Form990
Click to see attachment
Department of the TreasuryInternal Revenue Service
Return of Organization Exempt From Income Tax
Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code (except private foundations)
MediumBullet Do not enter social security numbers on this form as it may be made public.
MediumBullet Go to www.irs.gov/Form990 for instructions and the latest information.
OMB No. 1545-0047
2018
Open to Public Inspection
A For the 2019 calendar year, or tax year beginning 01-01-2018 , and ending 12-31-2018
BCheck if applicable:
CName of organization
SOUTHEASTERN OHIO REGIONAL MEDICAL
CENTER INC
 
Doing business as
 
 
Number and street (or P.O. box if mail is not delivered to street address)
1341 CLARK STREET
 
Room/suite
City or town, state or province, country, and ZIP or foreign postal code
CAMBRIDGE, OH43725
D Employer identification number

31-4391798
E Telephone number

G Gross receipts $ 109,513,749
F Name and address of principal officer:
TIMOTHY R EVANCHO
1341 CLARK STREET
CAMBRIDGE,OH43725
I
Tax-exempt status: (   ) LeftBullet (insert no.) or
J
Website:MediumBullet
WWW.SEORMC.ORG
H(a)
Is this a group return for
subordinates?
H(b)
Are all subordinates
included?
If "No," attach a list. (see instructions)
H(c)
Group exemption number MediumBullet  
K Form of organization:  
L Year of formation: 1946
M State of legal domicile: OH
Part I
Summary
Activities  & Governance 1 Briefly describe the organization’s mission or most significant activities: GENERAL COMMUNITY HOSPITAL WITH A MISSION TO PROVIDE HIGH QUALITY, COMPREHENSIVE, AFFORDABLE, PATIENT-CENTERED HEALTHCARE IN A CARING AND SAFE ENVIRONMENT, WHILE ADDRESSING COMMUNITY NEEDS.
2 Check this box MediumBullet
3 Number of voting members of the governing body (Part VI, line 1a) ........ 3 15
4 Number of independent voting members of the governing body (Part VI, line 1b) ..... 4 14
5 Total number of individuals employed in calendar year 2018 (Part V, line 2a) ...... 5 1,029
6 Total number of volunteers (estimate if necessary) ............. 6 115
7a Total unrelated business revenue from Part VIII, column (C), line 12 ........ 7a 0
b Net unrelated business taxable income from Form 990-T, line 34 ......... 7b 0
Revenues Prior Year Current Year
8 Contributions and grants (Part VIII, line 1h) ......... 148,620 110,562
9 Program service revenue (Part VIII, line 2g) ......... 100,514,229 98,481,433
10 Investment income (Part VIII, column (A), lines 3, 4, and 7d ) .... 971,596 1,122,799
11 Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e) 470,000 470,757
12 Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12) 102,104,445 100,185,551
Expenses; 13 Grants and similar amounts paid (Part IX, column (A), lines 1–3 )... 0 0
14 Benefits paid to or for members (Part IX, column (A), line 4)..... 0 0
15 Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10) 51,817,958 50,466,707
16a Professional fundraising fees (Part IX, column (A), line 11e) ..... 165,000 0
b Total fundraising expenses (Part IX, column (D), line 25) MediumBullet19,119    
17 Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e).... 52,268,868 52,359,023
18 Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25) 104,251,826 102,825,730
19 Revenue less expenses. Subtract line 18 from line 12....... -2,147,381 -2,640,179
Net Assets or Fund Balances; Beginning of Current Year End of Year
20 Total assets (Part X, line 16)............. 65,714,995 57,217,436
21 Total liabilities (Part X, line 26)............. 41,157,792 36,034,974
22 Net assets or fund balances. Subtract line 21 from line 20..... 24,557,203 21,182,462
Part II
Signature Block
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than officer) is based on all information of which preparer has any knowledge.
Sign Here
JumboBullet
Signature of officer Date
JumboBullet
Type or print name and title
Paid Preparer Use Only
Print/Type preparer's name
Preparer's signature
Date
PTIN
Firm's name MediumBullet

Firm's EIN MediumBullet
Firm's address MediumBullet



Phone no.
May the IRS discuss this return with the preparer shown above? (see instructions) ..........
For Paperwork Reduction Act Notice, see the separate instructions.
Cat. No. 11282Y Form 990 (2018)
Form 990 (2018)
Page 2
Part III
Statement of Program Service Accomplishments
Check if Schedule O contains a response or note to any line in this Part III..............
1
Briefly describe the organization’s mission: GENERAL COMMUNITY HOSPITAL WITH A MISSION TO PROVIDE HIGH QUALITY, COMPREHENSIVE, AFFORDABLE, PATIENT-CENTERED HEALTHCARE IN A CARING AND SAFE ENVIRONMENT, WHILE ADDRESSING COMMUNITY NEEDS.
2
Did the organization undertake any significant program services during the year which were not listed on
the prior Form 990 or 990-EZ? .....................
If "Yes," describe these new services on Schedule O.
3
Did the organization cease conducting, or make significant changes in how it conducts, any program
services? ...........................
If "Yes," describe these changes on Schedule O.
4
Describe the organization’s program service accomplishments for each of its three largest program services, as measured by expenses. Section 501(c)(3) and 501(c)(4) organizations are required to report the amount of grants and allocations to others, the total expenses, and revenue, if any, for each program service reported.
4a (Code:   ) (Expenses $ 87,552,559 including grants of $ 0 ) (Revenue $ 93,444,557 )
GENERAL HOSPITAL - MEDICAL SERVICES FOR INPATIENTS AND OUTPATIENTS - SEE ATTACHED SCHEDULE H FOR ADDITONAL INFORMATION
4b (Code:   ) (Expenses $ 10,831,243 including grants of $ 0 ) (Revenue $ 5,036,876 )
OPERATION OF PHYSICIAN OFFICES
4c (Code:   ) (Expenses $   including grants of $   ) (Revenue $   )
4d Other program services (Describe in Schedule O.)
(Expenses $   including grants of $   ) (Revenue $   )
4e Total program service expensesMediumBullet98,383,802
Form 990 (2018)
Form 990 (2018)
Page 3
Part IV
Checklist of Required Schedules
Yes
No
1
Is the organization described in section 501(c)(3) or 4947(a)(1) (other than a private foundation)? If "Yes," complete Schedule AClick to see attachment.....................
1
Yes
 
2
Is the organization required to complete Schedule B, Schedule of Contributors (see instructions)? ...
2
 
No
3
Did the organization engage in direct or indirect political campaign activities on behalf of or in opposition to candidates for public office? If "Yes," complete Schedule C, Part I.............
3
 
No
4
Section 501(c)(3) organizations. Did the organization engage in lobbying activities, or have a section 501(h) election in effect during the tax year? If "Yes," complete Schedule C, Part II..............
4
 
No
5
Is the organization a section 501(c)(4), 501(c)(5), or 501(c)(6) organization that receives membership dues, assessments, or similar amounts as defined in Revenue Procedure 98-19? If "Yes," complete Schedule C, Part III.................
5
 
No
6
Did the organization maintain any donor advised funds or any similar funds or accounts for which donors have the right to provide advice on the distribution or investment of amounts in such funds or accounts? If "Yes," complete Schedule D, Part IClick to see attachment..................
6
 
No
7
Did the organization receive or hold a conservation easement, including easements to preserve open space,
the environment, historic land areas, or historic structures? If "Yes," complete Schedule D, Part IIClick to see attachment...
7
 
No
8
Did the organization maintain collections of works of art, historical treasures, or other similar assets? If "Yes," complete Schedule D, Part IIIClick to see attachment.............
8
 
No
9
Did the organization report an amount in Part X, line 21 for escrow or custodial account liability; serve as a custodian for amounts not listed in Part X; or provide credit counseling, debt management, credit repair, or debt negotiation services? If "Yes," complete Schedule D, Part IVClick to see attachment..............
9
 
No
10
Did the organization, directly or through a related organization, hold assets in temporarily restricted endowments, permanent endowments, or quasi-endowments? If "Yes," complete Schedule D, Part VClick to see attachment......
10
Yes
 
11
If the organization’s answer to any of the following questions is "Yes," then complete Schedule D, Parts VI, VII, VIII, IX, or X as applicable.
a
Did the organization report an amount for land, buildings, and equipment in Part X, line 10?
If "Yes," complete Schedule D, Part VI.Click to see attachment...................
11a
Yes
 
b
Did the organization report an amount for investments—other securities in Part X, line 12 that is 5% or more of its total assets reported in Part X, line 16? If "Yes," complete Schedule D, Part VIIClick to see attachment.......
11b
 
No
c
Did the organization report an amount for investments—program related in Part X, line 13 that is 5% or more of its total assets reported in Part X, line 16? If "Yes," complete Schedule D, Part VIIIClick to see attachment.......
11c
 
No
d
Did the organization report an amount for other assets in Part X, line 15 that is 5% or more of its total assets reported in Part X, line 16? If "Yes," complete Schedule D, Part IXClick to see attachment............
11d
Yes
 
e
Did the organization report an amount for other liabilities in Part X, line 25? If "Yes," complete Schedule D, Part XClick to see attachment
11e
 
No
f
Did the organization’s separate or consolidated financial statements for the tax year include a footnote that addresses the organization’s liability for uncertain tax positions under FIN 48 (ASC 740)? If "Yes," complete Schedule D, Part XClick to see attachment
11f
Yes
 
12a
Did the organization obtain separate, independent audited financial statements for the tax year?
If "Yes," complete Schedule D, Parts XI and XII Click to see attachment.................
12a
Yes
 
b
Was the organization included in consolidated, independent audited financial statements for the tax year? If "Yes," and if the organization answered "No" to line 12a, then completing Schedule D, Parts XI and XII is optional Click to see attachment
12b
Yes
 
13
Is the organization a school described in section 170(b)(1)(A)(ii)? If "Yes," complete Schedule E
13
 
No
14a
Did the organization maintain an office, employees, or agents outside of the United States? .....
14a
 
No
b
Did the organization have aggregate revenues or expenses of more than $10,000 from grantmaking, fundraising, business, investment, and program service activities outside the United States, or aggregate foreign investments valued at $100,000 or more? If "Yes," complete Schedule F, Parts I and IV.........
14b
 
No
15
Did the organization report on Part IX, column (A), line 3, more than $5,000 of grants or other assistance to or for any foreign organization? If “Yes,” complete Schedule F, Parts II and IV.....
15
 
No
16
Did the organization report on Part IX, column (A), line 3, more than $5,000 of aggregate grants or other assistance to or for foreign individuals? If “Yes,” complete Schedule F, Parts III and IV...
16
 
No
17
Did the organization report a total of more than $15,000 of expenses for professional fundraising services on Part IX, column (A), lines 6 and 11e? If "Yes," complete Schedule G, Part I(see instructions) ....
17
 
No
18
Did the organization report more than $15,000 total of fundraising event gross income and contributions on Part VIII, lines 1c and 8a? If "Yes," complete Schedule G, Part II............
18
 
No
19
Did the organization report more than $15,000 of gross income from gaming activities on Part VIII, line 9a? If "Yes," complete Schedule G, Part III...................
19
 
No
20a
Did the organization operate one or more hospital facilities? If "Yes," complete Schedule H....Click to see attachment
20a
Yes
 
b
If "Yes" to line 20a, did the organization attach a copy of its audited financial statements to this return? Click to see attachment
20b
Yes
 
21
Did the organization report more than $5,000 of grants or other assistance to any domestic organization or domestic government on Part IX, column (A), line 1? If “Yes,” complete Schedule I, Parts I and II.....
21
 
No
22
Did the organization report more than $5,000 of grants or other assistance to or for domestic individuals on Part IX, column (A), line 2? If “Yes,” complete Schedule I, Parts I and III........
22
 
No
Form 990 (2018)
Form 990 (2018)
Page 4
Part IV
Checklist of Required Schedules (continued)
Yes
No
23
Did the organization answer "Yes" to Part VII, Section A, line 3, 4, or 5 about compensation of the organization’s current and former officers, directors, trustees, key employees, and highest compensated employees? If "Yes," complete Schedule J....................... Click to see attachment
23
Yes
 
24a
Did the organization have a tax-exempt bond issue with an outstanding principal amount of more than $100,000 as of the last day of the year, that was issued after December 31, 2002? If “Yes,” answer lines 24b through 24d and complete Schedule K. If “No,” go to line 25a...............Click to see attachment
24a
Yes
 
b
Did the organization invest any proceeds of tax-exempt bonds beyond a temporary period exception?...
24b
 
No
c
Did the organization maintain an escrow account other than a refunding escrow at any time during the year
to defease any tax-exempt bonds? ...............
24c
 
No
d
Did the organization act as an "on behalf of" issuer for bonds outstanding at any time during the year?...
24d
 
No
25a
Section 501(c)(3), 501(c)(4), and 501(c)(29) organizations. Did the organization engage in an excess benefit transaction with a disqualified person during the year? If "Yes," complete Schedule L, Part I............ Click to see attachment
25a
 
No
b
Is the organization aware that it engaged in an excess benefit transaction with a disqualified person in a prior year, and that the transaction has not been reported on any of the organization’s prior Forms 990 or 990-EZ? If "Yes," complete Schedule L, Part I...................Click to see attachment
25b
 
No
26
Did the organization report any amount on Part X, line 5, 6, or 22 for receivables from or payables to any current or former officers, directors, trustees, key employees, highest compensated employees, or disqualified persons? If "Yes," complete Schedule L, Part II................Click to see attachment
26
 
No
27
Did the organization provide a grant or other assistance to an officer, director, trustee, key employee, substantial contributor or employee thereof, a grant selection committee member, or to a 35% controlled entity or family member of any of these persons? If "Yes," complete Schedule L, Part III......... Click to see attachment
27
 
No
28
Was the organization a party to a business transaction with one of the following parties (see Schedule L, Part IV instructions for applicable filing thresholds, conditions, and exceptions):
a
A current or former officer, director, trustee, or key employee? If "Yes," complete Schedule L,
Part IV
........................Click to see attachment
28a
 
