2011-11-14T17:12:35-06:00 2010-12-31 PLANTE & MORAN PLLC 65 EAST STATE ST STE 600 COLUMBUS OH 43215 990 2010-01-01 341883284 LIMA MEMORIAL JOINT OPERATING COMPANY LIMA 4192283335 1001 BELLEFONTAINE AVENUE LIMA OH 45804 ERIC D POHJALA 4192283335 2011-11-10 1 BERNIE OSTROWSKI 6148493000 2010 2016-03-07 17:11:31Z LIMA MEMORIAL HEALTH SYSTEM MICHAEL SWICK 1001 BELLEFONTAINE AVENUE LIMA OH 45804 152934669 0 X WWW.LIMAMEMORIAL.ORG X 1999 OH WE ARE HERE TO IMPROVE THE QUALITY OF LIFE IN OUR COMMUNITIES THROUGH COMPREHENSIVE HEALTH SERVICES. 12 12 1551 12 0 0 550878 386040 150869236 151272113 -77145 506565 7601441 739744 158944410 152904462 372591 5184182 0 0 69819628 68291428 0 0 179064 73387348 74091486 143579567 147567096 15364843 5337366 205236935 209668000 77802572 76001280 127434363 133666720 X WE ARE HERE TO IMPROVE THE QUALITY OF LIFE IN OUR COMMUNITIES THROUGH COMPREHENSIVE HEALTH SERVICES. 0 0 119049938 392658 151913327 SEE SCHEDULE OAS ONE OF THE LARGEST NOT-FOR-PROFIT HEALTH CARE ORGANIZATIONS IN WEST CENTRAL OHIO, LIMA MEMORIAL HEALTH SYSTEM IS COMMITTED TO IMPROVING THE QUALITY OF LIFE IN OUR COMMUNITIES THROUGH COMPREHENSIVE HEALTH SERVICES. LIMA MEMORIAL IS CONTINUALLY IMPROVING ITS SERVICES AND FACILITIES BY KEEPING UP WITH THE LATEST TECHNOLOGIES, PROVIDING CONTINUING EDUCATION TO OUR HEALTH CARE TEAM AND UPDATING OUR FACILITIES. OUR PATIENT SATISFACTION NUMBERS CONTINUE TO IMPROVE AND WE CONTINUALLY ACHIEVE QUALITY SCORES THAT ARE BETTER THEN THE STATE AND NATIONAL AVERAGES.THE HEALTH SYSTEM PROVIDES COMPREHENSIVE HEALTH CARE THAT ALLOW US TO CARE FOR OUR PATIENTS FROM BIRTH THROUGH ELDER YEARS. THESE SERVICES INCLUDE, BUT ARE NOT LIMITED TO:-24-HOUR EMERGENCY SERVICES INCLUDING LEVEL II TRAUMA-CHEST PAIN CENTER WITH PCI-THE HEART AND VASCULAR INSTITUTE-ORTHOPEDICS-OBSTETRICS AND PEDIATRICS-WOMEN'S HEALTH CENTER-RADIOLOGY-LABORATORY-INPATIENT AND OUTPATIENT REHABILITATION SERVICES-NEUROLOGY-RENAL SERVICES IN 2010, LIMA MEMORIAL CONTRIBUTED AN ESTIMATED $28 MILLION IN COMMUNITY VALUE IN TERMS OF COMMUNITY BENEFIT EXPENDITURES, CHARITY CARE AND GOVERNMENT-SPONSORED HEALTH CARE. THIS NUMBER NOT ONLY INDICATES OUR COMMITMENT TO OUR COMMUNITIES, BUT ALSO FULFILLS OUR PURPOSE AS A NOT-FOR-PROFIT ORGANIZATION BY POSITIVELY IMPACTING THE MEMBERS OF OUR COMMUNITIES. THOUSANDS OF PEOPLE HAVE BENEFITED FROM THE COMPASSION, CARE AND EXPERTISE OF OUR PHYSICIANS, NURSES, ASSOCIATES AND VOLUNTEERS.EXAMPLES OF PROGRAMS BENEFITING THE BROADER COMMUNITY INCLUDE, BUT ARE NOT LIMITED TO:-COMMUNITY WELLNESS DAY-GO RED - HEART HEALTH AWARENESS FOR WOMEN EVENTS-JOURNEY TO REMEMBER WOMEN'S HEALTH BENEFIT-MEALS ON WHEELS -KIDS CLINIC-CHILDREN'S DEVELOPMENTAL CENTER-BABY FAIR-CHEST PAIN CENTER-BONE DENSITY SCREENINGS-AUDIOLOGY SCREENINGS-CARDIAC RISK ASSESSMENT SCREENINGS-PROSTATE SCREENINGS-SKIN CANCER SCREENINGS-CANCER RESOURCE CENTER-MEDICARE ELIGIBILITY PROGRAM-BREAST CANCER SURVIVOR SUPPORT GROUP-FAMILY BIRTH CLINICS-WOMEN'S RESOURCE CENTER-TV AND RADIO PSAS-BREAST FEEDING CLASS AND CLINIC-SMOKING SESSION-I'M SPECIAL PROGRAM-BLOOD DRIVESAS HEALTH CARE CONTINUES TO CHANGE, LIMA MEMORIAL WILL CONTINUE TO PROVIDE THE HIGHEST QUALITY OF CARE IN A FAMILY ATMOSPHERE TO OUR PATIENTS BY CONTINUALLY ADVANCING OUR SERVICES AND FACILITIES. IN ADDITION, THE HEALTH SYSTEM WILL SUPPORT OUR COMMUNITIES, NOT ONLY THROUGH COMPREHENSIVE HEALTH CARE, BUT ALSO THROUGH OUTREACH ACTIVITIES SUCH AS HEALTH CARE AWARENESS AND PREVENTION PROGRAMS, FREE PUBLIC HEALTH SCREENINGS, FINANCIAL SUPPORT FOR MANY COMMUNITY ORGANIZATIONS, AND OUTREACH TO THE UNDERSERVED.COMMUNITY