UNIVERSITY HOSPITALS HEALTH SYSTEM INC: Form 990, tax year 2010
View the entire original 990 at ProPublica ↗
- Organization
- UNIVERSITY HOSPITALS HEALTH SYSTEM INC (EIN 34-1425870)
- Tax period
- 2010-01-01 to 2010-12-31
- Filed
- 2011-11-15
- IRS object ID
- 201103199349307330
- Schema version
- 2010v3.4
- 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 | 2011-11-15T15:46:24-06:00 | Timestamp |
| Tax Period End Date | 2010-12-31 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
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 | 2010-01-01 | 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 | 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 | 2011-11-15 | DateSigned |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | Bernie Ostrowski | Name |
| Phone | 6148493000 | Phone |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2010 | TaxYear |
| Build TS | 2016-03-07 17:11:31Z | 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 | 333385521 | 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 | 10 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 10 | NbrIndependentVotingMembers |
| Total Nbr Employees | 3134 | TotalNbrEmployees |
| Total Nbr Volunteers | 1185 | TotalNbrVolunteers |
| Total Gross UBI | -69937 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | -69937 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 2840267 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 1034685 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 299641906 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 322305254 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 3561874 | InvestmentIncomePriorYear |
| Investment Income Current Year | 4519470 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 3612542 | OtherRevenuePriorYear |
| Other Revenue Current Year | 5526112 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 309656589 | TotalRevenuePriorYear |
| Total Revenue Current Year | 333385521 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 19150 | 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 | 152159789 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 158229661 | 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 | 122100361 | OtherExpensePriorYear |
| Other Expenses Current Year | 161329423 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 274279300 | TotalExpensesPriorYear |
| Total Expenses Current Year | 319559084 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 35377289 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 13826437 | RevenuesLessExpensesCY |
| Total Assets BOY | 506469727 | TotalAssetsBOY |
| Total Assets EOY | 505232384 | TotalAssetsEOY |
| Total Liabilities BOY | 291675649 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 283003948 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 214794078 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 222228436 | 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 | 286882022 | Expense |
| Revenue | 322305254 | 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. Today, Lake Hospital System is comprised of seventeen facilities in Lake, Geauga, and Cuyahoga counties, including three acute care facilities - TriPoint Medical Center in Concord Township, West Medical Center in Willoughby, and a new stand-alone emergency room in Madison; four outpatient medical campuses - the Mentor Campus, the Madison Campus, the Willowick Campus and the Chardon Campus; three diagnostic imaging sites - Mentor Diagnostics, Willoughby Hills Diagnostics and Lyndhurst Diagnostics; one urgent care center - Lake Health Tyler Boulevard Urgent Care; two Physical Therapy sites located inside the Mentor and Willoughby Fitworks ; and four walk-in care centers - Painesville Quick Care Center, Perry Walk-in Care Center located inside the Perry Community Fitness Center, and the Clinic at Middlefield and the Clinic at Madison both located inside WalMart Supercenters. Accessibility and superior quality throughout our service area is key to our mission. In October of 2009 we opened TriPoint Medical Center, which incorporates a healing environment that puts the patient and family at the center of the experience. We also continue to invest in state-of-the-art technology, such as an imaging-guided system for complex brain surgeries and 64-slice CT scanning. For the ninth 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 2010, we provided over $848,078 in community benefit through our health system operations in Lake and Geauga counties. This includes over 250 community education programs, including 44 blood drives which brought in 1,259 pints of blood for the American Red Cross. During these community events and health fairs, we performed 3198 blood pressure checks, 951 cholesterol screenings and 513 heel screenings for free or at a low cost. We also contributed nearly $286,704 in 2010 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 2010 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 | 286882022 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 1 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 1 | LobbyingActivities |
