4A (Expenses $ 431222356 including grants of $ 0) (Revenue $ 585674801)
OUTPATIENT SERVICES - IN 2014, SUMMA HEALTH SYSTEM, SUMMA BARBERTON CITIZENS HOSPITAL, THE WADSWORTH-RITTMAN AREA HOSPITAL ASSOCIATION AND SUMMA PHYSICIANS, INC. PROVIDED MORE THAN 1.5 MILLION OCCASIONS OF SERVICE, INCLUDING 174,502 EMERGENCY ROOM VISITS, 15,740 SURGICAL OPERATIONS, AND MORE THAN 1.3 MILLION OTHER OUTPATIENT VISITS.

4B (Expenses $ 292261904 including grants of $ 0) (Revenue $ 385444800)
INPATIENT SERVICES - FOR 2014, SUMMA HEALTH SYSTEM (SHS), SUMMA BARBERTON CITIZENS HOSPITAL (SBH) AND THE WADSWORTH-RITTMAN AREA HOSPITAL ASSOCIATION (WRH) HAD 752 BEDS IN SERVICE, ADMITTED 38,838 ADULT PATIENTS, AND DELIVERED 4,005 NEWBORNS. THE ADULT PATIENTS RECEIVED 173,312 DAYS OF CARE, INPATIENT SURGERIES TOTALED 7,393, EMERGENCY ADMITS TOTALED 27,007 AND THE AVERAGE LENGTH OF STAY WAS 4.46 DAYS.

4C (Expenses $ 44543076 including grants of $ 0) (Revenue $ 12397313)
RESEARCH/EDUCATION - SUMMA HEALTH HAS A HISTORY OF SPONSORING AND SUPPORTING BASIC AND CLINICAL RESEARCH TO UNDERSTAND DISEASES AND TREATMENT. CENTERS, PROGRAMS AND LABS FACILITATE RESEARCH IN A NUMBER OF MEDICAL FIELDS. SUMMA HEALTH FOSTERS A LEARNING ENVIRONMENT FOR THE NEXT GENERATION OF CAREGIVERS. AT THREE OF SUMMA HEALTH'S HOSPITALS, OVER 200 MEDICAL SCHOOL GRADUATES TRAIN IN 17 ACCREDITED RESIDENCY PROGRAMS. SUMMA HEALTH PROVIDES CLINICAL LEARNING EXPERIENCES TO MORE THAN 250 NURSING AND ALLIED HEALTH STUDENTS.