BENEFIT DEFINITIONSLIMA MEMORIAL HEALTH SYSTEM'S 2007 COMMUNITY BENEFIT REPORT WAS PREPARED IN ACCORDANCE WITH THE REPORTING GUIDELINES PUBLISHED BY THE CATHOLIC HEALTH ASSOCIATION. COMMUNITY BENEFITS REPORTED BY THE HEALTH SYSTEM RESPOND TO AN IDENTIFIED COMMUNITY NEED AND MEET AT LEAST ONE OF THE FOLLOWING CRITERIA:-GENERATE A LOW OR NEGATIVE MARGIN;-RESPOND TO THE NEEDS OF SPECIAL POPULATIONS, SUCH AS MINORITIES, FRAIL, ELDERLY, POOR PERSONS WITH DISABILITIES, THE CHRONICALLY MENTALLY ILL, AND PERSONS WITH AIDS; AND-SUPPLY SERVICES OR PROGRAMS THAT WOULD LIKELY BE DISCONTINUED IF THE DECISION WERE MADE ON A PURELY FINANCIAL BASIS.THESES SERVICES INCLUDE:-COMMUNITY HEALTH SERVICES; -HEALTH PROFESSIONS EDUCATION;-SUBSIDIZED HEALTH SERVICES; -RESEARCH ACTIVITIES;-FINANCIAL CONTRIBUTIONS;-COMMUNITY BUILDING ACTIVITIES;-COMMUNITY BENEFIT OPERATIONS;-COST OF CHARITY CARE; AND-GOVERNMENT SPONSORED HEALTH CARE. 119049938 1 1 0 1 0 0 0 0 0 1 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 1 0 1 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 236 0 1 1551 1 0 0 0 0 0 0 0 0 0 0 X 12 12 0 0 0 0 1 0 0 1 1 0 0 1 1 1 1 1 1 1 1 1 0 OH X STACEY DEITERING 4199984733 121 W HIGH ST LIMA OH 45801 X JOHN H JOHNSON 1.00 X X 0 0 0 BARBARA STEELE 1.00 X X 0 0 0 ARTURO POLIZZI 1.00 X X 0 0 0 KERMIT STROH 1.00 X X 0 0 0 FRED BARRINGTON 1.00 X 0 0 0 BILL ROBINSON 1.00 X 0 0 0 PRAVEEN MALHOTRA MD 1.00 X 0 0 0 BARRETT RYDELL 1.00 X 0 0 0 NEERAJ KANWAL MD 1.00 X 0 0 0 GARY AKENBERGER 1.00 X 0 0 0 JACK RANDOLPH 1.00 X 0 0 0 SUSAN PAYDEN 1.00 X 0 0 0 MIKE SWICK 34.00 X 395533 0 207341 ROBERT E ARMSTRONG JR 30.00 X 253969 0 75514 ERIC D POHJALA 34.00 X 236822 0 71548 CHARLES LYNN THOMPSON MD 19.00 X 276359 0 61310 LYNN CARPENTER 4.00 X 129915 0 28108 ANITA GOOD 40.00 X 128194 0 23223 JULIE NEU 38.00 X 141788 0 31154 MARK RECKER 40.00 X 127468 0 13541 SUE ANN FICKEL 40.00 X 104328 0 22998 1794376 0 534737 28 1 1 0 TUTTLE CONSTRUCTION INC 880 SHAWNEE RD PO BOX 1153 LIMA OH 45802 NONEMPLOYEE COMPENSATION 1693425 HEALTH PERFORMANCE MANAGEMENT 1001 BELLEFONTAINE AVE LIMA OH 45804 MEDICAL SERVICES 1291333 NORTH CENTRAL OHIO PHYSICIANS SERVICES 1005 BELLEFONTAINE AVE LIMA OH 45804 MEDICAL SERVICES 1080412 HYLANT GROUP 811 MADISON AVE TOLEDO OH 43603 NONEMPLOYEE COMPENSATION 997686 ANESTHESIA ASSOC OF LIMA INC 1103 BANK ONE BUILDING LIMA OH 45801 MEDICAL SERVICES 943014 32 321105 64935 386040 PATIENT SERVICE REVENU 621110 151272113 151272113 151272113 939 939 261543 30207 231336 231336 231336 505626 505626 505626 505626 EDUCATIONAL SERVICES 621110 73676 73676 DIETARY REVENUE 621110 66375 66375 HEALTH PERFORMANCE K-1 525990 40302 40302 328055 328055 508408 152904462 151780521 0 737901 5168537 5168537 15645 15645 1240727 1240727 50662783 41107098 9390450 165235 1620488 1296390 324098 10946874 8757499 2189375 3820556 3056445 764111 21542843 17234274 4308569 528341 415800 103950 8591 26840544 21468495 5367124 4925 5866 4693 1173 2303171 1842537 460634 186983 149432 37358 193 2133251 1706601 426650 9543035 7634428 1908607 1487778 1190222 297556 BAD DEBT EXPENSE 6263453 5010762 1252691 INTEREST RATE SWAP 1668869 1668869 RECRUITING 1048519 891241 157278 EDUCATION & REWARDS 252008 201510 50378 120 ADMINISTRATIVE EXPENSE 115926 92741 23185 170899 136719 34180 147567096 119049938 28338094 179064 13282087 9490568 23809111 6024076 20845019 21570962 1074644 2773209 4978054 4693774 1159701 1427623 195249566 107651705 91014883 87597861 1982675 24556055 1314962 1707712 45775799 49826160 205236935 209668000 10374936 11546614 45945000 47617500 6697319 629296 14785317 16207870 77802572 76001280 X 127429265 133597397 5098 69323 127434363 133666720 205236935 209668000 X 5337366 894991 X X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 9578 0 0 0 0 0 1 9578 0 0 0 9578 0 EXPLANATION OF OTHER LOBBYING ACTIVITIES: PART II-B, LINE 1I: LOBBYING EXPENSES ARE INCURRED IN CONNECTION WITH THE DUES PAID TO THE OHIO HOSPITAL ASSOCIATION AND THE AMERICAN HOSPITAL ASSOCIATION. 