| Donor Advised Funds | 0 | DonorAdvisedFunds |
| Conservation Easements | 0 | ConservationEasements |
| Collections Of Art | 0 | CollectionsOfArt |
| Credit Counseling | 0 | CreditCounseling |
| Term Or Permanent Endowments | 0 | 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 | 0 | 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 | 1 | EscrowAccount |
| On Behalf Of Issuer | 1 | 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 | 0 | DisregardedEntity |
| Related Entity | 1 | RelatedEntity |
| Related Org Controlled Entity | 1 | RelatedOrgControlledEntity |
| Transaction Related Entity | 1 | TransactionRelatedEntity |
| Transfers To Exempt Non Chrtbl Org | 0 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 232 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | 1 | ComplianceWithBackupWitholding |
| Number Of Employees | 3134 | NumberOfEmployees |
| Employment Tax Returns Filed | 1 | EmploymentTaxReturnsFiled |
| Unrelated Business Income | 1 | UnrelatedBusinessIncome |
| Form990-T Filed | 1 | Form990-TFiled |
| Foreign Financial Account | 0 | ForeignFinancialAccount |
| 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 | 10 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 10 | 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 | 1 | 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 (21 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 Kephart | ||||||||
| Vice Chair | 8.00 | X | X | 0 | 0 | 0 | ||
| Greg D Taylor | ||||||||
| Treasurer | 8.00 | X | X | 0 | 0 | 0 | ||
| Daniel B Cudnik | ||||||||
| Secretary | 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 | ||||||||
| Trustee | 8.00 | X | 0 | 0 | 0 | |||
| Timothy P Doyle | ||||||||
| Trustee | 8.00 | X | 0 | 0 | 0 | |||
| Robert G Schiebli | ||||||||
| Trustee | 8.00 | X | 0 | 0 | 0 | |||
| Cynthia Moore-Hardy | ||||||||
| President & CEO | 40.00 | X | 621187 | 0 | 38941 | |||
| Robert Tracz | ||||||||
| Senior VP Finance & CFO | 40.00 | X | 319915 | 0 | 32592 | |||
| Theodore Nichols | ||||||||
| Senior VP Medical Affairs | 40.00 | 268758 | 0 | 24003 | X | |||
| Steven R Karns | ||||||||
| Senior VP Administrative Services | 40.00 | 291648 | 0 | 31035 | X | |||
| Richard D Cicero | ||||||||
| Senior VP Business Development | 40.00 | 245067 | 0 | 15184 | X | |||
| Mary L Orgrinc | ||||||||
| Chief Nursing Officer | 40.00 | 249274 | 0 | 36916 | X | |||
| Jerrold M Peters | ||||||||
| Chief Information Officer | 40.00 | 162708 | 0 | 6631 | X | |||
| Barbara J Moran | ||||||||
| VP Clinical Services | 40.00 | 161023 | 0 | 22278 | X | |||
| Andrea M Wasdovich | ||||||||
| VP Periop Critical | 40.00 | 160887 | 0 | 17100 | X | |||
| Gary J Robinson | ||||||||
| VP Government Relations | 40.00 | 162693 | 0 | 19356 | X | |||
| Theodore F Hoffman | ||||||||
| VP Support Services | 40.00 | 143210 | 0 | 7093 | X | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 2786370 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 0 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 251129 | TotalOtherCompensation |
| Number Individuals GT100 K | 46 | 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 Services | 11202148 |
| Cardinal Health | |||||
| 7000 Cardinal Pl | Dublin | OH | 43017 | Medical Services | 8330668 |
| Gilbane Building Company | |||||
| 7 Jackson Walkway | Providence | RI | 02903 | Construction | 8098131 |
| Medtronic Inc | |||||
| 710 Medtronic Pkwy | Minneapolis | MN | 55432 | Medical Services | 4151055 |
| Draeger Medical Inc | |||||
| 3135 Quarry Rd | Telford | PA | 18969 | Medical Services | 3689273 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 183 | NumberOfContractorsGT100K |
| Related Organizations | 1034685 | RelatedOrganizations |
| Total Contributions | 1034685 | TotalContributions |
Program Service Revenue ProgramServiceRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | Patient Care | Description |
| Business Code | 621110 | BusinessCode |
| Total Revenue Column | 322305254 | TotalRevenueColumn |
| Related Or Exempt Function Income | 322305254 | RelatedOrExemptFunctionIncome |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 322305254 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 3763967 | TotalRevenueColumn |
| Exclusion | $3,763,967 | ExclusionAmount |
Income From Invest Bond Proceeds IncomeFromInvestBondProceeds