No
b
A family member of a current or former officer, director, trustee, or key employee? If "Yes," complete Schedule L, Part IV.....................Click to see attachment
28b
Yes
 
c
An entity of which a current or former officer, director, trustee, or key employee (or a family member thereof) was an officer, director, trustee, or direct or indirect owner? If "Yes," complete Schedule L, Part IV... Click to see attachment
28c
Yes
 
29
Did the organization receive more than $25,000 in non-cash contributions? If "Yes," complete Schedule M..
29
 
No
30
Did the organization receive contributions of art, historical treasures, or other similar assets, or qualified conservation contributions? If "Yes," complete Schedule M .............
30
 
No
31
Did the organization liquidate, terminate, or dissolve and cease operations? If "Yes," complete Schedule N, Part I.
31
 
No
32
Did the organization sell, exchange, dispose of, or transfer more than 25% of its net assets? If "Yes," complete Schedule N, Part II...........
32
 
No
33
Did the organization own 100% of an entity disregarded as separate from the organization under Regulations sections 301.7701-2 and 301.7701-3? If "Yes," complete Schedule R, Part I........Click to see attachment
33
Yes
 
34
Was the organization related to any tax-exempt or taxable entity? If "Yes," complete Schedule R, Part II, III, or IV, and Part V, line 1.........................Click to see attachment
34
Yes
 
35a
Did the organization have a controlled entity within the meaning of section 512(b)(13)?
35a
 
No
b
If ‘Yes’ to line 35a, did the organization receive any payment from or engage in any transaction with a controlled entity within the meaning of section 512(b)(13)? If "Yes," complete Schedule R, Part V, line 2 ...
35b
 
 
36
Section 501(c)(3) organizations. Did the organization make any transfers to an exempt non-charitable related organization? If "Yes," complete Schedule R, Part V, line 2............. Click to see attachment
36
 
No
37
Did the organization conduct more than 5% of its activities through an entity that is not a related organization and that is treated as a partnership for federal income tax purposes? If "Yes," complete Schedule R, Part VIClick to see attachment
37
 
No
38
Did the organization complete Schedule O and provide explanations in Schedule O for Part VI, lines 11b and 19? Note. All Form 990 filers are required to complete Schedule O. ............
38
Yes
 
Part V
Statements Regarding Other IRS Filings and Tax Compliance
Check if Schedule O contains a response or note to any line in this Part V...........
Yes
No
1a
Enter the number reported in Box 3 of Form 1096 Enter -0- if not applicable ..
1a
162
b
Enter the number of Forms W-2G included in line 1a. Enter -0- if not applicable .
1b
0
c
Did the organization comply with backup withholding rules for reportable payments to vendors and reportable gaming (gambling) winnings to prize winners? ..................
1c
Yes
 
Form 990 (2018)
Form 990 (2018)
Page 5
2a
Enter the number of employees reported on Form W-3, Transmittal of Wage and
Tax Statements, filed for the calendar year ending with or within the year covered by this return ..................
2a
1,029
b
If at least one is reported on line 2a, did the organization file all required federal employment tax returns?
Note. If the sum of lines 1a and 2a is greater than 250, you may be required to e-file (see instructions)
2b
Yes
 
3a
Did the organization have unrelated business gross income of $1,000 or more during the year?...
3a
 
No
b
If “Yes,” has it filed a Form 990-T for this year? If “No” to line 3b, provide an explanation in Schedule O...
3b
 
 
4a
At any time during the calendar year, did the organization have an interest in, or a signature or other authority over, a financial account in a foreign country (such as a bank account, securities account, or other financial account)? ..
4a
 
No
b
If "Yes," enter the name of the foreign country: MediumBullet
See instructions for filing requirements for FinCEN Form 114, Report of Foreign Bank and Financial Accounts (FBAR).
5a
Was the organization a party to a prohibited tax shelter transaction at any time during the tax year? ..
5a
 
No
b
Did any taxable party notify the organization that it was or is a party to a prohibited tax shelter transaction?
5b
 
No
c
If "Yes," to line 5a or 5b, did the organization file Form 8886-T? ............
5c
 
 
6a
Does the organization have annual gross receipts that are normally greater than $100,000, and did the organization solicit any contributions that were not tax deductible as charitable contributions? ...
6a
 
No
b
If "Yes," did the organization include with every solicitation an express statement that such contributions or gifts were not tax deductible? ......................
6b
 
 
7
Organizations that may receive deductible contributions under section 170(c).
a
Did the organization receive a payment in excess of $75 made partly as a contribution and partly for goods and services provided to the payor? ....................
7a
Yes
 
b
If "Yes," did the organization notify the donor of the value of the goods or services provided? .....
7b
Yes
 
c
Did the organization sell, exchange, or otherwise dispose of tangible personal property for which it was required to file Form 8282? .........................
7c
 
No
d
If "Yes," indicate the number of Forms 8282 filed during the year ....
7d
 
e
Did the organization receive any funds, directly or indirectly, to pay premiums on a personal benefit contract?
7e
 
No
f
Did the organization, during the year, pay premiums, directly or indirectly, on a personal benefit contract? ..
7f
 
No
g
If the organization received a contribution of qualified intellectual property, did the organization file Form 8899 as required? ......................
7g
 
 
h
If the organization received a contribution of cars, boats, airplanes, or other vehicles, did the organization file a Form 1098-C? ..........................
7h
 
 
8
Sponsoring organizations maintaining donor advised funds.
Did a donor advised fund maintained by the sponsoring organization have excess business holdings at any time during the year? .........................
8
 
 
9a
Did the sponsoring organization make any taxable distributions under section 4966?...
9a
 
 
b
Did the sponsoring organization make a distribution to a donor, donor advisor, or related person?...
9b
 
 
10
Section 501(c)(7) organizations. Enter:
a
Initiation fees and capital contributions included on Part VIII, line 12 ...
10a
 
b
Gross receipts, included on Form 990, Part VIII, line 12, for public use of club facilities
10b
 
11
Section 501(c)(12) organizations. Enter:
a
Gross income from members or shareholders .........
11a
 
b
Gross income from other sources (Do not net amounts due or paid to other sources against amounts due or received from them.) ..........
11b
 
12a
Section 4947(a)(1) non-exempt charitable trusts. Is the organization filing Form 990 in lieu of Form 1041?
12a
 
 
b
If "Yes," enter the amount of tax-exempt interest received or accrued during the year.
12b
 
13
Section 501(c)(29) qualified nonprofit health insurance issuers.
a
Is the organization licensed to issue qualified health plans in more than one state?
Note. See the instructions for additional information the organization must report on Schedule O.
13a
 
 
b
Enter the amount of reserves the organization is required to maintain by the states in which the organization is licensed to issue qualified health plans ....
13b
 
c
Enter the amount of reserves on hand ............
13c
 
14a
Did the organization receive any payments for indoor tanning services during the tax year?.....
14a
 
No
b
If "Yes," has it filed a Form 720 to report these payments? If "No," provide an explanation in Schedule O..
14b
 
 
15
Is the organization subject to the section 4960 tax on payment(s) of more than $1,000,000 in remuneration or excess parachute payment(s) during the year? If "Yes," see instructions and file Form 4720, Schedule N .....
15
 
No
16
Is the organization an educational institution subject to the section 4968 excise tax on net investment income?
If "Yes," complete Form 4720, Schedule O ................
16
 
No
Form 990 (2018)
Form 990 (2018)
Page 6
Part VI
Governance, Management, and Disclosure For each "Yes" response to lines 2 through 7b below, and for a "No" response to lines 8a, 8b, or 10b below, describe the circumstances, processes, or changes in Schedule O. See instructions.
Check if Schedule O contains a response or note to any line in this Part VI..............
Section A. Governing Body and Management
Yes
No
1a
Enter the number of voting members of the governing body at the end of the tax year
1a
15
If there are material differences in voting rights among members of the governing body, or if the governing body delegated broad authority to an executive committee or similar committee, explain in Schedule O.
b
Enter the number of voting members included in line 1a, above, who are independent
1b
14
2
Did any officer, director, trustee, or key employee have a family relationship or a business relationship with any other officer, director, trustee, or key employee? .................
2
Yes
 
3
Did the organization delegate control over management duties customarily performed by or under the direct supervision of officers, directors or trustees, or key employees to a management company or other person? .
3
Yes
 
4
Did the organization make any significant changes to its governing documents since the prior Form 990 was filed? .
4
 
No
5
Did the organization become aware during the year of a significant diversion of the organization’s assets? .
5
 
No
6
Did the organization have members or stockholders? ................
6
 
No
7a
Did the organization have members, stockholders, or other persons who had the power to elect or appoint one or more members of the governing body? ....................
7a
Yes
 
b
Are any governance decisions of the organization reserved to (or subject to approval by) members, stockholders, or persons other than the governing body? ...................
7b
 
No
8
Did the organization contemporaneously document the meetings held or written actions undertaken during the year by the following:
a
The governing body? .......................
8a
Yes
 
b
Each committee with authority to act on behalf of the governing body? ............
8b
Yes
 
9
Is there any officer, director, trustee, or key employee listed in Part VII, Section A, who cannot be reached at the organization’s mailing address? If "Yes," provide the names and addresses in Schedule O.......
9
 
No
Section B. Policies (This Section B requests information about policies not required by the Internal Revenue Code.)
Yes
No
10a
Did the organization have local chapters, branches, or affiliates? ............
10a
 
No
b
If "Yes," did the organization have written policies and procedures governing the activities of such chapters, affiliates, and branches to ensure their operations are consistent with the organization's exempt purposes?
10b
 
 
11a
Has the organization provided a complete copy of this Form 990 to all members of its governing body before filing the form? ............................
11a
Yes
 
b
Describe in Schedule O the process, if any, used by the organization to review this Form 990. .....
12a
Did the organization have a written conflict of interest policy? If "No," go to line 13.......
12a
Yes
 
b
Were officers, directors, or trustees, and key employees required to disclose annually interests that could give rise to conflicts? ..........................
12b
Yes
 
c
Did the organization regularly and consistently monitor and enforce compliance with the policy? If "Yes," describe in Schedule O how this was done...................
12c
Yes
 
13
Did the organization have a written whistleblower policy? ...............
13
Yes
 
14
Did the organization have a written document retention and destruction policy? .........
14
Yes
 
15
Did the process for determining compensation of the following persons include a review and approval by independent persons, comparability data, and contemporaneous substantiation of the deliberation and decision?
a
The organization’s CEO, Executive Director, or top management official ...........
15a
Yes
 
b
Other officers or key employees of the organization ................
15b
Yes
 
If "Yes" to line 15a or 15b, describe the process in Schedule O (see instructions).
16a
Did the organization invest in, contribute assets to, or participate in a joint venture or similar arrangement with a taxable entity during the year? ......................
16a
Yes
 
b
If "Yes," did the organization follow a written policy or procedure requiring the organization to evaluate its participation in joint venture arrangements under applicable federal tax law, and take steps to safeguard the organization’s exempt status with respect to such arrangements? ............
16b
Yes
 
Section C. Disclosure
17
List the States with which a copy of this Form 990 is required to be filedMediumBullet
OH
18
Section 6104 requires an organization to make its Form 1023 (or 1024-A if applicable), 990, and 990-T (501(c)(3)s only) available for public inspection. Indicate how you made these available. Check all that apply.
19
Describe in Schedule O whether (and if so, how) the organization made its governing documents, conflict of interest policy, and financial statements available to the public during the tax year.
20
State the name, address, and telephone number of the person who possesses the organization's books and records:
MediumBulletTIMOTHY R EVANCHO1341 CLARK STREET   CAMBRIDGE,OH43725 (740) 439-8179
Form 990 (2018)
Form 990 (2018)
Page 7
Part VII
Compensation of Officers, Directors,Trustees, Key Employees, Highest Compensated Employees, and Independent Contractors
Check if Schedule O contains a response or note to any line in this Part VII..............
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees
1a Complete this table for all persons required to be listed. Report compensation for the calendar year ending with or within the organization’s tax year.
RoundBullet List all of the organization’s current officers, directors, trustees (whether individuals or organizations), regardless of amount
of compensation. Enter -0- in columns (D), (E), and (F) if no compensation was paid.

RoundBullet List all of the organization’s current key employees, if any. See instructions for definition of "key employee."
RoundBullet List the organization’s five current highest compensated employees (other than an officer, director, trustee or key employee)
who received reportable compensation (Box 5 of Form W-2 and/or Box 7 of Form 1099-MISC) of more than $100,000 from the
organization and any related organizations.

RoundBullet List all of the organization’s former officers, key employees, or highest compensated employees who received more than $100,000
of reportable compensation from the organization and any related organizations.

RoundBullet List all of the organization’s former directors or trustees that received, in the capacity as a former director or trustee of the
organization, more than $10,000 of reportable compensation from the organization and any related organizations.

List persons in the following order: individual trustees or directors; institutional trustees; officers; key employees; highest
compensated employees; and former such persons.
Check this box if neither the organization nor any related organization compensated any current officer, director, or trustee.
(A)
Name and Title
(B)
Average hours per week (list any hours for related organizations below dotted line)
(C)
Position (do not check more than one box, unless person is both an officer and a director/trustee)
(D)
Reportable compensation from the organization (W- 2/1099-MISC)
(E)
Reportable compensation from related organizations (W- 2/1099-MISC)
(F)
Estimated amount of other compensation from the organization and related organizations
Individual Trustee or Director; Institutional Trustee; OfficerInd; Key Employee; Highest compensated employee; FormerOfcrDirectorTrusteeInd;
(1) GREG ADAMS......................................................................
TRUSTEE
2.00
.................
 
X           0 0 0
(2) SHAWN RAY......................................................................
CHAIR
8.00
.................
 
X   X       0 0 0
(3) BRIAN SHANAHAN......................................................................
VICE CHAIR
5.00
.................
 
X   X       0 0 0
(4) PHILIP HEARING......................................................................
TREASURER
5.00
.................
 
X   X       0 0 0
(5) MATTHEW P ELLI......................................................................
TRUSTEE
2.00
.................
 
