2011-11-11T08:36:39-06:00 2010-12-31 BLUE & CO LLC 8800 LYRA DRIVE SUITE 450 COLUMBUS OH 43240 990 2010-01-01 310650283 MCCULLOUGH-HYDE MEMORIAL HOSPITAL MCCU 5135245310 110 NORTH POPLAR STREET OXFORD OH 45056 JOHN CLEMENTS 5135245310 2011-10-24 1 STEPHEN A SHERIDAN 6148852583 2010 2016-03-07 17:11:31Z JOHN CLEMENTS 110 NORTH POPLAR STREET OXFORD OH 45056 66195186 0 X WWW.MHMH.ORG X 1953 OH ACUTE CARE HOSPITAL FACILITY DELIVERING QUALITY SERVICES TO OUR PATIENTS AND THE COMMUNITIES WE SERVE. 10 10 0 0 306902 0 835519 472450 64735435 64810749 7503 14279 968395 897708 66546852 66195186 38988 10000 0 0 28622493 28783775 0 0 0 35075655 36832589 63737136 65626364 2809716 568822 49095839 50013680 26837859 27186878 22257980 22826802 ACUTE CARE HOSPITAL FACILITY DELIVERING QUALITY SERVICES TO OUR PATIENTS AND THE COMMUNITIES WE SERVE. 0 0 62854424 65175889 OPERATING ROOMPHARMACYIMAGING 62854424 1 1 0 1 0 0 0 0 0 1 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 1 0 1 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 1 1 0 0 0 0 0 0 0 X 10 10 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 IN OH X JAMES MILLER 5135245310 110 NORTH POPLAR STREET OXFORD OH 450561292 WILLIAM DOUGLAS ROSS 1.00 X 0 0 0 THOMAS W SPEH 1.00 X 0 0 0 PAIGE WOOD 1.00 X 0 0 0 SUSAN CROSS LIPNICKEY 1.00 X 0 0 0 JOHN HARLAND MD 1.00 X 0 0 0 JACK MANN 1.00 X 0 0 0 RICHARD NORMAN 1.00 X 0 0 0 ALAN OAK 1.00 X 0 0 0 WILLIAM RICHARDSON 1.00 X 0 0 0 MICHAEL A RUDOLPH 1.00 X 0 0 0 PAMELA COLLINS 40.00 X 134003 0 7627 CHRISTOPHER LAUER 40.00 X 199772 0 13771 TAMMY C WOOD 40.00 X 127572 0 13415 BRYAN HEHEMANN 40.00 X 224481 0 13836 KENNETH KELLER MD 40.00 X 246573 0 18924 MATTHEW BIRKLE MD 40.00 X 245298 0 18905 DONALD BECKER 40.00 X 132126 0 16571 MARK CRISTELL 40.00 X 122648 0 14873 BECKY STEWARD 40.00 X 113621 0 16256 1546094 0 134178 11 0 1 0 CPSI 600 WALL STREET MOBILE AL 36695 COMPUTER SYSTEMS 1086725 MAYO MEDICAL LABORATORIES 200 FIRST STREET SW ROCHESTER MN 55905 MEDICAL 521429 MASTERPLAN 9582 TOPANGA CANYON BLVD CHASTSWORTH CA 91311 BIOMEDICAL 410879 SOAP 118 EAST SUPERIOR STREET WAYLAND MI 49348 TRANSCRIPTION 408784 WESTERN OHIO ANESTHESIA ASSOCIATES INC 110 N POPLAR STREET OXFORD OH 45056 ANESTHESIA SERVICES 330000 5 472450 472450 PATIENT SERVICES 900099 64810749 64810749 64810749 13683 13683 306902 306902 306902 306902 596 596 596 596 MISCELLANEOUS 900099 208623 208623 CAFETERIA INCOME 900099 161655 161655 OCCUPATIONAL HEALTH 900099 97778 97778 122750 58739 64011 590806 66195186 65175889 306902 239945 10000 10000 783126 783126 21920952 21920952 342543 342543 4145119 4145119 1592035 1592035 248715 248715 100706 100706 6788335 6499946 288389 300514 293103 7411 10436929 10326595 110334 1168933 1168933 3643447 2672137 971310 66517 28588 37929 60589 41326 19263 4054724 4054724 408002 408002 BAD DEBTS 8365196 8365196 MISCELLANEOUS 1189982 202099 987883 65626364 62854424 2771940 0 5690700 6276513 5876689 8061967 1037663 1143460 979350 906249 69996784 39762939 30778691 30233845 4732746 3391646 49095839 50013680 4389446 5334341 21503287 19461501 945126 2391036 26837859 27186878 X 22257980 22826802 22257980 22826802 49095839 50013680 568822 0 X 0 1 0 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 5670 5670 0 EXPLANATION OF OTHER LOBBYING ACTIVITIES: PART II-B, LINE 1I: SUPPORT PROVIDED THROUGH DUES PAID TO OHA AND AHA 548615 548615 26135753 11862027 14273726 4230996 770180 3460816 36280207 26123960 10156247 2801213 1006772 1794441 30233845 UNAMORTIZED FINANCE COSTS 167095 DUE FROM ENDOWMENT 1241293 DOCTORS' LOANS RECEIVABLE 1611988 CASH SURRENDER VALUE 27755 KEY BANK TRUSTEED FUNDS 343515 3391646 ESTIMATED THIRD PARTY SETTLEMENTS 2391036 2391036 66195186 65626364 568822 568822 1 1 1 X 1 X 1 1 1 0 1 1 1053948 1053948 0.01840 820625 618818 201807 0.00350 1874573 618818 1255755 0.02190 99735 3992 95743 0.00170 99735 3992 95743 0.00170 1974308 622810 1351498 0.02360 55762 55762 0.00100 55762 55762 0.00100 1 3509223 0 9816611 11228383 -1411772 X 1 1 5 1 MCCULLOUGH HYDE MEMORIAL HOSPITAL

