4A (Expenses $ 359562227 including grants of $ 0) (Revenue $ 418863977)
LAKE HOSPITAL SYSTEM, INC., IS A 120-YEAR-OLD HEALTH CARE INSTITUTION THAT HAS PRIMARILY SERVED THE HEALTH CARE NEEDS OF RESIDENTS IN LAKE COUNTY AND THE SURROUNDING COMMUNITIES SINCE 1902. LAKE HEALTH HAS HAD A LONG-STANDING TRADITION OF PROVIDING SERVICES AND PROGRAMS BASED ON THE HEALTH CARE NEEDS OF THE COMMUNITIES THAT WE SERVE. WE HAVE BEEN GUIDED BY OUR MISSION TO PROVIDE LOCAL ACCESS, HEALING WITH COMPASSION AND SUPERIOR QUALITY AND OUR CORE VALUES - RESPECT, INNOVATION, TEAMWORK, STEWARDSHIP, AND INTEGRITY. WE HAVE BEEN GUIDED BY A COLLABORATIVE HEALTH NEEDS ASSESSMENT CONDUCTED IN COOPERATION WITH THE LAKE COUNTY GENERAL HEALTH DISTRICT, LAKE HEALTH HAS DEVELOPED PROGRAMS, SERVICES AND PARTNERSHIPS TO ADDRESS THE MOST PRESSING HEALTH ISSUES. THE HIGH PRIORITY AREAS INCLUDE COVID 19, DIABETES, CHRONIC DISEASE, BEHAVIORAL HEALTH, AND ACCESS TO CARE. IN APRIL 2021, LAKE HEALTH JOINED UNIVERSITY HOSPITALS. AS SUCH, LAKE HEALTH'S TAX ID REMAINS THE SAME, AND IT FILES ITS TAX RETURN INDEPENDENTLY FROM UH.LAKE HEALTH IS COMPRISED OF 11 FACILITIES IN LAKE, GEAUGA, AND CUYAHOGA COUNTIES, AND WHICH INCLUDE THE FOLLOWING:1. TRIPOINT MEDICAL CENTER (FULL-SERVICE, ACUTE CARE HOSPITAL)2. LAKE WEST MEDICAL CENTER (FULL-SERVICE, ACUTE CARE HOSPITAL)3. BEACHWOOD MEDICAL CENTER (FULL-SERVICE ACUTE CARE HOSPITAL)4. MENTOR HEALTH CENTER (OUTPATIENT LAB AND DIAGNOSTICS, PHYSICIAN OFFICES, OUTPATIENT SURGERY, CANCER SERVICES)5. BRUNNER, SANDEN DEITRICK WELLNESS CENTER (URGENT CARE, OUTPATIENT LAB AND DIAGNOSTICS, PHYSICIAN OFFICES, PHYSICAL THERAPY, OCCUPATIONAL HEALTH SERVICES AND A MEDICALLY BASED FITNESS CENTER)6. MADISON HEALTH CENTER (OUTPATIENT LAB AND DIAGNOSTICS, PHYSICIAN OFFICES, PHYSICAL THERAPY)7. WILLOWICK HEALTH CENTER (URGENT CARE, OUTPATIENT LAB AND DIAGNOSTICS, PHYSICIAN OFFICES)8. CHARDON HEALTH CENTER (, OUTPATIENT LAB AND DIAGNOSTICS, PHYSICIAN OFFICES)9. PERRICO HEALTH CENTER (PHYSICIAN OFFICES, PHYSICAL THERAPY, OUTPATIENT LAB AND DIAGNOSTICS)10. LAKE SOM HEALTH CENTER (PHYSICIAN OFFICES, LAB, AND DIAGNOSTICS)11. LAKE CONTINUING CARE CENTER (COMPREHENSIVE, INPATIENT REHABILITATION; GERIATRIC PSYCHIATRY)ACCESSIBILITY IS KEY TO OUR MISSION. WE HAVE CONTRACTED WITH MOST INSURANCE PROVIDERS TO ENSURE A VAST ARRAY OF PRIMARY CARE PHYSICIANS AND SPECIALISTS. LAKE HEALTH ALSO OPERATES THREE FULL-SERVICE EMERGENCY DEPARTMENTS INCLUDING: TRIPOINT MEDICAL CENTER IN CONCORD TOWNSHIP, LAKE WEST MEDICAL CENTER IN WILLOUGHBY AND BEACHWOOD MEDICAL CENTER IN BEACHWOOD. THESE EMERGENCY DEPARTMENTS ARE OPEN TO ALL PERSONS, REGARDLESS OF ABILITY TO PAY.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 HEALTH PROVIDES SERVICES AND PROGRAMS BASED ON THE HEALTH CARE NEEDS OF THE COMMUNITIES WE SERVE. IN FACT, TAKING HEALTH EDUCATION PROGRAMS AND SCREENINGS TO WHERE PEOPLE LIVE, WORK AND PLAY IS FUNDAMENTAL TO OUR MISSION. IN 2021, WE CONTINUED OUR MISSION OF HELPING TO CARE AND EDUCATE OUR COMMUNITIES REGARDING COVID-19. WE ALSO PUT A FOCUS ON HELPING PATIENTS FEEL COMFORTABLE TO RETURN FOR HEALTH CARE IN OUR COMMUNITIES AND PROVIDING ADDITIONAL ACCESS FOR PATIENTS.IN 2021, LAKE HEALTH PROVIDED APPROXIMATELY $450,000 IN COMMUNITY BENEFIT THROUGH HEALTH EDUCATION, WHICH CONTINUED TO FOCUS ON LAKE HEALTH CONTRIBUTED APPROXIMATELY $8.5 MILLION IN 2021 IN CASH AND IN-KIND DONATIONS TO CIVIC AND COMMUNITY PROGRAMS AND PARTNERSHIPS WITH A HEALTH AND WELLNESS FOCUS. SOME OF THE PROGRAMS AND EVENTS ARE HIGHLIGHTED BELOW.COMMUNITY PROGRAMS AND EVENTS:LAKE HEALTH CONTINUED TO BE AN ANCHOR INSTITUTE IN COMMUNITY BY SUPPORTING OVER 50 LOCAL ORGANIZATION WITH AN EMPHASIS ON SUPPORTING ORGANIZATIONS THAT ALIGNED WITH PROVIDING SUPPORT AS IDENTIFIED IN OUR COMMUNITY HEALTH NEEDS ASSESSMENT. INCLUDING, LAKE COUNTY FREE MEDICAL CLINIC, LAKE COUNTY COUNCIL ON AGING, AND FORBES HOUSE. WE ALSO CONTINUED TO PROVIDING COMMUNITY PROGRAMS INCLUDING: INFANT AND CHILDBIRTH PROGRAMS INCLUDING CHILDBIRTH PREPARATION, INFANT CARE, BREASTFEEDINGPROGRAM, SIBLING PROGRAM, INFANT AND CHILD CPR, AND CAR SEAT CHECKS.SUPPORT GROUPS, INCLUDING BREASTFEEDING, BREAST CANCER, DIABETES, STROKE, AND AMPUTEE UNITED WAY DAY OF CARING AND HARVEST FOR HUNGERSCHOOL PARTNERSHIPSBREAST HEALTH FOR HISPANIC WOMENINTEGRATIVE HEALTH AND WELLNESS