4D (Expenses $ 0 including grants of $ 0) (Revenue $ 0)
Part III Line 4D - Other Program Services - Final Section: SUMMARY ALTHOUGH REIMBURSEMENT FOR SERVICES RENDERED IS CRITICAL TO THE OPERATIONS AND STABILITY OF SUMMA HEALTH, NOT ALL INDIVIDUALS POSSESS THE ABILITY TO PURCHASE ESSENTIAL MEDICAL SERVICES. SUMMA HEALTH PROVIDED SERVICES TO ALL PATIENTS ON A NON-DISCRIMINATORY BASIS AND WITHOUT REGARD TO ANY PATIENT'S ABILITY TO PAY FOR SUCH SERVICES OR THE INDIVIDUAL'S PARTICIPATION IN A GOVERNMENT-SPONSORED OR SUBSIDIZED HEALTHCARE SYSTEM. PATIENTS WERE ENCOURAGED TO APPLY FOR UNCOMPENSATED CARE AND, DEPENDING ON THEIR LEVEL OF INCOME AND NUMBER OF DEPENDENTS, ALL (OR A PORTION) OF THEIR BILL WAS REDUCED. GROSS ANNUAL FAMILY INCOME WAS COMPARED USING A SLIDING SCALE BASED ON THE FEDERAL POVERTY INCOME GUIDELINES TO DETERMINE ITHE CHARITY DISCOUNT FOR WHICH THE PATIENT MAY BE ELIGIBLE. IN 2014, SUMMA HEALTH PROVIDED CHARITY CARE TO THE INDIGENT (INCLUDING UNREIMBURSED MEDICAID) AT THE COST OF APPROXIMATELY $14.2 MILLION. THIS AMOUNT DOES NOT INCLUDE SERVICES PROVIDED WRITTEN OFF AS BAD DEBT. IN ADDITON TO UNCOMPENSATED MEDICAL CARE, SUMMA HEALTH PROVIDED WELLNESS PROGRAMS, COMMUNITY EDUCATION PROGRAMS AND SPECIAL PROGRAMS FOR THE ELDERLY, HANDICAPPED, AND MEDICALLY UNDERSERVED. SUMMA HEALTH ALSO OPERATED A VARIETY OF BROAD COMMUNITY SUPPORT ACTIVITIES. THESE PROGRAMS WERE OFFERED AT A REDUCED PRICE OR PROVIDED TO THE COMMUNITY FREE OF CHARGE. SUMMA HEALTH OPERATES ITS FACILITIES IN A MANNER CONSISTENT WITH THE COMMUNITY BENEFIT REQUIREMENTS OF REV. RULE 69-545 AND SUBSEQUENT CASE LAW AND IRS GUIDELINES. SUMMA HEALTH'S HOSPITALS PROVIDE EMERGENCY SERVICES WHICH ARE OPEN AND AVAILABLE TO ALL PERSONS OF THE COMMUNITY, REGARDLESS OF THEIR ABILITY TO PAY. THE BOARD OF DIRECTORS CONSISTED OF PERSONS WHO ARE BROADLY REPRESENTATIVE OF THE COMMUNITY AND MEDICAL STAFF. SUMMA PHYSICIANS INC. - PROGRAM SERVICE ACCOMPLISHMENTS SUMMA PHYSICIANS INC. (SPI) IS A SUMMA HEALTH ENTITY COMPRISED OF MULTI-SPECIALTY PHYSICIANS AND PRACTICES. IN TOTAL, SPI EMPLOYS NEARLY 300 PHYSICIANS AND MORE THAN 700 SUPPORT STAFF IN MORE THAN 30 SPECIALTIES AND SUB-SPECIALTIES. SPI PROMOTES STRONG AFFILIATION AND EMPLOYMENT OF PHYSICIANS TO ENSURE COMMUNITY AND HOSPITAL NEEDS FOR PHYSICIAN SERVICES ARE MET. IN 2014, SPI CONTINUED ITS DEVELOPMENT OF PRIMARY CARE PODS AND THE MEDICAL HOME MODEL OF CARE, TO FURTHER ENHANCE THE FOCUSED PATIENT CARE MODEL, BETTER COMMUNICATE QUALITY INITIATIVES AND ENHANCE PHYSICIAN RECRUITMENT. SUMMA FOUNDATION - PROGRAM SERVICE ACCOMPLISHMENTS THROUGH PHILANTHROPY, SUMMA FOUNDATION SUPPORTS MEDICAL EDUCATION, RESEARCH, TECHNOLOGY, AND CLINICAL INNOVATION. ENCOMPASSING FUNDRAISING, RESOURCE DEVELOPMENT, COMMUNITY BENEFIT, DIVERSITY AND GOVERNMENT RELATIONS, SUMMA FOUNDATION WORKS TO DEVELOP NEW, DIVERSIFIED AND INCREASED RESOURCES AND BUILD RELATIONSHIPS THAT INFLUENCE HEALTH POLICY TO ADVANCE THE REGIONAL PRIORITIES OF SUMMA HEALTH. DEVELOPMENT THE FOUNDATION'S DEVELOPMENT DEPARTMENT OFFERS A SPECTRUM OF PHILANTHROPIC OPTIONS FOR DONORS DESIGNED TO CREATE A POSITIVE IMPACT ON SUMMA HEALTH'S OPERATIONS, PROGRAMS, PROJECTS AND PERCEPTIONS AND TO AFFECT POSITIVE CHANGE IN THE COMMUNITIES SUMMA HEALTH SERVES. DEVELOPMENT HOUSES THE GRANT AND PROPOSAL DEVELOPMENT OFFICES CREATED TO IDENTIFY THE RESOURCES AND EXPERTISE OF EXTERNAL AND INTERNAL PARTNERS TO GENERATE FUNDING OR RESEARCH, EDUCATION AND CLINICAL AND SYSTEM PROJECTS. PHILANTHROPIC COMMITMENTS TO THE SUMMA FOUNDATION IN 2014 TOTALED $9.1 MILLION. COMMUNITY BENEFIT AND DIVERSITY THIS DEPARTMENT LEADS EFFORTS TO ADDRESS HEALTH DISPARITIES AND OTHER IMPORTANT COMMUNITY NEEDS AND RAISE AWARENESS OF HEALTH AND HEALTHCARE ISSUES AFFECTING THE COMMUNITIES SERVED BY SUMMA HEALTH. COMMUNITY BENEFIT AND DIVERSITY PROVIDE WELLNESS AND EDUCATIONAL TOOLS, FACILITATE ECONOMIC DEVELOPMENT PROGRAMS, DEVELOP COMMUNITY PARTNERSHIPS, COMMUNICATE SUMMA HEALTH'S BENEFIT TO THE COMMUNITY AND ENGAGE THE COMMUNITY AND ITS WORKFORCE WITHIN THE SYSTEM AND THROUGHOUT THE REGION. GOVERNMENT RELATIONS THIS DEPARTMENT IS DEDICATED TO ELEVATING SUMMA HEALTH AS A CREDIBLE LEADER AND PARTNER IN THE HEALTH POLICY PLANNING PROCESS. THIS DEPARTMENT COLLABORATES WITH THE SYSTEM DEVELOPMENT TEAM TO BEST POSITION SUMMA EDUCATION, RESEARCH AND CLINICAL INNOVATION PRIORITIES WITH PUBLIC SECTOR FUNDING OPPORTUNITIES.