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 755503 | TotalRevenueColumn |
| Exclusion | $755,503 | ExclusionAmount |
Gross Rents GrossRents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 2368324 | Real |
Rental Income Or Loss RentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 2368324 | Real |
Net Rental Income Or Loss NetRentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 2368324 | TotalRevenueColumn |
| Exclusion | $2,368,324 | ExclusionAmount |
Other Revenue Misc OtherRevenueMisc (3 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | ExclusionExclusionAmount | Unrelated Business RevenueUnrelatedBusinessRevenue |
|---|---|---|---|---|
| Food and Service | 621110 | 1086128 | $1,086,128 | |
| Passthrough Income | 523000 | 221012 | $290,949 | -69937 |
| OB Sales and Rentals | 621110 | 38500 | $38,500 |
Miscellaneous Revenue MiscellaneousRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 1812148 | TotalRevenueColumn |
| Exclusion | $1,812,148 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 3157788 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 333385521 | TotalRevenueColumn |
| Related Or Exempt Function Income | 322305254 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | -69937 | UnrelatedBusinessRevenue |
| Exclusion | $10,115,519 | ExclusionAmount |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3045844 | Total |
| Management And General | 3045844 | ManagementAndGeneral |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 129980031 | Total |
| Program Services | 119723287 | ProgramServices |
| Management And General | 10256744 | ManagementAndGeneral |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3640532 | Total |
| Program Services | 3276479 | ProgramServices |
| Management And General | 364053 | ManagementAndGeneral |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 13688347 | Total |
| Program Services | 12319512 | ProgramServices |
| Management And General | 1368835 | ManagementAndGeneral |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 7874907 | Total |
| Program Services | 7087416 | ProgramServices |
| Management And General | 787491 | ManagementAndGeneral |
Fees For Services Management FeesForServicesManagement
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2889619 | Total |
| Management And General | 2889619 | ManagementAndGeneral |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 473425 | Total |
| Management And General | 473425 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 129000 | Total |
| Management And General | 129000 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 18109147 | Total |
| Program Services | 16298242 | ProgramServices |
| Management And General | 1810905 | ManagementAndGeneral |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2025680 | Total |
| Program Services | 2025680 | ProgramServices |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 51024486 | Total |
| Program Services | 45922037 | ProgramServices |
| Management And General | 5102449 | ManagementAndGeneral |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 6053489 | Total |
| Program Services | 5448140 | ProgramServices |
| Management And General | 605349 | ManagementAndGeneral |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 16072509 | Total |
| Program Services | 14465258 | ProgramServices |
| Management And General | 1607251 | ManagementAndGeneral |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 676683 | Total |
| Program Services | 169171 | ProgramServices |
| Management And General | 507512 | ManagementAndGeneral |
Conferences Meetings ConferencesMeetings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 569047 | Total |
| Program Services | 142262 | ProgramServices |
| Management And General | 426785 | ManagementAndGeneral |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 5660451 | Total |
| Program Services | 5660451 | ProgramServices |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 26639388 | Total |
| Program Services | 26639388 | ProgramServices |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1404684 | Total |
| Program Services | 936391 | ProgramServices |
| Management And General | 468293 | ManagementAndGeneral |
Other Expenses OtherExpenses (5 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral |
|---|---|---|---|
| Bad Debt Expense | 26064187 | 26064187 | |
| Hospital Franchise Fee | 2627317 | 2627317 | |
| Print and Publications | 359003 | 323103 | 35900 |
| Other Expenses | 287898 | 143949 | 143949 |
| Postage and Shipping | 263410 | 237069 | 26341 |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 319559084 | Total |
| Program Services | 286882022 | ProgramServices |