X           0 0 0
(6) COLLEEN H HEACOCK......................................................................
TRUSTEE
2.00
.................
 
X           0 0 0
(7) DONALD J CROCK......................................................................
TRUSTEE
2.00
.................
 
X           0 0 0
(8) SHON GRESS......................................................................
TRUSTEE
2.00
.................
 
X           0 0 0
(9) MARIBETH WRIGHT......................................................................
SECRETARY
5.00
.................
 
X   X       0 0 0
(10) MICHAEL D SARAP MD......................................................................
TRUSTEE
2.00
.................
 
X           5,125 0 0
(11) MARCIA WINNETT......................................................................
TRUSTEE
2.00
.................
 
X           0 0 0
(12) PATRICK GOGGIN MD......................................................................
TRUSTEE
2.00
.................
 
X           11,750 0 0
(13) RAYMOND M CHOREY......................................................................
PRESIDENT & CEO
0.00
.................
40.00
X   X       0 347,489 25,318
(14) THOMASINA CROCK......................................................................
TRUSTEE
2.00
.................
 
X           0 0 0
(15) SUELLEN JOHNSON......................................................................
TRUSTEE
2.00
.................
 
X           0 0 0
(16) CHERYL L HERBERT......................................................................
PRESIDENT & CEO
0.00
.................
40.00
X   X       0 0 0
(17) TIMOTHY R EVANCHO......................................................................
V.P. FINANCE & CFO/ASST TREASURER
0.00
.................
40.00
    X       0 186,160 19,800
Form 990 (2018)
Form 990 (2018)
Page 8
Part VII
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees (continued)
(A)
Name and Title
(B)
Average hours per week (list any hours for related organizations below dotted line)
(C)
Position (do not check more than one box, unless person is both an officer and a director/trustee)
(D)
Reportable compensation from the organization (W- 2/1099-MISC)
(E)
Reportable compensation from related organizations (W- 2/1099-MISC)
(F)
Estimated amount of other compensation from the organization and related organizations
Individual Trustee or Director; Institutional Trustee; OfficerInd; Key Employee; Highest compensated employee; FormerOfcrDirectorTrusteeInd;
(18) ANGELA S LONG........................................................................
V.P. NURSING SERVICES
0.00
.......................40.00
    X       0 182,699 16,665
(19) STEVEN M BROOKS........................................................................
V.P. HUMAN RESOURCES
0.00
.......................40.00
    X       0 140,485 23,259
(20) BARBARA PURDUM........................................................................
ASSISTANT SECRETARY
40.00
.......................0.00
    X       55,643 0 438
(21) E EDWIN CONAWAY........................................................................
VP MEDICAL AFFAIRS
2.00
.......................20.00
    X       10,000 151,051 23,452
(22) GINA F WOODS........................................................................
CHIEF NURSING OFFICER
0.00
.......................40.00
    X       0 0 0
(23) ELAINE BEED MD........................................................................
PHYSICIAN
40.00
.......................0.00
        X   555,856 0 0
(24) KARL W KUMLER MD........................................................................
PHYSICIAN
40.00
.......................0.00
        X   632,286 0 21,111
(25) CARL F JUENG MD........................................................................
PHYSICIAN
40.00
.......................0.00
        X   539,838 0 26,279
(26) EYAD MAHAYRI MD........................................................................
PHYSICIAN
40.00
.......................0.00
        X   501,118 0 26,279
(27) CLIFFORD B MAXIMO MD........................................................................
PHYSICIAN
40.00
.......................0.00
        X   453,139 0 26,279






1b Sub-Total................MediumBullet
c Total from continuation sheets to Part VII, Section A....MediumBullet
d Total (add lines 1b and 1c)...........MediumBullet 2,764,755 1,007,884 208,880
2
Total number of individuals (including but not limited to those listed above) who received more than $100,000 of reportable compensation from the organization MediumBullet22
Yes
No
3
Did the organization list any former officer, director or trustee, key employee, or highest compensated employee on line 1a? If "Yes," complete Schedule J for such individual ..............
3
 
No
4
For any individual listed on line 1a, is the sum of reportable compensation and other compensation from the organization and related organizations greater than $150,000? If "Yes," complete Schedule J for such
individual
...........................
4
Yes
 
5
Did any person listed on line 1a receive or accrue compensation from any unrelated organization or individual for services rendered to the organization? If "Yes," complete Schedule J for such person ........
5
 
No
Section B. Independent Contractors
1
Complete this table for your five highest compensated independent contractors that received more than $100,000 of compensation from the organization. Report compensation for the calendar year ending with or within the organization’s tax year.
(A)
Name and business address
(B)
Description of services
(C)
Compensation
SOUTHERN OH EMERGENCY PHYSICIANS

PO BOX 674579
DETROIT,MI482674579
EMERGENCY ROOM PHYSICIANS 1,473,009
MEDSTAFF SERVICES LLC

PO BOX 1895
POWELL,OH43065
HOSPITALIST PHYSICIAN SERVICES 1,241,700
SHIFTWISE

200 SW MARKET ST SUITE 700
PORTLAND,OR97201
MEDICAL STAFFING 974,480
NORTHSTAR ANESTHESIA OF OHIO LLC

6225 STATE HWY 161 200
IRVING,TX75038
ANESTHISIA SERVICES 887,655
LABORATORY CORPORATION

133 E DAVIS ST
BURLINGTON,NC272162140
LABORATORY SERVICES 578,837
2
Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization MediumBullet23
Form 990 (2018)
Form 990 (2018)
Page 9
Part VIII
Statement of Revenue
Check if Schedule O contains a response or note to any line in this Part VIII.............
(A)
Total revenue
(B)
Related or
exempt
function
revenue
(C)
Unrelated
business
revenue
(D)
Revenue
excluded from
tax under sections
512 - 514
Contributions, Gifts, GrantAmt and OtherAmt Similar Amounts 1a Federated campaigns..1a  
b Membership dues..1b  
c Fundraising events..1c  
d Related organizations1d  
e Government grants (contributions)1e  
f All other contributions, gifts, grants, and similar amounts not included above1f 110,562
g Noncash contributions included in lines 1a - 1f:$  
h Total. Add lines 1a-1f.......MediumBullet 110,562
 Program Service RevenueAmt Business Code
2a MEDICARE & MEDICAID 622110 51,468,098 51,468,098    
b HEALTH & MEDICAL SERVICES 622110 41,467,731 41,467,731    
c PHYSICIAN OFFICES 621110 5,545,604 5,545,604    
d
e
f All other program service revenue.        
g Total. Add lines 2a–2f ....MediumBullet 98,481,433
 OtherAmtRevenueAmt 3 Investment income (including dividends, interest, and othersimilar amounts) ......MediumBullet 424,793     424,793
4 Income from investment of tax-exempt bond proceedsMediumBullet        
5 Royalties...........MediumBullet        
(ii) Personal (i) Real
6a Gross rents    
b Less: rental expenses    
c Rental income or (loss)    
d Net rental income or (loss)......MediumBullet        
(ii) Other (i) Securities
7a Gross amount from sales of assets other than inventory   10,026,204
b Less: cost or other basis and sales expenses   9,328,198
c Gain or (loss)   698,006
d Net gain or (loss).....MediumBullet 698,006     698,006
8a Gross income from fundraising events (not including $   of contributions reported on line 1c). See Part IV, line 18 ....
a  
b Less: direct expenses ...b  
c Net income or (loss) from fundraising events..MediumBullet      
9a Gross income from gaming activities.
See Part IV, line 19 ...
a  
b Less: direct expenses ...b  
c Net income or (loss) from gaming activities..MediumBullet        
10a Gross sales of inventory, less
returns and allowances ..
a  
b Less: cost of goods sold ..b  
c Net income or (loss) from sales of inventory..MediumBullet        
Business Code Miscellaneous Revenue
11a CAFETERIA SALES 722300 470,757     470,757
b            
c            
d All other revenue ....        
e Total. Add lines 11a–11d ...... MediumBullet 470,757
12 Total revenue. See Instructions......MediumBullet 100,185,551 98,481,433 0 1,593,556
Form 990 (2018)
Form 990 (2018)
Page 10
Part IX
Statement of Functional Expenses
Section 501(c)(3) and 501(c)(4) organizations must complete all columns. All other organizations must complete column (A).Check if Schedule O contains a response or note to any line in this Part IX..............
Do not include amounts reported on lines 6b,
7b, 8b, 9b, and 10b of Part VIII.
(A)
Total expenses
(B)
Program service expenses
(C)
Management and general expenses
(D)
Fundraising expenses
1 Grants and other assistance to domestic organizations and domestic governments. See Part IV, line 21    
2 Grants and other assistance to domestic individuals. See Part IV, line 22    
3 Grants and other assistance to foreign organizations, foreign governments, and foreign individuals. See Part IV, line 15 and 16.    
4 Benefits paid to or for members    
5 Compensation of current officers, directors, trustees, and key employees .... 82,518 26,875 55,643  
6 Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) .... 1,053,097 1,053,097    
7 Other salaries and wages 38,129,924 37,963,732 151,344 14,848
8 Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) .... 609,516 606,044 3,240 232
9 Other employee benefits ....... 7,647,854 7,614,279 30,659 2,916
10 Payroll taxes ........... 2,943,798 2,926,082 16,593 1,123
11 Fees for services (non-employees):        
a Management ...... 1,560,740   1,560,740  
b Legal ......... 143,388   143,388  
c Accounting ........... 62,775   62,775  
d Lobbying ...........        
e Professional fundraising services. See Part IV, line 17    
f Investment management fees ...... 98,347   98,347  
g Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O) 13,345,564 11,718,381 1,627,183  
12 Advertising and promotion .... 329,753 329,753    
13 Office expenses ....... 1,148,496 1,085,389 63,107  
14 Information technology ...... 1,441,774 1,441,774    
15 Royalties ..        
16 Occupancy ........... 2,111,595 2,048,655 62,940  
17 Travel ............ 42,634 38,948 3,686  
18 Payments of travel or entertainment expenses for any federal, state, or local public officials .        
19 Conferences, conventions, and meetings .... 24,904 23,155 1,749  
20 Interest ........... 281,709 281,709    
21 Payments to affiliates .......        
22 Depreciation, depletion, and amortization .. 4,939,322 4,751,632 187,690  
23 Insurance ... 750,104 750,104    
24 Other expenses. Itemize expenses not covered above (List miscellaneous expenses in line 24e. If line 24e amount exceeds 10% of line 25, column (A) amount, list line 24e expenses on Schedule O.)
a MEDICAL SUPPLIES 17,014,879 17,014,879    
b PROVISION FOR BAD DEBTS 4,296,507 4,296,507    
c REPAIRS & MAINTENANCE 2,115,812 2,108,555 7,257  
d FRANCHISE FEE 1,399,435 1,399,435    
e All other expenses 1,251,285 904,817 346,468  
25 Total functional expenses. Add lines 1 through 24e 102,825,730 98,383,802 4,422,809 19,119
26 Joint costs. Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation. Check here MediumBullet if following SOP 98-2 (ASC 958-720).        
Form 990 (2018)
Form 990 (2018)
Page 11
Part X
Balance Sheet
Check if Schedule O contains a response or note to any line in this Part IX..............
(A)
Beginning of year
(B)
End of year
Assets 1 Cash–non-interest-bearing ........ 4,508,286 1 4,001,647
2 Savings and temporary cash investments .........   2  
3 Pledges and grants receivable, net ......   3  
4 Accounts receivable, net ............. 10,846,508 4 10,828,097
5 Loans and other receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of Schedule L .............
  5  
6 Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), persons described in section 4958(c)(3)(B), and contributing employers and sponsoring organizations of section 501(c)(9) voluntary employees' beneficiary organizations (see instructions) Complete Part II of Schedule L ..............
25,675 6 0
7 Notes and loans receivable, net .... 166,738 7 124,381
8 Inventories for sale or use ........ 2,914,079 8 2,712,353
9 Prepaid expenses and deferred charges ...... 2,839,957 9 2,500,533
10a Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D 10a 98,219,673
b Less: accumulated depreciation 10b 80,381,212 21,623,258 10c 17,838,461
11 Investments—publicly traded securities . 19,605,574 11 12,204,387
12 Investments—other securities. See Part IV, line 11 .....   12  
13 Investments—program-related. See Part IV, line 11 .. 791,270 13 691,670
14 Intangible assets ...............   14  
15 Other assets. See Part IV, line 11 ........... 2,393,650 15 6,315,907
16 Total assets. Add lines 1 through 15 (must equal line 34)... 65,714,995 16 57,217,436
Liabilities 17 Accounts payable and accrued expenses ..... 29,270,209 17 26,938,022
18 Grants payable ...   18  
19 Deferred revenue .........   19  
20 Tax-exempt bond liabilities ......... 9,113,129 20 6,817,536
21 Escrow or custodial account liability. Complete Part IV of Schedule D   21  
22 Loans and other payables to current and former officers, directors, trustees, key employees, highest compensated employees, and disqualified
persons. Complete Part II of Schedule L..   22  
23 Secured mortgages and notes payable to unrelated third parties .. 2,774,454 23 2,279,416
24 Unsecured notes and loans payable to unrelated third parties ..   24  
25 Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17 - 24). Complete Part X of Schedule D   25  
26 Total liabilities. Add lines 17 through 25.. 41,157,792 26 36,034,974
Net Assets or Fund Balance Organizations that follow SFAS 117 (ASC 958), check here MediumBullet and complete lines 27 through 29, and lines 33 and 34.
27 Unrestricted net assets 24,557,203 27 21,182,462
28 Temporarily restricted net assets ...........   28  
29 Permanently restricted net assets   29  
Organizations that do not follow SFAS 117 (ASC 958), check here MediumBullet and complete lines 30 through 34.
30 Capital stock or trust principal, or current funds .....   30  
31 Paid-in or capital surplus, or land, building or equipment fund ...   31  
32 Retained earnings, endowment, accumulated income, or other funds   32  
33 Total net assets or fund balances ........... 24,557,203 33 21,182,462
34 Total liabilities and net assets/fund balances ........ 65,714,995 34 57,217,436
Form 990 (2018)
Form 990 (2018)
Page 12
Part XI
Reconcilliation of Net Assets
Check if Schedule O contains a response or note to any line in this Part XI..............
1
Total revenue (must equal Part VIII, column (A), line 12) ............
1
100,185,551
2
Total expenses (must equal Part IX, column (A), line 25) ............
2
102,825,730
3
Revenue less expenses. Subtract line 2 from line 1 ..............
3
-2,640,179
4
Net assets or fund balances at beginning of year (must equal Part X, line 33, column (A)) ..
4
24,557,203
5
Net unrealized gains (losses) on investments ...............
5
-1,456,277
6
Donated services and use of facilities .................
6
 