Schedule H, Part V, Section B, Line 5 Facility 1, 1
Facility 1, 1 - Summa Health System, Summa Barberton Citizens Hospital, The Wadsworth-Rittman Area Hospital, Summa Western Reserve Hospital, LLC (Group 1). Interviews were conducted with community leaders in March - April 2013 to gain their insight on what they thought were the significant health needs of children and adults in their communities, the factors that affect those health needs, other existing community health needs assessments, possible collaboration opportunities, and to solicit suggestions on what the hospitals can do to address the prioritized health needs identified in the CHNA. These community leaders represent the broad interests of the communities served by the hospital facility including the medically underserved, low-income persons, minority groups, those with chronic disease needs, and leaders from local public health agencies and departments who have special knowledge and expertise in public health. Leaders from the following community organizations were consulted during this CHNA: Summit County Job and Family Services, Director Akron Public Schools, Executive Director for Business Affairs Portage County Job and Family Services, Administrator Medina City School District, Nursing Director for the Medina County Educational Service Center Medina County Job and Family Services, Medicaid Eligibility Services Administrator Portage County Mental Health and Recovery Board, Executive Director Portage County Health Department, Health Commissioner Robinson Memorial Hospital, Vice President for Business Development Summit County Public Health, Deputy Health Commissioner for Planning Kent City School District, Director of Business Services Medina County Health Department, Health Commissioner County of Summit Alcohol, Drug Addiction, and Mental Health Services Board, Executive Director Focus groups were conducted with community residents in April - May 2013 to get their input on what they thought were the significant health needs of children and adults in their communities, the factors that affect those needs, the solutions they thought would solve those needs, and what the hospitals and other community groups could do to address those needs. Due to the observed information gap in the epidemiologic data on the health of children, adult and child substance abuse issues, and adult and child mental health issues, several questions were asked to probe more deeply on these issues. In addition, a questionnaire was distributed to focus group participants to gather demographic information and basic perceptions of community health. The discussion guide, questionnaire, and protocol were reviewed and approved by the Kent State University Institutional Review Board. A total of 60 people participated in the Community Resident Focus Groups. Additional detail can be found on the Summa Health website at http://www.summahealth.org/about-us/about-Summa/community-benefit-and-diversity/communityneedsassessment2013.

Schedule H, Part V, Section B, Line 6a Facility 1, 1
Facility 1, 1 - Summa Health System, Summa Barberton Citizens Hospital, The Wadsworth-Rittman Area Hospital, Summa Western Reserve Hospital, LLC (Group 1). SUMMA HEALTH CONDUCTED THE CHNA ON BEHALF OF EACH OF ITS SIX HOSPITAL FACILITIES LISTED IN PART V, SECTION A. In addition, Summa Health collaborated with Akron General Health System and Akron Children's Hospital in conducting the CHNA.

Schedule H, Part V, Section B, Line 6b Facility 1, 1
Facility 1, 1 - Summa Health System, Summa Barberton Citizens Hospital, The Wadsworth-Rittman Area Hospital, Summa Western Reserve Hospital, LLC (Group 1). Kent State University College of Public Health

Schedule H, Part V, Section B, Line 11 Facility 1, 1
Facility 1, 1 - Summa Health System, Summa Barberton Hospital, Summa Wadsworth-Rittman Area Hospital, Summa Western Reserve Hospital (Group 1). The adult health needs of asthma, cancer, cardiovascular disease, diabetes, mental health, substance abuse, lifestyle factors, access to care factors, and quality of care factors will be addressed by Summa Health System. The health needs of asthma, cancer and diabetes are being addressed through increasing consumer knowledge base of risk factors, risk behaviors, and genetic considerations which lead to asthma and/or asthma related disease development. Increase knowledge of the signs and symptoms of asthma and asthma related diseases. Another objective is to increase the number of individuals who have access to primary care medical homes. The health need of mental health is being addressed by improving identification, diagnosis, and treatment of depression; improving identification and treatment of patients with suicidal tendencies; and increasing the number of individuals who have access to primary care medical homes. The health need of substance abuse is being addressed by decreasing adult alcohol abuse; decreasing adult prescription drug abuse; and decreasing adult opioid drug abuse. The health need of lifestyle factors is being addressed by decreasing smoking and tobacco use in adults and increasing the number of individuals who have access to primary care medical homes. The health need of access to care factors is being addressed by increasing the number of individuals who have access to primary care medical homes; increasing access to primary care providers; increasing access to dental care providers; and increasing access to mental health providers. The health need of quality of care factors is being addressed by decreasing hospital readmissions; increasing the number of individuals who have access to primary care medical homes; increasing consumer knowledge base of risk factors, risk behaviors, and genetic considerations which lead to increased incidence of diabetes; and informing the community and creating community awareness of the health care needs and issues of seniors. A detailed description of the actions being taken to address the health needs identified above can be found on the Summa Health Implementation Strategy available at http://www.summahealth.org/about-us/about-summa/community-benefit-and-diversity/communityneedsassessment2013. Due to community resources available to assist individuals in obtaining healthy food, including the Akron Canton Regional food Bank, Summa Health hospital facilities chose not to address this environmental factor health need. In addition, the community resources available to assist children, specifically Akron Children's Hospital, in the areas of childhood chronic disease, child development, child lifestyle risk factors, child mental health and substance abuse, child safety, child access to care factors and child environmental risk factors, led to the determination by Summa Health hospital facilities to not address these child health needs.

Schedule H, Part V, Section B, Line 22 Facility 1, 1
Facility 1, 1 - Summa Health System, Summa Barberton Citizens Hospital, the Wadsworth-Rittman Area Hospital, Summa Western Reserve Hospital, LLC. Patients whose income is equal to or less than 200% of the Federal Poverty Guidelines, adjusted for number dependents, receive a 100% discount for charity care. If the patient's income exceeds 200% of the Federal Poverty Guidelines and up to 400% of the Federal Poverty Guidelines a sliding scale charity care discount of either 20%, 60% or 80% of billed charges is applied. This sliding scale charity care discount policy is being reevaluated to be effective January, 2016 whereby the charity care discount percentage would be applied to the average allowed amounts for commercially insured patients