4465715 4465715 129669522 73167331 56502191 60840720 34329988 26510732 273609 154386 119223 87597861 BOND ISSUE COSTS 509200 INVESTMENTS IN AFFILIATED ORG. 49316960 49826160 ACCRUED PENSION LIABILITY 1949335 PROFESSIONAL LIABILITY RESERVE 531000 FIN 47 ASBESTOS LIABILITY 2781632 THIRD PARTY PAYOR SETTLEMENTS 2688360 MINORITY INTEREST IN CONSOLIDATED SUBS 466178 FAIR VALUE OF INTEREST RATE SWAP AG 7791365 16207870 1 1 X 1 X 1 X 1 1 1 0 1 1 7696035 2963942 4732093 0.03350 17325126 11607069 5718057 0.04050 25021161 14571011 10450150 0.07400 55 2903 6093509 0 6093509 0.04310 1 500 1536600 0 1536600 0.01090 262994 0 262994 0.00190 56 3403 7893103 7893103 0.05590 56 3403 32914264 14571011 18343253 0.12990 0 2006184 381175 39518001 49840699 -10322698 X 1 1 1 HEALTH PERFORMANCE MANAGEMENT COMPANY LLC CARDIOLOGY CO-MANAGEMENT 0.25000 0.75000 2 LMHS WOMEN'S HEALTH CO-MANAGEMENT COMPANY LLC CO-MANAGEMENT 0.50000 0.50000 1 1 LIMA MEMORIAL HEALTH SYSTEM

1001 BELLEFONTAINE AVE LIMA OH 45804

X X X NOT REQUIRED 1 2 MEDICAL PARK

525 EASTOWN RD LIMA OH 45807

MRI, CT YMCA - WELLNESS CENTER

345 S ELIZABETH ST LIMA OH 45801

WELLNESS CENTER PART I, LINE 7: THE HOSPITAL USED A COST-TO-CHARGE COSTING METHODOLOGY TO CALCULATE THE AMOUNTS REPORTED IN LINE 7. THE HOSPITAL DERIVED THE COST-TO-CHARGE RATIO FROM THE USE OF WORKSHEET 2.PART I, LINE 7E:IN ADDITION TO LIMA MEMORIAL JOINT OPERATING COMPANY'S COMMUNITY HEALTH IMPROVEMENT SERVICES AND COMMUNITY BENEFIT OPERATIONS, THIS LINE AMOUNT ALSO INCLUDES COMMUNITY BENEFIT PROVIDED BY LIMA MEMORIAL PROFESSIONAL CORPORATION, WHICH IS A RELATED ENTITY, IN AS MUCH AS LIMA MEMORIAL PROFESSIONAL CORPORATION'S ACTIVITY, ARE CARRIED ON IN A MANNER CONSISTENT WITH AND DIRECTLY IN CONNECTION WITH THE TAX EXEMPT PURPOSE OF LIMA MEMORIAL JOINT OPERATING COMPANY. PART I, LINE 7, COLUMN (F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $ 6263453. PART II: BEYOND THE NUMBERS: KEY COMMUNITY BENEFITS ACTIVITIES OF 2010LIMA MEMORIAL DEVELOPS PROGRAMS AND SERVICES TO ADDRESS COMMUNITY HEALTH NEEDS AND MAKES INVESTMENTS IN INITIATIVES THAT ALIGN WITH THE HEALTH SYSTEM'S MISSION, VISION, AND VALUES. THE MAJORITY OF LIMA MEMORIAL'S COMMUNITY BENEFIT INVESTMENT WAS IN THE AREA OF CHARITABLE CARE TO ENSURE THAT THOSE WITHOUT INSURANCE OR WITH LIMITED INSURANCE HAVE ACCESS TO NEEDED MEDICAL CARE. BEYOND THAT FOCUS ARE PROGRAMS AND SERVICES THAT BENEFIT EVERY RESIDENT AND SUPPORT THE FAR REACHING GOAL OF A HEALTHIER WEST CENTRAL OHIO. LIMA MEMORIAL HEALTH SYSTEM CANNOT MEET ALL OF THE HEALTHCARE NEEDS WITHOUT THE ENGAGEMENT AND SUPPORT OF KEY STAKEHOLDERS INCLUDING OUR MEDICAL STAFF, AS WELL AS OTHER COMMUNITY ORGANIZATIONS. COMMUNITY HEALTH SERVICESIN 2010, LIMA MEMORIAL HEALTH SYSTEM PROVIDED AND/OR PARTICIPATED IN MORE THAN 100 COMMUNITY HEALTH SERVICE PROGRAMS. INCLUDED IN THIS CATEGORY ARE HEALTH AND WELLNESS EDUCATION, HEALTH SCREENINGS, COMMUNITY DEVELOPMENT, AND SERVICES TO HELP PEOPLE ADOPT HEALTHY LIFE-STYLE CHANGES. ALSO INCLUDED ARE THE MYRIAD OF SUPPORT GROUP ACTIVITIES THAT HELP PATIENTS AND THEIR FAMILIES MANAGE CHRONIC HEALTH CONDITIONS. KEY INITIATIVES THIS PAST YEAR INCLUDE DIAGNOSTIC HEART AND VASCULAR SCREENINGS FOR