UNIVERSITY HOSPITALS HEALTH SYSTEM INC: Form 990, tax year 2011

View the entire original 990 at ProPublica ↗

Organization: UNIVERSITY HOSPITALS HEALTH SYSTEM INC (EIN 34-1425870)
Tax period: 2011-01-01 to 2011-12-31
Filed: 2012-11-13
IRS object ID: 201243189349303069
Schema version: 2011v1.2
Source: Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header
Form 990
Schedule A
Schedule B
Schedule C
Schedule D
Schedule H
Schedule J
Schedule K
Schedule O
Schedule R

Return header ReturnHeader

Field	Value	IRS element (for citing)
Timestamp	2012-11-13T15:40:59-06:00	Timestamp
Tax Period End Date	2011-12-31	TaxPeriodEndDate

Preparer Firm PreparerFirm

Field	Value	IRS element (for citing)
EIN	381357951	EIN

Preparer Firm Business Name PreparerFirmBusinessName

Field	Value	IRS element (for citing)
Business Name Line1	PLANTE & MORAN PLLC	BusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

Field	Value	IRS element (for citing)
Address Line1	65 E STATE ST SUITE 600	AddressLine1
City	COLUMBUS	City
State	OH	State
ZIP Code	43215	ZIPCode

Field	Value	IRS element (for citing)
Return Type	990	ReturnType
Tax Period Begin Date	2011-01-01	TaxPeriodBeginDate

Filer Filer

Field	Value	IRS element (for citing)
EIN	341425870	EIN

Name Name

Field	Value	IRS element (for citing)
Business Name Line1	LAKE HOSPITAL SYSTEM INC DBA LAKE HEALTH	BusinessNameLine1

Field	Value	IRS element (for citing)
Name Control	LAKE	NameControl
Phone	4403541991	Phone

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	7590 AUBURN ROAD	AddressLine1
City	CONCORD	City
State	OH	State
ZIP Code	44077	ZIPCode

Officer Officer

Field	Value	IRS element (for citing)
Name	MICHAEL KITTOE	Name
Title	SENIOR VP & CFO	Title
Phone	4403541051	Phone
Date Signed	2012-11-13	DateSigned
Authorize Third Party	1	AuthorizeThirdParty

Preparer Preparer

Field	Value	IRS element (for citing)
Name	BERNIE OSTROWSKI	Name
PTIN	P00366367	PTIN
Phone	6148493000	Phone

Field	Value	IRS element (for citing)
Tax Year	2011	TaxYear
Build TS	2016-02-24 21:20:13Z	BuildTS

Form 990 IRS990

Doing Business As DoingBusinessAs

Field	Value	IRS element (for citing)
Business Name Line1	LAKE HEALTH	BusinessNameLine1

Field	Value	IRS element (for citing)
Name Of Principal Officer Person	CYNTHIA MOORE-HARDY	NameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

Field	Value	IRS element (for citing)
Address Line1	7590 AUBURN ROAD	AddressLine1
City	CONCORD	City
State	OH	State
ZIP Code	44077	ZIPCode

Field	Value	IRS element (for citing)
Gross Receipts	484363187	GrossReceipts
Group Return For Affiliates	0	GroupReturnForAffiliates
Organization501c3	X	Organization501c3
Web Site	WWW.LAKEHEALTH.ORG	WebSite
Type Of Organization Corporation	X	TypeOfOrganizationCorporation
Year Formation	1983	YearFormation
State Legal Domicile	OH	StateLegalDomicile
Activity Or Mission Description	TO PROVIDE HEALTH CARE SERVICES TO THE RESIDENTS OF LAKE COUNTY AND NEIGHBORING COMMUNITIES IN PARTNERSHIP WITH THOSE WHO SHARE A COMMITMENT TO LOCAL ACCESS, HEALING WITH COMPASSION AND SUPERIOR QUALITY.	ActivityOrMissionDescription
Nbr Voting Members Governing Body	11	NbrVotingMembersGoverningBody
Nbr Independent Voting Members	11	NbrIndependentVotingMembers
Total Nbr Employees	3138	TotalNbrEmployees
Total Nbr Volunteers	1097	TotalNbrVolunteers
Total Gross UBI	215338	TotalGrossUBI
Net Unrelated Business Txbl Income	-454407	NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year	1034685	ContributionsGrantsPriorYear
Contributions Grants Current Year	3759667	ContributionsGrantsCurrentYear
Program Service Revenue Prior Year	322305254	ProgramServiceRevenuePriorYear
Program Service Revenue CY	340907830	ProgramServiceRevenueCY
Investment Income Prior Year	4519470	InvestmentIncomePriorYear
Investment Income Current Year	9389784	InvestmentIncomeCurrentYear
Other Revenue Prior Year	5526112	OtherRevenuePriorYear
Other Revenue Current Year	5951465	OtherRevenueCurrentYear
Total Revenue Prior Year	333385521	TotalRevenuePriorYear
Total Revenue Current Year	360008746	TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year	0	GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY	0	GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year	0	BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY	0	BenefitsPaidToMembersCY
Salaries Etc Prior Year	158229661	SalariesEtcPriorYear
Salaries Etc Current Year	138153710	SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year	0	TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY	0	TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year	0	TotalFundrsngExpCurrentYear
Other Expense Prior Year	161329423	OtherExpensePriorYear
Other Expenses Current Year	198624008	OtherExpensesCurrentYear
Total Expenses Prior Year	319559084	TotalExpensesPriorYear
Total Expenses Current Year	336777718	TotalExpensesCurrentYear
Revenues Less Expenses Prior Year	13826437	RevenuesLessExpensesPriorYear
Revenues Less Expenses CY	23231028	RevenuesLessExpensesCY
Total Assets BOY	505232384	TotalAssetsBOY
Total Assets EOY	518364693	TotalAssetsEOY
Total Liabilities BOY	283003948	TotalLiabilitiesBOY
Total Liabilities EOY	308304287	TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY	222228436	NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY	210060406	NetAssetsOrFundBalancesEOY
Info In Schedule O Part III	X	InfoInScheduleOPartIII
Mission Description	IT IS LAKE HOSPITAL SYSTEM'S MISSION TO PROVIDE COMPREHENSIVE HEALTH CARE SERVICES TO THE RESIDENTS OF LAKE COUNTY AND NEIGHBORING COMMUNITIES IN PARTNERSHIP WITH THOSE WHO SHARE A COMMITMENT TO LOCAL ACCESS, HEALING WITH COMPASSION AND SUPERIOR QUALITY.	MissionDescription
Significant New Program Services	0	SignificantNewProgramServices
Significant Change	0	SignificantChange
Expense	241678495	Expense
Grants	0	Grants
Revenue	340868863	Revenue
Description	SEE SCHEDULE OAS AN INDEPENDENT, COMMUNITY-BASED HOSPITAL SYSTEM, LAKE HOSPITAL SYSTEM (LHS) HAS HAD A LONG-STANDING TRADITION OF PROVIDING SERVICES AND PROGRAMS BASED ON THE HEALTH CARE NEEDS OF THE COMMUNITIES THAT WE SERVE. WE ARE GUIDED BY OUR MISSION TO PROVIDE LOCAL ACCESS, HEALING WITH COMPASSION AND SUPERIOR QUALITY AND OUR CORE VALUES - RESPECT, INNOVATION, TEAMWORK, STEWARDSHIP AND INTEGRITY. LAKE HOSPITAL SYSTEM'S GROWTH AS A COMMUNITY-BASED HEALTH CARE SYSTEM CONTINUES TO BUILD ON ITS LONG HISTORY OF PROVIDING PROGRESSIVE, PERSONALIZED CARE THAT YOU NORMALLY WOULDN'T EXPECT TO FIND AT A COMMUNITY HOSPITAL. GUIDED BY A COLLABORATIVE HEALTH NEEDS ASSESSMENT CONDUCTED IN COOPERATION WITH THE LAKE COUNTY GENERAL HEALTH DISTRICT, LAKE HEALTH HAS DEVELOPED PROGRAMS, SERVICES AND PARTNERSHIPS TO ADDRESS THE MOST PRESSING HEALTH ISSUES. THE HIGH PRIORITY AREAS INCLUDE OBESITY, INACTIVE LIFESTYLES AND SMOKING. LAKE HEALTH'S GROWTH AS A COMMUNITY-BASED HEALTH CARE SYSTEM CONTINUES TO BUILD ON ITS LONG HISTORY OF PROVIDING PROGRESSIVE, PERSONALIZED CARE THAT YOU NORMALLY WOULDN'T EXPECT TO FIND AT A COMMUNITY HOSPITAL. LAKE HEALTH IS COMPRISED OF 16 FACILITIES IN LAKE, GEAUGA AND CUYAHOGA COUNTIES, WHICH INCLUDE THE FOLLOWING:1. TRIPOINT MEDICAL CENTER (FULL-SERVICE, ACUTE CARE HOSPITAL)2. WEST MEDICAL CENTER (FULL-SERVICE, ACUTE CARE HOSPITAL)3. MENTOR CAMPUS (OUTPATIENT LAB AND DIAGNOSTICS, PHYSICIAN OFFICES, CANCER SERVICES)4. CHARDON CAMPUS (URGENT CARE, OUTPATIENT LAB AND DIAGNOSTICS, PHYSICIAN OFFICES)5. WILLOWICK CAMPUS (URGENT CARE, OUTPATIENT LAB AND DIAGNOSTICS, PHYSICIAN OFFICES)6. TYLER BLVD. URGENT CARE (URGENT CARE, OCCUPATIONAL HEALTH)7. MADISON CAMPUS (FREE-STANDING ER, OUTPATIENT LAB AND DIAGNOSTICS, PHYSICIAN OFFICES, PHYSICAL THERAPY)8. CLINIC AT MADISON (WALK-IN CARE LOCATED IN WALMART SUPER CENTER)9. CLINIC AT MIDDLEFIELD (WALK-IN CARE LOCATED IN WALMART SUPER CENTER)10. PERRY WALK-IN CARE CENTER (WALK-IN CARE, PHYSICAL THERAPY)11. PAINESVILLE QUICK CARE CENTER (WALK-IN CARE)12. MENTOR DIAGNOSTICS (OUTPATIENT IMAGING)13. WILLOUGHBY HILLS DIAGNOSTICS (OUTPATIENT IMAGING)14. LYNDHURST DIAGNOSTICS (OUTPATIENT IMAGING)15. MENTOR PHYSICAL THERAPY (PHYSICAL THERAPY)16. WILLOUGHBY PHYSICAL THERAPY) (PHYSICAL THERAPY)ACCESSIBILITY IS KEY TO OUR MISSION. WE HAVE CONTRACTED WITH MOST INSURANCE PROVIDERS TO INSURE A VAST ARRAY OF PRIMARY CARE PHYSICIANS AND SPECIALISTS. LAKE HEALTH ALSO OPERATES THREE FULL-SERVICE EMERGENCY DEPARTMENTS WITHIN LAKE COUNTY AT TRIPOINT MEDICAL CENTER IN CONCORD TOWNSHIP, WEST MEDICAL CENTER IN WILLOUGHBY, AND THE FREE-STANDING MADISON EMERGENCY DEPARTMENT WITHIN THE MADISON CAMPUS. THESE EMERGENCY DEPARTMENTS ARE OPEN TO ALL PERSONS, REGARDLESS OF ABILITY TO PAY.FOR THE TENTH YEAR IN A ROW, WE WERE HONORED AS ONE OF NORTHCOAST 99'S "BEST PLACES TO WORK IN NORTHEAST OHIO." OUR GROWTH AS A HOSPITAL SYSTEM REFLECTS THE MANY WAYS WE ARE BUILDING ON OUR MISSION AND HOW WE ASPIRE TO BE MORE THAN YOUR TYPICAL COMMUNITY HOSPITAL. WE WANT OUR PATIENTS TO RECEIVE SUPERIOR PATIENT CARE WITHOUT HAVING TO LEAVE THE COMMUNITY, AND THAT'S WHY WE ARE COMMITTED TO BRINGING THE BEST RESOURCES TOGETHER TO PROVIDE AN EXPANDED LEVEL OF COMMUNITY CARE.LAKE HOSPITAL SYSTEM PROVIDES SERVICES AND PROGRAMS BASED ON THE HEALTH CARE NEEDS OF THE COMMUNITIES WE SERVE. IN FACT, TAKING HEALTH PROGRAMS AND SCREENINGS TO WHERE PEOPLE LIVE, WORK AND PLAY IS FUNDAMENTAL TO OUR MISSION. IN 2011, WE PROVIDED OVER $563,000 IN COMMUNITY BENEFIT THROUGH OUR HEALTH SYSTEM OPERATIONS IN LAKE AND GEAUGA COUNTIES. THIS INCLUDES OVER 250 COMMUNITY EDUCATION PROGRAMS. WE ALSO CONTRIBUTED NEARLY $159,537 IN 2011 IN CASH AND IN-KIND DONATIONS TO CIVIC AND COMMUNITY EVENTS, PROGRAMS AND PARTNERSHIPS WITH A HEALTH AND WELLNESS FOCUS. SOME OF THE PROGRAMS AND EVENTS ARE HIGHLIGHTED BELOW. MANY OF THEM ARE FACILITATED THROUGH OUR HEALTH PROMOTION DEPARTMENT AND/OR OUR COMMUNITY OUTREACH COORDINATOR.COMMUNITY PROGRAMS AND EVENTS:ALZEHEIMER'S EDUCATION SERIESAMERICAN HEART WALKCARDIAC HEALTH EDUCATION PROGRAMSBABY TALK PROGRAMS INCLUDING CHILDBIRTH PREPARATION, INFANT CARE, BREASFEEDING PROGRAM, SIBLING PROGRAM, INFANT AND CHILD CPR, TEEN CHILDBIRTH PREPARATION, CARING FOR KIDS, AND CAR SEAT CHECKS.GET HEALTHY LAKE COUNTY B FIT 4 LIFEHEALTHY HEART PROGRAMLIFECYCLES FOR WOMENOSTEOPOROSIS EDUCATION & EXERCISE PREVENTION CLASSESPORTER SCIENCE CENTER DIGESTION MODULESENIOR CONNECTIONSUPPORT GROUPS WHICH INCLUDE BREAST CANCER, BREASTFEEDING, EPILEPSY, IDEAS DIABETES, MENDED HEARTS CARDIAC, PROSTATE, PULMONARY, AND A WEIGHT MANAGEMENT.UNITED WAY DAY OF CARINGWOMEN'S HEALTH SCREENING PROJECTWOMEN'S HEART INITIATIVELAKE HOSPITAL SYSTEM JOINED FORCES WITH LAKE METROPARKS, LAKE COUNTY YMCA AND THE LAKE COUNTY GENERAL HEALTH DISTRICT AGAIN IN 2011 TO CONTINUE B FIT 4 LIFE, A CORPORATE CHALLENGE IN WHICH AREA BUSINESSES VIE FOR THE MOST POINTS AS THEIR EMPLOYEES EXERCISE THEIR WAY TO BETTER HEALTH. B FIT 4 LIFE IS A PART OF GET HEALTHY LAKE COUNTY, A COUNTYWIDE INITIATIVE THAT FEATURES EDUCATION, PREVENTION AND WELLNESS PROGRAMS TO ENHANCE AND IMPROVE THE QUALITY OF LIFE IN LAKE COUNTY AND NEIGHBORING COMMUNITIES.	Description
Total Program Service Expense	241678495	TotalProgramServiceExpense
Described In501 C3	1	DescribedIn501C3
Schedule B Required	1	ScheduleBRequired
Political Activities	0	PoliticalActivities
Lobbying Activities	1	LobbyingActivities
Subject To Proxy Tax	0	SubjectToProxyTax
Donor Advised Funds	0	DonorAdvisedFunds
Conservation Easements	0	ConservationEasements
Collections Of Art	0	CollectionsOfArt
Credit Counseling	0	CreditCounseling
Term Or Permanent Endowments	1	TermOrPermanentEndowments
Report Land Bldg Equip	1	ReportLandBldgEquip
Report Invest Oth Securities	0	ReportInvestOthSecurities
Report Prog Rel Invest	0	ReportProgRelInvest
Report Other Assets	0	ReportOtherAssets
Report Other Liabilities	1	ReportOtherLiabilities
Report Fin48 Footnote	0	ReportFin48Footnote
Independent Audit Financial Stmt	0	IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt	1	ConsolidatedAuditFinancialStmt
School	0	School
Foreign Office	0	ForeignOffice
Foreign Activities	0	ForeignActivities
More Than5000 K To Organizations	0	MoreThan5000KToOrganizations
More Than5000 K To Individuals	0	MoreThan5000KToIndividuals
Professional Fundraising	0	ProfessionalFundraising
Fundraising Activities	0	FundraisingActivities
Gaming	0	Gaming
Hospital	1	Hospital
Financial Stmt Attached	1	FinancialStmtAttached
Grants To Organizations	0	GrantsToOrganizations
Grants To Individuals	0	GrantsToIndividuals
Schedule J Required	1	ScheduleJRequired
Tax Exempt Bonds	1	TaxExemptBonds
Invest Tax Exempt Bonds	0	InvestTaxExemptBonds
Escrow Account	0	EscrowAccount
On Behalf Of Issuer	0	OnBehalfOfIssuer
Excess Benefit Transaction	0	ExcessBenefitTransaction
Prior Excess Benefit Transaction	0	PriorExcessBenefitTransaction
Loan To Officer Or DQP	0	LoanToOfficerOrDQP
Grant To Related Person	0	GrantToRelatedPerson
Bsnss Rltnshp With Organization	0	BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member	0	BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp	0	OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions	0	DeductibleNonCashContributions
Deductible Contributions Of Art	0	DeductibleContributionsOfArt
Terminated	0	Terminated
Partial Liquidation	0	PartialLiquidation
Disregarded Entity	1	DisregardedEntity
Related Entity	1	RelatedEntity
Related Org Controlled Entity	1	RelatedOrgControlledEntity
Transaction Related Entity	1	TransactionRelatedEntity
Transfers To Exempt Non Chrtbl Org	1	TransfersToExemptNonChrtblOrg
Activities Conducted Partnership	0	ActivitiesConductedPartnership
Schedule O Required	1	ScheduleORequired
Number Forms Transmitted With1096	229	NumberFormsTransmittedWith1096
Number W2 G Included	0	NumberW2GIncluded
Compliance With Backup Witholding	1	ComplianceWithBackupWitholding
Number Of Employees	3138	NumberOfEmployees
Employment Tax Returns Filed	1	EmploymentTaxReturnsFiled
Unrelated Business Income	1	UnrelatedBusinessIncome
Form990-T Filed	1	Form990-TFiled
Foreign Financial Account	1	ForeignFinancialAccount
Name Of Foreign Country	CJ	NameOfForeignCountry
Prohibited Tax Shelter Trans	0	ProhibitedTaxShelterTrans
Taxable Party Notification	0	TaxablePartyNotification
Non Deductible Contributions	0	NonDeductibleContributions
Quid Pro Quo Contributions	0	QuidProQuoContributions
Form8282 Property Disposed Of	0	Form8282PropertyDisposedOf
Funds To Pay Premiums	0	FundsToPayPremiums
Premiums Paid	0	PremiumsPaid
Indoor Tanning Services	0	IndoorTanningServices
Info In Schedule O Part VI	X	InfoInScheduleOPartVI
Nbr Voting Governing Body Members	11	NbrVotingGoverningBodyMembers
Number Independent Voting Members	11	NumberIndependentVotingMembers
Family Or Business Relationship	0	FamilyOrBusinessRelationship
Delegation Of Management Duties	0	DelegationOfManagementDuties
Changes To Organizing Docs	0	ChangesToOrganizingDocs
Material Diversion Or Misuse	0	MaterialDiversionOrMisuse
Members Or Stockholders	0	MembersOrStockholders
Election Of Board Members	0	ElectionOfBoardMembers
Decisions Subject To Approval	0	DecisionsSubjectToApproval
Minutes Of Governing Body	1	MinutesOfGoverningBody
Minutes Of Committees	1	MinutesOfCommittees
Officer Mailing Address	0	OfficerMailingAddress
Local Chapters	0	LocalChapters
Form990 Provided To Governing Body	1	Form990ProvidedToGoverningBody
Conflict Of Interest Policy	1	ConflictOfInterestPolicy
Annual Disclosure Covered Persons	1	AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement	1	RegularMonitoringEnforcement
Whistleblower Policy	1	WhistleblowerPolicy
Document Retention Policy	1	DocumentRetentionPolicy
Compensation Process CEO	1	CompensationProcessCEO
Compensation Process Other	1	CompensationProcessOther
Investment In Joint Venture	1	InvestmentInJointVenture
Written Policy Or Procedure	1	WrittenPolicyOrProcedure
States Where Copy Of Return Is Filed	OH	StatesWhereCopyOfReturnIsFiled
Upon Request	X	UponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