7
Investment expenses .....................
7
 
8
Prior period adjustments .....................
8
 
9
Other changes in net assets or fund balances (explain in Schedule O) ........
9
721,715
10
Net assets or fund balances at end of year. Combine lines 3 through 9 (must equal Part X, line 33, column (B))
10
21,182,462
Part XII
Financial Statements and Reporting
Check if Schedule O contains a response or note to any line in this Part XII.............
Yes
No
1
Accounting method used to prepare the Form 990:  
If the organization changed its method of accounting from a prior year or checked "Other," explain in
Schedule O.
2a
Were the organization’s financial statements compiled or reviewed by an independent accountant?
2a
 
No
If ‘Yes,’ check a box below to indicate whether the financial statements for the year were compiled or reviewed on a separate basis, consolidated basis, or both:
b
Were the organization’s financial statements audited by an independent accountant?
2b
Yes
 
If ‘Yes,’ check a box below to indicate whether the financial statements for the year were audited on a separate basis, consolidated basis, or both:
c
If "Yes," to line 2a or 2b, does the organization have a committee that assumes responsibility for oversight of the audit, review, or compilation of its financial statements and selection of an independent accountant?
2c
Yes
 
If the organization changed either its oversight process or selection process during the tax year, explain in Schedule O.
3a
As a result of a federal award, was the organization required to undergo an audit or audits as set forth in the Single Audit Act and OMB Circular A-133?
3a
 
No
b
If "Yes," did the organization undergo the required audit or audits? If the organization did not undergo the required audit or audits, explain why in Schedule O and describe any steps taken to undergo such audits.
3b
 
 
Form 990 (2018)
Form 990 (2018)
Additional Data


Software ID:  
Software Version:  
Form 990, Special Condition Description:
Special Condition Description
SCHEDULE A
(Form 990 or 990EZ)

Department of the Treasury
Internal Revenue Service
Public Charity Status and Public Support
Complete if the organization is a section 501(c)(3) organization or a section 4947(a)(1) nonexempt charitable trust.
right arrow Attach to Form 990 or Form 990-EZ.
right arrow Go to www.irs.gov/Form990 for the latest information.
OMB No. 1545-0047
2018
Open to Public
Inspection
Name of the organization
SOUTHEASTERN OHIO REGIONAL MEDICAL
CENTER INC
Employer identification number

31-4391798
Part I
Reason for Public Charity Status (All organizations must complete this part.) See instructions.
The organization is not a private foundation because it is: (For lines 1 through 12, check only one box.)
1
2
3
4
5
6
7
8
9

10
11
12
a
b
c
d
e
f
Enter the number of supported organizations ...............................  
g
Provide the following information about the supported organization(s).
(i) Name of supported organization (ii) EIN (iii) Type of organization (described on lines 1- 10 above (see instructions)) (iv) Is the organization listed in your governing document? (v) Amount of monetary support (see instructions) (vi) Amount of other support (see instructions)
Yes No
Total
 
   
For Paperwork Reduction Act Notice, see the Instructions for
Form 990 or 990-EZ.
Cat. No. 11285F
Schedule A (Form 990 or 990-EZ) 2018

Schedule A (Form 990 or 990-EZ) 2018
Page 2
Part II
Support Schedule for Organizations Described in Sections 170(b)(1)(A)(iv), 170(b)(1)(A)(vi), and 170(b)(1)(A)(ix)
(Complete only if you checked the box on line 5, 7, 8, or 9 of Part I or if the organization failed to qualify under Part III. If the organization fails to qualify under the tests listed below, please complete Part III.)
Section A. Public Support
Calendar year (or fiscal year beginning in) right arrow (a) 2014 (b) 2015 (c) 2016 (d) 2017 (e) 2018 (f) Total
1 Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grant.") ..            
2 Tax revenues levied for the organization's benefit and either paid to or expended on its behalf....            
3 The value of services or facilities furnished by a governmental unit to the organization without charge..            
4 Total. Add lines 1 through 3            
5 The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f)..  
6 Public support. Subtract line 5 from line 4.  
Section B. Total Support
Calendar year (or fiscal year beginning in) right arrow (a) 2014 (b) 2015 (c) 2016 (d) 2017 (e) 2018 (f) Total
7 Amounts from line 4..            
8 Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources...            
9 Net income from unrelated business activities, whether or not the business is regularly carried on..            
10 Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.)..            
11 Total support. Add lines 7 through 10  
12
12
 
13
First five years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501(c)(3) organization, check this box and stop here........................................right arrow
Section C. Computation of Public Support Percentage
14
14
 
15
15
 
16a
b
17a
b
18
Private foundation. If the organization did not check a box on line 13, 16a, 16b, 17a, or 17b, check this box and see
instructions ..................................................... right arrow
Schedule A (Form 990 or 990-EZ) 2018

Schedule A (Form 990 or 990-EZ) 2018
Page 3
Part III
Support Schedule for Organizations Described in Section 509(a)(2)
(Complete only if you checked the box on line 10 of Part I or if the organization failed to qualify under Part II. If the organization fails to qualify under the tests listed below, please complete Part II.)
Section A. Public Support
Calendar year (or fiscal year beginning in) right arrow (a) 2014 (b) 2015 (c) 2016 (d) 2017 (e) 2018 (f) Total
1 Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .            
2 Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose            
3 Gross receipts from activities that are not an unrelated trade or business under section 513 .....            
4 Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...            
5 The value of services or facilities furnished by a governmental unit to the organization without charge            
6 Total. Add lines 1 through 5            
7a Amounts included on lines 1, 2, and 3 received from disqualified persons            
b Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year.            
c Add lines 7a and 7b..            
8 Public support. (Subtract line 7c from line 6.)  
Section B. Total Support
Calendar year (or fiscal year beginning in) right arrow (a) 2014 (b) 2015 (c) 2016 (d) 2017 (e) 2018 (f) Total
9 Amounts from line 6...            
10a Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..            
b Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.            
c Add lines 10a and 10b.            
11 Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.            
12 Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.) ..            
13 Total support. (Add lines 9, 10c, 11, and 12.)..            
14
Section C. Computation of Public Support Percentage
15
15
 
16
16
 
Section D. Computation of Investment Income Percentage
17
17
 
18
18
 
19a
b
20
Schedule A (Form 990 or 990-EZ) 2018

Schedule A (Form 990 or 990-EZ) 2018
Page 4
Part IV
Supporting Organizations
(Complete only if you checked a box on line 12 of Part I. If you checked 12a of Part I, complete Sections A and B. If you checked 12b of Part I, complete Sections A and C. If you checked 12c of Part I, complete Sections A, D, and E. If you checked 12d of Part I, complete Sections A and D, and complete Part V.)
Section A. All Supporting Organizations
Yes
No
1
Are all of the organization’s supported organizations listed by name in the organization’s governing documents?
If "No," describe in Part VI how the supported organizations are designated. If designated by class or purpose,
describe the designation. If historic and continuing relationship, explain.
1
 
 
2
Did the organization have any supported organization that does not have an IRS determination of status under section 509(a)(1) or (2)? If "Yes," explain in Part VI how the organization determined that the supported organization was described in section 509(a)(1) or (2).
2
 
 
3a
Did the organization have a supported organization described in section 501(c)(4), (5), or (6)? If "Yes," answer (b) and (c) below.
3a
 
 
b
Did the organization confirm that each supported organization qualified under section 501(c)(4), (5), or (6) and satisfied the public support tests under section 509(a)(2)? If "Yes," describe in Part VI when and how the organization made the determination.
3b
 
 
c
Did the organization ensure that all support to such organizations was used exclusively for section 170(c)(2)(B) purposes? If "Yes," explain in Part VI what controls the organization put in place to ensure such use.
3c
 
 
4a
Was any supported organization not organized in the United States ("foreign supported organization")? If “Yes” and if you checked 12a or 12b in Part I, answer (b) and (c) below.
4a
 
 
b
Did the organization have ultimate control and discretion in deciding whether to make grants to the foreign supported organization? If “Yes,” describe in Part VI how the organization had such control and discretion despite being controlled or supervised by or in connection with its supported organizations.
4b
 
 
c
Did the organization support any foreign supported organization that does not have an IRS determination under sections 501(c)(3) and 509(a)(1) or (2)? If “Yes,” explain in Part VI what controls the organization used to ensure that all support to the foreign supported organization was used exclusively for section 170(c)(2)(B) purposes.
4c
 
 
5a
Did the organization add, substitute, or remove any supported organizations during the tax year? If “Yes,” answer (b) and (c) below (if applicable). Also, provide detail in Part VI, including (i) the names and EIN numbers of the supported organizations added, substituted, or removed; (ii) the reasons for each such action; (iii) the authority under the organization's organizing document authorizing such action; and (iv) how the action was accomplished (such as by amendment to the organizing document).
5a
 
 
b
Type I or Type II only. Was any added or substituted supported organization part of a class already designated in the organization's organizing document?
5b
 
 
c
Substitutions only. Was the substitution the result of an event beyond the organization's control?
5c
 
 
6
Did the organization provide support (whether in the form of grants or the provision of services or facilities) to anyone other than (i) its supported organizations, (ii) individuals that are part of the charitable class benefited by one or more of its supported organizations, or (iii) other supporting organizations that also support or benefit one or more of the filing organization’s supported organizations? If “Yes,” provide detail in Part VI.
6
 
 
7
Did the organization provide a grant, loan, compensation, or other similar payment to a substantial contributor (defined in section 4958(c)(3)(C)), a family member of a substantial contributor, or a 35% controlled entity with regard to a substantial contributor? If “Yes,” complete Part I of Schedule L (Form 990 or 990-EZ) .
7
 
 
8
Did the organization make a loan to a disqualified person (as defined in section 4958) not described in line 7? If “Yes,” complete Part I of Schedule L (Form 990 or 990-EZ).
8
 
 
9a
Was the organization controlled directly or indirectly at any time during the tax year by one or more disqualified persons as defined in section 4946 (other than foundation managers and organizations described in section 509(a)(1) or (2))? If “Yes,” provide detail in Part VI.
9a
 
 
b
Did one or more disqualified persons (as defined in line 9a) hold a controlling interest in any entity in which the supporting organization had an interest? If “Yes,” provide detail in Part VI.
9b
 
 
c
Did a disqualified person (as defined in line 9a) have an ownership interest in, or derive any personal benefit from, assets in which the supporting organization also had an interest? If “Yes,” provide detail in Part VI.
9c
 
 
10a
Was the organization subject to the excess business holdings rules of section 4943 because of section 4943(f) (regarding certain Type II supporting organizations, and all Type III non-functionally integrated supporting organizations)? If “Yes,” answer line 10b below.
10a
 
 
b
Did the organization have any excess business holdings in the tax year? (Use Schedule C, Form 4720, to determine whether the organization had excess business holdings).
10b
 
 
Schedule A (Form 990 or 990-EZ) 2018

Schedule A (Form 990 or 990-EZ) 2018
Page 5
Part IV
Supporting Organizations (continued)
Yes
No
11
Has the organization accepted a gift or contribution from any of the following persons?
a
A person who directly or indirectly controls, either alone or together with persons described in (b) and (c) below, the governing body of a supported organization?
11a
 
 
b
A family member of a person described in (a) above?
11b
 
 
c
A 35% controlled entity of a person described in (a) or (b) above? If “Yes” to a, b, or c, provide detail in Part VI.
11c
 
 
Section B. Type I Supporting Organizations
Yes
No
1
Did the directors, trustees, or membership of one or more supported organizations have the power to regularly appoint or elect at least a majority of the organization’s directors or trustees at all times during the tax year? If “No,” describe in Part VI how the supported organization(s) effectively operated, supervised, or controlled the organization’s activities. If the organization had more than one supported organization, describe how the powers to appoint and/or remove directors or trustees were allocated among the supported organizations and what conditions or restrictions, if any, applied to such powers during the tax year.
1
 
 
2
Did the organization operate for the benefit of any supported organization other than the supported organization(s) that operated, supervised, or controlled the supporting organization? If “Yes,” explain in Part VI how providing such benefit carried out the purposes of the supported organization(s) that operated, supervised or controlled the supporting organization.
2
 
 
Section C. Type II Supporting Organizations
Yes
No
1
Were a majority of the organization’s directors or trustees during the tax year also a majority of the directors or trustees of each of the organization’s supported organization(s)? If “No,” describe in Part VI how control or management of the supporting organization was vested in the same persons that controlled or managed the supported organization(s).
1
 
 
Section D. All Type III Supporting Organizations
Yes
No
1
Did the organization provide to each of its supported organizations, by the last day of the fifth month of the organization’s tax year, (i) a written notice describing the type and amount of support provided during the prior tax year, (ii) a copy of the Form 990 that was most recently filed as of the date of notification, and (iii) copies of the organization’s governing documents in effect on the date of notification, to the extent not previously provided?
1
 
 
2
Were any of the organization’s officers, directors, or trustees either (i) appointed or elected by the supported organization(s) or (ii) serving on the governing body of a supported organization? If "No," explain in Part VI how the organization maintained a close and continuous working relationship with the supported organization(s).
2
 
 
3
By reason of the relationship described in (2), did the organization’s supported organizations have a significant voice in the organization’s investment policies and in directing the use of the organization’s income or assets at all times during the tax year? If "Yes," describe in Part VI the role the organization’s supported organizations played in this regard.
3
 
