4A (Expenses $ 1783214000 including grants of $ 30716000) (Revenue $ 2019580000)
"Caring for the community has been an unwavering commitment of University Hospitals (""the System"") since its founding in 1866. Commitment to the community remains at the core of the System's mission: To Heal. To Teach. To Discover. In 2011, University Hospitals dedicated more than $267 million to community benefit programs in Northeast Ohio consisting of:- Education and training = $48.5 million- Research = $46.1 million- Charity care = $47.1 million- Medicaid shortfall = $89.9 million- Community health improvement services = $10.6 million- Other community programs and support = $36.3 million- Hospital Care Assurance Program (HCAP) receipts = ($11.5 million)Defer to Schedule H for further detail on how the System measures and reports community benefit. Community benefit for 2011 totaled $267 million up from $243.5 million in 2010. In addition to charity care and insufficient funding from the Medicaid program, the System incurs significant losses related to self-pay patients who fail to make payment for services rendered or insured patients who fail to remit co-payments and deductibles as required under applicable health insurance arrangements. The 2011 provision for bad debt of $51.6 million represents revenues for services provided that are deemed uncollectible.The UH health system provides work directly for about 19,100 employees and physicians. As the seventh largest employer in Ohio, UH supports the economy as well as state and local governments. UH employees pay more than $52.1 million annually in state and local income taxes. At the same time, UH provides many more Community benefits directly and indirectly through new or expanded business opportunities and through important capital investments in our facilities.As part of our Vision 2010 strategic plan, UH has committed - and continues to commit - millions of dollars to facilities and operations within the city of Cleveland and throughout our region, providing thousands of new construction and hospital-based jobs. New facilities and services at UH Case Medical Center, our world-renowned academic medical center in Cleveland, provide Cleveland residents and people from throughout the region and the world with the finest in primary and specialty health care. The facilities allow us to conduct vital medical research and offer advanced training for students and health professionals.Vision 2010's Quentin & Elisabeth Alexander Neonatal Intensive Care Unit at University Hospitals Rainbow Babies & Children's Hospital serves our most vulnerable children. UH's new Seidman Cancer Center and emergency facilities at UH Case Medical Center and UH Ahuja Medical Center, all opened in 2011, provided expanded employment opportunities while extending UH's mission to more patients. University Hospitals Ahuja Medical Center in Beachwood has provided hundreds of new jobs. New state-of-the-art outpatient health centers in the region have spurred economic growth while giving people access to the care they need close to home and expanding our community benefit programs. University Hospitals is proud to contribute to the health of our citizens and to be a positive economic force in our region.For more detailed information on the System's community benefit or to view the 2011 Community Benefit Report, please visit the System's website at www.UHhospitals.org."

Part I, Line 3c: The amount of financial assistance discount granted by UH in 2011 was based on the following guidelines: Patients must be uninsured, provide financial information to qualify them for financial assistance, if applicable, agree to allow UH to apply for third-party coverage, and financial assistance discount were based on amounts generally billed. If it is determined that any patient, including an uninsured charity patient, is unable to pay any account balances owed, the patient shall be determined to be medically indigent. Medically indigent patient balances shall be fully discounted and designated as financial assistance.UH participates in Ohio's Hospital Care Assurance Program (HCAP). Through HCAP, UH provides basic, medically necessary hospital-level services free of charge to Ohio residents whose income is below the poverty level (below 100 percent of the FPG). Patients who meet that income criterion must fill out and sign an application for HCAP.

Part I, Line 6a: The Parent organization, University Hospitals (34-0714775), prepares an Annual Community Benefit Report that encompasses all of University Hospitals Health System including the subordinate organizations completing Schedule H.