WEST MEDICAL CENTER
"PART V, SECTION B, LINE 5: LAKE HEALTH IDENTIFIED COMMUNITY HEALTH NEEDS BY UNDERGOING A NEEDS ASSESSMENT PROCESS. THIS PROCESS INCORPORATED A COMPREHENSIVE REVIEW BY LAKE HEALTH'S SENIOR LEADERSHIP TEAM ALONG WITH SECONDARY AND PRIMARY DATA INPUT COMPILED USING THE EXPERTISE OF DIXON HUGHES GOODMAN, LLP (""DHG"") AND ARTOWER ADVISORY SERVICES, LLC (""ARTOWER""). THE COLLECTIVE COMMUNITY HEALTH NEEDS ASSESSMENT (""CHNA"")TEAM REVIEWED SEVERAL SOURCES OF QUANTITATIVE HEALTH, AS WELL AS SOCIAL AND DEMOGRAPHIC DATA SPECIFIC TO LAKE HEALTH'S SERVICE AREA. LAKE HEALTH ALSO TOOK ADVANTAGE OF THIS OPPORTUNITY TO COLLABORATE WITH ITS ADMINISTRATORS, PHYSICIANS, PUBLIC HEALTH AGENCIES, AND LOCAL ORGANIZATIONS IN IDENTIFYING AND ADDRESSING THE NEEDS OF THE COMMUNITY."

