KAHL 343,021. TOTAL TO FORM 990, PART XI, LINE 5: -562,110. 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 1 1 1 1 0 AKRON GENERAL HEALTH SYSTEM N 653440 FAIR MARKET VALUE AKRON GENERAL HEALTH SYSTEM O 90300 FAIR MARKET VALUE AKRON GENERAL MEDICAL CENTER Q 1870446 COST AKRON GENERAL MEDICAL CENTER P 2072536 COST AKRON GENERAL MEDICAL CENTER O 112089 COST PARTNERS PHYSICIAN GROUP P 664615 COST PARTNERS PHYSICIAN GROUP O 665618 COST AKRON GENERAL FOUNDATION B 343021 FAIR MARKET VALUE