AT-RISK ADULTS, CHILDHOOD DIABETES EDUCATION IN AREA SCHOOLS, INJURY PREVENTION AND AWARENESS, AND HEALTHY EATING EVENTS.A THIRD SUBSET OF THIS CATEGORY INCLUDES HEALTH CARE SUPPORT SERVICES, OR THOSE SERVICES THAT ARE PROVIDED TO ASSIST COMMUNITY MEMBERS IN ACCESSING BOTH INFORMATION AND THE MEDICAL CARE THAT THEY NEED. CHIEF AMONG THE HEALTH SYSTEM'S SUPPORT INITIATIVES ARE THE FINANCIAL COUNSELORS THAT ENSURE THAT PATIENTS WHO ARE STRUGGLING FINANCIALLY AND/OR LACK MEDICAL INSURANCE ARE AFFORDED THE CARE THAT THEY NEED.HEALTH PROFESSIONS EDUCATIONLIMA MEMORIAL HEALTH SYSTEM BELIEVES THAT HAVING HIGHLY TRAINED MEDICAL PERSONNEL BENEFITS EVERYONE IN THE COMMUNITY. BEYOND ON-GOING EDUCATION FOR PHYSICIANS, NURSES, TECHNICIANS, AND OTHER CLINICIANS, THE HEALTH SYSTEM SUPPORTED NUMEROUS SPECIAL INITIATIVES IN 2010 TO FURTHER THE CAPABILITIES OF AREA MEDICAL PERSONNEL.AS PART OF THE PARTNERSHIPS WITH NUMEROUS COLLEGES AND UNIVERSITIES, LIMA MEMORIAL SERVED AS A TRAINING SITE FOR NEARLY 300 NURSING STUDENTS IN 2010. LIMA MEMORIAL PROVIDES EDUCATION OUTREACH BEYOND THE WALLS OF THE HOSPITAL TO SUPPORT MEDICAL EDUCATION IN THE COMMUNITY BY PROVIDING HUNDREDS OF HOURS OF TRAINING FOR AREA EMTS AND PARAMEDICS. FINANCIAL CONTRIBUTIONSLIMA MEMORIAL PROVIDES BOTH CASH AND IN-KIND SUPPORT TO INDIVIDUALS AND OTHER COMMUNITY ORGANIZATIONS. THE SPONSORSHIP FUND PROVIDES FUNDING SUPPORT TO WEST-CENTRAL OHIO PROGRAMS THAT ADDRESS IDENTIFIED COMMUNITY NEEDS AND SERVE VULNERABLE POPULATIONS. IN 2010, LIMA MEMORIAL CONTRIBUTED TO MORE THAN 50 ORGANIZATIONS INCLUDING THE EQUESTRIAN THERAPY PROGRAM, YMCA OF LIMA, AMERICAN CANCER SOCIETY, THE ALLEN COUNTY SHERIFFS DEPARTMENT, THE UNITED WAY, AND THE AMERICAN RED CROSS. COMMUNITY BENEFIT OPERATIONSFOR 2010, THE ONLY COMMUNITY BENEFITS EXPENSE RECORDED IS THE STAFF EXPENSE TO TRACK AND REPORT ON THE HEALTH SYSTEM'S COMMUNITY BENEFIT INVESTMENT. THE APPLICABLE COSTS FOR STAFF ENGAGING IN ACTUAL COMMUNITY BENEFIT SERVICES AND PROGRAMMING ARE REPORTED WITHIN SPECIFIC INITIATIVES AND ACTIVITIES. LAST YEAR'S EXPENSE OF $11,787 REPRESENTS THE FUNCTIONAL ALLOCATION OF STAFF TIME AND MAY BE UNDERREPORTED. CHARITY CAREIN ACCORDANCE WITH REPORTING REQUIREMENTS, LIMA MEMORIAL'S CHARITY CARE EXPENSE IS BASED UPON COSTS VERSUS CHARGES. CHARITY CARE INCLUDES LIMA MEMORIAL'S TRADITIONAL INPATIENT AND EMERGENCY SERVICES. WHEN A PATIENT IS APPROVED TO RECEIVE FINANCIAL ASSISTANCE, THAT APPROVAL IS FOR A SIX-MONTH PERIOD AND INCLUDES ALL HOSPITAL CARE. THIS APPROACH ENSURES THAT ASSISTANCE IS PORTABLE AND THAT PATIENTS HAVE ACCESS TO NEEDED MEDICAL SERVICES BY MAKING A SINGLE APPLICATION.A KEY GOAL IS TO IDENTIFY COMMUNITY MEMBERS IN NEED SOONER. THE RESULT IS MORE CHARITY CARE AND FEWER BAD DEBTS.GOVERNMENT SPONSORED HEALTHCAREPAYMENT SHORTFALLS FOR PUBLIC INSURANCE PROGRAMS, INCLUDING MEDICAID AND MEDICARE, WERE $17,467,895 IN 2010, AN INCREASE OF 2 PERCENT OVER 2009. PART III, LINE 4: ACCOUNTS RECEIVABLE FOR PATIENTS, INSURANCE COMPANIES, AND GOVERNMENTAL AGENCIES ARE BASED ON GROSS CHARGES. AN ALLOWANCE FOR CONTRACTUAL ADJUSTMENTS AND INTERIM PAYMENT ADVANCES IS BASED ON EXPECTED PAYMENT RATES FROM PAYORS BASED ON CURRENT REIMBURSEMENT METHODOLOGIES. THIS AMOUNT ALSO INCLUDES AMOUNTS RECEIVED AS INTERIM PAYMENTS AGAINST UNPAID CLAIMS BY CERTAIN PAYORS. THE ALLOWANCE FOR CONTRACTUAL ADJUSTMENTS IS REPORTED AS PART OF THE PATIENT ACCOUNTS RECEIVABLE AMOUNT ON THE CONSOLIDATED BALANCE SHEET. AN ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS IS ESTABLISHED ON AN AGGREGATE BASIS BY USING HISTORICAL WRITE-OFF RATE FACTORS