TRIPOINT MEDICAL CENTER
"PART V, SECTION B, LINE 5: LAKE HEALTH IDENTIFIED COMMUNITY HEALTH NEEDS BY UNDERGOING A NEEDS ASSESSMENT PROCESS. THIS PROCESS INCORPORATED A COMPREHENSIVE REVIEW BY LAKE HEALTH'S SENIOR LEADERSHIP TEAM ALONG WITH SECONDARY AND PRIMARY DATA INPUT COMPILED USING THE EXPERTISE OF DIXON HUGHES GOODMAN, LLP (""DHG"") AND ARTOWER ADVISORY SERVICES, LLC (""ARTOWER""). THE COLLECTIVE COMMUNITY HEALTH NEEDS ASSESSMENT (""CHNA"")TEAM REVIEWED SEVERAL SOURCES OF QUANTITATIVE HEALTH, AS WELL AS SOCIAL AND DEMOGRAPHIC DATA SPECIFIC TO LAKE HEALTH'S SERVICE AREA. LAKE HEALTH ALSO TOOK ADVANTAGE OF THIS OPPORTUNITY TO COLLABORATE WITH ITS ADMINISTRATORS, PHYSICIANS, PUBLIC HEALTH AGENCIES, AND LOCAL ORGANIZATIONS IN IDENTIFYING AND ADDRESSING THE NEEDS OF THE COMMUNITY."

WEST MEDICAL CENTER
PART V, SECTION B, LINE 6A: AS ALLOWED BY IRS GUIDELINES, LAKE HEALTH DECIDED TO PRODUCE A JOINT CHNA REPORT FOR ITS TWO LAKE COUNTY HOSPITALS, WEST MEDICAL CENTER AND TRIPOINT MEDICAL CENTER. GUIDELINES STATE THAT COLLABORATING FACILITIES MUST DEFINE THEIR COMMUNITIES TO BE THE SAME AND CONDUCT A JOINT CHNA PROCESS.

TRIPOINT MEDICAL CENTER
PART V, SECTION B, LINE 6A: AS ALLOWED BY IRS GUIDELINES, LAKE HEALTH DECIDED TO PRODUCE A JOINT CHNA REPORT FOR ITS TWO LAKE COUNTY HOSPITALS, WEST MEDICAL CENTER AND TRIPOINT MEDICAL CENTER. GUIDELINES STATE THAT COLLABORATING FACILITIES MUST DEFINE THEIR COMMUNITIES TO BE THE SAME AND CONDUCT A JOINT CHNA PROCESS.

WEST MEDICAL CENTER
PART V, SECTION B, LINE 11: IN ACKNOWLEDGING THE WIDE RANGE OF PRIORITY HEALTH ISSUES THAT EMERGED FROM THE CHNA PROCESS, LAKE HEALTH WILL FOCUS ON THOSE MOST WITHIN ITS IMMEDIATE ABILITY TO INFLUENCE.

TRIPOINT MEDICAL CENTER
PART V, SECTION B, LINE 11: IN ACKNOWLEDGING THE WIDE RANGE OF PRIORITY HEALTH ISSUES THAT EMERGED FROM THE CHNA PROCESS, LAKE HEALTH WILL FOCUS ON THOSE MOST WITHIN ITS IMMEDIATE ABILITY TO INFLUENCE.

WEST MEDICAL CENTER
PART V, SECTION B, LINE 15E: THE CONTACT INFORMATION FOR SOURCES OF ASSISTANCE WITH FAP APPLICATIONS IS ON THE LAKE HEALTH WEBSITE BUT NOT CURRENTLY ON THE FAP OR FAP APPLICATION.

TRIPOINT MEDICAL CENTER
PART V, SECTION B, LINE 15E: THE CONTACT INFORMATION FOR SOURCES OF ASSISTANCE WITH FAP APPLICATIONS IS ON THE LAKE HEALTH WEBSITE BUT NOT CURRENTLY ON THE FAP OR FAP APPLICATION.

PART V, SECTION B, LINE 22D
UNINSURED PATIENTS WHO DO NOT QUALIFY FOR LAKE HEALTH'S FINANCIAL ASSISTANCE PROGRAM ARE BILLED FOR GROSS CHARGES AND ARE OFFERED A 30% PROMPT PAY DISCOUNT IF PAYMENT IS RECEIVED WITHIN 30 DAYS OF THE FIRST PATIENT STATEMENT OR A PAYMENT PLAN IS AGREED UPON. THEMAXIMUM AMOUNTS THAT CAN BE CHARGED TO FAP-ELIGIBLE INDIVIDUALS FOR EMERGENCY OR OTHER MEDICALLY NECESSARY CARE ARE THE AMOUNTS GENERALLY BILLED TO INDIVIDUALS WHO HAVE INSURANCE COVERING SUCH CARE.