Schedule H, Part V, Section B, Line 5 Facility 2, 1
Facility 2, 1 - Crystal Clinic Orthopaedic Center LLC (Group 2). Interviews were conducted with community leaders in March - April 2013 to gain their insight on what they thought were the significant health needs of children and adults in their communities, the factors that affect those health needs, other existing community health needs assessments, possible collaboration opportunities, and to solicit suggestions on what the hospitals can do to address the prioritized health needs identified in the CHNA. These community leaders represent the broad interests of the communities served by the hospital facility including the medically underserved, low-income persons, minority groups, those with chronic disease needs, and leaders from local public health agencies and departments who have special knowledge and expertise in public health. Leaders from the following community organizations were consulted during this CHNA: Summit County Job and Family Services, Director Akron Public Schools, Executive Director for Business Affairs Portage County Job and Family Services, Administrator Medina City School District, Nursing Director for the Medina County Educational Service Center Medina County Job and Family Services, Medicaid Eligibility Services Administrator Portage County Mental Health and Recovery Board, Executive Director Portage County Health Department, Health Commissioner Robinson Memorial Hospital, Vice President for Business Development Summit County Public Health, Deputy Health Commissioner for Planning Kent City School District, Director of Business Services Medina County Health Department, Health Commissioner County of Summit Alcohol, Drug Addiction, and Mental Health Services Board, Executive Director Focus groups were conducted with community residents in April - May 2013 to get their input on what they thought were the significant health needs of children and adults in their communities, the factors that affect those needs, the solutions they thought would solve those needs, and what the hospitals and other community groups could do to address those needs. Due to the observed information gap in the epidemiologic data on the health of children, adult and child substance abuse issues, and adult and child mental health issues, several questions were asked to probe more deeply on these issues. In addition, a questionnaire was distributed to focus group participants to gather demographic information and basic perceptions of community health. The discussion guide, questionnaire, and protocol were reviewed and approved by the Kent State University Institutional Review Board. A total of 60 people participated in the Community Resident Focus Groups.

Schedule H, Part V, Section B, Line 6a Facility 2, 1
Facility 2, 1 - Crystal Clinic Orthopaedic Center LLC (Group 2). Summa Health conducted the CHNA on behalf of its six hospital facilities listed in Part V, Section A. In addition, Summa Health collaborated with Akron General Health System and Akron Children's Hospital in conducting the CHNA.

Schedule H, Part V, Section B, Line 6b Facility 2, 1
Facility 2, 1 - Crystal Clinic Orthopaedic Center LLC, (Group 2). Kent State University College of Public Health

Schedule H, Part V, Section B, Line 11 Facility 2, 1
Facility 2, 1 - Crystal Clinic Orthopaedic Center LLC (Group 2). Due to the nature of the adult orthopaedic specialty services provided by Crystal Clinic Orthopaedic Center, LLC, the adult identified health need of Quality of Care Factors - Hospital Readmissions will be the only health need addressed by Crystal Clinic Orthopaedic Center, LLC. The health need of quality of care - hospital readmissions is being addressed by providing education and support for patients at risk for poor bone health and decreasing hospital readmissions post bone related procedures. A detailed description of the actions being taken to address the health needs identified above can be found on the Summa Health Implementation Strategy available at http://www.summahealth.org/about-us/about-summa/community-benefit-and-diversity/communityneedsassessment2013. The community resources provided by a variety of institutions and agencies including Akron Children's Hospital and Summa Health System, Summa Barberton Hospital, and Summa Wadsworth-Rittman Hospital led to the determination by Crystal Clinic Orthopaedic Center, LLC to not address any other identified health need.

Schedule H, Part V, Section B, Line 5 Facility 3, 1
Facility 3, 1 - Summa Rehabilitation Hospital (Group 3). Interviews were conducted with community leaders in March - April 2013 to gain their insight on what they thought were the significant health needs of children and adults in their communities, the factors that affect those health needs, other existing community health needs assessments, possible collaboration opportunities, and to solicit suggestions on what the hospitals can do to address the prioritized health needs identified in the CHNA. These community leaders represent the broad interests of the communities served by the hospital facility including the medically underserved, low-income persons, minority groups, those with chronic disease needs, and leaders from local public health agencies and departments who have special knowledge and expertise in public health. Leaders from the following community organizations were consulted during this CHNA: Summit County Job and Family Services, Director Akron Public Schools, Executive Director for Business Affairs Portage County Job and Family Services, Administrator Medina City School District, Nursing Director for the Medina County Educational Service Center Medina County Job and Family Services, Medicaid Eligibility Services Administrator Portage County Mental Health and Recovery Board, Executive Director Portage County Health Department, Health Commissioner Robinson Memorial Hospital, Vice President for Business Development Summit County Public Health, Deputy Health Commissioner for Planning Kent City School District, Director of Business Services Medina County Health Department, Health Commissioner County of Summit Alcohol, Drug Addiction, and Mental Health Services Board, Executive Director Focus groups were conducted with community residents in April - May 2013 to get their input on what they thought were the significant health needs of children and adults in their communities, the factors that affect those needs, the solutions they thought would solve those needs, and what the hospitals and other community groups could do to address those needs. Due to the observed information gap in the epidemiologic data on the health of children, adult and child substance abuse issues, and adult and child mental health issues, several questions were asked to probe more deeply on these issues. In addition, a questionnaire was distributed to focus group participants to gather demographic information and basic perceptions of community health. The discussion guide, questionnaire, and protocol were reviewed and approved by the Kent State University Institutional Review Board. A total of 60 people participated in the Community Resident Focus Groups.

