2011-11-15T11:47:53-06:00 2010-12-31 S R SNODGRASS AC 4134 PARK AVENUE ASHTABULA OH 44004 990 2010-01-01 340726081 ASHTABULA COUNTY MEDICAL CENTER ASHT 4409972262 2420 LAKE AVENUE ASHTABULA OH 44004 ALANNA DAMES 4409976553 2011-11-15 1 RICHARD VANEK 4409932142 2010 2016-03-07 17:11:31Z KEVIN MILLER 2420 LAKE AVENUE ASHTABULA OH 44004 97342156 0 X WWW.ACMCHEALTH.ORG X 1902 OH OPERATION OF HOSPITAL 18 14 1070 0 289050 -89690 63729 330859 88547050 89954226 415816 133617 549777 1011074 89576372 91429776 0 0 0 0 47206960 48889551 0 0 0 38878803 39952806 86085763 88842357 3490609 2587419 67911679 72037415 32610700 34747560 35300979 37289855 TO PROVIDE THE BEST POSSIBLE MEDICAL CARE THROUGH ALL PHASES OF LIFE TO THOSE SEEKING HELP. THE ACMC HEALTH CARE TEAM IS COMMITTED TO PRESERVING THE HUMAN RIGHTS AND DIGNITY OF THOSE WHO RECEIVE OUR CARE AND THOSE WHO PROVIDE IT. 0 0 72850733 90586204 ASHTABULA COUNTY MEDICAL CENTER IS A PRIVATE, NOT-FOR-PROFIT COMMUNITY ORIENTED MEDICAL CENTER THAT PROVIDES THE BEST POSSIBLE MEDICAL CARE THROUGH ALL PHASES OF LIFE TO THOSE SEEKING HELP. IN 2010 WE MET OUR MISSION OF MEETING OUR COMMUNITY'S HEALTH CARE NEEDS AS EVIDENCED BY APPROXIMATELY 33,842 EMERGENCY DEPARTMENT VISITS, 6,294 INPATIENT DISCHARGES, 1,755 INPATIENT SURGERIES, 7,201 OUTPATIENT SURGERIES, 497 BIRTHS, AND 73,484 RADIOLOGY PROCEDURES. IN 2010, ACMC PROVIDED CHARITY HEALTH CARE SERVICES TO PEOPLE UNABLE TO PAY IN THE AMOUNT OF $6,354,652. 72850733 1 0 0 0 0 0 0 0 0 1 1 0 1 0 0 0 1 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 0 0 0 0 1 0 0 0 0 0 0 1 0 0 0 0 1 63 0 1070 1 1 1 0 0 0 0 0 0 0 X 18 14 0 1 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 OH X ALANNA DAMES 4409976553 2420 LAKE AVENUE ASHTABULA OH 44004 REV NEROY CARTER 0.30 X 0 0 0 RICHARD MOLE 0.30 X 0 0 0 JOE GIANGOLA 0.30 X 0 0 0 MARTY COLE 0.30 X 0 0 0 BILL DINGLEDINE 0.30 X 0 0 0 ELEANOR JAMMAL 0.30 X 0 0 0 SUSAN STOCKER PHD 0.30 X 0 0 0 JOE VENDEL 0.30 X 0 0 0 STEVE WALLING 0.30 X 0 0 0 FRED DEGRANDIS 0.30 X 0 0 0 IAN GLASS MD 0.30 X 0 0 0 JASON HERGENROEDER 0.30 X 0 0 0 SUK K CHOI MD 60.00 X X 510752 0 0 ASHOK V KONDRU MD 0.30 X 0 0 0 NAFISA KONDRU MD 0.30 X 0 0 0 TIM O'BRIEN MD 60.00 X X 252270 0 0 DAVID L PARKER MD 60.00 X X 262185 0 0 SHIRLEY VIALL 0.30 X 0 0 0 KEVIN MILLER 40.00 X X 0 0 0 ROGER CORLETT 0.30 X 0 0 0 PHILIP PAWLOWSKI 40.00 X 0 0 0 DAVE MORONY 40.00 X 123167 0 0 MERILEE REBERA 40.00 X 127906 0 0 LEW HUTCHISON 40.00 X 0 0 0 ROBERT SINCICH 40.00 X 0 0 0 TINA STASIEWSKI 40.00 X 77524 0 0 KERRY GERKEN 40.00 X 0 0 0 PAT WESTON-HALL 40.00 X 0 208371 0 KATHY CRAWFORD 