| Management And General | 32677062 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 11055288 | BOY |
| EOY | 18569470 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 38953784 | BOY |
| EOY | 36187079 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4483405 | BOY |
| EOY | 4217281 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 6949697 | BOY |
| EOY | 9190117 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 455483926 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 192011786 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 276246195 | BOY |
| EOY | 263472140 | EOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 157039493 | BOY |
| EOY | 160946010 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 11741865 | BOY |
| EOY | 12650287 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 506469727 | BOY |
| EOY | 505232384 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 41277695 | BOY |
| EOY | 26091905 | EOY |
Deferred Revenue DeferredRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 304002 | BOY |
| EOY | 386100 | EOY |
Tax Exempt Bond Liabilities TaxExemptBondLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 242374767 | BOY |
| EOY | 247769632 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 7719185 | BOY |
| EOY | 8756311 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 291675649 | BOY |
| EOY | 283003948 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 214794078 | BOY |
| EOY | 222228436 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 214794078 | BOY |
| EOY | 222228436 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 506469727 | BOY |
| EOY | 505232384 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | 13826437 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | -6392079 | 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 | $12,467 | OtherActivitiesAmount |
| Total Lobbying Expenditures IIB | 12467 | TotalLobbyingExpendituresIIB |
| Not Described In501c3 | 0 | NotDescribedIn501c3 |
| Form4720 Filed4912 Tax | 0 | Form4720Filed4912Tax |
Form990 Schedule C Part IV Form990ScheduleCPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | Explanation of Other Lobbying Activities: | Identifier |
| Return Reference | Part II-B, Line 1i: | ReturnReference |
| Explanation | Annual Membership Dues to AHA, OHA, GCP: 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
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 11354186 | OtherCostOrOtherBasis |
| Book Value | 11354186 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 184299075 | OtherCostOrOtherBasis |
| Depreciation | 35402113 | Depreciation |
| Book Value | 148896962 | BookValue |
Leasehold Improvements LeaseholdImprovements
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 1757979 | OtherCostOrOtherBasis |
| Depreciation | 563559 | Depreciation |
| Book Value | 1194420 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 237290001 | OtherCostOrOtherBasis |
| Depreciation | 152634573 | Depreciation |
| Book Value | 84655428 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 20782685 | OtherCostOrOtherBasis |
| Depreciation | 3411541 | Depreciation |
| Book Value | 17371144 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 263472140 | TotalOfBookValueLandBuildings |
Other Liabilities OtherLiabilities (5 entries)
| DescriptionDescription | AmountAmount |
|---|---|
| Lease Obligation | $838,574 |
| Third Party Settlements | $3,209,856 |
| Payable to affiliate | $1,287,143 |
| Deferred Compensation | $659,918 |
| Workers Comp Liability | $2,760,820 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 8756311 | TotalOfAmounts |
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 |
| Pcent100 | X | Pcent100 |
| 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 | 10425385 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 4839489 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 5585896 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.01900 | PercentOfTotalExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 23381026 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 18799769 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 4581257 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.01560 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 33806411 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 23639258 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 10167153 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.03460 | PercentOfTotalExpense |
Community Health Services CommunityHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 486941 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 486941 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00170 | PercentOfTotalExpense |