Schedule H, Part V, Section B, Line 6a Facility 3, 1
Facility 3, 1 - Summa Rehabilitation Hospital (Group 3). Summa Health conducted the CHNA on behalf of its six hospital facilities listed in Part V, Section A. IN addition, Summa Health collaborated with Akron General Health System and Akron Children's Hospital in conducting the CHNA.

Schedule H, Part V, Section B, Line 6b Facility 3, 1
Facility 3, 1 - Summa Rehabilitation Hospital (Group 3). Kent State University College of Public Health

Schedule H, Part V, Section B, Line 11 Facility 3, 1
Facility 3, 1 - Summa Rehabilitation Hospital (Group 3). Due to the nature of the adult rehabilitation specialty services provided by Summa Rehab Hospital, LLC, the adult identified health need of Quality of Care Factors - Hospital Readmissions will be the only health need addressed by Summa Rehab Hospital, LLC. The health need of quality of care factors - hospital readmissions is being addressed by decreasing hospital readmissions by improving post-operative outcomes for patients undergoing joint repairs and increasing consumer knowledge of aspects of preoperative care that improves post-operative outcomes and decreasing incidence of hospital readmissions. A detailed description of the actions being taken to address the health needs identified above can be found on the Summa Health Implementation Strategy available at http://www.summahealth.org/about-us/about-summa/community-benefit-and-diversity/communityneedsassessment2013. The community resources provided by a variety of institutions and agencies including Akron Children's Hospital and Summa Health System, Summa Barberton Hospital, and Summa Wadsworth-Rittman Hospital led to the determination by Summa Rehab Hospital, LLC to not address any other identified health needs.

Schedule H, Part VI, Line 7 State Filing of Community Benefit Report
The State of Ohio does not require the filing of the community benefit report. However, information from the community benefit report is shared annually with the Ohio Hospital Association

Schedule H, Part I, Line 6a Community benefit report prepared by related organization
Summa Health

Schedule H, Part I, Line 7g Subsidized Health Services
"The amount of subsidized health services reported on Line 7(g) attributable to Summa Physicians, Inc. (""SPI"") is $14,286,911."

Schedule H, Part I, Line 7 Costing Methodology used to calculate financial assistance
Cost of financial assistance at cost was calculated with a cost to charge ratio using Worksheet 2. The cost related to Medicaid patients was determined using Summa Health's cost accounting system. For subsidized services Summa Health's cost accounting system is used to determine cost related to specific services excluding traditional Medicaid and Medicaid managed care patients. Costs for charity and bad debt accounts are deducted using a ratio of cost to charge specific to that subsidized service. Costs for other programs reflect the direct and indirect costs of providing those programs.

Schedule H, Part II Community Building Activities
Summa Health addresses various community concerns including health improvement, poverty, workforce development, and access to health care. Summa Health hospitals conduct community health education and support groups, health fairs and screenings for the communities served. Summa Health hospitals work with state and local leadership to address community needs and provide healthcare services to the poor and underserved. Summa Health hospitals provide programs to improve the physical surroundings and housing in the communities served. Inadequate housing has a negative impact on the health of residents in the area by leading to violence in the neighborhoods. A robust economy positively impacts residents covered by health insurance and improves the capacity of the community to support health services.

Schedule H, Part III, Line 2 Bad debt expense - methodology used to estimate amount
"A COST-TO-CHARGE RATIO IS USED TO DETERMINE THE AMOUNT REFLECTED ON LINE 2. FOR A DESCRIPTION OF THE ACCOUNTING FOR BAD DEBT, SEE ""NET PATIENT SERVICE REVENUE AND PATIENT ACCOUNTS RECEIVABLE"" ON PAGE 14 OF THE ATTACHED CONSOLIDATED AUDITED FINANCIAL STATEMENTS UNDER FOOTNOTE 2, ""ACCOUNTING POLICIES""."

Schedule H, Part III, Line 3 Bad Debt Expense Methodology
Summa Health's financial assistance policy does not permit the cost of patients who are uncooperative or unable to be located to be reclassified from financial assistance to bad debt. Summa Health's financial assistance policy requires an application and supporting documentation. Therefore, zero dollars are reported on Part III, Line 3 as amounts included in bad debt that could be attributable to patients eligible under Summa Health's financial assistance policy.

Schedule H, Part III, Line 4 Bad debt expense - financial statement footnote
Summa Health's audited financial statements contain a footnote that describes bad debt expense. Summa Health has adopted ASU 2011-07 which results in bad debt expense being reflected as a deduction from revenue rather than an operating expense. Notes to consolidated financial statements, B. Accounting Policies, Net Patient Service Revenue and Patient Accounts Receivable (page 14) states Summa Health maintains an allowance for doubtful accounts based on the expected collectibility of patient accounts receivable. The provision for doubtful 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.

Schedule H, Part III, Line 8 Community benefit & methodology for determining medicare costs
Medicare allowable cost are based on information provided on worksheet B, Part I, Column 26, Line 118 from the various hospitals' Medicare cost reports. Costing method used was total allowable cost less all costs deemed non-allowable by Medicare regulations. Any Medicare shortfall incurred by Summa Health is not reported as a community benefit.