 
Section E. Type III Functionally-Integrated Supporting Organizations
1
Check the box next to the method that the organization used to satisfy the Integral Part Test during the year (see instructions):
a
b
c
2
Activities Test. Answer (a) and (b) below.
Yes
No
a
Did substantially all of the organization’s activities during the tax year directly further the exempt purposes of the supported organization(s) to which the organization was responsive? If "Yes," then in Part VI identify those supported organizations and explain how these activities directly furthered their exempt purposes, how the organization was responsive to those supported organizations, and how the organization determined that these activities constituted substantially all of its activities.
2a
 
 
b
Did the activities described in (a) constitute activities that, but for the organization’s involvement, one or more of the organization’s supported organization(s) would have been engaged in? If "Yes," explain in Part VI the reasons for the organization’s position that its supported organization(s) would have engaged in these activities but for the organization’s involvement.
2b
 
 
3
Parent of Supported Organizations. Answer (a) and (b) below.
a
Did the organization have the power to regularly appoint or elect a majority of the officers, directors, or trustees of each of the supported organizations? Provide details in Part VI.
3a
 
 
b
Did the organization exercise a substantial degree of direction over the policies, programs and activities of each of its supported organizations? If "Yes," describe in Part VI. the role played by the organization in this regard.
3b
 
 
Schedule A (Form 990 or 990-EZ) 2018

Schedule A (Form 990 or 990-EZ) 2018
Page 6
Part V
Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations
1
Section A - Adjusted Net Income (A) Prior Year (B) Current Year
(optional)
1 Net short-term capital gain 1    
2 Recoveries of prior-year distributions 2    
3 Other gross income (see instructions) 3    
4 Add lines 1 through 3 4    
5 Depreciation and depletion 5    
6 Portion of operating expenses paid or incurred for production or collection of gross income or for management, conservation, or maintenance of property held for production of income (see instructions) 6    
7 Other expenses (see instructions) 7    
8 Adjusted Net Income (subtract lines 5, 6 and 7 from line 4) 8    
Section B - Minimum Asset Amount (A) Prior Year (B) Current Year
(optional)
1 Aggregate fair market value of all non-exempt-use assets (see instructions for short tax year or assets held for part of year): 1
a Average monthly value of securities 1a    
b Average monthly cash balances 1b    
c Fair market value of other non-exempt-use assets 1c    
d Total (add lines 1a, 1b, and 1c) 1d    
e Discount claimed for blockage or other factors
(explain in detail in Part VI):  
2 Acquisition indebtedness applicable to non-exempt use assets 2    
3 Subtract line 2 from line 1d 3    
4 Cash deemed held for exempt use. Enter 1-1/2% of line 3 (for greater amount, see instructions). 4    
5 Net value of non-exempt-use assets (subtract line 4 from line 3) 5    
6 Multiply line 5 by .035 6    
7 Recoveries of prior-year distributions 7    
8 Minimum Asset Amount (add line 7 to line 6) 8    
Section C - Distributable Amount Current Year
1 Adjusted net income for prior year (from Section A, line 8, Column A) 1  
2 Enter 85% of line 1 2  
3 Minimum asset amount for prior year (from Section B, line 8, Column A) 3  
4 Enter greater of line 2 or line 3 4  
5 Income tax imposed in prior year 5  
6 Distributable Amount. Subtract line 5 from line 4, unless subject to emergency temporary reduction (see instructions) 6  
7
Schedule A (Form 990 or 990-EZ) 2018

Schedule A (Form 990 or 990-EZ) 2018
Page 7
Part V
Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations (continued)
Section D - Distributions Current Year
1 Amounts paid to supported organizations to accomplish exempt purposes  
2 Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in
excess of income from activity
 
3 Administrative expenses paid to accomplish exempt purposes of supported organizations  
4 Amounts paid to acquire exempt-use assets  
5 Qualified set-aside amounts (prior IRS approval required)  
6 Other distributions (describe in Part VI). See instructions  
7Total annual distributions. Add lines 1 through 6.  
8 Distributions to attentive supported organizations to which the organization is responsive (provide
details in Part VI). See instructions
 
9 Distributable amount for 2018 from Section C, line 6  
10 Line 8 amount divided by Line 9 amount  
Section E - Distribution Allocations (see instructions) (i)
Excess Distributions
(ii)
Underdistributions
Pre-2018
(iii)
Distributable
Amount for 2018
1 Distributable amount for 2018 from Section C, line
6
 
2 Underdistributions, if any, for years prior to 2018 (reasonable cause required-- explain in Part VI).
See instructions.
 
3 Excess distributions carryover, if any, to 2018:
a From 2013.......  
b From 2014.......  
c From 2015.......  
d From 2016.......  
e From 2017.......  
fTotal of lines 3a through e  
g Applied to underdistributions of prior years  
h Applied to 2018 distributable amount  
i Carryover from 2013 not applied (see
instructions)
 
j Remainder. Subtract lines 3g, 3h, and 3i from 3f.  
4Distributions for 2018 from Section D, line 7:
$  
a Applied to underdistributions of prior years  
b Applied to 2018 distributable amount  
c Remainder. Subtract lines 4a and 4b from 4.  
5 Remaining underdistributions for years prior to
2018, if any. Subtract lines 3g and 4a from line 2.
If the amount is greater than zero, explain in Part VI.
See instructions.
 
6 Remaining underdistributions for 2018. Subtract
lines 3h and 4b from line 1. If the amount is greater
than zero, explain in Part VI. See instructions.
 
7 Excess distributions carryover to 2019. Add lines
3j and 4c.
 
8 Breakdown of line 7:
a Excess from 2014......  
b Excess from 2015.....  
c Excess from 2016.....  
d Excess from 2017.....  
e Excess from 2018.....  
Schedule A (Form 990 or 990-EZ) (2018)

Schedule A (Form 990 or 990-EZ) 2018
Page 8
Part VI
Supplemental Information. Provide the explanations required by Part II, line 10; Part II, line 17a or 17b; Part III, line 12; Part IV, Section A, lines 1, 2, 3b, 3c, 4b, 4c, 5a, 6, 9a, 9b, 9c, 11a, 11b, and 11c; Part IV, Section B, lines 1 and 2; Part IV, Section C, line 1; Part IV, Section D, lines 2 and 3; Part IV, Section E, lines 1c, 2a, 2b, 3a and 3b; Part V, line 1; Part V, Section B, line 1e; Part V Section D, lines 5, 6, and 8; and Part V, Section E, lines 2, 5, and 6. Also complete this part for any additional information. (See instructions).
Facts And Circumstances Test
 
Return Reference Explanation
Schedule A (Form 990 or 990-EZ) 2018


Additional Data


Software ID:  
Software Version:  
SCHEDULE D
(Form 990)
Department of the Treasury
Internal Revenue Service
Supplemental Financial Statements
SchDMd Bullet Complete if the organization answered "Yes," on Form 990,
Part IV, line 6, 7, 8, 9, 10, 11a, 11b, 11c, 11d, 11e, 11f, 12a, or 12b.
SchDMd Bullet Attach to Form 990.
SchDMd Bullet Go to www.irs.gov/Form990 for the latest information.
OMB No. 1545-0047
2018
Open to Public Inspection
Name of the organization
SOUTHEASTERN OHIO REGIONAL MEDICAL
CENTER INC
Employer identification number

31-4391798
Part I
Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered "Yes" on Form 990, Part IV, line 6.
(a) Donor advised funds (b) Funds and other accounts
1 Total number at end of year .........    
2 Aggregate value of contributions to (during year)    
3 Aggregate value of grants from (during year)    
4 Aggregate value at end of year ........    
5
Did the organization inform all donors and donor advisors in writing that the assets held in donor advised funds are the organization’s property, subject to the organization’s exclusive legal control? ............
6
Did the organization inform all grantees, donors, and donor advisors in writing that grant funds can be used only for charitable purposes and not for the benefit of the donor or donor advisor, or for any other purpose conferring impermissible private benefit? ...................................
Part II
Conservation Easements. Complete if the organization answered "Yes" on Form 990, Part IV, line 7.
1
Purpose(s) of conservation easements held by the organization (check all that apply).
2
Complete lines 2a through 2d if the organization held a qualified conservation contribution in the form of a conservation easement on the last day of the tax year.
Held at the End of the Year
a Total number of conservation easements ...................... 2a  
b Total acreage restricted by conservation easements .................... 2b  
c Number of conservation easements on a certified historic structure included in (a) ..... 2c  
d Number of conservation easements included in (c) acquired after 7/25/06, and not on a historic structure listed in the National Register ... 2d  
3
Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during the
tax year SchDMd Bullet  
4
Number of states where property subject to conservation easement is located SchDMd Bullet  
5
Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and enforcement of the conservation easements it holds? ............
6
Staff and volunteer hours devoted to monitoring, inspecting, handling of violations, and enforcing conservation easements during the year
SchDMd Bullet  
7
Amount of expenses incurred in monitoring, inspecting, handling of violations, and enforcing conservation easements during the year
SchDMd Bullet $  
8
Does each conservation easement reported on line 2(d) above satisfy the requirements of section 170(h)(4)(B)(i) and section 170(h)(4)(B)(ii)? .............................
9
In Part XIII, describe how the organization reports conservation easements in its revenue and expense statement, and
balance sheet, and include, if applicable, the text of the footnote to the organization’s financial statements that describes
the organization’s accounting for conservation easements.
Part III
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets.
Complete if the organization answered "Yes" on Form 990, Part IV, line 8.
1a
If the organization elected, as permitted under SFAS 116 (ASC 958), not to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide, in Part XIII, the text of the footnote to its financial statements that describes these items.
b
If the organization elected, as permitted under SFAS 116 (ASC 958), to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide the following amounts relating to these items:
(i)
Revenue included on Form 990, Part VIII, line 1 .........................SchDMd Bullet $  
(ii)
Assets included in Form 990, Part X ...............................SchDMd Bullet $  
2
If the organization received or held works of art, historical treasures, or other similar assets for financial gain, provide the
following amounts required to be reported under SFAS 116 (ASC 958) relating to these items:
a
Revenue included on Form 990, Part VIII, line 1 ..........................SchDMd Bullet $  
b
Assets included in Form 990, Part X ...............................SchDMd Bullet $  
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 52283D
Schedule D (Form 990) 2018

Schedule D (Form 990) 2018
Page 2
Part III
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)
3
Using the organization’s acquisition, accession, and other records, check any of the following that are a significant use of its collection items (check all that apply):
a
d
b
e
 
c
4
Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIII.
5
During the year, did the organization solicit or receive donations of art, historical treasures or other similar
assets to be sold to raise funds rather than to be maintained as part of the organization’s collection?...
Part IV
Escrow and Custodial Arrangements. Complete if the organization answered "Yes" on Form 990, Part IV, line 9, or reported an amount on Form 990, Part X, line 21.
1a
Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................
b If "Yes," explain the arrangement in Part XIII and complete the following table: Amount
c Beginning balance ............................. 1c  
d Additions during the year ............................ 1d  
e Distributions during the year .......................... 1e  
f Ending balance ................................ 1f  
2a
Did the organization include an amount on Form 990, Part X, line 21, for escrow or custodial account liability? ...
b
If "Yes," explain the arrangement in Part XIII. Check here if the explanation has been provided in Part XIII ....
Part V
Endowment Funds. Complete if the organization answered "Yes" on Form 990, Part IV, line 10.
(a)Current year (b)Prior year (c)Two years back (d)Three years back (e)Four years back
1a Beginning of year balance .... 20,717 18,028 16,871 17,436 15,959
b Contributions ... 200 450 150 150 150
c Net investment earnings, gains, and losses -926 2,544 1,278 -454 1,805
d Grants or scholarships ...          
e Other expenditures for facilities
and programs ...
         
f Administrative expenses .... 315 305 271 261 478
g End of year balance ...... 19,676 20,717 18,028 16,871 17,436
2
Provide the estimated percentage of the current year end balance (line 1g, column (a)) held as:
a
Board designated or quasi-endowment SchDMd Bullet100.000 %
b
Permanent endowment SchDMd Bullet0 %
c
Temporarily restricted endowment SchDMd Bullet0 %
The percentages on lines 2a, 2b, and 2c should equal 100%.
3a
Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes
No
(i) unrelated organizations .................
3a(i)
 
No
(ii) related organizations .................
3a(ii)
Yes
 
b
If "Yes" on 3a(ii), are the related organizations listed as required on Schedule R? .........
3b
Yes
 
4
Describe in Part XIII the intended uses of the organization's endowment funds.
Part VI
Land, Buildings, and Equipment.
Complete if the organization answered "Yes" on Form 990, Part IV, line 11a. See Form 990, Part X, line 10.
Description of property (a) Cost or other basis
(investment)
(b) Cost or other basis (other) (c) Accumulated depreciation (d) Book value
1a Land .....   1,088,965 1,088,965
b Buildings ....   46,982,824 40,312,333 6,670,491
c Leasehold improvements        
d Equipment ....   49,907,944 40,068,879 9,839,065
e Other .....   239,940   239,940
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).)..SchDMdBullet 17,838,461
Schedule D (Form 990) 2018

Schedule D (Form 990) 2018
Page 3
Part VII
Investments—Other Securities. Complete if the organization answered "Yes" on Form 990, Part IV, line 11b. See Form 990, Part X, line 12.
(a) Description of security or category
(including name of security)
(b) Book value (c) Method of valuation:
Cost or end-of-year market value
(1) Financial derivatives.........    
(2) Closely-held equity interests........    
(3)Other
(A)
(B)
(C)
(D)
(E)
(F)
(G)
(H)
Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)Small Bullet  
Part VIII
Investments—Program Related. Complete if the organization answered 'Yes' on Form 990, Part IV, line 11c. See Form 990, Part X, line 13.
(a) Description of investment (b) Book value (c) Method of valuation:
Cost or end-of-year market value
(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)Small Bullet  
Part IX
Other Assets. Complete if the organization answered 'Yes' on Form 990, Part IV, line 11d. See Form 990, Part X, line 15.
(a) Description (b) Book value
(1) RESTRICTED CASH BOND FUND 6,315,907
(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........Small Bullet 6,315,907
Part X
Other Liabilities. Complete if the organization answered 'Yes' on Form 990, Part IV, line 11e or 11f. See Form 990, Part X, line 25.
1.(a) Description of liability (b) Book value
(1) Federal income taxes  
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)Small Bullet  
2. Liability for uncertain tax positions. In Part XIII, provide the text of the footnote to the organization's financial statements that reports the organization's liability for uncertain tax positions under FIN 48 (ASC 740). Check here if the text of the footnote has been provided in Part XIII
Schedule D (Form 990) 2018