Field	Value	IRS element (for citing)
Business Name Line1	FINANCE DEPT LHS	BusinessNameLine1

Field	Value	IRS element (for citing)
Telephone Number	4403541991	TelephoneNumber

Address US AddressUS

Field	Value	IRS element (for citing)
Address Line1	7590 AUBURN ROAD	AddressLine1
City	CONCORD	City
State	OH	State
ZIP Code	44077	ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (22 entries)

TitleTitle	Average Hours Per WeekAverageHoursPerWeek	Individual Trustee Or DirectorIndividualTrusteeOrDirector	OfficerOfficer	Reportable Comp From OrganizationReportableCompFromOrganization	Reportable Comp From Related OrgsReportableCompFromRelatedOrgs	Other CompensationOtherCompensation	Key EmployeeKeyEmployee	Highest Compensated EmployeeHighestCompensatedEmployee
SUSAN TULLAI-MCGUINNESS
CHAIR	8.00	X	X	0	0	0
BRUCE M KEPHART
VICE CHAIR	8.00	X	X	0	0	0
DANIEL B CUDNIK MD
SECRETARY	8.00	X	X	0	0	0
MICHAEL E MAYHER
TREASURER	8.00	X	X	0	0	0
LILLIE MAE WILSON
TRUSTEE	8.00	X		0	0	0
THOMAS P JUBECK
TRUSTEE	8.00	X		0	0	0
JOHN F PLATZ
TRUSTEE	8.00	X		0	0	0
I JAMES HACKENBERG ESQ
TRUSTEE	8.00	X		0	0	0
TIMOTHY P DOYLE MD
TRUSTEE	8.00	X		0	0	0
ROBERT G SCHIEBLI
TRUSTEE	8.00	X		0	0	0
PAUL C SIRKO
TRUSTEE	8.00	X		0	0	0
CYNTHIA MOORE-HARDY
PRESIDENT & CEO	40.00		X	611137	0	39222
MICHAEL E KITTOE
SENIOR VP FINANCE & CFO	40.00		X	233567	0	119
STEVEN R KARNS
SENIOR VP ADMINISTRATIVE SERVICES	40.00			261227	0	30863	X
THEODORE NICHOLS
SENIOR VP MEDICAL AFFAIRS	40.00			256486	0	25063	X
MARY L ORGRINC
CHIEF NURSING OFFICER	40.00			231417	0	37573	X
RICHARD D CICERO
SENIOR VP BUSINESS DEVELOPMENT	40.00			231171	0	16191	X
JOYCE A TAYLOR
VP QUALITY SERVICES	40.00			191803	0	24318		X
ANDREA M WASDOVICH
VP PERIOPERATIVE & CRITICAL CARE SERVICES	40.00			168225	0	17851		X
BARBARA J MORAN
VP ACUTE CARE SERVICES	40.00			165558	0	19646		X
CYNTHIA J RACER
VP CLINICAL SERVICES	40.00			167269	0	7153		X
CHARLES S JOSEY
VP FINANCE	40.00			161406	0	6061		X

Field	Value	IRS element (for citing)
Total Reportable Comp From Org	2679266	TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs	0	TotalReportableCompFrmRltdOrgs
Total Other Compensation	224060	TotalOtherCompensation
Number Individuals GT100 K	44	NumberIndividualsGT100K
Formers Listed	0	FormersListed
Total Comp GT150 K	1	TotalCompGT150K
Compensation From Other Sources	0	CompensationFromOtherSources

Contractor Compensation ContractorCompensation (5 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1	CityAddressOfContractor/AddressUS/City	StateAddressOfContractor/AddressUS/State	ZIP CodeAddressOfContractor/AddressUS/ZIPCode	Description Of ServicesDescriptionOfServices	CompensationCompensation
MCKESSON INC
1 POST ST	SAN FRANCISCO	CA	94104	MEDICAL SUPPLIES & SERVICES	11397648
CARDINAL HEALTH INC
7000 CARDINAL PL	DUBLIN	OH	43017	MEDICAL SUPPLIES & SERVICES	7501176
MEDTRONIC INC
710 MEDTRONIC PKWY	MINNEAPOLIS	MN	55432	MEDICAL SUPPLIES & SERVICES	4065571
SIEMENS USA
511 BENEDICT AVE	TARRYTOWN	NY	10591	MEDICAL SUPPLIES & SERVICES	3842382
MAROUS BROTHERS CONSTRUCTION INC
1702 JOSEPH LLOYD PKWY	WILLOUGHBY	OH	44094	CONSTRUCTION	3581159

Field	Value	IRS element (for citing)
Number Of Contractors GT100 K	199	NumberOfContractorsGT100K
Related Organizations	2209509	RelatedOrganizations
Government Grants	1550158	GovernmentGrants
Total Contributions	3759667	TotalContributions

Program Service Revenue ProgramServiceRevenue

Field	Value	IRS element (for citing)
Description	PATIENT CARE	Description
Business Code	621110	BusinessCode
Total Revenue Column	340907830	TotalRevenueColumn
Related Or Exempt Function Income	340868863	RelatedOrExemptFunctionIncome
Unrelated Business Revenue	38967	UnrelatedBusinessRevenue

Field	Value	IRS element (for citing)
Total Program Service Revenue	340907830	TotalProgramServiceRevenue

Investment Income InvestmentIncome

Field	Value	IRS element (for citing)
Total Revenue Column	5365214	TotalRevenueColumn
Exclusion	$5,365,214	ExclusionAmount

Income From Invest Bond Proceeds IncomeFromInvestBondProceeds

Field	Value	IRS element (for citing)
Total Revenue Column	1308528	TotalRevenueColumn
Exclusion	$1,308,528	ExclusionAmount

Gross Rents GrossRents

Field	Value	IRS element (for citing)
Real	2389897	Real

Less Rental Expenses LessRentalExpenses

Field	Value	IRS element (for citing)
Real	0	Real

Rental Income Or Loss RentalIncomeOrLoss

Field	Value	IRS element (for citing)
Real	2389897	Real

Net Rental Income Or Loss NetRentalIncomeOrLoss

Field	Value	IRS element (for citing)
Total Revenue Column	2389897	TotalRevenueColumn
Exclusion	$2,389,897	ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

Field	Value	IRS element (for citing)
Securities	127070483	Securities

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

Field	Value	IRS element (for citing)
Securities	124354441	Securities

Gain Or Loss GainOrLoss

Field	Value	IRS element (for citing)
Securities	2716042	Securities

Net Gain Or Loss Investments NetGainOrLossInvestments

Field	Value	IRS element (for citing)
Total Revenue Column	2716042	TotalRevenueColumn
Exclusion	$2,716,042	ExclusionAmount