Schedule H, Part III, Line 9b Collection practices for patients eligible for financial assistance
SUMMA WILL NOT PURSUE LEGAL ACTION FOR NON-PAYMENT OF BILLS AGAINST ANY PATIENT WHO IS WITHOUT ACCESS TO HEALTH INSURANCE AND WITHOUT OTHER SIGNIFICANT INCOME OR NET WORTH. BEFORE INITIATING LEGAL ACTION FOR NON-PAYMENT, OUR HOSPITALS WILL, IN CONJUNCTION WITH THE PATIENT, MAKE SURE THAT THE PATIENT IS NOT ELIGIBLE FOR ANY ASSISTANCE PROGRAM AND DOES NOT QUALIFY UNDER THE HOSPITALS' CHARITY CARE POLICY. THE HOSPITAL RESERVES THE RIGHT TO PLACE A LIEN ON THE PATIENT'S (GUARANTOR'S) REAL ESTATE; HOWEVER, THE HOSPITAL WILL NOT EXECUTE FORECLOSURE PROCEEDINGS IF THIS IS THE PATIENT'S (GUARANTOR'S) PRIMARY RESIDENCE.

Schedule H, Part VI, Line 2 Needs assessment
IN ADDITION TO THE CHNA DESCRIBED IN PART V, SECTION B, THE HEALTH CARE NEEDS OF THE COMMUNITY ARE COLLABORATIVELY ASSESSED BY SURVEY PROCESSES CONDUCTED BY SUMMA HEALTH, SUMMIT COUNTY PUBLIC HEALTH, HEALTHY CONNECTIONS NETWORK, CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON, THE UNITED WAY, SOCIAL SERVICES ADVISORY BOARD OF SUMMIT COUNTY, AND AKRON GENERAL MEDICAL CENTER.

Schedule H, Part VI, Line 3 Patient education of eligibility for assistance
IN ACCORDANCE WITH THE RULES SET FORTH BY OHIO ADMINISTRATIVE CODE SECTION 2101:3-2-07.17 NOTICES, SUMMA Health System, SUMMA BARBERTON CITIZENS HOSPITAL, THE WADSWORTH-RITTMAN AREA HOSPITAL ASSOCIATION, AND SUMMA WESTERN RESERVE HOSPITAL, LLC HAVE NOTICES POSTED IN THE EMERGENCY ROOM, ADMISSION AREAS, CASHIER'S OFFICE, AND OTHER APPROPRIATE AREAS. THE NOTICES SPECIFY THE RIGHTS OF INDIVIDUALS TO RECEIVE WITHOUT CHARGE, BASIC MEDICALLY NECESSARY HOSPITAL-LEVEL SERVICES. A FINANCIAL COUNSELOR WHO IS ASSIGNED TO PATIENTS AT THE POINT OF ADMISSION REVIEWS THE AVAILABILITY OF FINANCIAL ASSISTANCE PROGRAMS AND ASSISTS WITH THE APPLICATION IF REQUESTED. THE SUMMA WEBSITE PROVIDES INFORMATION REGARDING FINANCIAL ASSISTANCE. CUSTOMER SERVICE REPRESENTATIVES PROVIDE FINANCIAL COUNSELING WITH EXPLANATION OF ASSISTANCE PROGRAMS TO PATIENTS WHO CALL. EACH STATEMENT SENT TO THE PATIENT CONTAINS AN EXPLANATION OF THE FREE CARE PROGRAM AS WELL AS AN APPLICATION ON THE BACK SIDE OF THE STATEMENT.

Schedule H, Part VI, Line 4 Community information
SUMMA HEALTH HAS CARE DELIVERY SITES IN PRIMARILY THREE COUNTIES IN NORTHEAST OHIO: SUMMIT, PORTAGE AND MEDINA. BASED ON THE 2010 CENSUS, THESE COUNTIES CONSTITUTE A POPULATION OF APPROXIMATELY 854,000 INDIVIDUALS. SUMMIT COUNTY HAS THE LARGEST POPULATION (547,000) AND ACCOUNTS FOR MORE THAN 60% OF THE PERSONS SERVED BY SUMMA. MEDINA (150,000) AND PORTAGE (158,000) COUNTIES HAVE SIMILAR POPULATIONS, WITH PORTAGE BEING SLIGHTLY LARGER. EACH ACCOUNTS FOR LESS THAN 20% OF THE PERSONS SERVED BY SUMMA. MORE THAN 50% OF THE HOUSEHOLDS IN SUMMIT AND PORTAGE COUNTIES MAKE LESS THAN $50,000 ANNUALLY AND 15.0% AND 14.5% OF HOUSEHOLDS MAKE LESS THAN $15,000 ANNUALLY RESPECTIVELY. FOR THE CALENDAR YEAR 2014, THE AVERAGE MONTHLY UNEMPLOYMENT RATES FOR MEDINA, PORTAGE, AND SUMMIT COUNTIES WERE 4.1%, 4.8%, AND 4.9% RESPECTIVELY. LOW INCOMES AND AN ESSENTIALLY STAGNANT UNEMPLOYMENT RATE ADD TO SUMMA'S BURDEN FOR CHARITY CARE. DESPITE THESE CHALLENGES, DEMAND FOR SUMMA'S SERVICES IN THESE COMMUNITIES IS PROJECTED TO GROW. WHILE THE TOTAL POPULATION OF SUMMIT COUNTY IS EXPECTED TO DECLINE (BY -1.2%), THE POPULATION IN PORTAGE IS EXPECTED TO REMAIN FLAT, AND MEDINA IS PROJECTED TO SEE GROWTH (1.4%) OVER THE 5-YEAR PERIOD 2013-2018. MORE IMPORTANTLY, THE AGE GROUP THAT DEMAND HEALTHCARE SERVICES THE MOST (AGE 65 AND OLDER) IS EXPECTED TO GROW SIGNIFICANTLY. IN MEDINA COUNTY ALONE, THIS GROUP IS EXPECTED TO INCREASE 18.2%, WHILE PORTAGE AND SUMMIT ARE EXPECTED TO GROW 16.0% AND 11.8% RESPECTIVELY OVER THE FIVE YEAR PERIOD.