PART I, LINE 3C:
OHIO HOSPITAL CARE ASSURANCE PROGRAM (HCAP)AS A PARTICIPANT IN THE HCAP PROGRAM, LAKE HEALTH OFFERS EMERGENCY AND OTHER MEDICALLY NECESSARY HOSPITAL-LEVEL SERVICES FREE OF CHARGE IF YOU ARE A RESIDENT OF OHIO AND EITHER (1) YOU ARE CURRENTLY AN ELIGIBLE RECIPIENT OF THE GENERAL ASSISTANCE OR THE DISABILITY ASSISTANCE PROGRAMS OR (2) YOUR INCOME IS AT OR BELOW 100% OF THE FEDERAL POVERTY GUIDELINES (FPG).LAKE HEALTH ASSISTIN ADDITION TO HCAP, LAKE HEALTH HAS A FINANCIAL ASSISTANCE POLICY CALLED LAKE HEALTH ASSIST. THIS PROVIDES FINANCIAL ASSISTANCE FOR EMERGENCY AND OTHER MEDICALLY NECESSARY CARE DISCOUNTED FROM OUR NORMAL CHARGES IF YOU ARE AN UNINSURED OHIO RESIDENT AND YOUR INCOME DOES NOT EXCEED FOUR TIMES THE FEDERAL POVERTY GUIDELINES (FPG). ALL APPLICANTS WILL BE SCREENED FOR MEDICAID COVERAGE AND MUST COOPERATE WITH THE MEDICAID REPRESENTATIVES TO BE ELIGIBLE FOR ASSISTANCE UNDER OUR FINANCIAL ASSISTANCE POLICY. THE FINANCIAL ASSISTANCE POLICY DOES NOT APPLY TO NON-OHIO RESIDENTS, INDIVIDUALS WITH INSURANCE, MEDICAID, OR MEDICAID PE. IF YOU ARE ELIGIBLE FOR FINANCIAL ASSISTANCE UNDER OUR FINANCIAL ASSISTANCE POLICY, YOU WILL RECEIVE FREE OR OTHER DISCOUNTED ASSISTANCE ACCORDING TO THE SCALE. PAYMENT OF THE FULL BALANCE IS NOT REQUIRED PRIOR TO RECEIVING THE DISCOUNT; AFTER A FINANCIAL ASSISTANCE DISCOUNT IS APPLIED, THE REMAINING BALANCE WILL BE BILLED TO THE PATIENT.

PART I, LINE 6A:
COMMUNITY BENEFIT REPORT IS PREPARED BY UH LAKE HEALTH MARKETING AND FINANCE DEPARTMENT.

PART I, LINE 7:
A COST-TO-CHARGE RATIO IS USED. THIS RATIO TAKES THE TOTAL COSTS, INCLUDING ALLOCATED COSTS FROM OVERHEAD DEPARTMENTS, OF PROVIDING PATIENT CARE DIVIDED BY TOTAL GROSS REVENUE.

PART I, LINE 7G:
SUBSIDIZED HEALTH SERVICES INCLUDE VARIOUS FREE COMMUNITY SCREENING EVENTS FOR HEALTH CONDITIONS SUCH AS BLOOD PRESSURE, CHOLESTEROL, BONE DENSITY, PROSTATE CANCER, SKIN CANCER, HEART DISEASE AND OBESITY.

PART I, LN 7 COL(F):
AN ESTIMATED PROVISION FOR UNCOLLECTIBLE ACCOUNTS IS RECORDED THAT RESULTS IN NET PATIENT SERVICE REVENUE BEING REPORTED AT THE ESTIMATED AMOUNTS EXPECTED TO BE COLLECTED. PATIENT ACCOUNTS RECEIVABLE ARE REDUCED BY AN ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS. THE ESTIMATION OF THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS IS BASED PRIMARILY ON THE TYPE AND AGE OF THE PATIENT ACCOUNTS RECEIVABLE AND THE EFFECTIVENESS OF COLLECTION EFFORTS. THE POLICY IS TO RESERVE A PORTION OF ALL SELF-PAY RECEIVABLES, INCLUDING AMOUNTS DUE FROM THE UNINSURED AND AMOUNTS RELATED TO CO-PAYMENTS AND DEDUCTIBLES, AS THESE CHARGES ARE RECORDED. PATIENT ACCOUNTS RECEIVABLE BALANCES AND THE EFFECTIVENESS OF THE RESERVE POLICIES ARE REVIEWED ON A MONTHLY BASIS, AND VARIOUS ANALYTICS SUPPORT THE BASIS FOR THE ESTIMATES. ROUTINE HINDSIGHT PROCEDURES ARE PERFORMED TO EVALUATE HISTORICAL WRITE-OFF AND COLLECTION EXPERIENCE TO DETERMINE THE REASONABLENESS OF THE PROCESS FOR ESTIMATING THE ALLOWANCE FOR BAD DEBT. CHARITY CARE AND OTHER COMMUNITY BENEFITS AS A PERCENTAGE OF EXPENSE IS CALCULATED USING TOTAL EXPENSES FROM FORM 990, PART IX LESS BAD DEBT EXPENSE OF $35,625,368 FROM PART IX.