Schedule D (Form 990) 2018
Page 4
Part XI Reconciliation of Revenue per Audited Financial Statements With Revenue per Return Complete if the organization answered 'Yes' on Form 990, Part IV, line 12a.
1 Total revenue, gains, and other support per audited financial statements ....... 1 100,125,998
2 Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a Net unrealized gains (losses) on investments .... 2a  
b Donated services and use of facilities ......... 2b  
c Recoveries of prior year grants ........... 2c  
d Other (Describe in Part XIII.) ............ 2d 4,875
e Add lines 2a through 2d ..................... 2e 4,875
3 Subtract line 2e from line 1.................. 3 100,121,123
4 Amounts included on Form 990, Part VIII, line 12, but not on line 1:
a Investment expenses not included on Form 990, Part VIII, line 7b . 4a  
b Other (Describe in Part XIII.) ........... 4b 64,428
c Add lines 4a and 4b.................... 4c 64,428
5 Total revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ...... 5 100,185,551
Part XII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return. Complete if the organization answered 'Yes' on Form 990, Part IV, line 12a.
1 Total expenses and losses per audited financial statements ........... 1 102,766,177
2 Amounts included on line 1 but not on Form 990, Part IX, line 25:
a Donated services and use of facilities ......... 2a  
b Prior year adjustments ............ 2b  
c Other losses ................ 2c  
d Other (Describe in Part XIII.) ............ 2d 4,875
e Add lines 2a through 2d.................... 2e 4,875
3 Subtract line 2e from line 1................... 3 102,761,302
4 Amounts included on Form 990, Part IX, line 25, but not on line 1:
a Investment expenses not included on Form 990, Part VIII, line 7b .. 4a  
b Other (Describe in Part XIII.) ............ 4b 64,428
c Add lines 4a and 4b..................... 4c 64,428
5 Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ...... 5 102,825,730
Part XIII
Supplemental Information
Provide the descriptions required for Part II, lines 3, 5, and 9; Part III, lines 1a and 4; Part lV, lines 1b and 2b; Part V, line 4; Part X, line 2; Part XI, lines 2d and 4b; and Part XII, lines 2d and 4b. Also complete this part to provide any additional information.
Return Reference Explanation
PART V, LINE 4: ENDOWMENT FUND HELD BY PARENT COMPANY, GUERNSEY HEALTH SYSTEMS. USED FOR SUPPORT OF CHARITABLE HEALTH CARE SERVICES.
PART X, LINE 2: ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA REQUIRE MANAGEMENT TO EVALUATE TAX POSITIONS TAKEN AND RECOGNIZE A TAX LIABILITY IF AN UNCERTAIN POSITION HAS BEEN TAKEN THAT MORE LIKELY THAN NOT WOULD NOT BE SUSTAINED UPON EXAMINATION BY VARIOUS FEDERAL AND STATE TAXING AUTHORITIES. MANAGEMENT HAS ANALYZED THE TAX POSITIONS TAKEN BY THESE ENTITIES AND HAS CONCLUDED THAT AS OF DECEMBER 31, 2018 AND 2017, THERE ARE NO UNCERTAIN POSITIONS TAKEN OR EXPECTED TO BE TAKEN THAT WOULD REQUIRE RECOGNITION OF A LIABILITY OR DISCLOSURE IN THE ACCOMPANYING CONSOLIDATED FINANCIAL STATEMENTS.
PART XI, LINE 2D - OTHER ADJUSTMENTS: SALE OF SCRAP & WASTE REPORTED ON PART IX LINE 24E 4,875.
PART XI, LINE 4B - OTHER ADJUSTMENTS: PHYSICIAN LOAN LOSS REPORTED ON PART IX LINE 11G 64,428.
PART XII, LINE 2D - OTHER ADJUSTMENTS: SALE OF SCRAP & WASTE REPORTED ON PART IX LINE 24E 4,875.
PART XII, LINE 4B - OTHER ADJUSTMENTS: PHYSICIAN LOAN LOSS REPORTED ON PART IX LINE 11G 64,428.
Schedule D (Form 990) 2018


Additional Data


Software ID:  
Software Version:  




SCHEDULE H
(Form 990)
Department of the Treasury
Internal Revenue Service
Hospitals
MediumBullet Complete if the organization answered "Yes" on Form 990, Part IV, question 20.
MediumBullet Attach to Form 990.
MediumBullet Go to www.irs.gov/Form990EZ for instructions and the latest information.
OMB No. 1545-0047
2018
Open to Public Inspection
Name of the organization
SOUTHEASTERN OHIO REGIONAL MEDICAL
CENTER INC
Employer identification number

31-4391798
Part I
Financial Assistance and Certain Other Community Benefits at Cost
Yes
No
1a
Did the organization have a financial assistance policy during the tax year? If "No," skip to question 6a . . . .
1a
Yes
 
b
If "Yes," was it a written policy? ......................
1b
Yes
 
2
If the organization had multiple hospital facilities, indicate which of the following best describes application of the financial assistance policy to its various hospital facilities during the tax year.
3
Answer the following based on the financial assistance eligibility criteria that applied to the largest number of the organization's patients during the tax year.
a
Did the organization use Federal Poverty Guidelines (FPG) as a factor in determining eligibility for providing free care?
If "Yes," indicate which of the following was the FPG family income limit for eligibility for free care:
3a
Yes
 
%
b
Did the organization use FPG as a factor in determining eligibility for providing discounted care? If "Yes," indicate
which of the following was the family income limit for eligibility for discounted care: . . . . . . . .
3b
Yes
 
%
c
If the organization used factors other than FPG in determining eligibility, describe in Part VI the criteria used for determining eligibility for free or discounted care. Include in the description whether the organization used an asset test or other threshold, regardless of income, as a factor in determining eligibility for free or discounted care.
4
Did the organization's financial assistance policy that applied to the largest number of its patients during the tax year provide for free or discounted care to the "medically indigent"? . . . . . . . . . . . . .

4

Yes

 
5a
Did the organization budget amounts for free or discounted care provided under its financial assistance policy during
the tax year? . . . . . . . . . . . . . . . . . . . . . . .

5a

Yes

 
b
If "Yes," did the organization's financial assistance expenses exceed the budgeted amount? . . . . . .
5b
Yes
 
c
If "Yes" to line 5b, as a result of budget considerations, was the organization unable to provide free or discountedcare to a patient who was eligibile for free or discounted care? . . . . . . . . . . . . .
5c
 
No
6a
Did the organization prepare a community benefit report during the tax year? . . . . . . . . .
6a
 
No
b
If "Yes," did the organization make it available to the public? . . . . . . . . . . . . .
6b
 
 
Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.
7
Financial Assistance and Certain Other Community Benefits at Cost
Financial Assistance and
Means-Tested
Government Programs
(a) Number of activities or programs (optional) (b) Persons served (optional) (c) Total community benefit expense (d) Direct offsetting revenue (e) Net community benefit expense (f) Percent of total expense
a Financial Assistance at cost
(from Worksheet 1) . . .
  1,724 944,573 0 944,573 0.960 %
b Medicaid (from Worksheet 3, column a) . . . . .   33,471 21,724,595 14,322,642 7,401,953 7.510 %
c Costs of other means-tested government programs (from Worksheet 3, column b) . .   0 0 0    
d Total Financial Assistance and Means-Tested Government Programs . . . . .   35,195 22,669,168 14,322,642 8,346,526 8.470 %
Other Benefits
e Community health improvement services and community benefit operations (from Worksheet 4). 26 5,173 198,468 18,649 179,819 0.180 %
f Health professions education (from Worksheet 5) . . . 6 319 133,373 0 133,373 0.140 %
g Subsidized health services (from Worksheet 6) . . . . 0 0 0 0    
h Research (from Worksheet 7) . 0 0 0 0    
i Cash and in-kind contributions for community benefit (from Worksheet 8) . . . . 5 528 59,461 63 59,398 0.060 %
j Total. Other Benefits . . 37 6,020 391,302 18,712 372,590 0.380 %
k Total. Add lines 7d and 7j . 37 41,215 23,060,470 14,341,354 8,719,116 8.850 %
For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2018
Schedule H (Form 990) 2018
Page
Part II
Community Building Activities Complete this table if the organization conducted any community building activities during the tax year, and describe in Part VI how its community building activities promoted the health of the communities it serves.
(a) Number of activities or programs (optional) (b) Persons served (optional) (c) Total community building expense (d) Direct offsetting
revenue
(e) Net community building expense (f) Percent of total expense
1 Physical improvements and housing 0 0 0 0    
2 Economic development 1 0 491 0 491 0 %
3 Community support 2 20 7,297 0 7,297 0.010 %
4 Environmental improvements 0 0 0 0    
5 Leadership development and
training for community members
0 0 0 0    
6 Coalition building 2 24 1,595 0 1,595 0 %
7 Community health improvement advocacy 0 0 0 0    
8 Workforce development 1 6 1,063 0 1,063 0 %
9 Other 0 0 0 0    
10 Total 6 50 10,446   10,446 0.010 %
Part III
Bad Debt, Medicare, & Collection Practices
Section A. Bad Debt Expense
Yes
No
1
Did the organization report bad debt expense in accordance with Heathcare Financial Management Association Statement No. 15? ..........................
1
 
 
2
Enter the amount of the organization's bad debt expense. Explain in Part VI the methodology used by the organization to estimate this amount. ......
2
3,121,097
3
Enter the estimated amount of the organization's bad debt expense attributable to patients eligible under the organization's financial assistance policy. Explain in Part VI the methodology used by the organization to estimate this amount and the rationale, if any, for including this portion of bad debt as community benefit. ......
3
2,184,768
4
Provide in Part VI the text of the footnote to the organization’s financial statements that describes bad debt expense or the page number on which this footnote is contained in the attached financial statements.
Section B. Medicare
5
Enter total revenue received from Medicare (including DSH and IME).....
5
38,049,797
6
Enter Medicare allowable costs of care relating to payments on line 5.....
6
41,391,099
7
Subtract line 6 from line 5. This is the surplus (or shortfall)........
7
-3,341,302
8
Describe in Part VI the extent to which any shortfall reported in line 7 should be treated as community benefit.Also describe in Part VI the costing methodology or source used to determine the amount reported on line 6.Check the box that describes the method used:
Section C. Collection Practices
9a
Did the organization have a written debt collection policy during the tax year? ..........
9a
Yes
 
b
If "Yes," did the organization’s collection policy that applied to the largest number of its patients during the tax year
contain provisions on the collection practices to be followed for patients who are known to qualify for financial assistance? Describe in Part VI .........................

9b

Yes

 
Part IV
Management Companies and Joint Ventures(owned 10% or more by officers, directors, trustees, key employees, and physicians—see instructions)
(a) Name of entity (b) Description of primary
activity of entity
(c) Organization's
profit % or stock
ownership %
(d) Officers, directors,
trustees, or key
employees' profit %
or stock ownership %
(e) Physicians'
profit % or stock
ownership %
1
2
3
4
5
6
7
8
9
10
11
12
13
Schedule H (Form 990) 2018
Schedule H (Form 990) 2018
Page
Part VFacility Information
Section A. Hospital Facilities
(list in order of size from largest to smallest—see instructions)How many hospital facilities did the organization operate during the tax year?1Name, address, primary website address, and state license number (and if a group return, the name and EIN of the subordinate hospital organization that operates the hospital facility)
Licensed Hospital General-Medical-Surgical Children's Hospital Teaching Hospital Critical Hospital ResearchGrp Facility ER-24Hours ER-Other Other (describe) Facility reporting group
1 SOUTHEASTERN OHIO REGIONAL MEDICAL CENTER INC
1341 CLARK STREET
CAMBRIDGE,OH43725
SEORMC.ORG
X X         X      
Schedule H (Form 990) 2018
Schedule H (Form 990) 2018
Page 4
Part VFacility Information (continued)

Section B. Facility Policies and Practices

(Complete a separate Section B for each of the hospital facilities or facility reporting groups listed in Part V, Section A)
SOUTHEASTERN OHIO REGIONAL MEDICAL CENTE
Name of hospital facility or letter of facility reporting group  
Line number of hospital facility, or line numbers of hospital facilities in a facility
reporting group (from Part V, Section A):
1
Yes No
Community Health Needs Assessment
1 Was the hospital facility first licensed, registered, or similarly recognized by a state as a hospital facility in the current tax year or the immediately preceding tax year?........................ 1   No
2 Was the hospital facility acquired or placed into service as a tax-exempt hospital in the current tax year or the immediately preceding tax year? If “Yes,” provide details of the acquisition in Section C............... 2   No
3 During the tax year or either of the two immediately preceding tax years, did the hospital facility conduct a community health needs assessment (CHNA)? If "No," skip to line 12...................... 3 Yes  
If "Yes," indicate what the CHNA report describes (check all that apply):
a
b
c
d
e
f
g
h
i
j
4 Indicate the tax year the hospital facility last conducted a CHNA: 20 16
5 In conducting its most recent CHNA, did the hospital facility take into account input from persons who represent the broad interests of the community served by the hospital facility, including those with special knowledge of or expertise in public health? If "Yes," describe in Section C how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted ................. 5 Yes  
6 a Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If "Yes," list the other hospital facilities in Section C.................................. 6a   No
b Was the hospital facility’s CHNA conducted with one or more organizations other than hospital facilities?” If “Yes,” list the other organizations in Section C. ............................ 6b   No
7 Did the hospital facility make its CHNA report widely available to the public?.............. 7 Yes  
If "Yes," indicate how the CHNA report was made widely available (check all that apply):
a
b
c
d
8 Did the hospital facility adopt an implementation strategy to meet the significant community health needs
identified through its most recently conducted CHNA? If "No," skip to line 11. ..............
8 Yes  
9 Indicate the tax year the hospital facility last adopted an implementation strategy: 20 16
10 Is the hospital facility's most recently adopted implementation strategy posted on a website?......... 10 Yes  
a If "Yes" (list url): SEORMC.ORG/ABOUT/COMMUNITY-HEALTH-NEEDS-ASSESSMENT
b If "No," is the hospital facility’s most recently adopted implementation strategy attached to this return? ...... 10b    
11 Describe in Section C how the hospital facility is addressing the significant needs identified in its most recently conducted CHNA and any such needs that are not being addressed together with the reasons why such needs are not being addressed.
12a Did the organization incur an excise tax under section 4959 for the hospital facility's failure to conduct a CHNA as required by section 501(r)(3)?............................... 12a   No
b If "Yes" on line 12a, did the organization file Form 4720 to report the section 4959 excise tax?........ 12b    
c If "Yes" on line 12b, what is the total amount of section 4959 excise tax the organization reported on Form 4720 for all of its hospital facilities? $  