110 N POPLAR STREET OXFORD OH 45056

X X X X DSH 2 MCCULLOUGH HYDE MEMORIAL HOSPITAL

5151 MORNING SUN RD OXFORD OH 45056

X PHYSICAL THERAPY 3 MCCULLOUGH HYDE MEMORIAL HOSPITAL

10058 COOLEY RD BROOKVILLE IN 47012

X OUTPATIENT 4 MCCULLOUGH HYDE MEMORIAL HOSPITAL

1390 EATON RD HAMILTON OH 45013

X PHYSICAL THERAPY 5 MCCULLOUGH HYDE MEMORIAL HOSPITAL

2449 ROSS-MILLVILLE RD HAMILTON OH 45013

X OUTPATIENT-URGENT CARE-PT MCCULLOUGH-HYDE MEMORIAL HOSPITAL 1 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 $ 8365196. PART II: MCCULLOUGH-HYDE MEMORIAL HOSPITAL PROMOTES HEALTH AND WELLBEING IN OUR COMMUNITY IN NUMEROUS WAYS NOT LISTED IN THE COMMUNITY EVENTS AND PROGRAMS SECTION OF THE 990. EXAMPLES INCLUDE: 1. MHMH HELPED PROMOTE WELLNESS BY PROVIDING MEETING SPACE TO THE INFANT/CHILD LOSS BEREAVEMENT SUPPORT GROUP AND FIBROMYALGIA SUPPORT GROUP. 2. MHMH ASSISTED OUR LOCAL SCHOOL DISTRICT WITH IDENTIFIEDHEALTH/WELLNESS NEEDS. EXAMPLES INCLUDE: A. DEVELOPED AND PROVIDED CRISIS CARDS FOR ALL 8TH GRADERS AND ALL COUNSELORS IN THE SCHOOL DISTRICT B. DEVELOPED CURRICULUM THAT COMBINED TRADITIONAL LEARNING WITH EXERCISE TO HELP FIGHT OBESITY IN OUR ELEMENTARY STUDENTS C. DEVELOPED AND HELD MINI HEALTH SEMINARS FOR 6TH GRADE STUDENTS ON SLEEP, NUTRITION, EXERCISE AND MENTAL HEALTH 3. MHMH PROVIDED OFFICE SPACE AND MEETING SPACE FOR THE OXFORD COLLEGE CORNER CLINIC, WHICH IS A CLINIC THAT PROVIDES FREE HEALTH CARE TO THE UNINSURED AND UNDERINSURED ADULTS IN OUR COMMUNITY 4. MHMH IMPROVED THEIR EMPLOYEE WELLNESS PROGRAM BY: A. IMPLEMENTING A HEALTH RISK ASSESSMENT FOR THEIR EMPLOYEES TO IDENTIFY HEALTH NEEDS/CONCERNS IN OUR EMPLOYEE POPULATION B. OFFERING MAMMOGRAMS AND PROSTATE SCREENING TO APPROPRIATE EMPLOYEES FREE OF CHARGE C. INCENTIVIZING EMPLOYEES TO ADOPT HEALTHIER BEHAVIOR PART III, LINE 4: THE HOSPITAL HAS A DETAILED FINANCIAL ASSISTANCE POLICY WHICH STATES THAT TO PARTICIPATE IN CHARITY CARE CANDIDATES MUST COOPERATE FULLY. IN ADDITION THE HOSPITAL EDUCATES PATIENTS WITH LIMITED ABILITY TO PAY REGARDING FINANCIAL ASSISTANCE. FOR THIS REASON THE ORGANIZATION BELIEVES THAT IT ACCURATELY CAPTURES ALL CHARITY CARE DEDUCTIONS PROVIDED ACCORDING TO THE FINANCIAL ASSISTANCE POLICY AND THE AMOUNT OF BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S CHARITY CARE POLICY IS NEGLIGIBLE. PART III, LINE 8: THE SOURCE USED TO DETERMINE THE AMOUNT OF MEDICARE ALLOWABLE COSTS REPORTED FOR PART III, SECTION B, MEDICARE HAS BEEN PROVIDED FROM THE YEAR ENDED DECEMBER 31, 2010 REPORT: HOSPITAL STATEMENT OF REIMBURSABLE COST. PART