Subsidized Health Services SubsidizedHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 2595143 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 2595143 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00880 | PercentOfTotalExpense |
Cash And In Kind Contributions CashAndInKindContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 286704 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 286704 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00100 | PercentOfTotalExpense |
Total Other Benefits TotalOtherBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 3368788 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 3368788 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.01150 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 37175199 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 23639258 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 13535941 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.04610 | PercentOfTotalExpense |
Leadership Development LeadershipDevelopment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 7000 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 7000 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00000 | PercentOfTotalExpense |
Coalition Building CoalitionBuilding
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 1000 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 1000 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00000 | PercentOfTotalExpense |
Other Other
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 74433 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 74433 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00030 | PercentOfTotalExpense |
Total Total
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 82433 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 82433 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00030 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 1 | BadDebtExpenseReported |
| Bad Debt Expense | $7,851,236 | BadDebtExpenseAmount |
| Amount Attributable To | 2590908 | AmountAttributableTo |
| Amount Reimbursed By Medicare | 80471670 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 92965324 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | -12493654 | 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 |
| 4 Lake West Physicians Office | ||
| Medical Office Building | 0.10000 | 0.90000 |
| 5 Concord Medical Campus Physicians | ||
| Medical Office Building | 0.51470 | 0.48530 |
| 6 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 | NOT APPLICABLE | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital Facility Number | 1 | HospitalFacilityNumber |
Form990 Schedule H Part V Section C Form990ScheduleHPartVSectionC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Other Facilities | 35 | NumberOfOtherFacilities |
Other Facilities OtherFacilities (35 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 |
| LHPG Women's Health Specialists OBGYN | ||||
| 35040 Chardon Rd Bldg VII 205 | Willoughby Hills | OH | 44094 | Physician Office |
| Tyler Urgent Care | ||||
| 7956 Tyler Blvd | Mentor | OH | 44060 | Urgent Care Center |
| Chardon Urgent Care | ||||
| 510 Fifth Avenue | Chardon | OH | 44024 | Urgent Care Center |
| LHPG Mentor Pediatrics | ||||
| 9485 Mentor Avenue 101 | Mentor | OH | 44094 | Physician Office |
| Lyndhurst Diagnostic Center | ||||
| 5183 Mayfield Rd | Lyndhurst | OH | 44124 | Diagnostic Center |
| LHPG Mentor IMED | ||||
| 9485 Mentor Avenue 210 | Mentor | OH | 44060 | Physician Office |
| Mentor Medical Physician Building | ||||
| 9485 Mentor Avenue XXX-XX-XXXX | Mentor | OH | 44060 | Physician Office |
| Lake Wellness and Rehabilitation | ||||
| 9170 Mentor Avenue | Mentor | OH | 44060 | Rehabilitation Clinic |
| North Coast Family Practice | ||||
| 7580 Auburn Rd | Concord | OH | 44077 | Physician Office |
| LHPG OBGYN - Willow Medical | ||||
| 36001 Euclid Avenue Suite C-10 | Willoughby | OH | 44094 | Physician Office |
| LHPG Willoughby Pediatrics | ||||
| 36001 Euclid Avenue Suite B-16 | Willoughby | OH | 44094 | Physician Office |
| LHPG Willoughby IMED | ||||
| 36100 Euclid Avenue 240 260 | Willoughby | OH | 44094 | Physician Office |
| Mentor Diagnostic Center | ||||
| 8401 Mentor Ave Suite B | Mentor | OH | 44060 | Diagnostic Center |
| Willow Medical Building | ||||
| 36001 Euclid Avenue Suite B-3 | Willoughby | OH | 44094 | Physician Office |
| Madison Family Practice | ||||
| 6270 North Ridge Rd | Madison | OH | 44057 | Physician Office |
| Willoughby Hills Diagnostic Center | ||||
| 34600 Chardon Rd | Willoughby Hills | OH | 44094 | Diagnostic Center |
| LHPG Mentor Family Practice | ||||
| 6990 Lindsay Drive 3 | Mentor | OH | 44060 | Physician Office |
| Chardon Family Practice | ||||