Part I, Line 7: Amounts calculated and reported in this table were derived from the most accurate, available sources. A cost-to-charge ratio was used to determine Financial Assistance cost using hospital financial statements. Medicaid shortfall for group subordinates was calculated; 1) based on the tax year's Medicaid cost report adjusted to reflect full costs to direct offsetting revenue from the Medicaid cost report, or 2) based on a cost-to-charge ratio and Medicaid revenues derived using financial statements. Included in this Medicaid shortfall is the Ohio State Children's Health Insurance Program (SCHIP) shortfall. Community health improvement and community benefit operations costs have been reported based on actual direct costs using actual or average employee compensation rates and adding indirect costs which are calculated by a cost accounting system as a percentage of total cost. The Medicare Cost Report, adjusted to reflect full costs, was used to determine gross community benefit expense amounts for Health Professions Education; direct offsetting revenues are included from Medicare, Children's Hospitals Graduate Medical Education, and Medicaid for direct medical education. Research amounts were also based on the Medicare Cost Report, adjusted to reflect full costs, using costs assigned to Research cost centers, less industry-sponsored research direct and indirect costs. The expense of restricted cash contributions is reported based on the actual value of the contribution before indirect cost; restricted in-kind contributions are reported at fair market value. In calculating gross and net community benefit expenses, care was taken to avoid double-counting community benefit expenses.

Part I, Line 7g: Line 7g includes the costs and direct offsetting revenue associated with certain physician clinics that qualify to be reported as a subsidized health service. The total amount of gross community benefit expense included in line 7g for these clinics is: $23,409,049. The total amount of associated direct offsetting revenue is $17,949,820. The total amount of net community benefit expense included in line 7g is $5,459,229.

Part I, L7 Col(f): Bad debt expense reported in Part IX, Line 25 but subtracted for purposes of calculating the percentages for this column = $51,833,000.

Part II: Although difficult to measure and not reported numerically, UH benefits the community through important community building activities that ultimately promote improved health and well-being for the surrounding population. Guided by our community health needs assessments and community hospital boards of directors, UH continues to meet community needs through economic development opportunities, local, regional and national disaster preparedness efforts, advocacy and coalition building, among others.

Part III, Line 4: The hospitals financial statements are used to determine the bad debt expense as reported on line 2. Text to Audited Financial Statement Footnote - Provision for Bad Debt; In addition to charity care and insufficient funding from the Medicaid program, there are significant losses related to self-pay patients who fail to make payment for services rendered or insured patients who fail to remit co-payments and deductibles as required under applicable health insurance arrangements. The provision for bad debts represents revenues for services provided that are deemed to be uncollectible. Provision for bad debts totaled $57,304,000 and $52,423,000 for the years ended December 31, 2011 and 2010, respectively. End text to footnote.

Part III, Line 8: Costs were derived using the Medicare Cost Report. As a safety-net to the community, UH hospitals provide services to many low-income Medicare recipients. The Medicare losses sustained at these hospitals are a result of Medicare reimbursing at less than operating costs. IRS Rev. Rul. 69-545 established the community benefit standard for hospitals which indicates that if a hospital serves patients covered by governmental health benefits (including Medicare), then this indicates the hospital operates to promote the health of the community. In turn, treating Medicare patients should be considered a community benefit.

Part III, Line 9b: University Hospitals utilizes a single process to bill and collect for all patient payment portions of claims. All self-pay account balances are treated the same way regardless of whether the patient is insured or uninsured.

UH Case Medical Center
Part V, Section B, Line 11h: Another factor used in determining amounts charged to UH patients include residency criteria. To qualify for Financial Assistance at a UH facility a patient must be a resident of Northeast Ohio (UH's service area comprises an eight county region) or be a patient in a UH hospital facility's primary and secondary service area seeking treatment at one of UH's wholly-owned and operated hospital facilities that provide patient care.

UH Rainbow Babies & Children's Hospitals
Part V, Section B, Line 11h: Another factor used in determining amounts charged to UH patients include residency criteria. To qualify for Financial Assistance at a UH facility a patient must be a resident of Northeast Ohio (UH's service area comprises an eight county region) or be a patient in a UH hospital facility's primary and secondary service area seeking treatment at one of UH's wholly-owned and operated hospital facilities that provide patient care.

UH Geauga Medical Center
Part V, Section B, Line 11h: Another factor used in determining amounts charged to UH patients include residency criteria. To qualify for Financial Assistance at a UH facility a patient must be a resident of Northeast Ohio (UH's service area comprises an eight county region) or be a patient in a UH hospital facility's primary and secondary service area seeking treatment at one of UH's wholly-owned and operated hospital facilities that provide patient care.