Schedule H (Form 990) 2018
Schedule H (Form 990) 2018
Page 5
Part VFacility Information (continued)

Financial Assistance Policy (FAP)
SOUTHEASTERN OHIO REGIONAL MEDICAL CENTE
Name of hospital facility or letter of facility reporting group  
Yes No
Did the hospital facility have in place during the tax year a written financial assistance policy that:
13 Explained eligibility criteria for financial assistance, and whether such assistance included free or discounted care? 13 Yes  
If “Yes,” indicate the eligibility criteria explained in the FAP:
a
b
c
d
e
f
g
h
14 Explained the basis for calculating amounts charged to patients?................. 14 Yes  
15 Explained the method for applying for financial assistance?................... 15 Yes  
If “Yes,” indicate how the hospital facility’s FAP or FAP application form (including accompanying instructions) explained the method for applying for financial assistance (check all that apply):
a
b
c
d
e
16 Was widely publicized within the community served by the hospital facility?........ 16 Yes  
If "Yes," indicate how the hospital facility publicized the policy (check all that apply):
a
SEORMC.ORG
b
SEORMC.ORG
c
d
e
f
g
h
i
j
Schedule H (Form 990) 2018
Schedule H (Form 990) 2018
Page 6
Part VFacility Information (continued)

Billing and Collections
SOUTHEASTERN OHIO REGIONAL MEDICAL CENTE
Name of hospital facility or letter of facility reporting group  
Yes No
17 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained all of the actions the hospital facility or other authorized party may take upon nonpayment?.................................. 17 Yes  
18 Check all of the following actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP:
a
b
c
d
e
f
19 Did the hospital facility or other authorized party perform any of the following actions during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP?............ 19 Yes  
If "Yes," check all actions in which the hospital facility or a third party engaged:
a
b
c
d
e
20 Indicate which efforts the hospital facility or other authorized party made before initiating any of the actions listed (whether or not checked) in line 19. (check all that apply):
a
b
c
d
e
f
Policy Relating to Emergency Medical Care
21 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that required the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.................. 21 Yes  
If "No," indicate why:
a
b
c
d
Schedule H (Form 990) 2018
Schedule H (Form 990) 2018
Page 7
Part VFacility Information (continued)

Charges to Individuals Eligible for Assistance Under the FAP (FAP-Eligible Individuals)
SOUTHEASTERN OHIO REGIONAL MEDICAL CENTE
Name of hospital facility or letter of facility reporting group  
Yes No
22 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a
b
c
d
23 During the tax year, did the hospital facility charge any FAP-eligible individual to whom the hospital facility provided emergency or other medically necessary services more than the amounts generally billed to individuals who had insurance covering such care? ............................... 23   No
If "Yes," explain in Section C.
24 During the tax year, did the hospital facility charge any FAP-eligible individual an amount equal to the gross charge for any service provided to that individual? ........................... 24   No
If "Yes," explain in Section C.
Schedule H (Form 990) 2018
Schedule H (Form 990) 2018
Page 8
Part V
Facility Information (continued)
Section C. Supplemental Information for Part V, Section B. Provide descriptions required for Part V, Section B, lines 2, 3j, 5, 6a, 6b, 7d, 11, 13b, 13h, 15e, 16j, 18e, 19e, 20e, 21c, 21d, 23, and 24. If applicable, provide separate descriptions for each hospital facility in a facility reporting group, designated by facility reporting group letter and hospital facility line number from Part V, Section A (“A, 1,” “A, 4,” “B, 2,” “B, 3,” etc.) and name of hospital facility.
Form and Line Reference Explanation
SOUTHEASTERN OHIO REGIONAL MEDICAL CENTER PART V, SECTION B, LINE 5: SEE ATTACHED SUPPLEMENTAL INFORMATION
SOUTHEASTERN OHIO REGIONAL MEDICAL CENTER PART V, SECTION B, LINE 11: SEE ATTACHED SUPPLEMENTAL INFORMATION
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
Schedule H (Form 990) 2018
Schedule H (Form 990) 2018
Page 9
Part VFacility Information (continued)