40.00 X 0 0 0 MOUHAMAD S KABBANI 60.00 X 634113 0 0 JAMES CHILLCOTT 60.00 X 541601 0 0 ALEXANDER TAICH 60.00 X 506357 0 0 MARK A CABELIN 60.00 X 455180 0 0 LAXMAN R CINGIREDDI 60.00 X 412180 0 0 3903235 208371 0 36 0 1 0 AVI FOODSYSTEMS INC 2590 ELM ROAD NE WARREN OH 44483 CAFETERIA AND DIETARY SERVICES 1794749 HMP OF ASHTABULA COUNTY LTD 4535 DRESSLER ROAD CANTON OH 44718 HOSPITALIST MED/PROF SERVICES 926604 CLEVELAND CLINIC REF LAB 9500 EUCLID AVE CLEVELAND OH 44106 LABORATORY TESTING 913259 SS&G HEALTHCARE SERVICE 32125 SOLON ROAD CLEVELAND OH 44139 PHYSICIAN BILLING SERVICE 770109 CLEVELAND CLINIC FOUNDATION PO BOX 70060 CLEVELAND OH 44193 ADMINISTRATIVE SERVICES 719484 8 250000 80859 330859 PATIENT REVENUE 622110 89954226 89954226 89954226 223663 223663 5822334 5912205 175 -89871 -175 -90046 -90046 REBATES & REFUNDS 900099 330454 330454 PREMIER FITNESS 713940 289050 289050 MISC OPERATING REV 900099 194046 194046 197524 197524 1011074 91429776 90586204 289050 223663 1515938 1243071 272867 37202887 30506367 6696520 1580751 1296216 284535 5844636 4792602 1052034 2745339 2251178 494161 153378 125770 27608 74651 61214 13437 1713737 1405264 308473 112235 92033 20202 20473 16788 3685 3205429 2628452 576977 SUPPLIES 13625455 11172873 2452582 MEDICAL SERVICES & FEES 7993499 6554669 1438830 EQUIPMENT RENTAL/MAINTE 3951640 3240345 711295 PURCHASED ADMINISTRATIV 2835085 2324770 510315 INSURANCE 2102342 1723920 378422 4164882 3415201 749681 88842357 72850733 15991624 0 1677 1680 14511802 17678045 10827690 11490263 894310 727246 639910 897419 82992286 62836032 20811304 20156254 14272802 14591088 5952184 6495420 67911679 72037415 13497996 14556794 1891629 1896081 1781894 1364894 15439181 16929791 32610700 34747560 X 33741707 35476912 1559272 1812943 35300979 37289855 67911679 72037415 X 2587419 -598543 X 0 1 1 X 0 X 1900568 1900568 25810311 18181361 7628950 1883288 1598784 284504 52078173 43055887 9022286 1319946 1319946 20156254 INVESTMENTS IN SUBSIDIARIES 2319775 F OTHER INVETSMENTS 779 F INVESTMENT - DEF COMP PLAN 1886586 F EQUITIES 10383948 F 14591088 SELF-INSURANCE INVESTMENTS 5523283 OTHER RECEIVABLES-NET 882456 DUE FROM AFFILIATES 61608 OTHER ASSETS 28073 6495420 SELF INSURANCE 8805499 PENSION LIABILITY 8124292 16929791 1 1 X 1 X 0 1 1 0 0 2058907 2058907 0.02320 2058907 2058907 0.02320 2058907 2058907 0.02320 1 2381267 0 1 0 1 1 ASHTABULA COUNTY MEDICAL CENTER

2420 LAKE AVENUE ASHTABULA OH 44004