PART II, COMMUNITY BUILDING ACTIVITIES:
COMMUNITY BUILDING ACTIVITIESLAKE HEALTH PROVIDES SERVICES AND PROGRAMS BASED ON THE HEALTH CARE NEEDS OF THE COMMUNITIES IT SERVES. TAKING HEALTH EDUCATION PROGRAMS AND SCREENINGS TO WHERE PEOPLE LIVE, WORK AND PLAY IS FUNDAMENTAL TO THE LAKE HEALTH MISSION. IN 2021, LAKE HEALTH CONTINUED TO PROVIDE EDUCATION AND ASSISTANCE WITH THE COVID-19 CRISIS EXPANDED TO INCLUDE CHRONIC DISEASES AND ACCESS TO HEALTH CARE. IN 2021, LAKE HEALTH PROVIDED APPROXIMATELY $450,000 IN COMMUNITY BENEFIT THROUGH HEALTH EDUCATION. LAKE HEALTH ALSO CONTRIBUTED OVER $8.5 MILLION IN CASH AND IN-KIND DONATIONS TO CIVIC AND COMMUNITY PROGRAMS AND PARTNERSHIPS WITH A HEALTH AND WELLNESS FOCUS. COALITION BUILDING LAKE HEALTH IS COMMITTED TO BRINGING THE BEST RESOURCES TOGETHER TO PROVIDE AN EXPANDED LEVEL OF COMMUNITY CARE, WHICH IS WHY IT IS INVOLVED IN MANY COMMUNITY COALITIONS AND PARTNERSHIPS TO IMPROVE THE HEALTH OF INDIVIDUALS IN THE SERVICE AREA.AS PART OF ITS MISSION, LAKE HEALTH HAS A LONG HISTORY OF PARTNERING WITH OTHERS IN THE COMMUNITY WHO SHARE OUR VALUES OF PROVIDING LOCAL ACCESS, HEALING WITH COMPASSION AND SUPERIOR QUALITY. THESE PARTNERSHIPS PROVED TO BE INVALUABLE DURING THIS CHALLENGING TIME. OUR PARTNERSHIP WITH THE LAKE COUNTY ALCOHOL, DRUG ADDICTION, AND MENTAL HEALTH SERVICES (ADAMHS) BOARD ALLOWED US TO PROVIDE IMMEDIATE SUPPORT TO OUR TEAM MEMBERS COPING WITH THE STRESS OF THE PANDEMIC, ALONG WITH LAKE HEALTH'S BEHAVIORAL HEALTH AND CRISIS INTERVENTION TEAM. WE ALSO CONTINUE TO OPERATE A SENIOR CARE POST-ACUTE CARE NETWORK IN COORDINATION WITH OUR LONG TERM CARE INSTITUTES. THE NETWORK HELPS US TO PROVIDE A MEDICAL DIRECTOR ON SITE IN ORDER TO HELP BETTER COORDINATE CARE AND KEEP MORE SENIORS OUT OF THE ACUTE HOSPITAL SETTING BY BRINGING CARE ON SITE. WE ALSO CONTINUE TO PARTNER WITH OUR LOCAL SCHOOLS BY OPENING ON SITE SCHOOL CLINICS. THOSE CLINICS INCLUDE: LAKELAND COMMUNITY COLLEGE, MENTOR SCHOOL DISTRICT CARDINAL CLINIC AND THE WILLOUGHBY-EASTLAKE SCHOOL DISTRICT WELLNESS CLINIC.

PART III, LINE 2:
BAD DEBT IS ESTIMATED USING A HINDSIGHT ANALYSIS ON PREVIOUS YEARS ACCOUNTS RECEIVABLE. THOSE PERCENTAGES ARE THEN APPLIED TO CURRENT YEAR ACCOUNTS RECEIVABLE BY PAYOR TO ESTIMATE THE AMOUNT OF UNCOLLECTIBLE. ANYTHING OVER 365 DAYS IS FULLY RESERVED.