Other Revenue Misc OtherRevenueMisc (3 entries)

DescriptionDescription	Business CodeBusinessCode	Total Revenue ColumnTotalRevenueColumn	ExclusionExclusionAmount
FOOD SALES AND SERVICE	621110	1099607	$1,099,607
PURCHASE DISCOUNTS	621110	1089531	$1,089,531
OB SALES AND RENTALS	621110	31869	$31,869

Miscellaneous Revenue MiscellaneousRevenue

Field	Value	IRS element (for citing)
Total Revenue Column	1340561	TotalRevenueColumn
Unrelated Business Revenue	176371	UnrelatedBusinessRevenue
Exclusion	$1,164,190	ExclusionAmount

Field	Value	IRS element (for citing)
Total Other Revenue	3561568	TotalOtherRevenue

Total Revenue TotalRevenue

Field	Value	IRS element (for citing)
Total Revenue Column	360008746	TotalRevenueColumn
Related Or Exempt Function Income	340868863	RelatedOrExemptFunctionIncome
Unrelated Business Revenue	215338	UnrelatedBusinessRevenue
Exclusion	$15,164,878	ExclusionAmount

Comp Current Officers Directors CompCurrentOfficersDirectors

Field	Value	IRS element (for citing)
Total	884045	Total
Management And General	884045	ManagementAndGeneral

Other Salaries And Wages OtherSalariesAndWages

Field	Value	IRS element (for citing)
Total	111594671	Total
Program Services	89616434	ProgramServices
Management And General	21978237	ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

Field	Value	IRS element (for citing)
Total	2795723	Total
Program Services	2245114	ProgramServices
Management And General	550609	ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

Field	Value	IRS element (for citing)
Total	14917363	Total
Program Services	11979433	ProgramServices
Management And General	2937930	ManagementAndGeneral

Payroll Taxes PayrollTaxes

Field	Value	IRS element (for citing)
Total	7961908	Total
Program Services	6393834	ProgramServices
Management And General	1568074	ManagementAndGeneral

Fees For Services Management FeesForServicesManagement

Field	Value	IRS element (for citing)
Total	3312050	Total
Program Services	1097271	ProgramServices
Management And General	2214779	ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

Field	Value	IRS element (for citing)
Total	781148	Total
Management And General	781148	ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

Field	Value	IRS element (for citing)
Total	143366	Total
Program Services	4000	ProgramServices
Management And General	139366	ManagementAndGeneral

Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees

Field	Value	IRS element (for citing)
Total	775693	Total
Management And General	775693	ManagementAndGeneral

Fees For Services Other FeesForServicesOther

Field	Value	IRS element (for citing)
Total	44014542	Total
Program Services	30612544	ProgramServices
Management And General	13401998	ManagementAndGeneral

Advertising Advertising

Field	Value	IRS element (for citing)
Total	2313912	Total
Program Services	150306	ProgramServices
Management And General	2163606	ManagementAndGeneral

Office Expenses OfficeExpenses

Field	Value	IRS element (for citing)
Total	7114525	Total
Program Services	2577171	ProgramServices
Management And General	4537354	ManagementAndGeneral

Information Technology InformationTechnology

Field	Value	IRS element (for citing)
Total	6182777	Total
Program Services	5564499	ProgramServices
Management And General	618278	ManagementAndGeneral

Occupancy Occupancy

Field	Value	IRS element (for citing)
Total	14188822	Total
Program Services	6449689	ProgramServices
Management And General	7739133	ManagementAndGeneral

Travel Travel

Field	Value	IRS element (for citing)
Total	756238	Total
Program Services	237648	ProgramServices
Management And General	518590	ManagementAndGeneral

Conferences Meetings ConferencesMeetings

Field	Value	IRS element (for citing)
Total	535296	Total
Program Services	164540	ProgramServices
Management And General	370756	ManagementAndGeneral

Interest Interest

Field	Value	IRS element (for citing)
Total	6586767	Total
Management And General	6586767	ManagementAndGeneral

Depreciation Depletion DepreciationDepletion

Field	Value	IRS element (for citing)
Total	26623112	Total
Program Services	768056	ProgramServices
Management And General	25855056	ManagementAndGeneral

Insurance Insurance

Field	Value	IRS element (for citing)
Total	2133892	Total
Program Services	1542697	ProgramServices
Management And General	591195	ManagementAndGeneral

Other Expenses OtherExpenses (4 entries)

DescriptionDescription	TotalTotal	Program ServicesProgramServices	Management And GeneralManagementAndGeneral
MEDICAL SUPPLIES	46468830	46468830
BAD DEBT	32534509	32534509
HOSPITAL FRANCHISE FEE	2878657	2878657
MEMBERSHIP DUES	768412	106411	662001

All Other Expenses AllOtherExpenses

Field	Value	IRS element (for citing)
Total	511460	Total
Program Services	286852	ProgramServices
Management And General	224608	ManagementAndGeneral

Total Functional Expenses TotalFunctionalExpenses

Field	Value	IRS element (for citing)
Total	336777718	Total
Program Services	241678495	ProgramServices
Management And General	95099223	ManagementAndGeneral
Fundraising	0	Fundraising

Cash Non Interest Bearing CashNonInterestBearing

Field	Value	IRS element (for citing)
BOY	18569470	BOY
EOY	20142663	EOY

Accounts Receivable AccountsReceivable

Field	Value	IRS element (for citing)
BOY	36187079	BOY
EOY	36745129	EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

Field	Value	IRS element (for citing)
BOY	4217281	BOY
EOY	3040292	EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

Field	Value	IRS element (for citing)
BOY	9190117	BOY
EOY	6862559	EOY

Field	Value	IRS element (for citing)
Land Buildings Equipment Basis	476112372	LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec	216598732	LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

Field	Value	IRS element (for citing)
BOY	263472140	BOY
EOY	259513640	EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

Field	Value	IRS element (for citing)
BOY	160946010	BOY
EOY	178841090	EOY

Other Assets Total OtherAssetsTotal

Field	Value	IRS element (for citing)
BOY	12650287	BOY
EOY	13219320	EOY

Total Assets TotalAssets

Field	Value	IRS element (for citing)
BOY	505232384	BOY
EOY	518364693	EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

Field	Value	IRS element (for citing)
BOY	26091905	BOY
EOY	28937352	EOY

Deferred Revenue DeferredRevenue

Field	Value	IRS element (for citing)
BOY	386100	BOY
EOY	516223	EOY

Tax Exempt Bond Liabilities TaxExemptBondLiabilities

Field	Value	IRS element (for citing)
BOY	247769632	BOY
EOY	268942325	EOY

Other Liabilities OtherLiabilities

Field	Value	IRS element (for citing)
BOY	8756311	BOY
EOY	9908387	EOY

Total Liabilities TotalLiabilities

Field	Value	IRS element (for citing)
BOY	283003948	BOY
EOY	308304287	EOY

Field	Value	IRS element (for citing)
Follow SFAS117	X	FollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

Field	Value	IRS element (for citing)
BOY	222228436	BOY
EOY	210060406	EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

Field	Value	IRS element (for citing)
BOY	222228436	BOY
EOY	210060406	EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

Field	Value	IRS element (for citing)
BOY	505232384	BOY
EOY	518364693	EOY

Field	Value	IRS element (for citing)
Info In Schedule O Part XI	X	InfoInScheduleOPartXI
Reconcilation Revenue Expenses	23231028	ReconcilationRevenueExpenses
Reconcilation Other Changes	-35399058	ReconcilationOtherChanges
Info In Schedule O Part XII	X	InfoInScheduleOPartXII
Method Of Accounting Accrual	X	MethodOfAccountingAccrual
Accountant Compile Or Review	0	AccountantCompileOrReview
FS Audited	1	FSAudited
Audit Committee	1	AuditCommittee
Financial Statement Consolidated	X	FinancialStatementConsolidated
Federal Grant Audit Required	0	FederalGrantAuditRequired

Schedule A IRS990ScheduleA

Field	Value	IRS element (for citing)
Hospital170b1 Aiii	X	Hospital170b1Aiii

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

Field	Value	IRS element (for citing)
Contributor Number	RESTRICTED	ContributorNumber

Contributor Name Business ContributorNameBusiness

Field	Value	IRS element (for citing)
Business Name Line1	RESTRICTED	BusinessNameLine1

Contributor Address US ContributorAddressUS

Field	Value	IRS element (for citing)
Address Line1	RESTRICTED	AddressLine1
Address Line2	RESTRICTED	AddressLine2
City	RESTRICTED	City
State	RESTRICTED	State
ZIP Code	RESTRICTED	ZIPCode

Field	Value	IRS element (for citing)
Aggregate Contributions	RESTRICTED	AggregateContributions

Schedule C IRS990ScheduleC

Field	Value	IRS element (for citing)
Volunteers	0	Volunteers
Paid Staff Or Management	0	PaidStaffOrManagement
Media Advertisements	0	MediaAdvertisements
Mailings Members	0	MailingsMembers
Publications Or Broadcast	0	PublicationsOrBroadcast
Grants Other Organizations	0	GrantsOtherOrganizations
Direct Contact Legislators	0	DirectContactLegislators
Rallies Demonstrations	0	RalliesDemonstrations
Other Activities	1	OtherActivities
Other Activities	$8,529	OtherActivitiesAmount
Total Lobbying Expenditures IIB	8529	TotalLobbyingExpendituresIIB
Not Described In501c3	0	NotDescribedIn501c3

Form990 Schedule C Part IV Form990ScheduleCPartIV

Field	Value	IRS element (for citing)
Identifier	EXPLANATION OF LOBBYING ACTIVITIES:	Identifier
Return Reference	PART II-B, LINE 1:	ReturnReference
Explanation	ANNUAL MEMBERSHIP DUES TO AHA, OHA, GCHA: EXEMPT ORGANIZATIONS ON VARIOUS LEVELS OPERATING TO LEAD, REPRESENT, AND SERVE HEALTH CARE PROVIDER ORGANIZATIONS COMMITTED TO COMMUNITY HEALTH IMPROVEMENT. LOBBYING ACTIVITIES COMPRISE APPROXIMATELY 10% OF ANNUAL MEMBER DUES.	Explanation

Schedule D IRS990ScheduleD

Current Year CurrentYear

Field	Value	IRS element (for citing)
Beginning Of Year Balance	5629760	BeginningOfYearBalance
Contributions	403229	Contributions
Investment Earnings Or Losses	-24347	InvestmentEarningsOrLosses
Other Expenditures	1102217	OtherExpenditures
End Of Year Balance	4906425	EndOfYearBalance

Current Year Minus1 Year CurrentYearMinus1Year

Field	Value	IRS element (for citing)
Beginning Of Year Balance	6225581	BeginningOfYearBalance
Contributions	262613	Contributions
Investment Earnings Or Losses	104682	InvestmentEarningsOrLosses
Other Expenditures	963116	OtherExpenditures
End Of Year Balance	5629760	EndOfYearBalance

Current Year Minus2 Years CurrentYearMinus2Years

Field	Value	IRS element (for citing)
Beginning Of Year Balance	8375829	BeginningOfYearBalance
Contributions	582250	Contributions
Investment Earnings Or Losses	29764	InvestmentEarningsOrLosses
Other Expenditures	2762262	OtherExpenditures
End Of Year Balance	6225581	EndOfYearBalance

Current Year Minus3 Years CurrentYearMinus3Years

Field	Value	IRS element (for citing)
Beginning Of Year Balance	8709429	BeginningOfYearBalance
Contributions	857988	Contributions
Investment Earnings Or Losses	-440270	InvestmentEarningsOrLosses
Other Expenditures	751318	OtherExpenditures
End Of Year Balance	8375829	EndOfYearBalance

Field	Value	IRS element (for citing)
Board Designated EOY Balance	0.00000	BoardDesignatedEOYBalance
Permanent Endowment EOY Balance	0.44000	PermanentEndowmentEOYBalance
Term Endowment EOY Balance	0.56000	TermEndowmentEOYBalance
Endowments Held By Unrelated Orgs	0	EndowmentsHeldByUnrelatedOrgs
Endowments Held By Related Orgs	1	EndowmentsHeldByRelatedOrgs
Are Related Orgs Listed Schedule R	1	AreRelatedOrgsListedScheduleR

Land Land

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	11606783	OtherCostOrOtherBasis
Book Value	11606783	BookValue

Buildings Buildings

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	188586438	OtherCostOrOtherBasis
Depreciation	40632271	Depreciation
Book Value	147954167	BookValue

Leasehold Improvements LeaseholdImprovements

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	2213361	OtherCostOrOtherBasis
Depreciation	748404	Depreciation
Book Value	1464957	BookValue

Equipment Equipment

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	254321176	OtherCostOrOtherBasis
Depreciation	170857469	Depreciation
Book Value	83463707	BookValue

Other Land Buildings OtherLandBuildings

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	19384614	OtherCostOrOtherBasis
Depreciation	4360588	Depreciation
Book Value	15024026	BookValue

Field	Value	IRS element (for citing)
Total Of Book Value Land Buildings	259513640	TotalOfBookValueLandBuildings

Other Liabilities OtherLiabilities (5 entries)

DescriptionDescription	AmountAmount
LEASE OBLIGATION	$1,487,589
THIRD PARTY SETTLEMENTS	$3,181,127
PAYABLE TO AFFILIATE	$1,901,879
DEFERRED COMPENSATION	$723,837
WORKERS COMP LIABILITY	$2,613,955