APPLIED TO UNPAID ACCOUNTS BASED ON AGING. LOSS RATE FACTORS ARE BASED ON HISTORICAL LOSS EXPERIENCE AND ADJUSTED FOR ECONOMIC CONDITIONS AND OTHER TRENDS AFFECTING THE HOSPITAL'S ABILITY TO COLLECT OUTSTANDING AMOUNTS. UNCOLLECTIBLE AMOUNTS ARE WRITTEN OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS IN THE PERIOD THEY ARE DETERMINED TO BE UNCOLLECTIBLE.THE HOSPITAL MULTIPLIES GROSS WRITE-OFF CHARGES BY THE COST-TO-CHARGE RATIO DETERMINED IN WORKSHEET 2 TO DETERMINE THE AMOUNT REPORTED IN PART III, LINES 2 AND 3. ADDITIONAL BAD DEBT ATTRIBUTABLE TO PATIENTS IDENTIFIED UNDER CHARITY CARE WAS ESTIMATED BY A THIRD PARTY THROUGH THE SCREENING OF BAD DEBT PATIENTS AT POVERTY LEVEL. THE HOSPITAL APPLIES ANY DISCOUNTS/PAYMENTS RECEIVED AGAINST PATIENT ACCOUNTS BEFORE DETERMINING BAD DEBT EXPENSE. 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 2010 WAS $49,840,699. THE PAYMENTS RELATED TO THESE SERVICES WERE $39,518,001. LEAVING A MEDICARE SHORTFALL OF $10,322,698 FOR THE YEAR. THE MEDICARE SHORTFALL IS A COMMUNITY BENEFIT BECAUSE PROVIDING SERVICES TO THE ELDERLY IS A TAX EXEMPT PURPOSE CONSISTENT WITH LIMA MEMORIAL JOINT OPERATING COMPANY'S OVERALL EXEMPT STATUS, AND THE HOSPITAL ACCEPTS THESE PATIENTS REGARDLESS OF ITS IMPACT ON OVERALL PROFITABILITY. PART III, LINE 9B: PATIENTS DO NOT RECEIVE ANY NOTICE FROM LMH UNTIL BALANCES ARE DETERMINED TO BE THE PATIENT'S RESPONSIBILITY. PRIMARY SELF-PAY ACCOUNTS ARE REFERRED TO AN OUTSIDE AGENCY AS AN EXTENSION OF THE BUSINESS OFFICE AT DAY 45. ACCOUNTS REMAIN WITH THE AGENCY UNTIL IT IS AT A ZERO BALANCE OR 150 DAYS. AT 150 DAYS THE ACCOUNT IS CLOSED BACK AND GIVEN TO THE SUBSEQUENT AGENCY FOR REGULAR COLLECTION FOLLOW UP. BALANCE AFTER INSURANCE ACCOUNTS ARE REFERRED TO AN OUTSIDE AGENCY ONCE ANY MONEY IS MOVED INTO SELF PAY. THE ACCOUNT IS KEPT FOR A MINIMUM OF 90 DAYS AND THEN REFERRED TO A COLLECTION AGENCY. PART VI, LINE 2: LIMA MEMORIAL HEALTH SYSTEM REGULARLY PARTICIPATES IN COMPREHENSIVE COMMUNITY HEALTH NEEDS ASSESSMENTS TO IDENTIFY FAR-REACHING HEALTH NEEDS FACED BY PEOPLE IN THE COMMUNITIES SERVED BY THE HOSPITAL. ASSESSMENT RESULTS ARE EVALUATED OVER TIME AND SERVE AS THE BASIS TO DEVELOP NEW OR EXPANDED PLANS TO ADDRESS SERVICES IN RESPONSE TO NEED.LIMA MEMORIAL HEALTH SYSTEM JOINED OTHER AREA ORGANIZATIONS TO DEVELOP, IMPLEMENT AND UTILIZE THE 2009 ALLEN COUNTY COMMUNITY HEALTH NEEDS ASSESSMENT. THE NEEDS ASSESSMENT COLLECTED DATA FOR ALLEN COUNTY ADULTS (AGES 19 YEARS OF AGE AND OLDER) AND YOUTH (AGES 12 THROUGH 18) WHO PARTICIPATED IN A COUNTY-WIDE ASSESSMENT SURVEY DURING 2009. THE FINDINGS ARE BASED ON SELF-ADMINISTERED SURVEYS USING A STRUCTURED QUESTIONNAIRE. THE QUESTIONS WERE MODELED AFTER THE SURVEY INSTRUMENTS USED BY THE CENTERS FOR DISEASE CONTROL AND PREVENTION FOR THEIR NATIONAL AND STATE BEHAVIORAL RISK FACTOR SURVEILLANCE SYSTEM AND YOUTH RISK BEHAVIOR SURVEILLANCE SYSTEM. THE SURVEY ASSESSED THE FOLLOWING AREAS: COMMUNITY CONCERNS AND SERVICES, PHYSICAL HEALTH ISSUES AND BEHAVIORAL HEALTH ISSUES. FOR AREAS OUTSIDE OF ALLEN COUNTY, LIMA MEMORIAL UTILIZES DATA FROM ADDITIONAL COUNTY-BASED NEEDS ASSESSMENT WHEN AVAILABLE. THE RESULTS OF THIS SURVEY ARE BEING USED TO SHAPE LIMA MEMORIAL COMMUNITY OUTREACH EFFORTS.ASSESSMENT SUMMARYWHEN ASKED TO RANK COMMUNITY PROBLEMS FROM A PREPARED LIST, 43% OF RESPONDENTS NOTED UNEMPLOYMENT AS THE SINGLE MOST IMPORTANT PROBLEM FACING LOCAL FAMILIES. RESIDENTS IDENTIFY JOB TRAINING & EMPLOYMENT SERVICES AS THE SINGLE MOST IMPORTANT SERVICE NEED IN THE COUNTY IN 2009. CRIME PREVENTION SERVICES WAS RANKED THE SECOND MOST IMPORTANT/MOST NEEDED SERVICE IN 2009.OTHER IMPORTANT AND EMERGING COMMUNITY PROBLEMS ARE FAMILY ISSUES OF DOMESTIC VIOLENCE, QUALITY OF LIFE, AND PARENTING. OTHER IMPORTANT SERVICES INCLUDED HEALTH CARE SERVICES, YOUTH PROGRAMS AND CARE OF THE ELDERLY. ALMOST ONE-QUARTER (24%) OF ALLEN COUNTY ADULTS REPORTED IN 2009 THAT THEY HAD ATTEMPTED TO GET ASSISTANCE FROM A SOCIAL SERVICE AGENCY. 