PART III, LINE 3:
THERE IS NO ESTIMATE OF BAD DEBT ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S FINANCIAL ASSISTANCE POLICY. FOR PATIENTS WHO QUALIFY, THOSE PATIENTS ARE DEEMED TO BE UNABLE TO PAY AND ARE THEREFORE WRITTEN OFF TO CHARITY RATHER THAN BAD DEBT.

PART III, LINE 4:
PAGE 11 OF ATTACHED AUDITED FINANCIAL STATEMENTS, NOTE 2(G) - SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES, NET PATIENT SERVICE REVENUE ON THE BASIS OF HISTORICAL EXPERIENCE, A SIGNIFICANT PORTION OF THE SYSTEM'S UNINSURED PATIENTS WILL BE UNABLE OR UNWILLING TO PAY FOR THE SERVICES PROVIDED. THUS, THE SYSTEM RECORDS A SIGNIFICANT PROVISION FOR BAD DEBTS RELATED TO UNINSURED PATIENTS IN THE PERIOD THE SERVICES ARE PROVIDED.

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 WITH THE COMPLETION OF THE CHARITY/HCAP APPLICATION AND 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 THE 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 ABOUT 233,000) AND SELECTED ZIP CODES IN ITS SECONDARY SERVICE AREAS (CUYAHOGA, ASHTABULA AND GEAUGA COUNTIES WITH A POPULATION IN THE DEFINED ZIP CODES) OF 124,000. (POPULATION FIGURES ARE AS OF 2020.)

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 2021 WAS $61,097,345 THE PAYMENTS RELATED TO THESE SERVICES WERE $77,335,563 LEAVING A MEDICARE SHORTFALL OF $16,238,218 FOR THE YEAR.THE SYSTEM TREATS MEDICARE SHORTFALL AS COMMUNITY BENEFIT. THE REASONS FOR THIS TREATMENT INCLUDES (1) NON-NEGOTIABLE MEDICARE RATES ARE SOMETIMES NOT ALIGNED WITH THE TRUE COSTS OF TREATING MEDICARE PATIENTS; (2) THE SYSTEM IS ALLEVIATING THE FEDERAL GOVERNMENT'S BURDEN FOR DIRECTLY PROVIDING MEDICAL SERVICES; AND (3) IRS REV. RUL. 69-545 NOTES THAT IF A HOSPITAL SERVES PATIENTS WITH GOVERNMENT HEALTH BENEFITS, INCLUDING MEDICARE, THIS ACTION INDICATES THE HOSPITAL OPERATES TO PROMOTE THE HEALTH OF THE COMMUNITY.

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.PROCEDURE ELIGIBILITY 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 TEST 1. PATIENT DOES NOT HAVE GOVERNMENTAL OR PRIVATE INSURANCE COVERAGE; OR2. 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 MEANS TO PAY; OR5. PATIENT IS RESPONSIBLE FOR CO-PAYMENTS AND DEDUCTIBLES, CARRIES NO SECONDARY INSURANCE COVERAGE AND ONLY SOURCE OF INCOME IS SOCIAL SECURITY.PART 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 BASED UPON THE FEDERAL POVERTY INCOME GUIDELINES. IFFAMILY INCOME IS AT OR BELOW THE DESIGNATED THRESHOLD, THE PATIENT IS ELIGIBLE FOR THE PERCENT CHARITY DISCOUNT ASSOCIATED WITH THAT LEVEL OF INCOME; OR2. THE RELATIONSHIP BETWEEN THE PATIENT'S MEDICAL BILLS, FAMILY INCOME AND FAMILY ASSETS (INCLUDING, BUT NOT LIMITED TO SUCH ITEMS AS BANK ACCOUNTS, TRUSTS, PROPERTY, HOME EQUITY, ESTATE OR INVESTMENTS) INDICATES THAT THE PURSUIT OF PAYMENT WOULD ADVERSELY AFFECT THE WELL BEING OF THE PATIENT AND FAMILY MEMBERS, AND WHERE THE PAYMENT OF LAKE HOSPITAL'S BILL WOULD RESULT IN UNDUE HARDSHIP; OR3. PATIENT'S FAMILY INCOME EXCEEDS 250% OF THE FEDERAL INCOME POVERTY GUIDELINES, HOWEVER PATIENT HAS SUPPLIED INFORMATION TO SUPPORT EXCEPTIONAL LIVING CIRCUMSTANCES (I.E. TERMINAL ILLNESS, EXCESSIVE MEDICAL BILLS AND/OR MEDICATIONS, ETC.) OR 100% OF INCURRED CHARGES GREATER THAN 25% OF ANNUAL FAMILY INCOME (INCLUDING BANK ACCOUNTS, TRUSTS AND INVESTMENTS, BUT EXCLUDING PRIMARY RESIDENCE). BEFORE UNINSURED/UNCOMPENSATED CARE CAN BE AWARDED, THE FOLLOWING CONDITIONS MUST BE MET:1. IF LAKE HOSPITAL DETERMINES THAT THE PATIENT IS POTENTIALLY ELIGIBLE FOR MEDICAL ASSISTANCE, THE PATIENT MUST COOPERATE WITH LAKE HOSPITAL'S EFFORTS TO ESTABLISH ELIGIBILITY FOR GOVERNMENT ASSISTANCE PROGRAMS.2. IF LAKE HOSPITAL AWARDS UNINSURED/UNCOMPENSATED CARE, IT WILL ONLY COVER THE SERVICES PROVIDED UNDER THE ACCOUNT NUMBER(S) SHOWN ON THE ACCOMPANYING APPLICATION.3. PROOF OF INCOME AND FINANCIAL DOCUMENTATION WILL BE REQUESTED. (SEE HOSPITAL CARE ASSURANCE POLICY.)