UH Ahuja Medical Center
Part V, Section B, Line 11h: Another factor used in determining amounts charged to UH patients include residency criteria. To qualify for Financial Assistance at a UH facility a patient must be a resident of Northeast Ohio (UH's service area comprises an eight county region) or be a patient in a UH hospital facility's primary and secondary service area seeking treatment at one of UH's wholly-owned and operated hospital facilities that provide patient care.

UH Richmond Medical Center
Part V, Section B, Line 11h: Another factor used in determining amounts charged to UH patients include residency criteria. To qualify for Financial Assistance at a UH facility a patient must be a resident of Northeast Ohio (UH's service area comprises an eight county region) or be a patient in a UH hospital facility's primary and secondary service area seeking treatment at one of UH's wholly-owned and operated hospital facilities that provide patient care.

UH Bedford Medical Center
Part V, Section B, Line 11h: Another factor used in determining amounts charged to UH patients include residency criteria. To qualify for Financial Assistance at a UH facility a patient must be a resident of Northeast Ohio (UH's service area comprises an eight county region) or be a patient in a UH hospital facility's primary and secondary service area seeking treatment at one of UH's wholly-owned and operated hospital facilities that provide patient care.

UH Geneva Medical Center
Part V, Section B, Line 11h: Another factor used in determining amounts charged to UH patients include residency criteria. To qualify for Financial Assistance at a UH facility a patient must be a resident of Northeast Ohio (UH's service area comprises an eight county region) or be a patient in a UH hospital facility's primary and secondary service area seeking treatment at one of UH's wholly-owned and operated hospital facilities that provide patient care.

UH Conneaut Medical Center
Part V, Section B, Line 11h: Another factor used in determining amounts charged to UH patients include residency criteria. To qualify for Financial Assistance at a UH facility a patient must be a resident of Northeast Ohio (UH's service area comprises an eight county region) or be a patient in a UH hospital facility's primary and secondary service area seeking treatment at one of UH's wholly-owned and operated hospital facilities that provide patient care.

UH Extended Care Campus
Part V, Section B, Line 11h: Another factor used in determining amounts charged to UH patients include residency criteria. To qualify for Financial Assistance at a UH facility a patient must be a resident of Northeast Ohio (UH's service area comprises an eight county region) or be a patient in a UH hospital facility's primary and secondary service area seeking treatment at one of UH's wholly-owned and operated hospital facilities that provide patient care.

UH Case Medical Center
Part V, Section B, Line 13g: UH provides a summary of its Financial Assistance Policy rather than the entire detailed policy. The summary makes it easier for our patients to read and understand. This summary is publicized through the UH website, on all patient statements and bills, in areas of hospital registration and financial counseling, in patient access or financial assistance offices, through financial counselors, and through other methods as required by state or federal law. The summarized Financial Assistance Policy posted on the website was not based on the notice of proposed rulemaking (NPRM) that was issued by the IRS on June 22, 2012, because that NPRM was not yet available.

UH Rainbow Babies & Children's Hospitals
Part V, Section B, Line 13g: UH provides a summary of its Financial Assistance Policy rather than the entire detailed policy. The summary makes it easier for our patients to read and understand. This summary is publicized through the UH website, on all patient statements and bills, in areas of hospital registration and financial counseling, in patient access or financial assistance offices, through financial counselors, and through other methods as required by state or federal law. The summarized Financial Assistance Policy posted on the website was not based on the notice of proposed rulemaking (NPRM) that was issued by the IRS on June 22, 2012, because that NPRM was not yet available.

UH Geauga Medical Center
Part V, Section B, Line 13g: UH provides a summary of its Financial Assistance Policy rather than the entire detailed policy. The summary makes it easier for our patients to read and understand. This summary is publicized through the UH website, on all patient statements and bills, in areas of hospital registration and financial counseling, in patient access or financial assistance offices, through financial counselors, and through other methods as required by state or federal law. The summarized Financial Assistance Policy posted on the website was not based on the notice of proposed rulemaking (NPRM) that was issued by the IRS on June 22, 2012, because that NPRM was not yet available.

UH Ahuja Medical Center
Part V, Section B, Line 13g: UH provides a summary of its Financial Assistance Policy rather than the entire detailed policy. The summary makes it easier for our patients to read and understand. This summary is publicized through the UH website, on all patient statements and bills, in areas of hospital registration and financial counseling, in patient access or financial assistance offices, through financial counselors, and through other methods as required by state or federal law. The summarized Financial Assistance Policy posted on the website was not based on the notice of proposed rulemaking (NPRM) that was issued by the IRS on June 22, 2012, because that NPRM was not yet available.