| 510 Fifth Avenue | Chardon | OH | 44024 | Physician Office |
| LHPG Willoughby Hills IMED | ||||
| 2747 SOM Center Rd Unit D | Willoughby Hills | OH | 44094 | Physician Office |
| Willowick Primary Care | ||||
| 29804 Lakeshore Blvd | Willowick | OH | 44095 | Physician Office |
| LHPG General Surgery | ||||
| 36060 Euclid Avenue Suite 204 | Willoughby | OH | 44094 | Physician Office |
| Painesville Quick Clinic | ||||
| 74 S Park Place | Painesville | OH | 44077 | Quick Clinic |
| LHPG Orthopedic Surgery | ||||
| 36060 Euclid Avenue Suite 203 | Willoughby | OH | 44094 | Physician Office |
| LHPG Plastic Surgery | ||||
| 9500 Mentor Avenue Suite 200 | Mentor | OH | 44060 | Physician Office |
| LHPG West Cardio Electrophysiology | ||||
| 36100 Euclid Avenue 400 | Willoughby | OH | 44094 | Physician Office |
| Painesville IMED | ||||
| 1223 Mentor Ave | Painesville | OH | 44077 | Physician Office |
| Perry Health and Wellness Center | ||||
| 2 Success Boulevard | Perry | OH | 44081 | Quick Clinic |
| Willoughby Hills Sleep Center | ||||
| 34900 Chardon Rd Suite 105 | Willoughby Hills | OH | 44094 | Sleep Center |
| Middlefield Quick Clinic | ||||
| 15050 S Springdale Avenue | Middlefield | OH | 44062 | Quick Clinic |
| Physical Therapy - South LLC | ||||
| 36060 Euclid Avenue Suite 105 | Willoughby | OH | 44094 | Physician Office |
| Hackett Medical Building | ||||
| 8300 Tyler Rd | Mentor | OH | 44060 | Physician Office |
Form990 Schedule H Part VI Form990ScheduleHPartVI (14 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.Incomplete Applications: Admission/treatment, if deemed medically appropriate, will be deferred until the application process has been completed.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 7g: Cost Associated With Physicians ClinicsLake Health is the only hospital providing obstetrics, geropsychiatry, and inpatient rehabilitation services in Lake County. While each of these services operates at a financial loss, these services fill a community need that otherwise would be unmet. While the Centers for Geropsychiatry and Comprehensive Rehabilitation are only located only at the Lake West campus, obstetrics services are offered at both the Lake West and TriPoint campuses to ensure residents have access points on both east and west sides of the county. The reported loss on subsidized health services excludes losses attributable to Medicaid and charity patients as these losses are reported separately. | ||
| 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 $26,064,187 from Part IX. | ||
| Part II: Community advisory groups have been in place for 9 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 have been used to inform Lake Health management on issues ranging from way-finding in current facilities to design and program development at the new TriPoint Medical Center .Community leaders are also invited to participate in a physician shadowing experience. In 2010 approximately 8 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.Workforce development Lake Health also engages in the ongoing training and education of health care professionals. While the two nursing programs are identical in philosophy and curriculum, Lake Health provides the majority of the clinical training for the evening/weekend program at its facilities. In turn, the hope is that nursing students will feel welcomed and comfortable, pursuing careers right here in Lake County after graduation, meeting the local need. | ||
| Part III, Line 4: Bad Debt ExpenseUncompensated care includes charity care and bad debts. The System provides care to patients who meet 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. The provision for uncollectible accounts represents estimated uncollectible charges for patients unwiling to pay. The amount of uncompensated care for services provided was approximately $51.9 million and $48.4 million in 2010 and 2009, respectively, of which $25.9 million and $23.9 million in 2010 and 2009, respectively, represents charity care measured at established charge rates. 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 two 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 maintains an allowance for uncollectible accounts. The allowance for uncollectible accounts is based upon management's assessment of historical and expected net collections considering historical business and economic conditions, trends in health care coverages, and other collection indicators. Periodically throughout the year, management assesses the adequacy of the allowance for uncollectible accounts based upon historical write-off experience by payor category. | ||