PART VI, LINE 2:
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. THE SYSTEM HAS MADE SIGNIFICANT STRATEGIC ADVANCEMENTS IN SERVING THE RESIDENTS OF LAKE COUNTY AND SURROUNDING COMMUNITIES, RANGING FROM A CLINICAL INTEGRATION INITIATIVE TO INVESTMENTS IN NEW FACILITIES AND PROVIDER-CENTERED TECHNOLOGIES. RATHER THAN FOCUSING ON EPISODES OF CARE, THE SYSTEM AND ITS PHYSICIAN PARTNERS PROVIDE A LIFETIME OF HEALTH AND WELLNESS, EMBRACING A PHILOSOPHY OF PATIENT AND FAMILY-CENTERED CARE. THE SYSTEM AND ITS PHYSICIAN PARTNERS CONTINUE TO MOVE FORWARD IN FURTHER DEVELOPING A STRATEGIC PLAN THAT INCLUDES A FOCUS ON VALUE-BASED PURCHASING AND EVOLVING CARE MODELS.GUIDED BY A COLLABORATIVE HEALTH NEEDS ASSESSMENT CONDUCTED IN COOPERATION WITH THE LAKE COUNTY GENERAL HEALTH DISTRICT, LAKE HEALTH HAS DEVELOPED PROGRAMS, SERVICES AND PARTNERSHIPS TO ADDRESS THE MOST PRESSING HEALTH ISSUES IN OUR SERVICE AREAS AND THE SURROUNDING COMMUNITIES. THE HIGH PRIORITY AREAS INCLUDE ACCESS TO CARE, ALCOHOL ABUSE, DIABETES, DRUG OVERDOSE DEATHS, HEART DISEASE, HIGH BLOOD PRESSURE, LIMITED ACCESS TO HEALTHY FOODS, MENTAL HEALTH, AND OBESITY. LAKE HEALTH AND ITS PARTNERS ARE COMMITTED TO OFFERING THE BEST RESOURCES TO PROVIDE AN EXPANDED LEVEL OF CARE TO MEET THE NEEDS OF THE COMMUNITY.

PART VI, LINE 6:
IN 2021, UNIVERSITY HOSPITALS BECAME THE SOLE MEMBER OF LAKE HOSPITAL SYSTEM. AS SUCH, LAKE HOSPITAL SYSTEM'S TAX ID REMAINS THE SAME, AND FILES ITS TAX RETURN INDEPENDENTLY FROM UNIVERSITY HOSPITALS.