Field	Value	IRS element (for citing)
Total Of Amounts	9908387	TotalOfAmounts

Form990 Schedule D Part XIV Form990ScheduleDPartXIV

Field	Value	IRS element (for citing)
Identifier	DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS:	Identifier
Return Reference	PART V, LINE 4:	ReturnReference
Explanation	LAKE HEALTH'S PERMANENT AND TERM ENDOWMENT FUNDS ARE HELD BY LAKE HOSPITAL FOUNDATION, INC. DBA LAKE HEALTH FOUNDATION (THE "FOUNDATION"), A RELATED ORGANIZATION. THE FOUNDATION'S MISSION IS TO SECURE FINANCIAL AND NON-FINANCIAL SUPPORT TO USE IN REALIZING LAKE HEALTH'S VISION OF PROVIDING HEALTH CARE FOR THE COMMUNITY. THE FOUNDATION'S SOLE MEMBER IS LAKE HEALTH.	Explanation

Schedule H IRS990ScheduleH

Field	Value	IRS element (for citing)
Charity Care Policy	1	CharityCarePolicy
Written Policy	1	WrittenPolicy
Policy Applied To All Hospitals	X	PolicyAppliedToAllHospitals
FPG Reference Free Care	1	FPGReferenceFreeCare

Other Percentage OtherPercentage

Field	Value	IRS element (for citing)
Other	X	Other
Free Other Percentage	250.000000000000	FreeOtherPercentage

Field	Value	IRS element (for citing)
FPG Reference Discounted Care	1	FPGReferenceDiscountedCare
Pcent250	X	Pcent250
Free Disc Care Medically Indigent	1	FreeDiscCareMedicallyIndigent
Amounts Budgeted For Charity Care	1	AmountsBudgetedForCharityCare
Expenses Exceeded Budget	0	ExpensesExceededBudget
Annual Community Benefit Report	1	AnnualCommunityBenefitReport
Report Publically Available	1	ReportPublicallyAvailable

Charity Care At Cost CharityCareAtCost

Field	Value	IRS element (for citing)
Total Community Benefit Expense	10229551	TotalCommunityBenefitExpense
Direct Offsetting Revenue	4887339	DirectOffsettingRevenue
Net Community Benefit Expense	5342212	NetCommunityBenefitExpense
Percent Of Total Expense	0.01590	PercentOfTotalExpense

Unreimbursed Medicaid UnreimbursedMedicaid

Field	Value	IRS element (for citing)
Total Community Benefit Expense	24420147	TotalCommunityBenefitExpense
Direct Offsetting Revenue	11934469	DirectOffsettingRevenue
Net Community Benefit Expense	12485678	NetCommunityBenefitExpense
Percent Of Total Expense	0.03710	PercentOfTotalExpense

Total Charity Care TotalCharityCare

Field	Value	IRS element (for citing)
Total Community Benefit Expense	34649698	TotalCommunityBenefitExpense
Direct Offsetting Revenue	16821808	DirectOffsettingRevenue
Net Community Benefit Expense	17827890	NetCommunityBenefitExpense
Percent Of Total Expense	0.05300	PercentOfTotalExpense

Community Health Services CommunityHealthServices

Field	Value	IRS element (for citing)
Total Community Benefit Expense	155235	TotalCommunityBenefitExpense
Direct Offsetting Revenue	0	DirectOffsettingRevenue
Net Community Benefit Expense	155235	NetCommunityBenefitExpense
Percent Of Total Expense	0.00050	PercentOfTotalExpense

Subsidized Health Services SubsidizedHealthServices

Field	Value	IRS element (for citing)
Total Community Benefit Expense	26458	TotalCommunityBenefitExpense
Net Community Benefit Expense	26458	NetCommunityBenefitExpense
Percent Of Total Expense	0.00010	PercentOfTotalExpense

Cash And In Kind Contributions CashAndInKindContributions

Field	Value	IRS element (for citing)
Total Community Benefit Expense	159537	TotalCommunityBenefitExpense
Direct Offsetting Revenue	0	DirectOffsettingRevenue
Net Community Benefit Expense	159537	NetCommunityBenefitExpense
Percent Of Total Expense	0.00050	PercentOfTotalExpense

Total Other Benefits TotalOtherBenefits

Field	Value	IRS element (for citing)
Total Community Benefit Expense	341230	TotalCommunityBenefitExpense
Net Community Benefit Expense	341230	NetCommunityBenefitExpense
Percent Of Total Expense	0.00110	PercentOfTotalExpense

Total Community Benefits TotalCommunityBenefits

Field	Value	IRS element (for citing)
Total Community Benefit Expense	34990928	TotalCommunityBenefitExpense
Direct Offsetting Revenue	16821808	DirectOffsettingRevenue
Net Community Benefit Expense	18169120	NetCommunityBenefitExpense
Percent Of Total Expense	0.05410	PercentOfTotalExpense

Health Improvement Advocacy HealthImprovementAdvocacy

Field	Value	IRS element (for citing)
Total Community Building Expense	216164	TotalCommunityBuildingExpense
Net Community Building Expense	216164	NetCommunityBuildingExpense
Percent Of Total Expense	0.00060	PercentOfTotalExpense

Total Total

Field	Value	IRS element (for citing)
Total Community Building Expense	216164	TotalCommunityBuildingExpense
Net Community Building Expense	216164	NetCommunityBuildingExpense
Percent Of Total Expense	0.00060	PercentOfTotalExpense

Field	Value	IRS element (for citing)
Bad Debt Expense Reported	1	BadDebtExpenseReported
Bad Debt Expense	$9,392,921	BadDebtExpenseAmount
Amount Attributable To	1878584	AmountAttributableTo
Amount Reimbursed By Medicare	80902247	AmountReimbursedByMedicare
Cost Of Care Reimbursed By Medicare	92764984	CostOfCareReimbursedByMedicare
Medicare Surplus Or Shortfall	-11862737	MedicareSurplusOrShortfall

Costing Methodology Used CostingMethodologyUsed

Field	Value	IRS element (for citing)
Cost To Charge Ratio	X	CostToChargeRatio

Field	Value	IRS element (for citing)
Written Debt Collection Policy	1	WrittenDebtCollectionPolicy
Provision For Charity Care	1	ProvisionForCharityCare

Form990 Schedule H Part IV Form990ScheduleHPartIV (5 entries)

Description Ent Primary ActivityDescriptionEntPrimaryActivity	Organization Profit Or OwnershipOrganizationProfitOrOwnership	Physicans Profit Or OwnershipPhysicansProfitOrOwnership
1 MENTOR SURGERY CENTER
SAME DAY SURGERY	0.44900	0.55100
2 MMC PHYSICIANS OFFICE BUILDING
MEDICAL OFFICE BUILDING	0.40000	0.60000
3 LAKE WEST PHYSICIANS OFFICE
MEDICAL OFFICE BUILDING	0.10000	0.90000
4 CONCORD MEDICAL CAMPUS PHYSICIANS
MEDICAL OFFICE BUILDING	0.51470	0.48530
5 LAKE PHO
PHYSICIANS MED GROUP	0.50000	0.50000

Field	Value	IRS element (for citing)
Number Of Hospital Facilities	2	NumberOfHospitalFacilities

Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA (2 entries)

Facility NumberFacilityNumber	Address Line1Address/AddressLine1	CityAddress/City	StateAddress/State	ZIP CodeAddress/ZIPCode	Licensed HospitalLicensedHospital	General Medical And SurgicalGeneralMedicalAndSurgical	Er24 HoursEr24Hours
LAKEWEST MEDICAL CENTER
1	36000 EUCLID AVENUE	WILLOUGHBY	OH	44094	X	X	X
TRIPOINT MEDICAL CENTER
2	7590 AUBURN RD	CONCORD	OH	44077	X	X	X

Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB

Hospital Facility Name HospitalFacilityName

Field	Value	IRS element (for citing)
Business Name Line1	LAKEWEST & TRIPOINT MEDICAL CENTERS	BusinessNameLine1

Field	Value	IRS element (for citing)
Hospital Facility Number	1	HospitalFacilityNumber
CHNA Conducted	0	CHNAConducted
Eligibility Criteria Explained	1	EligibilityCriteriaExplained
Uses FPG Free	1	UsesFPGFree
FPG Free Percent	250.000000000000	FPGFreePercent
Uses FPG Discounted	1	UsesFPGDiscounted
FPG Discount Percent	250.000000000000	FPGDiscountPercent
Explains Basis	1	ExplainsBasis
Other Factors	X	OtherFactors
Explains Application Method	1	ExplainsApplicationMethod
Includes Publicity Measures	1	IncludesPublicityMeasures
Posted On Website	X	PostedOnWebsite
Attached To Invoices	X	AttachedToInvoices
Posted In Emergency Room	X	PostedInEmergencyRoom
Posted In Admission Office	X	PostedInAdmissionOffice
Provided On Admission	X	ProvidedOnAdmission
Available On Request	X	AvailableOnRequest
Actions On Nonpayment	1	ActionsOnNonpayment
Collection Activities	0	CollectionActivities
Nondiscrim Emergency Care Policy	1	NondiscrimEmergencyCarePolicy
Used Other Method	X	UsedOtherMethod
Amounts Generally Billed	0	AmountsGenerallyBilled
Gross Charges	0	GrossCharges

Form990 Schedule H Part V Section C Form990ScheduleHPartVSectionC

Field	Value	IRS element (for citing)
Number Of Other Facilities	43	NumberOfOtherFacilities

Other Facilities OtherFacilities (43 entries)

Address Line1Address/AddressLine1	CityAddress/City	StateAddress/State	ZIP CodeAddress/ZIPCode	Facility TypeFacilityType
MENTOR MEDICAL CAMPUS
9485 MENTOR AVENUE SUITE 101	MENTOR	OH	44060	GENERAL MEDICAL & SURGICAL CENTER-OUTPATIENT
MADISON URGENT CARE
6270 NORTH RIDGE RD	MADISON	OH	44057	URGENT CARE CENTER
LAKE COUNTY FAMILY PRACTICE
9500 MENTOR AVENUE SUITE 100	MENTOR	OH	44060	PHYSICIAN OFFICE
WILLOWICK URGENT CARE
29804 LAKESHORE BLVD	WILLOWICK	OH	44095	URGENT CARE CENTER
LYNDHURST DIAGNOSTIC CENTER
5183 MAYFIELD RD	LYNDHURST	OH	44124	DIAGNOSTIC CENTER
LHPG WOMEN'S HEALTH SPECIALISTS OBGYN
35040 CHARDON RD BLDG VII SUITE 205	WILLOUGHBY HILLS	OH	44094	PHYSICIAN OFFICE
TYLER URGENT CARE
7956 TYLER BLVD	MENTOR	OH	44060	URGENT CARE CENTER
MENTOR DIAGNOSTIC CENTER
8401 MENTOR AVE SUITE B	MENTOR	OH	44060	DIAGNOSTIC CENTER
CHARDON URGENT CARE
510 FIFTH AVENUE	CHARDON	OH	44024	URGENT CARE CENTER
LHPG MENTOR IMED
9485 MENTOR AVENUE SUITE 210	MENTOR	OH	44060	PHYSICIAN OFFICE
LHPG MENTOR PEDIATRICS
9485 MENTOR AVENUE SUITE 101	MENTOR	OH	44094	PHYSICIAN OFFICE
WILLOUGHBY HILLS DIAGNOSTIC CENTER
34600 CHARDON RD	WILLOUGHBY HILLS	OH	44094	DIAGNOSTIC CENTER
NORTH COAST FAMILY PRACTICE
7580 AUBURN RD	CONCORD	OH	44077	PHYSICIAN OFFICE
LHPG WILLOUGHBY IMED
36100 EUCLID AVENUE SUITES 240 260	WILLOUGHBY	OH	44094	PHYSICIAN OFFICE
LHPG OBGYN - WILLOW MEDICAL
36001 EUCLID AVENUE SUITE C-10	WILLOUGHBY	OH	44094	PHYSICIAN OFFICE
MADISON FAMILY PRACTICE
6270 NORTH RIDGE RD	MADISON	OH	44057	PHYSICIAN OFFICE
MADISON PEDIATRICS
6270 NORTH RIDGE RD	MADISON	OH	44057	PHYSICIAN OFFICE
LHPG WILLOUGHBY PEDIATRICS
36001 EUCLID AVENUE SUITE B-16	WILLOUGHBY	OH	44094	PHYSICIAN OFFICE
LAKE WELLNESS AND REHABILITATION
9170 MENTOR AVENUE	MENTOR	OH	44060	REHABILITATION CLINIC
CHARDON FAMILY PRACTICE
510 FIFTH AVENUE	CHARDON	OH	44024	PHYSICIAN OFFICE
WILLOUGHBY HILLS SLEEP CENTER
34900 CHARDON RD SUITE 105	WILLOUGHBY HILLS	OH	44094	SLEEP CENTER
LHPG MENTOR FAMILY PRACTICE
6990 LINDSAY DRIVE 3	MENTOR	OH	44060	PHYSICIAN OFFICE
WILLOWICK FAMILY PRACTICE
29804 LAKESHORE BLVD	WILLOWICK	OH	44095	PHYSICIAN OFFICE
LHPG WILLOUGHBY HILLS IMED
2747 SOM CENTER RD UNIT D	WILLOUGHBY HILLS	OH	44094	PHYSICIAN OFFICE
LHPG GENERAL SURGERY
36060 EUCLID AVENUE SUITE 204	WILLOUGHBY	OH	44094	PHYSICIAN OFFICE
CHARDON PEDIATRICS
510 FIFTH AVENUE SUITE 120	CHARDON	OH	44024	PHYSICIAN OFFICE
LHPG ORTHOPEDIC SURGERY
36060 EUCLID AVENUE SUITE 203	WILLOUGHBY	OH	44094	PHYSICIAN OFFICE
LHPG VASCULAR SURGERY
36001 EUCLID AVENUE SUITE B-3	WILLOUGHBY	OH	44094	PHYSICIAN OFFICE
PAINESVILLE QUICK CLINIC
74 S PARK PLACE	PAINESVILLE	OH	44077	QUICK CLINIC
LHPG PLASTIC SURGERY
9500 MENTOR AVENUE SUITE 200	MENTOR	OH	44060	PHYSICIAN OFFICE
LHPG WEST CARDIO ELECTROPHYSIOLOGY
36100 EUCLID AVENUE SUITE 400	WILLOUGHBY	OH	44094	PHYSICIAN OFFICE
LAKE WELLNESS AND REHABILITATION
34881 EUCLID AVE	WILLOUGHBY	OH	44094	REHABILITATION CLINIC
LHPG MENTOR GENERAL SURGERY
9500 MENTOR AVENUE SUITE 300	MENTOR	OH	44060	PHYSICIAN OFFICE
MIDDLEFIELD QUICK CLINIC
15050 S SPRINGDALE AVENUE	MIDDLEFIELD	OH	44062	QUICK CLINIC
LHPG MENTOR OBGYN
9485 MENTOR AVENUE SUITE 202	MENTOR	OH	44060	PHYSICIAN OFFICE
LHPG THOMAS FAMILY PRACTICE - MENTOR
8316 YELLOWBRICK RD	MENTOR	OH	44060	PHYSICIAN OFFICE
PERRY HEALTH AND WELLNESS CENTER
2 SUCCESS BOULEVARD	PERRY	OH	44081	QUICK CLINIC
PAINESVILLE IMED
1223 MENTOR AVE	PAINESVILLE	OH	44077	PHYSICIAN OFFICE
LHPG THOMAS FAMILY PRACTICE - EUCLID
26151 EUCLID AVE	EUCLID	OH	44132	PHYSICIAN OFFICE
MADISON QUICK CLINIC
6067 NORTH RIDGE RD	MADISON	OH	44057	QUICK CLINIC
PHYSICAL THERAPY - SOUTH LLC
36060 EUCLID AVENUE SUITE 105	WILLOUGHBY	OH	44094	PHYSICIAN OFFICE
MENTOR MEDICAL PHYSICIAN BUILDING
9485 MENTOR AVENUE SUITES XXX-XX-XXXX	MENTOR	OH	44060	PHYSICIAN OFFICE
HACKETT MEDICAL BUILDING
8300 TYLER RD	MENTOR	OH	44060	PHYSICIAN OFFICE