Schedule H, Part VI, Line 5 Promotion of community health
AMONG THE WAYS THE HOSPITALS WITHIN SUMMA HEALTH PROMOTE THE HEALTH OF THE COMMUNITY ARE BY MAINTAINING AN OPEN MEDICAL STAFF AND A COMMUNITY BOARD (COMMUNITY BENEFIT COMMITTEE). SUMMA'S HOSPITALS ADDRESS HEALTH DISPARITIES THROUGH PRACTICE, RESEARCH, EDUCATION AND COLLABORATION WITH OTHER COMMUNITY ORGANIZATIONS. CONTRIBUTIONS, BOTH FINANCIAL AND IN-KIND, ARE MADE TO INITIATIVES AND PROGRAMMING (I.E. FEDERALLY QUALIFIED HEALTH CENTER, OPEN M, CENTER FOR COMMUNITY HEALTH IMPROVEMENT) THAT ARE DEEMED TO PROMOTE THE HEALTH, WELLNESS AND IMPROVED QUALITY OF LIFE FOR THE COMMUNITIES SUMMA HEALTH SERVES.

Schedule H, Part VI, Line 6 Affiliated health care system
"SUMMA HEALTH IS ONE OF THE LARGEST INTEGRATED DELIVERY SYSTEMS IN OHIO, ENCOMPASSING A NETWORK OF HOSPITALS, COMMUNITY-BASED HEALTH CENTERS, A HEALTH PLAN, A PHYSICIAN-HOSPITAL ORGANIZATION, RESEARCH AND MEDICAL EDUCATION AND A FOUNDATION. SUMMA HEALTH IS RENOWNED FOR EXCELLENCE IN PATIENT CARE AND FOR EXCEPTIONAL APPROACHES TO HEALTHCARE DELIVERY. DURING 2014, SUMMA HEALTH PROVIDED INPATIENT CARE THROUGH FACILITIES LOCATED ON SIX CAMPUSES AND IN ADDITION, OUTPATIENT CARE IS EXTENDED THROUGHOUT THE REGION IN A NUMBER OF OUTPATIENT CENTERS, BOTH HOSPITAL-BASED AND FREESTANDING. BASED ON TWO CAMPUSES, SUMMA HEALTH SYSTEM IS LOCATED IN DOWNTOWN AKRON, OHIO AND HAS SERVED, TOGETHER WITH SUMMA HEALTH, AS THE LARGEST SAFETY-NET HOSPITAL IN THE COMMUNITY FOR MANY YEARS. SUMMA BARBERTON CITIZENS HOSPITAL (""SBH"") JOINED SUMMA HEALTH IN DECEMBER, 2007 WHEN SUMMA HEALTH COMPLETED ITS ACQUISTION OF BARBERTON CITIZENS HOSPITAL. SBH IS A 249-BED GENERAL ACUTE CARE COMMUNITY HOSPITAL THAT OFFERS INPATIENT SERVICES, OUTPATIENT SERVICES AND COMMUNITY OUTREACH PROGRAMS. SBH IS LOCATED IN THE TOWN OF BARBERTON IN SOUTHERN SUMMIT COUNTY. THE WADSWORTH-RITTMAN AREA HOSPITAL ASSOCIATION (""WRH"") AFFILIATED WITH SUMMA HEALTH IN NOVEMBER 2007, AND THEN MERGED WITH SUMMA HEALTH IN 2008. WRH IS A COMMUNITY-BASED OUTPATIENT FACILITY IN WADSWORTH, MEDINA COUNTY, OHIO, SITUATED TO THE WEST OF SUMMIT COUNTY. WRH SERVES COMMUNITIES IN MEDINA AND WAYNE COUNTIES. WRH'S INPATIENT FACILITIES WERE CLOSED IN JULY 2014 AND WRH WAS MERGED INTO SBH. SUMMA WESTERN RESERVE HOSPITAL, LLC (""SWRH"") IS A JOINT VENTURE BETWEEN SUMMA HEALTH SYSTEM AND THE WESTERN RESERVE HOSPITAL PARTNERS AND PROVIDES A FULL RANGE OF ACUTE MEDICAL SERVICES. SWRH PROVIDES ITS HOSPITAL OPERATIONS ON THE CAMPUS OF SUMMA CUYAHOGA FALLS GENERAL HOSPITAL. SWRH PROVIDES A FULL RANGE OF SERVICES, INCLUDING A 24-HOUR EMERGENCY ROOM AND ADHERES TO THE FINANCIAL ASSISTANCE POLICY OF SUMMA HEALTH. THE CRYSTAL CLINIC ORTHOPAEDIC CENTER, LLC (""CCOC""), A JOINT VENTURE BETWEEN SUMMA HEALTH SYSTEM AND THE CRYSTAL CLINIC, INTEGRATES THE INPATIENT AND OUTPATIENT SERVICES AND PHYSICIAN PRACTICES OF THE AKRON-AREA'S LEADING ORTHOPAEDIC PROGRAMS AND OPERATES AS A ""HOSPITAL WITHIN A HOSPITAL"" AT SUMMA ST. THOMAS HOSPITAL. CCOC ALSO ADHERES TO SUMMA'S FINANCIAL ASSISTANCE POLICY