| 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 $92,965,324. The payments related to these services were $80,471,670, leaving a Medicare shortfall of $12,493,654 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)Steps for Evaluating Uninsured/Uncompensated CareThe 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. | ||
| Part V, Section A: 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 sixteen facilities in Lake and Geauga and Cuyahoga counties, which includes two acute care facilities - TriPoint Medical Center in Concord Township and West Hospital in Willoughby; three outpatient medical campuses - the Mentor Campus, the Chardon Campus and the Madison Campus, which includes a free standing ED; two urgent care centers - Tyler Boulevard, and inside the Willowick Campus; four walk-in care clinics - Painesville Quick Care, the Perry Walk-in Care Center located inside the Perry Community Fitness Center and The Clinic at Middlefield and the Clinic at Madison both located inside Walmart Supercenters; and two Physical Therapy locations inside the Mentor and Willoughby Fitworks.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 rooms within Lake County at TriPoint Medical Center in Concord Township, West Hospital in Willoughby, and the new Madison Emergency Department. These emergency rooms are open to all persons regardless of ability to pay. | ||
| 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 Health District, Lake Health has developed programs, services and partnerships to address the most pressing health issues. The high priority areas included 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 eighth 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 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 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 6: 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 and 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 2010, we provided over $530,000 in community benefits through our health system operations in Lake and Geauga counties. This includes community education programs, including blood drives. During these community events and health fairs, we performed over 5,000 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 commmunity 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 and the American Heart Association to increase awareness of health issues in the community. These programs and services include:Community Calendars and NewslettersBOH Magazine & BOH Community CalendarNH Community CalendarHealth TasksEducation on Specific Disease ConditionsSenior Connection Lunch and LearnsSurgical Innovations Lecture SeriesRed Hot Mamas/LifeCyclesWear Red EventRunner's ClinicWillowick Community Open HouseHealth Promotion and Wellness ProgramsGet Healthy Lake County 10,000 Steps ProgramHealth Education Lectures and Workshops by staff to community groupsUnion Commmunity ChurchAARPD-6 Group - Willoughby Hills Friends ChurchOrchard Hollow ElementaryPerry LibraryEducation to the public about health issuesInformation through media releasesRadio call-in programs with health professionals WELWSchool health education programsHealthy Heart School ProgramWeb-based consumer heatlh informationADAME-NewsletterCarePagesSelf-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.Support GroupsBreast Cancer Support GroupBreast Feeding Support GroupCPAP Support GroupEpilepsy Support GroupIDEAS Insulin Support GroupLook Good, Feel BetterMended Hearts Cardiac Support GroupProstate Cancer Support GroupPulmonary Support GroupStroke Support GroupReach to RecoveryWeight 4 Life Support GroupCash and in-kind contributions to community groupsContributions including cash and non-cash items made to individuals or non-profit organizations for charitable purposes: Golf outings, community walks/runs and other community events that benefit Lake County and the surrounding area's growth and cultural wealth comprise this category.ScreeningsTotal Cholesterol, Glucose, HDLBlood PressureHeel Bone DensityHeart Check MachineSkin Cancer ScreeningProstate Cancer ScreeningPeripheral Vascular Disease ScreeningCarotid Artery ChecksHeight and Weight ChecksPrenatal/Childbirth classes serving at-risk population | ||
| 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 | |||||||||||||
| 601670 | 0 | 0 | 0 | 19517 | 0 | 34566 | 0 | 4375 | 0 | 660128 | 0 | 0 | 0 |
| Robert Tracz | |||||||||||||
| 289782 | 0 | 15000 | 0 | 15133 | 0 | 26217 | 0 | 6375 | 0 | 352507 | 0 | 0 | 0 |
| Theodore Nichols | |||||||||||||
| 251253 | 0 | 5000 | 0 | 12505 | 0 | 18268 | 0 | 5735 | 0 | 292761 | 0 | 0 | 0 |
| Steven R Karns | |||||||||||||
| 252168 | 0 | 25000 | 0 | 14480 | 0 | 25759 | 0 | 5276 | 0 | 322683 | 0 | 0 | 0 |
| Richard D Cicero | |||||||||||||
| 227333 | 0 | 11138 | 0 | 6596 | 0 | 11308 | 0 | 3876 | 0 | 260251 | 0 | 0 | 0 |