X X X NOT REQUIRED 1 0 0 0 0 0 0 0 0 0 0 0 X X X 0 0 0 0 0 0 0 0 0 SUK K CHOI MD 510752 0 0 0 0 0 0 0 0 0 510752 0 0 0 TIM O'BRIEN MD 252270 0 0 0 0 0 0 0 0 0 252270 0 0 0 DAVID L PARKER MD 262185 0 0 0 0 0 0 0 0 0 262185 0 0 0 PAT WESTON-HALL 0 208371 0 0 0 0 0 0 0 0 0 208371 0 0 MOUHAMAD S KABBANI 634113 0 0 0 0 0 0 0 0 0 634113 0 0 0 JAMES CHILLCOTT 541601 0 0 0 0 0 0 0 0 0 541601 0 0 0 ALEXANDER TAICH 506357 0 0 0 0 0 0 0 0 0 506357 0 0 0 MARK A CABELIN 455180 0 0 0 0 0 0 0 0 0 455180 0 0 0 LAXMAN R CINGIREDDI 412180 0 0 0 0 0 0 0 0 0 412180 0 0 0 KIMBERLY GIANGOLA WIFE 18541 EMPLOYMENT AGREEMENT WITH ACMC 0 FORM 990, PART VI, SECTION A, LINE 3 THE CLEVELAND CLINIC HOLDS AND EXERCISES A MANAGEMENT AGREEMENT WITH ACMC. FORM 990, PART VI, SECTION B, LINE 11 THE FORM 990 REPORT IS E-MAILED TO THE CHAIRMAN OF THE FINANCE COMMITTEE WHEN IT IS RECEIVED FROM THE PREPARER. AFTER REVIEW AND APPROVAL BY THE COMMITTEE, THE FORM 990 IS THEN PRESENTED TO THE BOARD FOR FINAL APPROVAL BEFORE FILING. FORM 990, PART VI, SECTION B, LINE 12C ALL OFFICERS, TRUSTEES, AND KEY EMPLOYEES ARE REQUIRED TO ANNUALLY REVIEW AND SIGN A CONFLICT OF INTEREST POLICY ACKNOWLEDGEMENT FORM. FORM 990, PART VI, SECTION B, LINE 15 SALARIES ARE REVIEWED AT A MINIMUM OF EVERY TWO YEARS. THEY ARE COMPARED TO LOCAL, REGIONAL,AND NATIONAL MARKET RATES AND IN CONJUNCTION WITH THE CEO AND CFO TO DETERMINE COMPENSATION. WHEN OPENINGS FOR KEY POSITIONS BECOME AVAILABLE, THE HR DEPARTMENT EXAMINES THE MARKET RATES TO DETERMINE A STARTING SALARY. EVERY YEAR THE TYPICAL SALARY HAS A 3% MERIT RATE INCREASE. FORM 990, PART VI, SECTION C, LINE 19 ALL REQUESTS ARE SENT TO THE CEO FOR DISTRIBUTION. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED GAINS ON INVESTMENTS: 405,122. INTERCOMPANY TRANFER FROM ACMC FOUNDATION 31,106. DIVIDENDS TO CLEVELAND CLINIC -1,646,000. EQUITY IN AFFILIATES 611,229. TOTAL TO FORM 990, PART XI, LINE 5: -598,543. ACMC FOUNDATION 2420 LAKE AVENUE ASHTABULA OH 44004 341392784 SUPPORTS THE ASHTABULA COUNTY MEDICAL CENTER OH 501(C)(3) ACTIVE 0 ROCK CREEK MEDICAL CENTER DBA GLENBEIGH HEALTH SOURCES RT 45 RIVERDALE ROAD ROCK CREEK OH 44084 341789783 OPERATE AND MAINTAIN A HOSPITAL AND OUTPATIENT CENTERS OH 501(C)(3) ACTIVE 0 ASHTABULA REGIONAL HOME HEALTH SERVICES 3949 JEFFERSON ROAD ASHTABULA OH 44004 341143158 HOME HEALTH SERVICES OH 501(C)(3) ACTIVE 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 1 ROCK CREEK MEDICAL CENTER DBA GLENBEIGH HEALTH SERVICES D 12634 LOAN RECORDS ACMC FOUNDATION D 38236 LOAN RECORDS ASHTABULA REGIONAL HOME HEALTH SERVICES D 10738 LOAN RECORDS ROCK CREEK MEDICAL CENTER DBA GLENBEIGH HEALTH SERVICES P 58138 CASH RECEIVED ACMC FOUNDATION P 101716 CASH RECEIVED ACMC FOUNDATION R 31106 CASH RECIEVED