III, LINE 9B: ONCE IT HAS BEEN DETERMINED THAT A PATIENT QUALIFIES FOR CHARITY CARE/FINANCIAL ASSISTANCE, COLLECTION PRACTICES ARE STOPPED. PART VI, LINE 2: MCCULLOUGH-HYDE USES A PROCESS OF ASSESSMENT TO GAUGE THE HEALTHCARE NEEDS OF THE COMMUNITY WE SERVE. THE COMPONENTS OF THAT PROCESS FOR 2010 WERE:1. A NINE-MONTH STRATEGIC PLANNING PROCESS WITH INPUT FROM VARIOUS STAKEHOLDER GROUPS INCLUDING THE MEDICAL STAFF, THE LOCAL COMMUNITY FOUNDATION, THE LOCAL FREE MEDICAL CLINIC (OXFORD COLLEGE CORNER CLINIC), THE LOCAL SOCIAL NEEDS UMBRELLA ORGANIZATION (FAMILY RESOURCE CENTER), AND SEVERAL SMALLER FOCUS GROUPS OF PATIENTS, COMMUNITY LEADERS, AND NON-PATIENTS.2. ALL UNINSURED EMERGENCY DEPARTMENT PATIENTS ARE ASSESSED BY STAFF AND REFERRED TO THE LOCAL FREE MEDICAL CLINIC FOR FOLLOW-UP CARE AND ASSISTANCE, WHEN APPROPRIATE. THAT DATA INFORMS POTENTIAL EDUCATION AND SERVICE PROGRAMS THAT THE HOSPITAL OFFERS TO THE COMMUNITY.3. ON-GOING PARTNERSHIPS WITH MIAMI UNIVERSITY, THE CITY OF OXFORD, AND THE LOCAL SCHOOL DISTRICT TO JOINTLY ADDRESS SPECIFIC HEALTH CARE NEEDS OF THEIR RESPECTIVE POPULATIONS.4. AN ON-GOING, LESS FORMAL PROGRAM, GATHERS INPUT FROM MINISTERS IN OUR CHAPLAIN PROGRAM AND FROM OUR MANY VOLUNTEERS. PART VI, LINE 3: FINANCIAL COUNSELORS ARE LOCATED IN THE PATIENT ACCESS AREAS AND PATIENTS ARE OFTEN REFERRED TO THEM AFTER THE COMPLETION OF THE REGISTRATION PROCESS. IN THE EVENT THAT FINANCIAL COUNSELORS ARE NOT AVAILABLE PATIENT ACCESS STAFF IS EDUCATED ON THE CHARITY CARE/FINANCIAL ASSISTANCE POLICIES AND HAVE APPLICATIONS AVAILABLE. CHARITY CARE INFORMATION IS ALSO INCLUDED ON OUR PATIENT STATEMENTS. ALL CUSTOMER SERVICE REPRESENTATIVES ARE FAMILIAR WITH OUR POLICIES AND CAN SPEAK TO OUR CUSTOMERS ABOUT CHARITY CARE/FINANCIAL ASSISTANCE ELIGIBILITY. BROCHURES EXPLAINING CHARITY CARE/FINANCIAL ASSISTANCE ARE ALSO AVAILABLE IN VARIOUS LOCATIONS THROUGHOUT THE HOSPITAL. PART VI, LINE 4: MCCULLOUGH HYDE MEMORIAL HOSPITAL SERVES A DIVERSE DEMOGRAPHIC INCLUDING THE NORTHWESTERN CORNER OF BUTLER COUNTY, OHIO, THE SOUTHWESTERN CORNER OF PREBLE COUNTY, OHIO AND THE COUNTIES OF FRANKLIN, UNION AND FAYETTE IN INDIANA. THE MAIN CAMPUS IS LOCATED IN OXFORD, OHIO, THE HOME OF MIAMI UNIVERSITY WITH A POPULATION RANGING TO NEARLY 30,000 DURING THE SCHOOL YEAR TO HALF THAT NUMBER DURING THE SUMMER.MHMH COUNTS ITS PRIMARY SERVICE AREA AS THE FOLLOWING: OXFORD,OH - 45056 - POPULATION 29,739 BROOKVILLE, IN - 47012 - POPULATION 10,455 COLLEGE CORNER, OH - 45003 - POPULATION 971 EATON, OH - 45320 - POPULATION 15,354 