IN PROVIDING BOTH INPATIENT AND OUTPATIENT SERVICES, INCLUDING SURGERY, ORTHOPAEDIC ONCOLOGY, TOTAL JOINT REPLACEMENT AND OTHERS. CCOC OFFERS OUTPATIENT AMBULATORY SURGERY AT THE CRYSTAL CLINIC SURGERY CENTER IN MONTROSE AND PHYSICAN PRACTICE LOCATIONS IN AKRON AND ITS SUBURBS OF BARBERTON, KENT, CUYAHOGA FALLS, MEDINA, GREEN AND STOW. SH's SHARE OF CCOC WAS SOLD IN DECEMBER, 2014. SUMMA REHAB HOSPITAL, LLC, A JOINT VENTURE BETWEEN SUMMA HEALTH SYSTEM AND VIBRA HEALTHCARE, OPENED ON THE CAMPUS OF SUMMA AKRON CITY HOSPITAL IN 2012. THIS 60-BED FACILITY PROVIDES INPATIENT REHABILITATION CARE AND SERVICES AND ADHERES TO SUMMA'S FINANCIAL ASSISTANCE POLICY. ESTABLISHED IN 1993, SUMMACARE OFFERS HEALTH CARE COVERAGE TO MEMBERS THROUGH ITS STATUS AS A MEDICARE ADVANTAGE ORGANIZATION. IT IS RECOGNIZED BY THE HEALTH INDUSTRY RESEARCH COMPANY AS A HEALTH PLAN WITH EFFECTIVE DISEASE MANAGEMENT PROGRAMS FOR ASTHMA, HEALTH FAILURE AND DIABETES. SUMMACARE, ALONG WITH ITS THIRD PARTY ADMINISTRATIVE SERVICES PRODUCTS COVERS MORE THAN 150,000 MEMBERS. SUMMA FOUNDATION IS A NONPROFIT ORGANIZATION ADVANCING TRANSFORMATIONAL PHILANTHROPY, COMMUNITY UNDERSTANDING AND GOODWILL FOR THE PROGRAMS AND PRIORITIES OF SUMMA HEALTH. THE FOUNDATION CREATES AND IMPLEMENTS INNOVATIVE PARTNERSHIPS, HEALTH POLICY OPPORTUNITIES AND FUNDING STRATEGIES TO SUPPORT SUMMA HEALTH'S EDUCATION, RESEARCH AND PATIENT CARE AGENDA. SUMMA HEALTH NETWORK, LLC IS THE INTEGRATED PHYSICIAN-HOSPITAL ORGANIZATION AFFILIATED WITH SUMMA HEALTH . WITH MORE THAN 1,400 PHYSICIANS PARTICIPATING, SUMMA HEALTH NETWORK OVERSEES MUTUALLY BENEFICIAL CONTRACTS WITH INSURANCE COMPANIES, PREFERRED PROVIDER ORGANIZATIONS, THIRD-PARTY ADMINISTRATORS AND OTHER PAYORS ON BEHALF OF ITS PHYSICIANS AND HOSPITAL MEMBERS. SUMMA HEALTH NETWORK ALSO OFFERS A COMPREHENSIVE PERFORMANCE INCENTIVE AND CLINICAL INTEGRATION NETWORKS THAT PARTNERS WITH PAYORS TO IMPROVE THE QUALITY OF CARE DELIVERED TO PATIENTS AND TO LOWER THE COST OF CARE. SUMMA ACCOUNTABLE CARE ORGANIZATION (D/B/A NEW HEALTH COLLABORATIVE (""NHC"")) IS A CLINICIAN-LED COLLABORATIVE, ORGANIZED TO COMPASSIONATELY CARE FOR AND SERVE PATIENTS IN AN ACCOUNTABLE, VALUE AND EVIDENCE-BASED MANNER. IN ACCORDANCE WITH THE AFFORDABLE CARE ACT, NHC CREATES INCENTIVES FOR PROVIDERS TO FURTHER ENHANCE THE QUALITY OF CARE. OHIO HEALTH CHOICE, INC. IS OHIO'S OLDEST PREFERRED PROVIDER ORGANIZATION (PPO) NETWORK AND ONE OF THE LARGEST IN THE STATE. CO-OWNED BY SUMMA HEALTH AND MERCY MEDICAL CENTER, OHIO HEALTH CHOICE IS A LEADER IN THE MANAGED HEALTHCARE INDUSTRY AND IS COMPRISED OF 198 HOSPITALS, 8,000 PRIMARY CARE PROVIDERS, 18,000 SPECIALISTS AND CONTRACTS WITH 94 THIRD PARTY ADMINISTRATORS COVERING MEMBERS ACROSS ALL 88 COUNTIES IN OHIO. SUMMA PHYSICIANS INC. (""SP"") IS A SUMMA HEALTH ENTITY OF MULTI-SPECIALTY PHYSICIANS AND PRACTICES. CURRENTLY, SP EMPLOYS CLOSE TO 300 PHYSICIANS IN MULTIPLE SPECIALTIES. SP PROMOTES STRONGER AFFILIATION AND EMPLOYMENT OF PHYSICIANS TO ENSURE COMMUNITY AND HOSPITAL NEEDS FOR PHYSICIANS SERVICES ARE MET."