58% OF THOSE ADULTS DID RECEIVE ASSISTANCE AND ONLY 1% OF ADULTS REPORTED THEY DID NOT KNOW WHERE TO LOOK FOR ASSISTANCE.PREVIOUS ASSESSMENTS BROUGHT TO LIGHT SOME OF THE PHYSICAL HEALTH CHALLENGES ALLEN COUNTY RESIDENTS FACED AND HIGH RATES OF CHRONIC DISEASE. ALTHOUGH ALLEN COUNTY DEATH RATES FOR HEART DISEASE, CANCER, STROKE, AND DIABETES HAVE DECREASED, THE NUMBER OF ADULTS WHO REPORT HAVING CLINICAL INDICATORS AND LIFESTYLE CHARACTERISTICS ASSOCIATED WITH THEM HAS INCREASED IN SEVERAL AREAS. TWO AREAS THAT HAVE INCREASED SINCE A 2002 SURVEY ARE CONSIDERABLY ABOVE STATE AND NATIONAL RATES ARE HIGH BLOOD PRESSURE AND EXCESSIVE BODY WEIGHT. ABOUT 3 OUT OF 4 ALLEN COUNTY ADULTS ARE CONSIDERED OVERWEIGHT OR OBESE BY BODY MASS INDEX STANDARDS(BMI). SOME POSITIVE CHANGES WERE NOTED - FEWER ADULTS REPORT NO LEISURE TIME ACTIVITY, INDICATING THEY ARE MORE ACTIVE THAN PREVIOUS ASSESSMENTS FOUND, AND CIGARETTE SMOKING IS DOWN IN ALLEN COUNTY, THOUGH STILL SLIGHTLY HIGHER THAN STATE AND NATIONAL RATES.HEALTH CARE WAS IDENTIFIED AS ONE OF THE TOP THREE MOST IMPORTANT SERVICES IN ALLEN COUNTY AND THE MAJORITY OF ADULTS (86%) REPORT HAVING HEALTH CARE COVERAGE. DESPITE THIS, FEWER WOMEN ARE PARTICIPATING IN SCREENINGS FOR EARLY DETECTION OF CANCER. A NOTABLE IMPROVEMENT FROM 2002 WAS THE PERCENTAGE OF ADULTS WHO HAVE VISITED A DENTIST IN THE PAST YEAR, THOUGH REPORTED DENTAL VISITS WITHIN THE PAST YEAR ARE STILL LOWER IN ALLEN COUNTY COMPARED TO STATE AND NATIONAL RATES. LIFESTYLE CHARACTERISTICS THAT CORRESPOND WITH REDUCED RISK FOR CHRONIC DISEASE INCLUDE A HEALTHY BODY WEIGHT, ADEQUATE FRUIT AND VEGETABLE CONSUMPTION, REGULAR LEISURE-TIME PHYSICAL ACTIVITY, AND NOT SMOKING, YET ONLY 0.8% OF ALLEN COUNTY ADULTS ENGAGE IN ALL FOUR HEALTHY LIFESTYLE CHARACTERISTICS.SOME OF THE HEALTH ISSUES FACING ALLEN COUNTY YOUTH INCLUDE EARLY SEXUAL ACTIVITY AND TEEN PREGNANCY, BULLYING, AND LACK OF SAFETY HABITS SUCH AS WEARING HELMETS WHEN RIDING BICYCLES AND ATVS, AND LACK OF REGULAR SEATBELT USE. PART VI, LINE 3: ALL PATIENTS OF LIMA MEMORIAL HOSPITAL ARE EDUCATED ON THE HOSPITAL'S CHARITY CARE PROGRAM DURING THE REGISTRATION PROCESS VIA WALL-POSTED STATEMENTS, HOSPITAL PERSONNEL INQUIRIES, ETC. INFORMATION REGARDING THE HOSPITAL'S CHARITY CARE IS ALSO FOUND ON LIMA MEMORIAL HOSPITAL'S WEBSITE. STATEMENTS GOING TO PATIENTS ALSO IDENTIFY THIS PROGRAM. PART VI, LINE 4: LIMA MEMORIAL HEALTH SYSTEM SERVES A 10 COUNTY AREA THAT INCLUDES MORE THAN 475,000 PEOPLE. THE COUNTIES INCLUDE ALLEN, AUGLAIZE, PUTNAM, HANCOCK, MERCER, HARDING, LOGAN, SHELBY, PAULDING, AND VAN WERT. THE MEDIUM HOUSEHOLD INCOME FOR THE REGION IS $44,300. 24% OF RESIDENTS ARE UNDER 18 YEARS-OLD, WHILE 14.5% OF RESIDENTS ARE 65 YEARS-OLD OR OLDER. 