Form990 Schedule H Part VI Form990ScheduleHPartVI (17 entries)

ExplanationExplanation	IdentifierIdentifier	Return ReferenceReturnReference
PART I, LINE 3C: THE FOLLOWING STEPS WILL BE FOLLOWED TO EVALUATE PATIENT'S REQUESTS FOR CONSIDERATION UNDER THE UNINSURED/UNCOMPENSATED CARE GUIDELINES. FINANCIAL INTERVIEW: A HOSPITAL REPRESENTATIVE WILL DISCUSS WITH PATIENTS THEIR INDIVIDUAL FINANCIAL POSITION AND OBTAIN FROM THEM INFORMATION REGARDING THEIR FINANCES. THIS INFORMATION WILL BE RECORDED ON THE HCAP APPLICATION. PATIENTS WILL BE REQUESTED TO SUPPLY COPIES OF THEIR TWO MOST RECENT PAY STUBS FOR ALL FAMILY MEMBERS EMPLOYED, COPIES OF THE PREVIOUS YEAR'S TAX RETURN AND ANY OTHER PERTINENT DOCUMENTATION SUPPORTING THEIR FINANCIAL POSITION.EVALUATION PROCESS: THE HOSPITAL REPRESENTATIVE WILL COMPLETE THE FINANCIAL INTERVIEW FORM. THE HOSPITAL REPRESENTATIVE WILL EVALUATE THE APPLICATION TO DETERMINE WHETHER THE PATIENT MAY BE ELIGIBLE FOR WELFARE OR MEDICAID COVERAGE. IF THIS COVERAGE IS AVAILABLE, THE REPRESENTATIVE WILL MAKE ARRANGEMENTS WITH THE PATIENT FOR COMPLETION OF THE MEDICAID ELIGIBILITY FORMS. IF WELFARE OR MEDICAID ELIGIBILITY IS NOT AVAILABLE, THE PATIENT WILL BE SENT AN APPLICATION AND WILL BE CONSIDERED FOR UNCOMPENSATED CARE. A COPY OF THE APPLICATION WILL BE FORWARDED TO THE PATIENT ACCOUNTING DEPARTMENT.DETERMINATION OF ELIGIBILITY: THE PATIENT ACCOUNTING DEPARTMENT WILL REVIEW THE APPLICATION AND THE PATIENT'S QUALIFICATION STATUS UNDER THE UNINSURED/UNCOMPENSATED CARE GUIDELINES. IF THE PATIENT QUALIFIES FOR UNINSURED/UNCOMPENSATED CARE AND SERVICES ARE PROVIDED, THEN THE ADJUSTMENT WILL BE RECORDED AS AN ADJUSTMENT FROM CHARGES FOR LAKE HOSPITAL'S UNINSURED/UNCOMPENSATED CHARITY CARE.PATIENTS NOT ELIGIBLE: PATIENTS WHO ARE DETERMINED NOT TO BE ELIGIBLE UNDER THE GUIDELINES WILL BE REQUESTED TO PAY A DEPOSIT EQUAL TO 50% OF THE ESTIMATED PATIENT RESPONSIBILITY FOR EITHER THE ELECTIVE INPATIENT OR OUTPATIENT SERVICES, AND TO MAKE ARRANGEMENTS FOR A PAYMENT PLAN TO SATISFY THE REMAINING BALANCE AFTER SERVICES ARE PROVIDED.ELIGIBILITY: EACH ADMISSION REPRESENTS A SEPARATE FINANCIAL ENCOUNTER AND WILL BE EVALUATED WITH NEW DATA TO DETERMINE IF A CHANGE HAS TAKEN PLACE. EACH OUTPATIENT APPLICATION WILL BE REVIEWED TO DETERMINE IF THERE HAS BEEN ANY CHANGE IN FINANCIAL STATUS. A NEW APPLICATION WILL BE REQUIRED EACH MONTH.
PART I, LINE 6A: AN ANNUAL COMMUNITY BENEFIT REPORT SUMARIZING THE ACTIVITIES OF THE ORGANIZATION IS PREPARED. THE REPORT IS WRITTEN IN USER-FRIENDLY LANGUAGE AND DISTRIBUTED AT ALL COMMUNITY PRESENTATIONS.
PART I, LINE 7: A COST-TO-CHARGE RATIO IS USED. THIS RATIO TAKES THE TOTAL COSTS, INCLUDING ALLOCATED COSTS FROM OVERHEAD DEPARTMENTS, OF PROVIDING PATIENT CARE DEVIDED BY TOTAL GROSS REVENUE.
PART I, LINE 7G: SUBSIDIZED HEALTH SERVICES INCLUDE VARIOUS FREE COMMUNITY SCREENING EVENTS FOR HEALTH CONDITIONS SUCH AS BLOOD PRESSURE, CHOLESTEROL, BONE DENSITY, PROSTATE CANCER, SKIN CANCER, HEART DISEASE AND OBESITY.
PART I, L7 COL(F): CHARITY CARE AND OTHER COMMUNITY BENEFITS AS A PERCENTAGE OF EXPENSES IS CALCULATED USING TOTAL EXPENSES FROM FORM 990, PART IX LESS BAD DEBT EXPENSE OF $32,534,509 FROM PART IX.
PART II: COMMUNITY BUILDING ACTIVITIESCOMMUNITY ADVISORY GROUPS HAVE BEEN IN PLACE FOR 10 YEARS. THESE DISTINCT GROUPS REPRESENT WOMEN, SENIORS AND PAST PATIENTS OF THE SYSTEM. EACH GROUP IS MADE UP OF APPROXIMATELY 20 MEMBERS. QUARTERLY MEETINGS ARE HELD IN WHICH EDUCATION IS FOLLOWED BY INPUT ON SPECIFIC PROGRAMS OR IMPROVEMENTS BEING CONSIDERED. THE GROUPS ARE MODERATED BY A THIRD-PARTY FACILITATOR TO AVOID BIASING THE GROUPS. THE INFORMATION FROM THESE GROUPS HAS BEEN USED TO INFORM LAKE HEALTH MANAGEMENT ON ISSUES RANGING FROM WAY-FINDING TO PROGRAM NEEDS.COMMUNITY LEADERS ARE ALSO INVITED TO PARTICIPATE IN A PHYSICIAN SHADOWING EXPERIENCE. IN 2011 APPROXIMATELY SEVEN MEMBERS OF THE COMMUNITY SPENT THE DAY WITH A PHYSICIAN. THE PARTICIPANTS WERE EXPOSED TO THE CHALLENGES FACED BY PROVIDERS IN DELIVERING CARE. IN EXCHANGE, PHYSICIANS ARE INVITED TO THEN SHADOW THE COMMUNITY LEADERS DURING THEIR NORMAL DAY.COALITION BUILDINGLAKE HEALTH IS INVOLVED IN MANY COMMUNITY COALITIONS AND PARTNERSHIPS TO IMPROVE THE HEALTH OF INDIVIDUALS IN THE SERVICE AREA. SOME OF THESE INCLUDE PARTICIPATION IN THE LAKE COUNTY STRATEGIC PLAN, ACHIEVE (A COMMUNITY COALITION TO IMPROVE THE ENVIRONMENT IN LAKE COUNTY), AND UNITED WAY PROGRAMS DESIGNED TO IMPROVE HEALTH, PARTICULARLY IN VULNERABLE COMMUNITIES.
PART III, LINE 4: THE SYSTEM MAINTAINS AN ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS. THE SYSTEMS ESTIMATION OF THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS IS BASED PRIMARILY UPON THE TYPE AND AGE OF THE PATIENT ACCOUNTS RECEIVABLE AND THE EFFECTIVENESS OF THE SYSTEMS COLLECTION EFFORTS. THE SYSTEMS POLICY IS TO RESERVE A PORTION OF ALL SELF-PAY RECEIVABLES, INCLUDING AMOUNTS DUE FROM THE UNINSURED AND AMOUNTS RELATED TO CO-PAYMENTS AND DEDUCTIBLES, AS THESE CHARGES ARE RECORDED. ON A MONTHLY BASIS, THE SYSTEM REVIEWS ITS PATIENT ACCOUNTS RECEIVABLE BALANCES, THE EFFECTIVENESS OF THE SYSTEMS RESERVE POLICIES AND VARIOUS ANALYTICS TO SUPPORT THE BASIS FOR ITS ESTIMATES. THESE EFFORTS PRIMARILY CONSIST OF REVIEWING THE FOLLOWING: HISTORICAL WRITE-OFF AND COLLECTION EXPERIENCE USING A HINDSIGHT OR LOOK-BACK APPROACH; REVENUE AND VOLUME TRENDS BY PAYOR, PARTICULARLY THE SELF-PAY COMPONENTS; CHANGES IN THE AGING AND PAYOR MIX OF PATIENT ACCOUNTS RECEIVABLE, INCLUDING INCREASED FOCUS ON ACCOUNTS DUE FROM THE UNINSURED AND ACCOUNTS THAT REPRESENT CO-PAYMENTS AND DEDUCTIBLES DUE FROM PATIENTS; CASH COLLECTIONS AS A PERCENTAGE OF NET PATIENT SERVICE REVENUE LESS PROVISION FOR UNCOLLECTIBLE ACCOUNTS; TRENDING OF DAYS REVENUE IN ACCOUNTS RECEIVABLE; AND VARIOUS ALLOWANCE COVERAGE STATISTICS. THE SYSTEM REGULARLY PERFORMS HINDSIGHT PROCEDURES TO EVALUATE HISTORICAL WRITE-OFF AND COLLECTION EXPERIENCE THROUGHOUT THE YEAR TO ASSIST IN DETERMINING THE REASONABLENESS OF ITS PROCESS FOR ESTIMATING THE ALLOWANCE FORUNCOLLECTIBLE ACCOUNTS.THE SYSTEM ACCEPTS ALL PATIENTS COVERED BY MEDICARE, MEDICAID, AND OTHER ASSISTANCE PROGRAMS AND TREATS ALL PATIENTS REQUIRING EMERGENCY CARE REGARDLESS OF THEIR ABILITY TO PAY. IN ADDITION TO PROVIDING DIRECT PATIENT CHARITY CARE AND IN FURTHERANCE OF ITS EXEMPT PURPOSE TO BENEFIT THE COMMUNITY, THE SYSTEM OPERATES THREE FULL-TIME EMERGENCY ROOMS OPEN TO THE PUBLIC, PROVIDES VARIOUS COMMUNITY SCREENINGS FOR THE DETECTION OF DISEASES AND DISORDERS AND PROVIDES VARIOUS COMMUNITY HEALTH EDUCATION CLASSES, LECTURES, AND LITERATURE. THE SYSTEM PROVIDES CARE TO PATIENTS WHO MEET CERTAIN CRITERIA UNDER ITS CHARITY CARE POLICY WITHOUT CHARGE OR AT AMOUNTS LESS THAN ITS ESTABLISHED RATES. THE SYSTEM DOES NOT PURSUE COLLECTION OF AMOUNTS DETERMINED TO QUALIFY AS CHARITY CARE AND CHARITY CARE IS NOT INCLUDED IN NET PATIENT SERVICE REVENUE. THE COST OF CHARITY CARE PROVIDED IN 2011 AND 2010 APPROXIMATED $7.2 MILLION AND $6.5 MILLION, RESPECTIVELY. THE SYSTEM ESTIMATED THESE COSTS USING A COST-TOCHARGE BASED RATIO. THE SYSTEM PARTICIPATES IN THE HOSPITAL CARE ASSURANCE PROGRAM (HCAP). OHIO CREATED HCAP TO FINANCIALLY SUPPORT THOSE HOSPITALS THAT SERVICE A DISPROPORTIONATE SHARE OF LOW-INCOME PATIENTS UNABLE TO PAY FOR CARE. HCAP FUNDS BASIC, MEDICALLY NECESSARY HOSPITAL SERVICES FOR PATIENTS WHOSE FAMILY INCOME IS AT OR BELOW THE FEDERAL POVERTY LEVEL, WHICH INCLUDES MEDICAID PATIENTS AND PATIENTS WITHOUT HEALTH INSURANCE. THE SYSTEM RECORDED NET HCAP REVENUES OF $3.1 MILLION AND $2.6 MILLION FOR THE YEARS ENDED DECEMBER 31, 2011 AND 2010, RESPECTIVELY, WHICH IS INCLUDED IN NET PATIENT SERVICE REVENUE IN THE ACCOMPANYING CONSOLIDATED STATEMENTS OF OPERATIONS AND CHANGES IN NET ASSETS.
PART III, LINE 8: BASED ON A COST TO CHARGE RATIO DETERMINED IN ACCORDANCE WITH MEDICARE COST REPORT REQUIREMENTS, THE COSTS OF PROVIDING CARE TO THE MEDICARE POPULATION IN 2011 WAS $92,764,984. THE PAYMENTS RELATED TO THESE SERVICES WERE $80,902,247, LEAVING A MEDICARE SHORTFALL OF $11,862,737 FOR THE YEAR. THE MEDICARE SHORTFALL IS A COMMUNITY BENEFIT BECAUSE PROVIDING SERVICES TO THE ELDERLY IS A TAX-EXEMPT PURPOSE CONSISTENT WITH THE HOSPITAL'S OVERALL EXEMPT STATUS, AND THE HOSPITAL ACCEPTS THESE PATIENTS REGARDLESS OF ITS IMPACT ON OVERALL PROFITABILITY.
PART III, LINE 9B: PROVISIONS ON COLLECTION PRACTICES FOR QUALIFIED PATIENTS:PATIENTS WHO DO NOT HAVE THE MEANS TO PAY FOR SERVICES PROVIDED AT LAKE HOSPITAL SYSTEM REQUEST TO BE CONSIDERED UNDER THE UNINSURED/UNCOMPENSATED CHARITY CARE GUIDELINES. THESE GUIDELINES DEFINE LAKE HOSPITAL SYSTEM'S COMMITMENT TO PROVIDING CARE TO PATIENTS WHO ARE IN THE GREATEST FINANCIAL NEED. PATIENTS WHO DO NOT HAVE INSURANCE COVERAGE, OR WHOSE OUT OF POCKET RESPONSIBILITY IS SUBSTANTIAL AFTER INSURANCE COVERAGE, OR WHOSE INCOME LEVEL IS AT OR BELOW 250% OF THE FEDERAL INCOME POVERTY GUIDELINES, ARE ELIGIBLE TO APPLY FOR UNINSURED CHARITY CARE ASSISTANCE.THE UNINSURED/UNCOMPENSATED CHARITY CARE PROGRAM DOES NOT RELIEVE NOR FORGIVE POINT-OF-SERVICE COPAYMENTS THAT THE PATIENT MAY BE REQUIRED TO PAY UNDER THE TERMS OF THEIR INSURANCE BENEFIT PLAN. PER VISIT COPAYMENTS WILL BE COLLECTED AT THE POINT OF SERVICE IN COMPLIANCE WITH THE INSURANCE BENEFIT TERMS.PROCEDUREELIGIBILITY FOR LAKE'S UNINSURED/UNCOMPENSATED CARE IS DETERMINED BY THE FOLLOWING TWO-PART TEST. THE LAKE HOSPITAL SYSTEMS UNINSURED/UNCOMPENSATED CARE PROGRAM REQUIRES PATIENTS TO MEET AT LEAST ONE CONDITION IN BOTH PART ONE AND PART TWO:PART ONE: INSURANCE TEST1. PATIENT DOES NOT HAVE GOVERNMENTAL OR PRIVATE INSURANCE COVERAGE; OR 2. PATIENT'S INSURANCE DOES NOT COVER THE MEDICALLY NECESSARY SERVICE; OR3. PATIENT'S INSURANCE BENEFITS ARE EXHAUSTED (I.E. LIFETIME RESERVE DAYS, MEDICARE); OR4. PATIENT HAS OR WILL OBTAIN MEDICALLY NECESSARY SERVICES FROM THE HOSPITAL FOR WHICH THEY DO NOT HAVE THE FINANCIAL MEAN TO PAY; OR5. PATIENT IS RESPONSIBLE FOR CO-PAYMENTS AND DEDUCTIBLES, CARRIES NO SECONDARY INSURANCE COVERAGE AND ONLY SOURCE OF INCOME IS SOCIAL SECURITYPART TWO: INCOME TEST (RELATIVE TO LAKE HOSPITAL CHARGES)1. FAMILY INCOME IS COMPARED TO THE FEDERAL POVERTY INCOME GUIDELINES (FAMILY INCLUDES PATIENT, PATIENT'S SPOUSE, AND ALL OF