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PRIOR TO 1985, UH 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.ON APRIL 16, 2021, UNIVERSITY HOSPITALS HEALTH SYSTEM (UHHS) BECAME THE SOLE CORPORATE MEMBER OF LAKE HEALTH SYSTEM, INC. THROUGH A MEMBERSHIP SUBSTITUTION. UHHS IS THE PARENT OF VARIOUS CORPORATIONS INVOLVED IN THE DELIVERY OF HEALTHCARE SERVICES, INCLUDING A NETWORK OF PHYSICIANS, OUTPATIENT CENTERS, HOSPITALS, WELLNESS, OCCUPATIONAL HEALTH, SKILLED NURSING, ELDER HEALTH, REHABILITATION, AND HOME CARE SERVICES THAT OPERATE IN THE NORTHEAST OHIO REGION. 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. 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 2016, WE PROVIDED OVER $600,000 IN COMMUNITY BENEFIT THROUGH HEALTH EDUCATION PROGRAMS, EXCLUDING BLOOD DRIVES. DURING THESE COMMUNITY EVENTS AND HEALTH FAIRS, WE PERFORMED OVER 11,600 BLOOD PRESSURE CHECKS, CHOLESTEROL SCREENINGS, GLUCOSE, HEEL SCREENINGS, SKIN CANCER SCREENINGS AND PROSTATE CANCER SCREENINGS FOR FREE OR AT LOW COST. LAKE HEALTH'S COMMITMENT TO HEALTH IMPROVEMENT SERVICES THAT PROVIDE A DEMONSTRATED COMMUNITY BENEFIT CAN BE BROADLY CATEGORIZED INTO THREE AREAS: COMMUNITY HEALTH EDUCATION, COMMUNITY-BASED CLINICAL SERVICES, AND CASH AND IN-KIND GIFTS. SOME OF THE PROGRAMS AND EVENTS ARE HIGHLIGHTED BELOW.COMMUNITY HEALTH EDUCATIONLAKE HEALTH HAS AN EXTENSIVE COMMUNITY HEALTH PROGRAM THAT PROVIDES HEALTH SCREENINGS, PHYSICIAN LECTURES, SELF-HELP, AND EXERCISE PROGRAMS IN MULTIPLE COMMUNITY LOCATIONS THROUGHOUT LAKE COUNTY AND SURROUNDING AREAS. OUR SUPPORT GROUPS HELP MEET EDUCATIONAL AND EMOTIONAL NEEDS RELATED TO A VARIETY OF CONDITIONS. WE ALSO PARTNER WITH MANY LOCAL ORGANIZATIONS, INCLUDING THE UNITED WAY, THE AMERICAN RED CROSS, THE AMERICAN HEART ASSOCIATION, THE ARTHRITIS FOUNDATION, THE ALZHEIMER'S ASSOCIATION, THE LAKE COUNTY YMCA, LAKE COUNTY GENERAL HEALTH DISTRICT, AND THE LAKE METROPARKS TO INCREASE AWARENESS OF HEALTH ISSUES IN THE COMMUNITY. THESE PROGRAMS AND SERVICES INCLUDE:A. COMMUNITY CALENDARS AND NEWSLETTERS THE BEST OF HEALTH MAGAZINE, MAILED QUARTERLY TO ABOUT 150,000 HOUSEHOLDS CALENDAR OF EVENTS IN THE NEWS-HERALD, TEN TIMES PER YEAR HEALTH TALKS IN THE NEWS-HERALD (WEEKLY)B. EDUCATION ON SPECIFIC DISEASE CONDITIONS SENIOR CONNECTION LUNCH AND LEARNS COMMUNITY HEALTH LECTURE SERIES ARTHRITIS EXPO STRESS MANAGEMENT BREAST HEALTH FOR HISPANIC WOMENC. HEALTH PROMOTION AND WELLNESS PROGRAMS BE FIT FOR LIFEE. EDUCATION TO THE PUBLIC ABOUT HEALTH ISSUES INFORMATION THROUGH MEDIA RELEASES WEBSITE SOCIAL MEDIA (FACEBOOK, TWITTER, GOOGLE+)F. SCHOOL HEALTH EDUCATION PROGRAMS HEART SMART KIDS ASSEMBLYG. DIGITAL CONSUMER HEALTH INFORMATION BABY AND TODDLER E-NEWSLETTER REGARDING HEALTH E-NEWSLETTER CONSTANT CONTACT E-BLASTS SOCIAL MEDIA (FACEBOOK, TWITTER, GOOGLE+) WEBSITE VIDEOSH. SOCIAL MEDIA CONSUMER HEALTH INFORMATION FACEBOOK POSTS AND REMINDERS TWITTER POSTS AND REMINDERS GOOGLE+ VIDEOSI. SELF-HELP WELLNESS WORKSHOP MINDFULNESS RETREATONE 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 BE FIT FOR LIFE. THE ANNUAL MINDFULNESS RETREAT PROVIDES A DAYLONG EVENT THAT PROVIDES RELAXATION AND THE OPPORTUNITY TO PAUSE, REFLECT AND HEAL.