95.4% OF OUR ENTIRE SERVICE AREA IS CAUCASIAN, WHILE 2.75% ARE AFRICAN AMERICAN. IN OUR PRIMARY SERVICE AREA OF ALLEN COUNTY 85.6% ARE CAUCASIAN, WHILE 11.7% ARE AFRICAN AMERICAN.THE REGION IS PRIMARILY RURAL WITH SMALL COMMUNITIES. THE LARGEST CITY IN THE REGION IS LIMA WITH A POPULATION OF MORE THAN 38,000. PART VI, LINE 7: LIMA MEMORIAL HEALTH SYSTEM DEVELOPS PROGRAMS AND SERVICES TO ADDRESS COMMUNITY HEALTH NEEDS TO SUPPORT THE GOAL OF A HEALTHIER WEST CENTRAL OHIO. REPORTS FILED WITH STATES PART VI, LINE 7 OH 1 TOLEDO CHILDREN'S HOSPITAL FOUNDATION 2142 N COVE BLVD TOLEDO OH 43606 344179070 501(C)6 5000 COMMUNITY DEVELOPMENT/HEALTH AND WELLNESS EQUESTRIAN THERAPY PROGRAM 22532 BOWSHER RD CRIDERSVILLE OH 45806 341376159 501(C)3 15000 THERAPY PROGRAM FOR CHILDREN WITH DISABILITIES LIMA AREA FAMILY YMCA 345 S ELIZABETH ST LIMA OH 45801 344431173 501(C)3 262994 COMMUNITY DEVELOPMENT/HEALTH AND WELLNESS LIMA SYMPHONY ORCHESTRA 133 N ELIZABETH ST LIMA OH 45807 344465022 501(C)3 7086 COMMUNITY DEVELOPMENT SUPPORTING ARTS AMERICAN RED CROSS 610 S COLLET ST LIMA OH 45805 999999999 501(C)3 10000 COMMUNITY DEVELOPMENT/HEALTH AND WELLNESS LIMA MEMORIAL FOUNDATION 1001 BELLEFONTAINE AVE LIMA OH 45804 341707570 501(C)3 5000 WOMEN'S HEALTH INITIATIVE ALLEN COUNTY VISIONARIES PO BOX 176 LIMA OH 45802 999999999 501(C)3 11575 COMMUNITY DEVELOPMENT ALLEN COUNTY FAIR 2750 HARDING HIGHWAY LIMA OH 45804 346570403 501(C)3 5000 COMMUNITY DEVELOPMENT LIMA MEMORIAL PROFESIONAL CORPORATION 1001 BELLEFONTAINE AVE LIMA OH 45804 341935236 501(C)3 4776349 GENERAL SUPPORT FOR HEALTHCARE INITIATVES OF LIMA MEMORIAL JOINT OPERATING COMPANY 7 1 EDUCATIONAL LOAN 7 15645 PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, PART I, LINE 2: IN MOST CASES THE EFFECTIVE USE OF FUNDS IS EVIDENT THROUGH THE POSITIVE RESULTS OF THE PROGRAMS WE FUND. IN ADDITION, LIMA MEMORIAL HAS BOARD REPRESENTATION ON MOST OF THE ORGANIZATIONS WE SUPPORT. IF THIS IS NOT THE CASE WE DO ASK FOR THEIR BUSINESS PLAN AND A LIST OF EXPENDITURES. X 1 1 X X X X X 1 1 0 0 0 0 0 0 0 MIKE SWICK 251061 0 132999 0 11473 0 183186 0 24155 0 602874 0 0 0 ROBERT E ARMSTRONG JR 183160 0 64955 0 5854 0 51359 0 24155 0 329483 0 0 0 ERIC D POHJALA 172173 0 59073 0 5576 0 47393 0 24155 0 308370 0 0 0 CHARLES LYNN THOMPSON MD 217989 0 49605 0 8765 0 41986 0 19324 0 337669 0 0 0 LYNN CARPENTER 108713 0 15000 0 6202 0 3953 0 24155 0 158023 0 0 0 ANITA GOOD 112969 0 14000 0 1225 0 3899 0 19324 0 151417 0 0 0 JULIE NEU 122900 0 14000 0 4888 0 11830 0 19324 0 172942 0 0 0 SUE ANN FICKEL 100556 0 0 0 3772 0 8505 0 14493 0 127326 0 0 0 PART I, LINE 1A LIMA MEMORIAL JOINT OPERATING COMPANY PROVIDES SOCIAL CLUB DUES TO THE CEO; THEY ARE TREATED AS TAXABLE COMPENSATION. PART I, LINES 4A-B SEVERANCE AMOUNT PAID IN ACCORDANCE WITH WRITTEN AGREEMENT: SUE FICKEL - $103,164 THE FOLLOWING INDIVIDUALS PARTICIPATED IN AN IRC 457(F) NON-QUALIFIED DEFERRED COMPENSATION PLAN, WHICH IS SUBJECT TO A SUBSTANTIAL RISK OF FORFEITURE: MIKE SWICK ROBERT E. ARMSTRONG ERIC D. POHJALA C. LYNN THOMPSON ANY ADDITIONAL AMOUNTS IN SCHEDULE J, PART II, COLUMN C FOR THE INDIVIDUALS LISTED ABOVE REPRESENTS A COMBINATION OF CONTRIBUTIONS TO OTHER RETIREMENT PLANS INCLUDING 401(K) AND 457(B). CITY OF LIMA-2007 BONDS 346400789 532567DH4 2007-07-18 25000000 SPIRIT OF CARING CAPITAL PROJECT 0 0 0 CITY OF LIMA-2003 BONDS 346400789 532567DG6 2003-04-10 10000000 EMERGENCY CENTER CAPITAL PROJECT 0 0 0 317693 25000000 2008 0 0 1 1 178783 10000000 2004 0 0 1 1 0 0 1 0 1 0.00000 0.00000 0.00000 1 0 0 1 0 1 0.00000 0.00000 0.00000 1 0 1 0 0 0 1 0 1 0 0 0 1 FORM 990, PART VI, SECTION A, LINE 6 THE SOLE MEMBER OF THE CORPORATION SHALL, AT ALL TIMES, BE LIMA MEMORIAL JOINT OPERATING COMPANY. FORM 990, PART VI, SECTION B, LINE 11 THE AUDIT COMMITTEE OF THE BOARD REVIEWS AND APPROVES THE FORM 990, AND A COPY OF THE FORM 990 IS PROVIDED TO THE BOARD, PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C EACH TRUSTEE, PRINCIPAL OFFICER, AND MEMBER OF A COMMITTEE WITH BOARD-DELEGATED POWERS SHALL ANNUALLY SIGN A