UH Richmond Medical Center
Part V, Section B, Line 13g: UH provides a summary of its Financial Assistance Policy rather than the entire detailed policy. The summary makes it easier for our patients to read and understand. This summary is publicized through the UH website, on all patient statements and bills, in areas of hospital registration and financial counseling, in patient access or financial assistance offices, through financial counselors, and through other methods as required by state or federal law. The summarized Financial Assistance Policy posted on the website was not based on the notice of proposed rulemaking (NPRM) that was issued by the IRS on June 22, 2012, because that NPRM was not yet available.

UH Bedford Medical Center
Part V, Section B, Line 13g: UH provides a summary of its Financial Assistance Policy rather than the entire detailed policy. The summary makes it easier for our patients to read and understand. This summary is publicized through the UH website, on all patient statements and bills, in areas of hospital registration and financial counseling, in patient access or financial assistance offices, through financial counselors, and through other methods as required by state or federal law. The summarized Financial Assistance Policy posted on the website was not based on the notice of proposed rulemaking (NPRM) that was issued by the IRS on June 22, 2012, because that NPRM was not yet available.

UH Geneva Medical Center
Part V, Section B, Line 13g: UH provides a summary of its Financial Assistance Policy rather than the entire detailed policy. The summary makes it easier for our patients to read and understand. This summary is publicized through the UH website, on all patient statements and bills, in areas of hospital registration and financial counseling, in patient access or financial assistance offices, through financial counselors, and through other methods as required by state or federal law. The summarized Financial Assistance Policy posted on the website was not based on the notice of proposed rulemaking (NPRM) that was issued by the IRS on June 22, 2012, because that NPRM was not yet available.

UH Conneaut Medical Center
Part V, Section B, Line 13g: UH provides a summary of its Financial Assistance Policy rather than the entire detailed policy. The summary makes it easier for our patients to read and understand. This summary is publicized through the UH website, on all patient statements and bills, in areas of hospital registration and financial counseling, in patient access or financial assistance offices, through financial counselors, and through other methods as required by state or federal law. The summarized Financial Assistance Policy posted on the website was not based on the notice of proposed rulemaking (NPRM) that was issued by the IRS on June 22, 2012, because that NPRM was not yet available.

UH Extended Care Campus
Part V, Section B, Line 13g: UH provides a summary of its Financial Assistance Policy rather than the entire detailed policy. The summary makes it easier for our patients to read and understand. This summary is publicized through the UH website, on all patient statements and bills, in areas of hospital registration and financial counseling, in patient access or financial assistance offices, through financial counselors, and through other methods as required by state or federal law. The summarized Financial Assistance Policy posted on the website was not based on the notice of proposed rulemaking (NPRM) that was issued by the IRS on June 22, 2012, because that NPRM was not yet available.

Part VI, Line 2: In calendar year 2008, UH assessed community health care needs by reviewing demographics, household income, ambulatory care sensitive discharges, health status and access indicators, federally designated areas and facilities, and local data sources for the respective communities served by each of the hospitals in the UH system. The needs assessments have been used to guide UH community benefit program development and to inform strategic planning.

"Part VI, Line 3: UH informs and educates patients and persons who may be billed for patient care about options for resolution of their balances, including assistance under government programs and under the UH Financial Assistance Program (""Assistance Program"") in a variety of ways. Signage for the state of Ohio Health Care Assurance Program (HCAP) and the UH Patient Financial Assistance program can be found in locations where patients register for care, patient access areas, and various points of entry such as our emergency departments. Supplemental brochures that reflect the UH Patient Financial Assistance Program and the HCAP program are also available. Information about the Assistance Program can also be found on the UH website in addition to being provided on the backs of patient statements, including a toll free phone number to call for assistance from one of our financial counselors."