THE PATIENT'S CHILDREN, NATURAL OR ADOPTIVE, UNDER THE AGE OF EIGHTEEN WHO LIVE IN THE HOME). THE SCHEDULE SHOWN BELOW WILL BE USED TO COMPARE FAMILY INCOME TO A SLIDING SCALE BASE UPON THE FEDERAL POVERTY INCOME GUIDELINES. IF FAMILY INCOME IS AT OR BELOW THE DESIGNATED THRESHOLD, THE PATIENT IS ELIGIBLE FOR THE PERCENT CHARITY DISCOUNT ASSOCIATED WITH THAT LEVEL OF INCOME; OR2. THE RELATIONSHIP BETWEEN THE PATIENT'S MEDICAL BILLS, FAMILY INCOME AND FAMILY ASSETS (INCLUDING, BUT NOT LIMITED TO SUCH ITEMS AS BANK ACCOUNTS, TRUSTS, PROPERTY, HOME EQUITY, ESTATE OR INVESTMENTS) INDICATES THAT THE PURSUIT OF PAYMENT WOULD ADVERSELY AFFECT THE WELL BEING OF THE PATIENT AND FAMILY MEMBERS, AND WHERE THE PAYMENT OF LAKE HOSPITAL'S BILL WOULD RESULT IN UNDUE HARDSHIP; OR3. PATIENT'S FAMILY INCOME EXCEEDS 250% OF THE FEDERAL INCOME POVERTY GUIDELINES, HOWEVER PATIENT HAS SUPPLIED INFORMATION TO SUPPORT EXCEPTIONAL LIVING CIRCUMSTANCES (I.E. TERMINAL ILLNESS, EXCESSIVE MEDICAL BILLS AND/OR MEDICATIONS, ETC.) OR 100% OF INCURRED CHARGES GREATER THAN 25% OF ANNUAL FAMILY INCOME (INCLUDING BANK ACCOUNTS, TRUSTS AND INVESTMENTS; BUT EXCLUDING PRIMARY RESIDENCE)BEFORE UNINSURED/ UNCOMPENSATED CARE CAN BE AWARDED, THE FOLLOWING CONDITIONS MUST BE MET:1. IF LAKE HOSPITAL DETERMINES THAT THE PATIENT IS POTENTIALLY ELIGIBLE FOR MEDICAL ASSISTANCE, THE PATIENT MUST COOPERATE WITH LAKE HOSPITAL'S EFFORTS TO ESTABLISH ELIGIBILITY FOR GOVERNMENT ASSISTANCE PROGRAMS.2. IF LAKE HOSPITAL AWARDS UNINSURED/UNCOMPENSATED CARE, IT WILL ONLY COVER THE SERVICES PROVIDED UNDER THE ACCOUNT NUMBER(S) SHOWN ON THE ACCOMPANYING APPLICATION.3. PROOF OF INCOME AND FINANCIAL DOCUMENTATION WILL BE REQUESTED. (SEE HOSPITAL CARE ASSURANCE POLICY)
PART V, SECTION B, LINE 11H: ALL PATIENTS ARE CHARGED STANDARD GROSS CHRAGES FOR CARE RECEIVED AT A LAKE HEALTH FACILITY. DISCOUNTS AND ADJUSTMENTS TO ARE SUBSEQUENTLY MADE TO PATIENTS ACCOUNTS BASED UPON SUBSIDIZED CARE DETERMINATION AND CONTRACT SERVICE AGREEMENTS WITH PRIVATE AND GOVERNMENT PAYERS. QUALIFIED SELF-PAY PATIENTS CAN ALSO RECEIVE DISCOUNTS FOR PROMPT PAYMENTS.	LAKEWEST & TRIPOINT MEDICAL CENTERS
PART V, SECTION B, LINE 19D: UNINSURED PATIENTS WHO DO NOT QUALIFY FOR LAKE HEALTHS FINANCIAL ASSISTANCE PROGRAM ARE BILLED FOR GROSS CHARGES AND ARE OFFERED A 30% PROMPT PAY DISCOUNT IF PAYMENT IS RECEIVED WITHIN 30 DAYS OF THE FIRST PATIENT STATEMENT OR A PAYMENT PLAN IS AGREED UPON.	LAKEWEST & TRIPOINT MEDICAL CENTERS
PART VI, LINE 2: AS AN INDEPENDENT, COMMUNITY-BASED HOSPITAL SYSTEM, LAKE HEALTH HAS HAD A LONG-STANDING TRADITION OF PROVIDING SERVICES AND PROGRAMS BASED ON THE HEALTH CARE NEEDS OF THE COMMUNITIES WE SERVE. WE ARE GUIDED BY OUR MISSION TO PROVIDE LOCAL ACCESS, HEALING WITH COMPASSION AND SUPERIOR QUALITY AND OUR CORE VALUES - RESPECT, INNOVATION, TEAMWORK, STEWARDSHIP AND INTEGRITY. GUIDED BY A COLLABORATIVE HEALTH NEEDS ASSESSMENT CONDUCTED IN COOPERATION WITH THE LAKE COUNTY GENERAL HEALTH DISTRICT, LAKE HEALTH HAS DEVELOPED PROGRAMS, SERVICES AND PARTNERSHIPS TO ADDRESS THE MOST PRESSING HEALTH ISSUES. THE HIGH PRIORITY AREAS INCLUDE OBESITY, INACTIVE LIFESTYLES AND SMOKING. PROGRAMS DESIGNED TO ADDRESS WEIGHT MANAGEMENT SPAN FROM EARLY CHILDHOOD THROUGH MATURE ADULTS. GET HEALTHY LAKE COUNTY IS NOW IN ITS NINTH YEAR OF OPERATION AND HAS NEARLY 2,500 MEMBERS. AND FOR THE TENTH YEAR IN A ROW, WE WERE HONORED AS ONE OF NORTHCOAST 99'S "BEST PLACES TO WORK IN NORTHEAST OHIO." OUR GROWTH AS A HEALTH SYSTEM REFLECTS THE MANY WAYS WE ARE BUILDING ON OUR MISSION AND HOW WE ASPIRE TO BE MORE THAN YOUR TYPICAL COMMUNITY HOSPITAL. WE WANT OUR PATIENTS AND THEIR FAMILIES TO RECEIVE SUPERIOR CARE WITHOUT HAVING TO LEAVE THE COMMUNITY. THAT'S WHY WE ARE COMMITTED TO OFFERING THE BEST RESOURCES TO PROVIDE AN EXPANDED LEVEL OF CARE TO MEET THE NEEDS OF THE COMMUNITY.
PART VI, LINE 3: 1. SIGNAGE POSTED AT FACILITY ACCESS POINTS FOR PATIENTS WHO CANNOT AFFORD TO PAY FOR MEDICAL CARE.2. CHARITY/HCAP APPLICATION FORMS GIVEN TO SELF-PAY PATIENTS AT TIME OF REGISTRATION. EXPLANATION OF ASSISTANCE PROVIDED TO COMPLETE APPLICATION IF NEEDED.3. UNINSURED INPATIENTS ARE VISITED BEDSIDE TO ASSIST CHARITY/HCAP APPLICATION AND ALSO TO PROVIDE APPLICATION ASSISTANCE WITH OTHER PROGRAMS SUCH AS MEDICAID, FOOD STAMPS, ETC.4. UNINSURED PATIENTS WHO RECEIVE OUTPATIENT SERVICES ARE CONTACTED BY PHONE TO ASSIST WITH CHARITY/HCAP APPLICATION AND OTHER PROGRAMS LISTED ABOVE.5. CHARITY/HCAP APPLICATION APPEARS ON THE BACK OF ALL PATIENT STATEMENTS.6. CHARITY/HCAP APPLICATION APPEARS ON LAKE HEALTH WEBSITE.
PART VI, LINE 4: LAKE HEALTH'S PRIMARY SERVICE AREA IS LAKE COUNTY (POPULATION OF 235,000) AND SELECTED ZIP CODES IN ITS SECONDARY SERVICE AREAS (CUYAHOGA, ASHTABULA AND GEAUGA COUNTIES WITH A POPULATION IN THE DEFINED ZIP CODES OF 268,113).
PART VI, LINE 5: PRIOR TO 1985, LAKE HEALTH'S FACILITIES WERE PUBLICLY OPERATED AS LAKE COUNTY MEMORIAL HOSPITALS. HOWEVER, IN 1985 THE BOARD OF COUNTY COMMISSIONERS AND HOSPITAL TRUSTEES AGREED TO PRIVATIZE THE HOSPITAL TO ENSURE THE VIABILITY OF A TECHNOLOGICALLY PROGRESSIVE HOSPITAL SYSTEM FOR LAKE COUNTY RESIDENTS. COUNTY COMMISSIONERS SERVE AS MEMBERS OF THE LAKE HOSPITAL CORPORATION AND, AS SUCH, APPOINT THE COMMUNITY LEADERS WHO SERVE ON THE SYSTEM'S GOVERNING BOARD.LAKE HEALTH HAS AN OPEN MEDICAL STAFF WITH PRIVILEGES AVAILABLE TO ALL QUALIFIED PHYSICIANS IN THE AREA. OVER 550 PHYSICIANS COMPRISE LAKE HEALTH'S MEDICAL STAFF.LAKE HEALTH'S COMMITMENT TO THE COMMUNITY IS READILY APPARENT IN THE BOARD OF TRUSTEES WHICH IS COMPRISED SOLELY OF COMMUNITY MEMBERS, APPOINTED BY THE COUNTY COMMISSIONERS. THE BOARD OF TRUSTEES OVERSEES AN ORGANIZATION THAT IS COMPRISED PRIMARILY OF AN OPEN MEDICAL STAFF. ALL PROCEEDS ARE REINVESTED IN CAPITAL OR OTHER PROGRAMS AND SERVICES DESIGNED TO MEET THE COMMUNITIES WE SERVE.LAKE HEALTH PROVIDES SERVICES AND PROGRAMS BASED ON THE HEALTH CARE NEEDS OF THE COMMUNITIES WE SERVE. IN FACT, TAKING HEALTH PROGRAMS AND SCREENINGS TO WHERE PEOPLE LIVE, WORK AND PLAY IS FUNDAMENTAL TO OUR MISSION. IN 2011, WE PROVIDED OVER $563,000 IN COMMUNITY BENEFITS THROUGH OUR HEALTH SYSTEM OPERATIONS IN LAKE, GEAUGA AND CUYAHOGA COUNTIES. THIS INCLUDES COMMUNITY EDUCATION PROGRAMS, INCLUDING BLOOD DRIVES. DURING THESE COMMUNITY EVENTS AND HEALTH FAIRS, WE PERFORMED OVER 3,000 BLOOD PRESSURE CHECKS, CHOLESTEROL SCREENINGS AND HEEL SCREENINGS FOR FREE OR AT LOW COST. LAKE HEALTH'S COMMITMENT TO HEALTH IMPROVEMENT SERVICES THAT PROVIDE A DEMONSTRATED COMMUNITY BENEFIT CAN BE BROADLY CATEGORIZED INTO THREE AREAS: COMMUNITY HEALTH EDUCATION, COMMUNITY-BASED CLINICAL SERVICES, AND CASH AND IN-KIND GIFTS. SOME OF THE PROGRAMS AND EVENTS ARE HIGHLIGHTED BELOW.COMMUNITY HEALTH EDUCATIONLAKE HEALTH HAS AN EXTENSIVE COMMUNITY HEALTH PROGRAM THAT PROVIDES HEALTH SCREENINGS, PHYSICIAN LECTURES, SELF-HELP AND EXERCISE PROGRAMS IN MULTIPLE COMMUNITY LOCATIONS THROUGHOUT LAKE COUNTY AND SURROUNDING AREAS. OUR SUPPORT GROUPS HELP MEET EDUCATIONAL AND EMOTIONAL NEEDS RELATED TO A VARIETY OF CONDITIONS. WE ALSO PARTNER WITH MANY LOCAL ORGANIZATIONS, INCLUDING THE UNITED WAY, THE AMERICAN RED CROSS, THE AMERICAN HEART ASSOCIATION, THE ARTHRITIS FOUNDATION, THE LAKE COUNTY Y, AND THE LAKE METROPARKS TO INCREASE AWARENESS OF HEALTH ISSUES IN THE COMMUNITY. THESE PROGRAMS AND SERVICES INCLUDE:A. COMMUNITY CALENDARS AND NEWSLETTERS THE BEST OF HEALTH MAGAZINE CALENDAR OF EVENTS IN THE NEWS-HERALD HEALTH TALKS IN THE NEWS-HERALD (WEEKLY)B. EDUCATION ON SPECIFIC DISEASE CONDITIONS SENIOR CONNECTION LUNCH AND LEARNS COMMUNITY HEALTH LECTURE SERIES LIFECYCLES FOR WOMEN LECTURE SERIES ORTHOPEDIC AND SPINE LECTURE SERIES WEAR RED EVENT ORTHOPEDIC AND SPINE CENTER SYMPOSIUM SLEEP DISORDERS ARTHRITIS EXPO KNOW YOUR NUMBERS DIABETESC. HEALTH PROMOTION AND WELLNESS PROGRAMS GET HEALTHY LAKE COUNTY 10,000 STEPS PROGRAMD. HEALTH EDUCATION LECTURES AND WORKSHOPS BY STAFF TO COMMUNITY GROUPS UNION COMMMUNITY CHURCH AARP D-6 GROUP - WILLOUGHBY HILLS FRIENDS CHURCH ORCHARD HOLLOW ELEMENTARY PERRY LIBRARYE. EDUCATION TO THE PUBLIC ABOUT HEALTH ISSUES INFORMATION THROUGH MEDIA RELEASESF. SCHOOL HEALTH EDUCATION PROGRAMS HEALTHY HEART SCHOOL PROGRAMG. WEB-BASED CONSUMER HEALTH INFORMATION REGARDING HEALTH E-NEWSLETTER CONSTANT CONTACT E-BLASTSH. SOCIAL MEDIA CONSUMER HEALTH INFORMATION FACEBOOK POSTS AND REMINDERS TWITTER POSTS AND REMINDERS YOUTUBE VIDEOSSELF-HELPLABEL READING TOURSBONING UP ON OSTEOPOROSISSTANDING TALL: EXERCISING TO HELP PREVENT OSTEOPOROSISWEIGHT 4 LIFE WEIGHT MANAGEMENT PROGRAMGOLF PROGRAMSONE OF THE MANY WAYS LAKE HEALTH IS BUILDING THE COMMUNITY IS THROUGH STRONG PARTNERSHIPS WITH OTHERS WHO SHARE OUR COMMITMENT TO LOCAL ACCESS, HEALING WITH COMPASSION AND SUPERIOR QUALITY. LAKE HEALTH JOINED FORCES WITH LAKE METROPARKS, LAKE COUNTY YMCA AND THE LAKE COUNTY HEALTH DISTRICT TO LAUNCH B FIT 4 LIFE.
PART VI, LINE 6: LAKE HOSPITAL SYSTEM, INC. DBA LAKE HEALTH IS THE PRIMARY HEALTHCARE-PROVIDING ENTITY WHICH OPERATES TWO HOSPITAL FACILITIES AND SEVERAL OTHER OUTPATIENT, URGENT CARE AND PHYSICIAN CLINICS THROUGHOUT LAKE COUNTY AND THE SURROUNDING COMMUNITY. LAKE HEALTH IS THE SOLE MEMBER OF LAKE HEALTH FOUNDATION, INC. DBA LAKE HEALTH FOUNDATION, A NOT-FOR-PROFIT ORGANIZATION WHICH IS THE FUNDRAISING ARM OF LAKE HEALTH. LAKE HEALTH IS ALSO THE SOLE MEMBER OF PRIMEHEALTH, INC. DBA LAKE HEALTH PHYSICIAN GROUP ("LHPG") WHICH EMPLOYS LAKE HEALTH'S NETWORK OF PHYSICIANS.LAKE HEALTH IS A 50% SHAREHOLDER IN LAKE PHO, INC. DBA LAKE HEALTH PHO ("THE PHO") WHICH IS A PHYSICIAN CREDENTIALING AND MEMBERSHIP ORGANIZATION. PHYSICIANS MUST BE A MEMBER OF THE PHO IN ORDER TO PRACTICE MEDICINE AT A LAKE HEALTH HOSPITAL OR PHYSICIAN CLINIC.THE LAKE HEALTH / UNIVERSITY HOSPITALS SEIDMAN CANCER CENTER IS A JOINT VENTURE BETWEEN LAKE HEALTH AND UNIVERSITY HOSPITALS HEALTH SYSTEM OF CLEVELAND THAT PROVIDES CANCER TREATMENT IN MENTOR, OHIO.MENTOR SURGERY CENTER, LLC, LAKE WEST MEDICAL SPECIALISTS, INC., AND CONCORD MEDICAL CAMPUS PHYSICIANS BUILDING, INC. ARE ENTITIES IN WHICH LAKE HEALTH OWNS A MINORITY STAKE. THESE ENTITIES LEASE MEDICAL OFFICE SPACE AT WHICH BOTH LAKE HEALTH AND NON-AFFILITATED PRACTITIONERS PRACTICE.
OH	REPORTS FILED WITH STATES	PART VI, LINE 7