| Mary L Orgrinc | |||||||||||||
| 222517 | 0 | 15000 | 0 | 11757 | 0 | 35104 | 0 | 1812 | 0 | 286190 | 0 | 0 | 0 |
| Jerrold M Peters | |||||||||||||
| 152452 | 0 | 5000 | 0 | 5256 | 0 | 2755 | 0 | 3876 | 0 | 169339 | 0 | 0 | 0 |
| Barbara J Moran | |||||||||||||
| 156490 | 0 | 0 | 0 | 4533 | 0 | 22278 | 0 | 0 | 0 | 183301 | 0 | 0 | 0 |
| Andrea M Wasdovich | |||||||||||||
| 156273 | 0 | 0 | 0 | 4614 | 0 | 13322 | 0 | 3778 | 0 | 177987 | 0 | 0 | 0 |
| Gary J Robinson | |||||||||||||
| 152232 | 0 | 2500 | 0 | 7961 | 0 | 18974 | 0 | 382 | 0 | 182049 | 0 | 0 | 0 |
| Theodore F Hoffman | |||||||||||||
| 138518 | 0 | 0 | 0 | 4692 | 0 | 5604 | 0 | 1489 | 0 | 150303 | 0 | 0 | 0 |
Form990 Schedule J Part III Form990ScheduleJPartIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Reference | Part I, Line 1a | ReturnReference |
| Explanation | Relevant Information Regarding Compensation Benefits Lake Hospital System, Inc. policy allows for use of first class travel only in situations when coach or business class is not available or flexibility is required for refundable tickets when circumstances indicate the potential for an immediate change in scheduled travel. Lake Hospital System, Inc.'s CEO received first class travel and reimbursement for country club and social club dues in 2010. 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 |
| Any Research Agreements | 0 | AnyResearchAgreements |
| Bond Counsel Routinely Engaged | 1 | BondCounselRoutinelyEngaged |
| 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 |
| Gross Proceeds Invested | 0 | GrossProceedsInvested |
| Exception To Rebate | 1 | ExceptionToRebate |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (8 entries)
| IdentifierIdentifier | ExplanationExplanation | Return ReferenceReturnReference |
|---|---|---|
| Form 990, Part VI | Current address of Robert Tracz: 6832 Convent Blvd. Sylvania, OH 43560 419-882-8373 | |
| 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. | |
| 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 12c | |
| The process for determing 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. | Form 990, Part VI, Section B, line 15 | |
| 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 18 | |
| 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 VI, Section C, line 19 | |
| Changes in Net Assets or Fund Balances: | Net unrealized gains on investments: 6,053,789. Underwriting support to Lake Hospital Foundation, Inc. -429,899. Contributions from Lake Hospital System, Inc. -241,134. Loss on disposal of assets -673. Cash payments on swap instrument -5,100,617. Loss on change of derivative -6,452,533. Passthrough Income -221,012. Total to Form 990, Part XI, Line 5: -6,392,079. | Form 990, Part XI, line 5: |
| 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) |
|---|---|---|
| EIN | 341425870 | EIN |
| 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 University Ireland 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 | O/P Surgery | OH | N/A | RELATED | 270994 | 1791617 | 0 | 1 | 0.44898 |
| Lake West Medical Specialists LLC | |||||||||||||
| 36000 Euclid Avenue | Willoughby | OH | 44094 | 341964657 | Office Space | OH | N/A | RELATED | 19955 | 422481 | 0 | 1 | 0.10000 |
| Concord Medical Campus Phys Bldg LLC | |||||||||||||
| 7580 Auburn Rd | Concord | OH | 44077 | 260550261 | Office Space | OH | N/A | UNRELATED | 48577 | 8886510 | 0 | 0 | 0.51471 |
Form990 Schedule R Part IV Form990ScheduleRPartIV (2 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Interlake Health Corporation | |||||||||||||||
| 7590 Auburn Rd | Concord | OH | 44077 | 341510475 | Interest Income | OH | Lake Hospital System Inc | C | 462 | 185000 | 1.00000 | ||||
| LHS Assurance Ltd | |||||||||||||||
| 980456229 | Insurance Company | Lake Hospital System Inc | C | 1.00000 | 23 Lime Tree Bay Ave Governors Sq | Grand Cayman | CJ | CJ | |||||||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | 0 | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | 1 | 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 University Ireland Cancer Center | ||
| I | 779923 | per books |
| Lake Hospital Foundation | ||
| C | 1034685 | per books |
| Lake Hospital Foundation | ||
| L | 343919 | per books |
| Lake Hospital Foundation | ||
| O | 429889 | per books |
| PrimeHealth Inc | ||
| O | 18751477 | per books |
| Mentor Surgery Center LLC | ||
| I | 480804 | per books |
| Mentor Surgery Center LLC | ||
| P | 252804 | per books |
| Lake West Medical Specialists LLC | ||
| I | 103783 | per books |
| Lake West Medical Specialists LLC | ||
| P | 59524 | per books |
| Concord Medical Campus Phys Bldg LLC | ||
| I | 1402524 | per books |
| Concord Medical Campus Phys Bldg LLC | ||
| P | 101235 | per books |