"Part VI, Line 4: The UH service area spans Northeast Ohio, and our clinical, education, research, and outreach programs benefit communities that extend well beyond this region. The main campus facility, UH Case Medical Center, is located in the city of Cleveland and provides high-quality health care in an urban setting for a diverse population that includes many low-income residents. UH Rainbow Babies & Children's Hospital (Rainbow) serves as a safety-net for Cleveland's children, with more than 60 percent of its patients enrolled in the state of Ohio Medicaid program. Based on the 2008 needs assessment, the UH Primary Service Area (PSA) included about 3 million persons, and its Secondary Service Area (SSA) included a population of approximately 1.2 million persons for a total service area population of approximately 4.2 million. The PSA encompasses an eight-county region including Ashtabula, Cuyahoga, Geauga, Lake, Lorain, Medina, Portage and Summit (referred to as the ""eight-county region""). The SSA encompasses seven counties including Ashland, Erie, Huron, Mahoning, Stark, Trumbull, and Wayne. Seventy percent of the UH service area population is located in the PSA, while the remaining 30 percent is located in the SSA. With approximately 1.3 million residents, Cuyahoga County accounts for 31 percent of the population comprising UH service area counties. UH continually invests in access to care for low income and vulnerable populations. Four UH health clinics are designated as Health Professional Shortage Areas (HPSAs) by the Health Resources and Services Administration (HRSA). These clinics include the Douglas Moore Health Clinic, Women's Health Center, Rainbow Ambulatory Practice, and Family Medicine Clinic, all located on the UH Case Medical Center campus. HRSA also designates Medically Underserved Areas (MUAs) and Medically Underserved Populations (MUPs) based on specific criteria. Twenty-five areas within the UH service area including Cuyahoga, Lorain, and Summit Counties qualify as MUAs, while one population in Kent, Portage County is a designated MUP. Cuyahoga County alone accounts for 20 MUAs located in 13 zip codes, representing 12 towns. The UH System's two critical access hospitals in Ashtabula County sit in Appalachia, as designated by the Appalachian Regional Commission.The 2008 needs assessment indicated that accross across Northern Ohio, 25 percent of households are estimated to have incomes less than $25,000; 53 percent less than $50,000."

Part VI, Line 5: Governed by a Board of Directors comprised primarily of persons residing in the UH Primary Service Area, UH continues to reinvest in itself and the community through enhanced clinical services, educational programs, research, and capital improvements that meet the health care needs of communities and patients it serves. UH provides an outstanding balance of high-quality clinical care within its walls, and community health outreach to local populations. As indicated in the above response to Part VI, Line 4, UH has made significant investments in access to care for low income and vulnerable populations. Four UH health clinics are designated as Health Professional Shortage Areas (HPSAs) by the Health Resources and Services Administration (HRSA). These clinics include the Douglas Moore Health Clinic, Women's Health Center, Rainbow Ambulatory Practice, and Family Medicine Clinic, all located on the UH Case Medical Center campus. HRSA also designates Medically Underserved Areas (MUAs) and Medically Underserved Populations (MUPs) based on specific criteria. Twenty-five areas within the UH service area including Cuyahoga, Lorain, and Summit Counties qualify as MUAs, while one population in Kent, Portage County is a designated MUP. Cuyahoga County alone accounts for 20 MUAs located in 13 zip codes, representing 12 towns. The UH System's two critical access hospitals in Ashtabula County sit in Appalachia, as designated by the Appalachian Regional Commission.UH is committed to training the next generation of physicians, nurses, specialists and other allied health care providers annually. Many of these students and trainees complete their education and take their knowledge and expertise to other parts of the state or country, thereby benefiting other communities. UH works to increase health and medical knowledge through government and non-profit funded research. The shared knowledge derived from these efforts improves the health and well-being of people throughout the nation and the world when they lead to new standards of care, new medical devices, or breakthroughs in tackling diseases.

Part VI, Line 6: University Hospitals (parent organization) together with its affiliates and subsidiaries is an integrated, health care delivery system. The System includes an academic medical center, six wholly-owned community hospitals, two of which are critical access facilities, ambulatory health care centers and physician practice offices throughout the region. The System also provides skilled nursing, elder health, rehabilitation and home care services. UH serves an essential role in the community by providing diverse populations throughout the Northeast Ohio region with comprehensive health care - from primary care to highly specialized medical care for the most serious of health problems. It provides the same quality and compassionate service to all, no matter their income, ability to pay or socioeconomic status. UH cares for the well-insured and the uninsured; men, women and children from every community in the region, from urban centers, small towns, rural areas and suburbs.