Schedule J IRS990ScheduleJ

Field	Value	IRS element (for citing)
First Class Or Charter Travel	X	FirstClassOrCharterTravel
Club Dues Or Fees	X	ClubDuesOrFees
Written Policy Re T And E Expenses	1	WrittenPolicyReTAndEExpenses
Substantiation Required	1	SubstantiationRequired
Independent Consultant	X	IndependentConsultant
Compensation Survey	X	CompensationSurvey
Board Or Committee Approval	X	BoardOrCommitteeApproval
Severance Payment	0	SeverancePayment
Supplemental Nonqual Retire Plan	0	SupplementalNonqualRetirePlan
Equity Based Comp Arrangement	0	EquityBasedCompArrangement
Comp Based On Revenue Of Filing Org	0	CompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related Orgs	0	CompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing Org	0	CompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate Orgs	0	CompBasedNetEarningsRelateOrgs
Any Non Fixed Payments	0	AnyNonFixedPayments
Initial Contract Exception	0	InitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (11 entries)

Base Compensation Filing OrgBaseCompensationFilingOrg	Comp Based On Related OrgsCompBasedOnRelatedOrgs	Bonus Filing OrgBonusFilingOrg	Bonus Related OrgsBonusRelatedOrgs	Other Compensation Filing OrgOtherCompensationFilingOrg	Other Compensation Related OrgsOtherCompensationRelatedOrgs	Deferred Comp Filing OrgDeferredCompFilingOrg	Deferred Comp Related OrgsDeferredCompRelatedOrgs	Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg	Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs	Total Compensation Filing OrgTotalCompensationFilingOrg	Total Compensation Related OrgsTotalCompensationRelatedOrgs	Comp Report Prior990 Filing OrgCompReportPrior990FilingOrg	Comp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs
CYNTHIA MOORE-HARDY
593910	0	0	0	17227	0	34589	0	4633	0	650359	0	0	0
MICHAEL E KITTOE
208469	0	25000	0	98	0	119	0	0	0	233686	0	0	0
STEVEN R KARNS
247780	0	0	0	13447	0	24800	0	6063	0	292090	0	0	0
THEODORE NICHOLS
244231	0	0	0	12255	0	18545	0	6518	0	281549	0	0	0
MARY L ORGRINC
220659	0	0	0	10758	0	35619	0	1954	0	268990	0	0	0
RICHARD D CICERO
224653	0	0	0	6518	0	11337	0	4854	0	247362	0	0	0
JOYCE A TAYLOR
186858	0	0	0	4945	0	22364	0	1954	0	216121	0	0	0
ANDREA M WASDOVICH
156114	0	7348	0	4763	0	13833	0	4018	0	186076	0	0	0
BARBARA J MORAN
161498	0	0	0	4060	0	19646	0	0	0	185204	0	0	0
CYNTHIA J RACER
161623	0	0	0	5646	0	3020	0	4133	0	174422	0	0	0
CHARLES S JOSEY
147647	0	12000	0	1759	0	108	0	5953	0	167467	0	0	0

Form990 Schedule J Part III Form990ScheduleJPartIII

Field	Value	IRS element (for citing)
Return Reference	PART I, LINE 1A	ReturnReference
Explanation	PART I, LINE 1: LAKE HOSPITAL SYSTEM, INC.'S CEO RECEIVED REIMBURSEMENT FOR FIRST CLASS TRAVEL, COUNTRY CLUB AND SOCIAL CLUB DUES IN 2011. THE CLUB DUES WERE INCLUDED IN TAXABLE INCOME AND THE FIRST CLASS TRAVEL WAS NOT INCLUDED.	Explanation

Schedule K IRS990ScheduleK

Form990 Schedule K Part I Form990ScheduleKPartI

Issuer Name IssuerName

Field	Value	IRS element (for citing)
Business Name Line1	COUNTY OF LAKE OHIO SERIES 2008	BusinessNameLine1

Field	Value	IRS element (for citing)
Issuer EIN	316001618	IssuerEIN
CUSIP Number	50943PBL2	CUSIPNumber
Date Issued	2008-06-26	DateIssued
Issue Price	187820719	IssuePrice
Description Of Purpose	CONSTRUCT A HOSPITAL, REFUNDING ISSUE	DescriptionOfPurpose
Defeased	0	Defeased
On Behalf Of Issuer	0	OnBehalfOfIssuer
Pool Financing	0	PoolFinancing

Form990 Schedule K Part II Form990ScheduleKPartII

Field	Value	IRS element (for citing)
Total Proceeds	187820719	TotalProceeds
Amount In Reserve Fund	5984333	AmountInReserveFund
Issuance Costs From Proceeds	1808396	IssuanceCostsFromProceeds
Credit Enhancement	57940	CreditEnhancement
Capital Expenditures	183896741	CapitalExpenditures
Year Of Subst Completion	2009	YearOfSubstCompletion
Current Refunding	1	CurrentRefunding
Advance Refunding	0	AdvanceRefunding
Final Allocation Made	1	FinalAllocationMade
Adequate Books And Recds Maintaind	1	AdequateBooksAndRecdsMaintaind