SOMERSVILLE, OH - 45064 - 2,963 CAMDEN, OH - 45311 - 7,215 LIBERTY, IN - 47353 - 5,698 WEST COLLEGE CORNER, IN - 47003 - 834 TOTAL PRIMARY SERVICE AREA POPULATION = 73,229AND ITS PRIMARY AND ITS SECONDARY SERVICE AREAS ARE THE FOLLOWING: HAMILTON, OH - 45013 - 54,814 CONNERSVILLE, IN - 47331 - 23,438 METAMORA, IN - 47030 - 1,631 OKEANA, OH - 45053 - 3,712 TOTAL SECONDARY SERVICE AREA POPULATION = 83,595IN TERMS OF SOCIO-ECONOMIC DEMOGRAPHICS, THE EDUCATIONAL ATTAINMENT IS LOWER THAN COUNTY, STATE AND NATIONAL AVERAGES AND THE UNEMPLOYMENT HIGHER THAN COUNTY, STATE AND NATIONAL AVERAGES IN ALL OF THE UNINCORPORATED AND RURAL AREAS SERVED BY MHMH. ALL OF THE AREAS IN INDIANA AND THE RURAL AREAS IN PREBLE AND BUTLER COUNTIES (CAMDEN, SOMERVILLE) ARE DESIGNATED AS HEALTH PROFESSIONAL SHORTAGE AREAS BY THE NATIONAL HEALTH SERVICE CORPS.MCCULLOUGH HYDE HAS RECRUITED, SUPPORTED AND WILL CONTINUE TO RECRUIT AND SUPPORT BOTH PRIMARY CARE PHYSICIANS AND SPECIALISTS TO MEET THE NEEDS OF RESIDENTS OF THESE COMMUNITIES. 0 TALAWANDA SCHOOL DISTRICT 131 WEST CHESTER ST OXFORD OH 45056 316005340 10000 SCHOOL PROGRAMS 1 X X X X 0 0 0 0 0 0 0 0 0 CHRISTOPHER LAUER 177752 0 13733 0 8287 0 0 0 13771 0 213543 0 0 0 BRYAN HEHEMANN 220014 0 0 0 4467 0 0 0 13836 0 238317 0 0 0 KENNETH KELLER MD 242003 0 0 0 4570 0 0 0 18924 0 265497 0 0 0 MATTHEW BIRKLE MD 245298 0 0 0 0 0 0 0 18905 0 264203 0 0 0 BUTLER COUNTY-SERIES 2009A 316000061 2003-05-07 17223844 CONTRUCTION/EXPANSION 0 0 0 BUTLER COUNTY-SERIES 2009B 316000061 2003-05-07 4776156 CONTRUCTION/EXPANSION 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 FORM 990, PART VI, SECTION B, LINE 11 THE 990 IS PROVIDED TO THE FINANCE COMMITTEE FOR THEIR REVIEW AND APPROVAL. THE RETURN WILL THEN BE PRESENTED TO THE ENTIRE BOARD FOR FINAL APPROVAL. FORM 990, PART VI, SECTION B, LINE 12C ANNUALLY THE CORPORATE COMPLIANCE OFFICER REQUIRES THE OFFICERS, TRUSTEES, DIRECTORS AND KEY EMPLOYEES TO DISCLOSE IN WRITING ANY INTEREST THAT COULD GIVE RISE TO CONFLICTS. FORM 990, PART VI, SECTION B, LINE 15 THE PROCESS FOR DETERMINING COMPENSATION INCLUDES INDEPENDENT CONSULTANT INPUT, WRITTEN EMPLOYMENT CONTRACT, COMPENSATION SURVEY STUDY AND APPROVAL BY THE BOARD. FORM 990, PART VI, SECTION C, LINE 19 UPON INDIVIDUAL REQUEST MCCULLOUGH-HYDE MEMORIAL HOSPITAL ENDOWMENT 110 NORTH POPLAR OXFORD OH 45056 237374256 OBTAIN CHARITABLE CONTRIBUTIONS, MANAGE THEM AND DISBURSE BY BOARD DIRECTION OH 501(C)(3) LINE 11A, I 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 MCCULLOUGH-HYDE MEMORIAL HOSPITAL ENDOWMENT C