STATEMENT WHICH AFFIRMS THAT SUCH PERSON: 1) HAS RECEIVED A COPY OF THE CONFLICTS OF INTEREST POLICY; 2) HAS READ AND UNDERSTANDS THE POLICY; 3) HAS AGREED TO COMPLY WITH THE POLICY; AND 4) UNDERSTANDS THAT THE CORPORATION IS A CHARITABLE ORGANIZATION AND THAT IN ORDER TO MAINTAIN ITS FEDERAL TAX EXEMPTION, IT MUST ENGAGE PRIMARILY IN ACTIVITIES WHICH ACCOMPLISH ONE OR MORE OF ITS TAX-EXEMPT PURPOSES. IF THE BOARD OR COMMITTEE HAS REASONABLE CAUSE TO BELIEVE THAT A MEMBER HAS FAILED TO DISCLOSE ACTUAL OR POSSIBLE CONFLICTS OF INTEREST, IT SHALL INFORM THE MEMBER OF THE BASIS FOR SUCH BELIEF AND AFFORD THE MEMBER AN OPPORTUNITY TO EXPLAIN THE ALLEGED FAILURE TO DISCLOSE. IF, AFTER HEARING THE RESPONSE OF THE MEMBER AND MAKING SUCH FURTHER INVESTIGATION AS MAY BE WARRANTED IN THE CIRCUMSTANCES, THE BOARD OR COMMITTEE DETERMINES THAT THE MEMBER HAS IN FACT FAILED TO DISCLOSE AN ACTUAL OR POSSIBLE CONFLICT OF INTEREST, IT SHALL TAKE APPROPRIATE DISCIPLINARY AND CORRECTIVE ACTION. FORM 990, PART VI, SECTION B, LINE 15 THE PROCESS FOR DETERMINING THE ORGANIZATION'S CEO, OTHER OFFICERS AND KEY EMPLOYEES' COMPENSATION INCLUDES: 1) REVIEW AND APPROVAL BY THE COMPENSATION COMMITTEE; 2) THE UTILIZATION OF AN INDEPENDENT COMPENSATION CONSULTANT; 3) COMPARABLE DATA; AND 4) CONTEMPORANEOUS DOCUMENTATION. THIS PROCESS WAS LAST COMPLETED IN 2010. FORM 990, PART VI, SECTION C, LINE 18 FORM 990 IS AVAILABLE UPON REQUEST. FORM 990, PART VI, SECTION C, LINE 19 THESE DOCUMENTS ARE CURRENTLY NOT AVAILABLE TO THE PUBLIC. FORM 990, PART VII ESTIMATE OF OFFICERS' ALLOCATION OF HOURS WORKED FOR LIMA MEMORIAL JOINT OPERATING COMPANY RELATED ENTITIES: LIMA MEMORIAL HOSPITAL: -MIKE SWICK: 1 -JOHN H. JOHNSON: 0 -BARBARA STEELE: 0 -ARTURO POLIZZI: 0 -KERMIT STROH: 1 -ROBERT E. ARMSTRONG: 1 -ERIC D. POHJALA: 1 LIMA MEMORIAL PROFESSIONAL CORPORATION: -MIKE SWICK: 4 -JOHN H. JOHNSON: 0 -BARBARA STEELE: 0 -ARTURO POLIZZI: 0 -KERMIT STROH: 0 -ROBERT E. ARMSTRONG: 8 -ERIC D. POHJALA: 4 ELM TREE FOUNDATION: -MIKE SWICK: 1 -JOHN H. JOHNSON: 0 -BARBARA STEELE: 0 -ARTURO POLIZZI: 0 -KERMIT STROH: 0 -ROBERT E. ARMSTRONG: 1 -ERIC D. POHJALA: 1 CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED GAINS ON INVESTMENTS: 786,676. IMPLEMENTATION OF NEW ACCOUNTING PRONOUNCEMENT -90,214. PRIOR PERIOD ADJUSTMENT 198,529. TOTAL TO FORM 990, PART XI, LINE 5: 894,991. FORM 990, PART XII, LINE 2C EXPLANATION THE AUDIT COMMITTEE ASSUMES RESPONSIBILITY FOR THE OVERSIGHT OF THE AUDIT AND THE SELECTION OF THE INDEPENDENT ACCOUNTANT. LIMA MEMORIAL HOSPITAL 1001 BELLEFONTAINE AVENUE LIMA OH 45804 344434676 HEALTHCARE OH 501(C)(3) 170(B)(1)(A)(III) N/A 0 LIMA MEMORIAL HOSPITAL FOUNDATION 1001 BELLEFONTAINE AVENUE LIMA OH 45804 341707570 SUPPORTING ORGANIZATION FOR LIMA MEMORIAL HOSPITAL OH 501(C)(3) 509(A)(3) N/A 1 LIMA MEMORIAL HOSPITAL AUXILIARY 1001 BELLEFONTAINE AVENUE LIMA OH 45804 341694632 SUPPORTING ORGANIZATION FOR LIMA MEMORIAL HOSPITAL OH 501(C)(3) 509(A)(3) N/A 1 LIMA MEMORIAL PROFESSIONAL CORPORATION 1001 BELLEFONTAINE AVENUE LIMA OH 45804 341935236 HEALTHCARE OH 501(C)(3) 170(B)(1)(A)(III) N/A 1 ELM TREE FOUNDATION 1220 EAST ELM STREET LIMA OH 45804 341417720 RENTAL REAL ESTATE OH N/A C 732316 2072233 1.00000 0 1 1 0 0 0 0 0 1 1 0 0 1 1 1 1 0 0 LIMA MEMORIAL HOSPITAL FOUNDATION C 387230 CASH TRANSACTION LIMA MEMORIAL PROFESSIONAL CORPORATION B 4776349 CASH TRANSACTION LIMA MEMORIAL PROFESSIONAL CORPORATION I 259555 LEASE CONTRACT ELM TREE FOUNDATION J 94523 LEASE CONTRACT LIMA MEMORIAL PROFESSIONAL CORPORATION O 363124 CASH TRANSACTION ELM TREE FOUNDATION P 150000 CASH TRANSACTION