Form990 Schedule K Part III Form990ScheduleKPartIII

Field	Value	IRS element (for citing)
Owning Bond Financed Property	0	OwningBondFinancedProperty
Any Lease Arrangements	0	AnyLeaseArrangements
Mngment Cntrct Bond Financd Prprty	1	MngmentCntrctBondFinancdPrprty
Engage Bond Counsel Contracts	1	EngageBondCounselContracts
Any Research Agreements	0	AnyResearchAgreements
Prcntge Prvt Business Use By Others	0.00000	PrcntgePrvtBusinessUseByOthers
Percentage Of Prvt Business Re UBI	0.00000	PercentageOfPrvtBusinessReUBI
Total Private Business Use	0.00000	TotalPrivateBusinessUse
Post Issuance Compliance Procdrs	1	PostIssuanceComplianceProcdrs

Form990 Schedule K Part IV Form990ScheduleKPartIV

Field	Value	IRS element (for citing)
Form8038 T Filed	0	Form8038TFiled
Variable Rate Issue	1	VariableRateIssue
Hedge Identified In Books And Recds	1	HedgeIdentifiedInBooksAndRecds

Name Of Hedge Provider NameOfHedgeProvider

Field	Value	IRS element (for citing)
Business Name Line1	UBS	BusinessNameLine1

Field	Value	IRS element (for citing)
Term Of Hedge	33.600000000000	TermOfHedge
Superintegrated Hedge	0	SuperintegratedHedge
Hedge Terminated	0	HedgeTerminated
Gross Proceeds Invested In GIC	1	GrossProceedsInvestedInGIC

Name Of GIC Provider NameOfGICProvider

Field	Value	IRS element (for citing)
Business Name Line1	FSA CAPITAL	BusinessNameLine1
Business Name Line2	MANAGEMENT SERVICES	BusinessNameLine2

Field	Value	IRS element (for citing)
Term Of GIC	1.100000000000	TermOfGIC
Regulatory Safe Harbor Satisfied	1	RegulatorySafeHarborSatisfied
Exception To Rebate	0	ExceptionToRebate

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (7 entries)

Return ReferenceReturnReference	ExplanationExplanation	IdentifierIdentifier
FORM 990, PART VI, SECTION B, LINE 11	THE PROCESS FOLLOWED BEFORE FILING THE LAKE HOSPITAL SYSTEM, INC. FORM 990 INCLUDES A DETAILED REVIEW COMPLETED BY AN INDEPENDENT OUTSIDE CPA FIRM, PRESENTATION TO AND REVIEW BY THE LHS CFO AND CEO, PRESENTATION AND REVIEW BY THE LHS FINANCE COMMITTEE, AND PRESENTATION TO THE LHS BOARD OF TRUSTEES.
FORM 990, PART VI, SECTION B, LINE 12C	THE LAKE HOSPITAL SYSTEM, INC. BOARD OF TRUSTEES COMPLETES A CONFLICT OF INTEREST QUESTIONNAIRE ANNUALLY, WHICH IS THEN REVIEWED BY THE LHS CFO AND DIRECTOR OF THE BOARD OF TRUSTEES. BOARD MEMBERS WILL EXCUSE THEMSELVES FROM THE BOARD MEETING WHEN A TOPIC OF POTENTIAL CONFLICT IS PRESENTED AND RETURN TO THE MEETING FOLLOWING THE COMPLETION OF DISCUSSION, MOTION, AND VOTE. COMPLIANCE WITH THE LHS CONFLICT OF INTEREST POLICY IS MONITORED AND ENFORCED BY THE BOARD CHAIR, COMMITTEE CHAIRS, AND THE DIRECTOR RESPONSIBLE FOR BOARD OF TRUSTEE MATTERS.
FORM 990, PART VI, SECTION B, LINE 15	THE PROCESS FOR DETERMINING COMPENSATION OF THE LAKE HOSPITAL SYSTEM, INC. CEO, OTHER OFFICERS, AND KEY EMPLOYEES INCLUDES MARKET RESEARCH, REVIEW, AND ASSESSMENT BY AN INDEPENDENT CONSULTING FIRM TO MAKE A RECOMMENDATION TO THE LHS BOARD OF DIRECTORS. THE BOARD REVIEWS THE REPORT PROVIDED IN CONJUNCTION WITH ANNUAL PERFORMANCE ASSESSMENTS, AND UTILIZES THIS INFORMATION TO DETERMINE COMPENSATION LEVEL. IN ADDITION, THE PROCEDURE FOR OTHER OFFICERS AND KEY EMPLOYEES INCLUDES REVIEW BY THE CEO. THE MOST RECENT COMPENSATION REVIEW TOOK PLACE IN FEBRUARY 2011.
FORM 990, PART VI, SECTION C, LINE 18	LAKE HOSPITAL SYSTEM, INC. MAKES ITS FORM 990, FORM 990-T, AND FORM 1023 AVAILABLE TO THE PUBLIC UPON REQUEST.
FORM 990, PART VI, SECTION C, LINE 19	LAKE HOSPITAL SYSTEM, INC. MAKES AVAILABLE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS TO THE PUBLIC UPON REQUEST, IN ADDITION TO FILING QUARTERLY FINANCIAL INFORMATION WITH NRMSIRS FOR COMPLIANCE WITH BOND ISSUES AND ANNUAL FINANCIAL INFORMATION WITH THE ATTORNEY GENERAL OF THE STATE OF OHIO. GOVERNING DOCUMENTS FOR LHS ARE AVAILABLE THROUGH THE WEBSITE OF THE OHIO SECRETARY OF STATE.
FORM 990, PART XI, LINE 5:	NET UNREALIZED LOSSES ON INVESTMENTS: -5,780,910. LOSS ON CHANGE OF DERIVATIVE -24,162,601. CASH PAYMENTS ON SWAP INSTRUMENT -5,100,791. UNDERWRITING SUPPORT TO LAKE HOSPITAL FOUNDATION, INC. -354,756. TOTAL TO FORM 990, PART XI, LINE 5: -35,399,058.	CHANGES IN NET ASSETS OR FUND BALANCES:
	FORM 990, PART XII, LINE 2C: LAKE HOSPITAL SYSTEM, INC. HAS AN AUDIT COMMITTEE RESPONSIBLE FOR OVERSIGHT OF THE AUDIT AND SELECTION OF THE INDEPENDENT ACCOUNTING FIRM. THE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR.

Schedule R IRS990ScheduleR

Form990 Schedule R Part I Form990ScheduleRPartI

Name Of Disregarded Entity NameOfDisregardedEntity

Field	Value	IRS element (for citing)
Business Name Line1	LAKE HEALTH IPHE	BusinessNameLine1

Address US AddressUS

Field	Value	IRS element (for citing)
Address Line1	7590 AUBURN RD	AddressLine1
City	CONCORD	City
State	OH	State
ZIP Code	44077	ZIPCode

Field	Value	IRS element (for citing)
Primary Activities	PHYSICIAN SERVICES	PrimaryActivities
Legal Domicile State	OH	LegalDomicileState
Total Income	0	TotalIncome
EOY Assets	0	EOYAssets

Direct Controlling Entity Name DirectControllingEntityName

Field	Value	IRS element (for citing)
Business Name Line1	LAKE HOSPITAL SYSTEM INC	BusinessNameLine1

Form990 Schedule R Part II Form990ScheduleRPartII (3 entries)

Address Line1AddressUS/AddressLine1	CityAddressUS/City	StateAddressUS/State	ZIP CodeAddressUS/ZIPCode	EINEIN	Primary ActivitiesPrimaryActivities	Legal Domicile StateLegalDomicileState	Exempt Code SectionExemptCodeSection	Public Charity StatusPublicCharityStatus	Business Name Line1DirectControllingEntityName/BusinessNameLine1	Controlled OrgControlledOrg
LAKE HEALTH UNIVERSITY HOSPITALS SEIDMAN CANCER CENTER
9485 MENTOR AVENUE	MENTOR	OH	44060	311565964	TREATMENT OF CANCER PATIENTS	OH	501 (C) (3)	3	LAKE HOSPITAL SYSTEM INC	1
LAKE HOSPITAL FOUNDATION
7590 AUBURN RD	CONCORD	OH	44077	341425872	RAISE FUNDS FOR BENEFIT OF LAKE HOSPITAL SYSTEM	OH	501 (C) (3)	11A	LAKE HOSPITAL SYSTEM INC	1
PRIMEHEALTH INC
7590 AUBURN RD	CONCORD	OH	44077	341778204	EMPLOYMENT OF PHYSICIANS	OH	501 (C) (3)	4	LAKE HOSPITAL SYSTEM INC	1

Form990 Schedule R Part III Form990ScheduleRPartIII (3 entries)

Address Line1AddressUS/AddressLine1	CityAddressUS/City	StateAddressUS/State	ZIP CodeAddressUS/ZIPCode	EINEIN	Primary ActivityPrimaryActivity	Legal Domicile StateLegalDomicileState	Direct Controlling Entity NADirectControllingEntityNA	Predominant Income TypePredominantIncomeType	Share Of Total IncomeShareOfTotalIncome	Share Of EOY AssetsShareOfEOYAssets	Disproportionate AllocationsDisproportionateAllocations	General Or Managing PartnerGeneralOrManagingPartner	Percentage OwnershipPercentageOwnership
MENTOR SURGERY CENTER LLC
9485 MENTOR AVENUE	MENTOR	OH	44060	341863257	OUTPATIENT SURGERY	OH	N/A	RELATED	327428	1676473	0	1	0.44900
LAKE WEST MEDICAL SPECIALISTS LLC
36000 EUCLID AVENUE	WILLOUGHBY	OH	44094	341964657	OFFICE SPACE	OH	N/A	RELATED	24525	417953	0	1	0.10000
CONCORD MEDICAL CAMPUS PHYS BLDG LLC
7580 AUBURN RD	CONCORD	OH	44077	260550261	OFFICE SPACE	OH	N/A	UNRELATED	120566	8818368	0	0	0.51470

Form990 Schedule R Part IV Form990ScheduleRPartIV (3 entries)

Address Line1AddressUS/AddressLine1	CityAddressUS/City	StateAddressUS/State	ZIP CodeAddressUS/ZIPCode	EINEIN	Primary ActivityPrimaryActivity	Legal Domicile StateLegalDomicileState	Business Name Line1DirectControllingEntityName/BusinessNameLine1	Type Of EntityTypeOfEntity	Share Of Total IncomeShareOfTotalIncome	Share Of EOY AssetsShareOfEOYAssets	Percentage OwnershipPercentageOwnership	Address Line1AddressForeign/AddressLine1	CityAddressForeign/City	CountryAddressForeign/Country	Legal Domicile Foreign CountryLegalDomicileForeignCountry	Direct Controlling Entity NADirectControllingEntityNA
INTERLAKE HEALTH CORPORATION
7590 AUBURN RD	CONCORD	OH	44077	341510475	INTEREST INCOME	OH	LAKE HOSPITAL SYSTEM INC	C	370	185370	1.00000
LHS ASSURANCE LTD
				980456229	INSURANCE COMPANY		LAKE HOSPITAL SYSTEM INC	C		18406949	1.00000	23 LIME TREE BAY AVE GOVERNORS SQ	GRAND CAYMAN	CJ	CJ
LAKE PHO INC
7590 AUBURN RD	CONCORD	OH	44077	341696001	PHYSICIAN MEMBERSHIP	OH		C	-31854	890720	0.50000					N/A

Field	Value	IRS element (for citing)
Receipt Of Int Ann Rents Royalties	1	ReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other Org	0	GiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other Org	1	GiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other Org	0	LoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other Org	0	LoansOrGuaranteesFromOtherOrg
Sale Of Assets To Other Org	0	SaleOfAssetsToOtherOrg
Purchase Of Assets From Other Org	0	PurchaseOfAssetsFromOtherOrg
Exchange Of Assets	0	ExchangeOfAssets
Rental Of Facilities To Other Orgs	1	RentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other Orgs	1	RentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other Orgs	0	PerformOfServicesForOtherOrgs
Perform Of Services By Other Orgs	1	PerformOfServicesByOtherOrgs
Sharing Of Facilities	1	SharingOfFacilities
Sharing Of Paid Employees	0	SharingOfPaidEmployees
Reimbursement Paid To Other Org	1	ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org	1	ReimbursementPaidByOtherOrg
Other Transfer To Other Org	0	OtherTransferToOtherOrg
Other Transfer From Other Org	0	OtherTransferFromOtherOrg

Transactions Related Orgs Table TransactionsRelatedOrgsTable (11 entries)

Transaction TypeTransactionType	Amount InvolvedAmountInvolved	Method Of Amt DeterminationMethodOfAmtDetermination
LAKE HEALTH UNIVERSITY HOSPITALS SEIDMAN CANCER CENTER
I	779923	PER BOOKS
LAKE HOSPITAL FOUNDATION
C	1709509	PER BOOKS
LAKE HOSPITAL FOUNDATION
L	283805	PER BOOKS
LAKE HOSPITAL FOUNDATION
O	70951	PER BOOKS
PRIMEHEALTH INC
O	20368921	PER BOOKS
MENTOR SURGERY CENTER LLC
I	480804	PER BOOKS
MENTOR SURGERY CENTER LLC
P	226775	PER BOOKS
LAKE WEST MEDICAL SPECIALISTS LLC
P	146658	PER BOOKS
CONCORD MEDICAL CAMPUS PHYS BLDG LLC
A	1402524	PER BOOKS
CONCORD MEDICAL CAMPUS PHYS BLDG LLC
P	275452	PER BOOKS
LHS ASSURANCE LTD
C	500000	PER BOOKS