Section D. Other Health Care Facilities That Are Not Licensed, Registered, or Similarly Recognized as a Hospital Facility
(list in order of size, from largest to smallest)
How many non-hospital health care facilities did the organization operate during the tax year?10
Name and address Type of Facility (describe)
1 1 - SOUTHEASTERN OHIO REGIONAL MEDICAL CENTE
10095 BRICK CHURCH ROAD
CAMBRIDGE,OH43725
OUTPATIENT FACILITY
2 2 - EYAD MAHAYRI MD
1335 CLARK STREET
CAMBRIDGE,OH43725
PHYSICIAN OFFICE
3 3 - CLIFFORD MAXIMO MD
1200 CLARK STREET
CAMBRIDGE,OH43725
PHYSICIAN OFFICE
4 4 - MELISSA NAU MD
205 SENECA AVENUE
BYESVILLE,OH43725
PHYSICIAN OFFICE
5 5 - MARY LILKO DO
1230A CLARK STREET
CAMBRIDGE,OH43725
PHYSICIAN OFFICE
6 6 - SUPERIOR MED ENT
1210 NEAL DRIVE
CAMBRIDGE,OH43725
PHYSICIAN OFFICE
7 7 - SIVARAM KOLLENGODE MD
1432 CLARK STREET SUITE C
CAMBRIDGE,OH43725
PHYSICIAN OFFICE
8 8 - RON ROUTH DO
18125 WOODSFIELD ROAD
CALDWELL,OH43724
PHYSICIAN OFFICE
9 9 - SUPERIOR MED PEDIATRICS & ADOLESCENT MED
1420 CLARK STREET
CAMBRIDGE,OH43725
PHYSICIAN OFFICE
10 10 - SUPERIOR MED ORTHOPEDICS
316 CLARK STREET
CAMBRIDGE,OH43725
PHYSICIAN OFFICE
Schedule H (Form 990) 2018
Schedule H (Form 990) 2018
Page 10
Part VI
Supplemental Information
Provide the following information.
1 Required descriptions. Provide the descriptions required for Part I, lines 3c, 6a, and 7; Part II and Part III, lines 2, 3, 4, 8 and 9b.
2 Needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any CHNAs reported in Part V, Section B.
3 Patient education of eligibility for assistance. Describe how the organization informs and educates patients and persons who may be billed for patient care about their eligibility for assistance under federal, state, or local government programs or under the organization’s financial assistance policy.
4 Community information. Describe the community the organization serves, taking into account the geographic area and demographic constituents it serves.
5 Promotion of community health. Provide any other information important to describing how the organization’s hospital facilities or other health care facilities further its exempt purpose by promoting the health of the community (e.g., open medical staff, community board, use of surplus funds, etc.).
6 Affiliated health care system. If the organization is part of an affiliated health care system, describe the respective roles of the organization and its affiliates in promoting the health of the communities served.
7 State filing of community benefit report. If applicable, identify all states with which the organization, or a related organization, files a community benefit report.
Form and Line Reference Explanation
PART I, LINE 7: THE COSTING METHODOLOGY USED IS BASED UPON THE SOUTHEASTERN MED'S DETAILED COST-TO-CHARGE RATIO. THE RATIO WAS BASED UPON THE DETAILED CALCULATIONS IN ACCORDANCE WITH THE IRS FORM 990 SCHEDULE H INSTRUCTIONS. THIS CALCULATION ADDRESSES ALL PATIENT SEGMENTS INCLUDING INPATIENT, OUTPATIENT, EMERGENCY ROOM, PRIVATE INSURANCE, MEDICARE, MEDICAID, UNINSURED AND SELF-PAY SERVICES. THE COST-TO-CHARGE RATIO WAS USED FOR SCHEDULE H CALCULATIONS IN LIEU OF USING A COST ACCOUNTING SYSTEM, AND WAS DERIVED FROM SCHEDULE H WORKSHEET 2, RATIO OF PATIENT CARE COST-TO-CHARGES.
PART I, LINE 7, COLUMN (F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $ 4,296,507.
PART III, LINE 2: SOUTHEASTERN MED'S COST-TO-CHARGE RATIO IS THE COSTING METHODOLOGY USED IN DETERMINING THE AMOUNTS REPORTED ON LINES 2 AND 3 OF PART III SECTION A OF SCHEDULE H. OTHER BAD DEBT AMOUNTS HAVE NOT BEEN INCLUDED IN THE COMMUNITY BENEFIT AMOUNTS REPORTED IN PART I LINE 7 OF SCHEDULE H. THE AMOUNTS REPORTED ON LINES 2 AND 3 OF PART III SECTION A OF SCHEDULE H HAVE BEEN REDUCED BY BAD DEBT RECOVERIES RECEIVED AND COSTS ARE REPORTED NET OF APPLICABLE DISCOUNTS. AMOUNTS ATTRIBUTABLE TO PATIENTS ELIGIBLE FOR CHARITY CARE HAVE BEEN DETERMINED BASED UPON HISTORICAL AVERAGES RELATING TO THE AMOUNT OF SERVICES PROVIDED TO SUCH PATIENTS.
PART III, LINE 3: SOUTHEASTERN MED'S COST-TO-CHARGE RATIO IS THE COSTING METHODOLOGY USED IN DETERMINING THE AMOUNTS REPORTED ON LINES 2 AND 3 OF PART III SECTION A OF SCHEDULE H. OTHER BAD DEBT AMOUNTS HAVE NOT BEEN INCLUDED IN THE COMMUNITY BENEFIT AMOUNTS REPORTED IN PART I LINE 7 OF SCHEDULE H. THE AMOUNTS REPORTED ON LINES 2 AND 3 OF PART III SECTION A OF SCHEDULE H HAVE BEEN REDUCED BY BAD DEBT RECOVERIES RECEIVED AND COSTS ARE REPORTED NET OF APPLICABLE DISCOUNTS. AMOUNTS ATTRIBUTABLE TO PATIENTS ELIGIBLE FOR CHARITY CARE HAVE BEEN DETERMINED BASED UPON HISTORICAL AVERAGES RELATING TO THE AMOUNT OF SERVICES PROVIDED TO SUCH PATIENTS.
PART II: COSTS ASSOCIATED WITH COMMUNITY HEALTH NEEDS PERFORMED WITH OTHER COMMUNITY BASED ORGANIZATIONS. ITEMS INCLUDE COMMUNITY DISASTER READINESS PLANNING AND PREPARATION, SPONSORSHIP OF MEDICAL EXPLORER POST WITH BOY SCOUTS OF AMERICA, AND HOSPITAL REPRESENTATION ON VARIOUS COMMUNITY COALITIONS.
PART III, LINE 4: FOOTNOTE FROM AUDIT DESCRIBING BAD DEBT EXPENSE: ALLOWANCE FOR DOUBTFUL ACCOUNTS - ACCOUNTS RECEIVABLE ARE REDUCED BY AN ALLOWANCE FOR DOUBTFUL ACCOUNTS BASED ON SOUTHEASTERN MED'S EVALUATION OF ITS MAJOR PAYER SOURCES OF REVENUE, THE AGING OF THE ACCOUNTS, HISTORICAL LOSSES, CURRENT ECONOMIC CONDITIONS, AND OTHER FACTORS UNIQUE TO THEIR SERVICE AREA AND THE HEALTHCARE INDUSTRY. FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PAYMENTS, WHICH INCLUDES BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND CO-PAYMENT BALANCES DUE FOR WHICH THIRD-PARTY COVERAGE EXISTS FOR PART OF THE BILL, SOUTHEASTERN MED RECORDS A SIGNIFICANT PROVISION FOR BAD DEBTS IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST EXPERIENCE, WHICH INDICATES THAT MANY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. THE DIFFERENCE BETWEEN THE STANDARD RATES (OR THE DISCOUNTED RATES IF NEGOTIATED) AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. THE DECEMBER 31, 2018 AND 2017 ALLOWANCE FOR DOUBTFUL ACCOUNTS OF $8,195,000 AND $6,722,000, RESPECTIVELY, RELATES TO RESERVES FOR SELF-PAY BALANCES AND CERTAIN THIRD-PARTY RECEIVABLES. THE ALLOWANCE FOR DOUBTFUL ACCOUNTS IS BASED ON A PERCENTAGE OF SELF-PAY ACCOUNTS RECEIVABLE AT DECEMBER 31, 2018 AND 2017. SOUTHEASTERN MED'S SELF-PAY WRITE-OFFS INCREASED $539,750 FROM $2,283,962 FOR 2017 TO $2,823,712 FOR 2018. WRITE-OFFS INCREASED PRIMARILY DUE TO A CLEAN-UP OF AGED ACCOUNTS IN THE CURRENT YEAR. SOUTHEASTERN MED ALSO RESERVES A CERTAIN PORTION OF AMOUNTS DUE FROM THIRD-PARTY PAYERS THAT ARE MORE THAN 365 DAYS OUTSTANDING.
PART III, LINE 8: SOUTHEASTERN MED HAS USED ITS COST-TO-CHARGE RATIO AS THE BASIS TO PREPARE ITS MEDICARE COST REPORT. THE AMOUNTS REPORTED ON PART III SECTION B LINE 8 ARE TAKEN DIRECTLY FROM THE MEDICARE AND MEDICAID COST REPORTS. THE SHORTFALL REPORTED ON PART III SECTION B LINE 7 HAS NOT BEEN INCLUDED IN THE COMMUNITY BENEFIT AMOUNTS INCLUDED IN PART I LINE 7 OF SCHEDULE H, BUT THEY DO PROVIDE A DIRECT BENEFIT TO THE COMMUNITY IN THAT LOCAL RESIDENTS ARE TREATED IN SPITE OF THIS OUT-OF-POCKET SHORTFALL NOT REIMBURSED TO SOUTHEASTERN MED.
PART III, LINE 9B: SOUTHEASTERN MED'S FINANCIAL ASSISTANCE GUIDELINES ALLOW PATIENTS TO RECEIVE HEALTHCARE AT REDUCED RATES BASED ON FINANCIAL STATUS. THE GOAL IS TO WORK WITH EACH INDIVIDUAL PATIENT TO FULLY EXPLORE PAYMENT OPTIONS, INCLUDING GOVERNMENT ASSISTANCE PROGRAMS AND PAYMENT PLANS.
PART VI, LINE 7, REPORTS FILED WITH STATES OH
SCHEDULE H, PART VI: COMMUNITY INFORMATION: SOUTHEASTERN MED IS THE SOLE HOSPITAL PROVIDER FOR GUERNSEY COUNTY. THE ORGANIZATION EMPLOYS MORE THAN 700 ASSOCIATES AND INCLUDES A MEDICAL STAFF OF APPROXIMATELY 225 PHYSICIANS AND EXTENDED CARE PROVIDERS. SOUTHEASTERN MED IS LOCATED IN CAMBRIDGE, OHIO WHICH IS IN THE RURAL APPALACHIAN AREA OF EAST CENTRAL AND SOUTHEASTERN OHIO. MORE THAN TWO-THIRDS OF SOUTHEASTERN MED'S PATIENTS ARE RESIDENTS OF THE GUERNSEY COUNTY COMMUNITY, MAKING GUERNSEY COUNTY THE PRIMARY COMMUNITY SERVED BY THE HOSPITAL. SOUTHEASTERN MED ALSO PROVIDES MEDICAL CARE FOR RESIDENTS OF SURROUNDING COMMUNITIES, SUCH AS NOBLE, MUSKINGUM, BELMONT, AND TUSCARAWAS COUNTIES. SOUTHEASTERN MED OFFERS HIGH-QUALITY HEALTH CARE SERVICES AND CONTINUOUSLY REINVESTS TO IMPROVE ITS FACILITIES AND TECHNOLOGY. THE HOSPITAL DEDICATES COUNTLESS RESOURCES TO THE BENEFIT OF THE COMMUNITY IN THE FORM OF HEALTH SCREENINGS, HEALTH FAIRS, EDUCATION, AND FREE OR REDUCED-COST HEALTH SERVICESTHE ACTIVE PROVIDERS ON THE SOUTHEASTERN MED MEDICAL STAFF BRING VAST EXPERIENCE, KNOWLEDGE AND COMPASSION TO PATIENTS THROUGHOUT GUERNSEY AND NOBLE COUNTIES. WITH MORE THAN 25 MEDICAL SPECIALTIES, SOUTHEASTERN MED PHYSICIANS OFFER QUALITY CARE WITH CLOSE-TO-HOME COMFORT. NINETY-THREE PERCENT OF SOUTHEASTERN MED PHYSICIANS HAVE EARNED BOARD CERTIFICATION, WHICH INVOLVES UNDERGOING RIGOROUS TRAINING, PASSING A NATIONAL EXAM AND TAKING STEPS TO MAINTAIN BOARD-CERTIFIED STATUS. BOARD CERTIFICATION DEMONSTRATES SOUTHEASTERN MED'S MEDICAL PROFESSIONALS' EXCEPTIONAL EXPERTISE IN THEIR PARTICULAR SPECIALTY OF MEDICAL PRACTICE.SOUTHEASTERN MED IS PROUD TO BE ACCREDITED BY THE JOINT COMMISSION, WHICH IS THE NATIONAL ACCREDITING BODY FOR HOSPITALS AND OTHER HEALTH CARE DELIVERY ORGANIZATIONS. THE JOINT COMMISSION'S MISSION IS TO CONTINUOUSLY IMPROVE THE SAFETY AND QUALITY OF CARE PROVIDED TO THE PUBLIC THROUGH THE PROVISION OF HEALTH CARE ACCREDITATION AND RELATED SERVICES THAT SUPPORT PERFORMANCE IMPROVEMENT IN HEALTH CARE ORGANIZATIONS.THE HEALTHY OHIO BUSINESS COUNCIL (HOBC) RECOGNIZED 73 OHIO EMPLOYERS FOR HEALTHY WORKSITE PRACTICES DURING THE 15TH ANNUAL HEALTHY OHIO HEALTHY WORKSITE AWARDS CEREMONY. THESE AWARDS RECOGNIZED OHIO EMPLOYERS WHO DEMONSTRATED A COMMITMENT TO EMPLOYEE WELLNESS THROUGH COMPREHENSIVE WORKSITE HEALTH PROMOTION AND WELLNESS PROGRAMS. APPLICANTS WERE SCORED ON THE EXTENT THEIR WELLNESS PROGRAMS FACILITATED AND ENCOURAGED EMPLOYEE HEALTH, ENHANCED PRODUCTIVITY, AND ENSURED A HEALTHY WORK ENVIRONMENT. SOUTHEASTERN MED RECEIVED A BRONZE AWARD.SOUTHEASTERN MED COLLABORATED WITH AREA COLLEGES AND UNIVERSITIES TO SUPPORT EDUCATIONAL AND CAREER OPPORTUNITIES. SOUTHEASTERN MED STRIVES TO BUILD A HEALTHIER COMMUNITY BY CARING FOR COMMUNITY MEMBERS WHO OTHERWISE WOULD HAVE LIMITED ACCESS TO QUALITY HEALTHCARE. IN ADDITION TO PROVIDING HOSPITAL-BASED MEDICAL SERVICES, SOUTHEASTERN MED COMMITS ITSELF TO PROVIDING A DIVERSE ARRAY OF FREE OR REDUCED COST HEALTH SCREENINGS AND WELLNESS EDUCATIONAL CLASSES DESIGNED TO IMPROVE THE HEALTH OF AREA RESIDENTS. WITH 95 BEDS AND A STAFF OF MORE THAN 700 EMPLOYEES, SOUTHEASTERN MED IS GUERNSEY COUNTY'S ONLY ADVANCED GENERAL ACUTE HOSPITAL AND LARGEST EMPLOYER.QUALITY EFFORTS AND ACTIVITIES HEALTHGRADES OUTSTANDING PATIENT EXPERIENCE AWARDS TOP 12% NATIONWIDE - THIS AWARD IS GIVEN TO THE TOP 15% OF HOSPITALS NATIONWIDE, BASED ON THE HOSPITAL CONSUMER ASSESSMENT OF HEALTHCARE PROVIDERS AND SYSTEMS (HCAHPS) PATIENT SURVEY, WHICH EVALUATES A HOSPITAL'S PERFORMANCE ACROSS 10 MEASUREMENTS RELATED TO COMMUNICATION, CLEANLINESS AND NOISE LEVELS, AND MEDICATION AND POST-DISCHARGE CARE INSTRUCTIONS. WHILE THE AWARD RECOGNIZES THE TOP 15%, SOUTHEASTERN MED PERFORMED AMONG THE TOP 12% OF HOSPITALS IN THE UNITED STATES, ACCORDING TO PATIENT SURVEY FEEDBACK. LEAPFROG PATIENT SAFETY "A" RATING THE LEAPFROG GROUP IS A NONPROFIT ORGANIZATION COMMITTED TO DRIVING QUALITY, SAFETY, AND TRANSPARENCY IN THE U.S. HEALTHCARE SYSTEM. THEY ASSIGN A,B,C,D AND F LETTER GRADES TO HOSPITALS NATIONWIDE. HEALTH RESOURCES & SERVICES ADMINISTRATION IS A FEDERAL AGENCY THAT ENCOURAGES HOSPITALS TO PROMOTE ORGAN TISSUE AND EYE DONATION. SOUTHEASTERN MED WAS ONE OF 23 HOSPITALS IN OHIO TO RECEIVE THE PLATINUM AWARD IN 2018. BUILDING A HEALTHY COMMUNITY MYHEALTH PATIENT PORTAL:TECHNOLOGY CONTINUES TO QUICKLY ADVANCE, AND SOUTHEASTERN MED IS COMMITTED TO MEETING THE NEEDS OF OUR COMMUNITY WHILE EMBRACING CHANGES IN TECHNOLOGY. ONE IMPORTANT ADVANCEMENT IN THAT TECHNOLOGY IS THE MYHEALTH PATIENT PORTAL. THE PORTAL ACTIVELY ENGAGES PATIENTS IN THEIR CARE BY GIVING THEM ACCESS TO VALUABLE HEALTH INFORMATION ONLINE. THIS ONLINE TOOL ALLOWS PATIENTS THE ABILITY TO MANAGE A WIDE RANGE OF HEALTH DATA FROM WHEREVER THEY ARE AND AT THEIR CONVENIENCE. PATIENTS CAN ACCESS THEIR ACCOUNT FROM ANYWHERE USING THE INTERNET, INCLUDING THEIR COMPUTER, SMARTPHONE, OR TABLET. IN ADDITION TO HANDLING THEIR OWN CARE, PARENTS AND THOSE WITH AUTHORIZED CONSENT WILL APPRECIATE THE ABILITY TO ACCESS THE RECORDS OF THOSE INDIVIDUALS FOR WHOM THEY MANAGE CARE.THE MYHEALTH PATIENT PORTAL GIVES PATIENTS INSTANT AND SECURE ACCESS TO THE PERSONAL HEALTH INFORMATION THEIR CARE TEAM ENTERED INTO THEIR RECORD. ALL OF THE INFORMATION IN THE PORTAL COMES FROM SOUTHEASTERN MED'S ELECTRONIC HEALTH RECORD. THIS ENSURES THAT PATIENTS HAVE ACCESS TO THE MOST UP-TO-DATE INFORMATION. THE INFORMATION AVAILABLE THROUGH THE PORTAL INCLUDES: ALLERGIES, DISCHARGE INSTRUCTIONS, MEDICATION LISTS, UPCOMING APPOINTMENTS AT SOUTHEASTERN MED, CONDITIONS, LAB RESULTS, DIAGNOSTIC IMAGING RESULTS, AND VISIT HISTORIES. SOUTHEASTERN MED ASSOCIATES PROVIDE EDUCATION TO PATIENTS AND FAMILIES ABOUT THE MYHEALTH PATIENT PORTAL AND ARE AVAILABLE TO ASSIST PATIENTS WITH PORTAL REGISTRATION BEFORE BEING DISCHARGED FROM THE HOSPITAL. THERE ARE MANY RESOURCES AVAILABLE AT SOUTHEASTERN MED TO HELP PATIENTS EASILY SIGN-UP AND VIEW THEIR PORTAL ACCOUNT. PROMOTION OF COMMUNITY HEALTH ADDRESSING THE HEALTH NEEDS OF OUR COMMUNITY IS AN IMPORTANT PART OF OUR NOT-FOR-PROFIT ORGANIZATION'S MISSION. SOUTHEASTERN MED IS COMMITTED TO AND RESPONDS TO THE COMMUNITY'S HEALTH AND WELLNESS NEEDS. IN ADDITION TO PROVIDING HOSPITAL-BASED SERVICES, SOUTHEASTERN MED OFFERS A VARIETY OF HEALTH EDUCATION AND WELLNESS SCREENING OPPORTUNITIES THROUGHOUT THE YEAR. EFFORTS ARE MADE TO ENSURE THAT MEMBERS OF THE COMMUNITY WHO HAVE LIMITED ACCESS TO CARE DUE TO LACK OF FINANCIAL RESOURCES OR AVAILABLE HEALTHCARE COVERAGE ARE ABLE TO RECEIVE REGULAR HEALTH AND WELLNESS SCREENINGS AND/OR EDUCATION. SOUTHEASTERN MED'S BOARD OF DIRECTORS IS COMPRISED OF PERSONS WHO RESIDE IN THE PRIMARY SERVICE AREA AND SURROUNDING COMMUNITIES. OTHER THAN THE PHYSICIAN CHIEF OF STAFF AND DR. MICHAEL SARAP, TRUSTEE, THEY ARE NEITHER EMPLOYEES NOR CONTRACTORS OF SOUTHEASTERN MED, BUT ARE SUPPORTIVE OF THE EFFORTS BY SOUTHEASTERN MED TO PROMOTE HEALTH AND WELLNESS IN THE COMMUNITY. RESOURCES ARE APPROVED AND PROVIDED FOR SUPPORTING IMPROVEMENTS IN PATIENT CARE, EDUCATION, AND HEALTH PROMOTION ACROSS THE BROADER COMMUNITY. THE FOLLOWING ARE EXAMPLES OF PROGRAMS REGULARLY OFFERED BY SOUTHEASTERN MED: HEALTH FAIRS FOR TARGETED POPULATIONS: HEARING SCREENINGS; DIABETES RISK SCREENINGS; BLOOD CHEMISTRY TESTS; SKIN CANCER SCREENINGS; COLORECTAL AND BREAST CANCER AWARENESS EDUCATION. OTHER SIGNIFICANT HEALTH AND WELLNESS COMMITMENTS BY SOUTHEASTERN MED INCLUDE FREE TOBACCO CESSATION CLASSES, FREE DIABETES EDUCATION CONSULTATIONS AND CLASSES, LOW-COST LUNG CANCER SCREENINGS, A VARIETY OF SUPPORT GROUPS, RELAY FOR LIFE AMERICAN CANCER SOCIETY FUNDRAISER PARTICIPATION, MEDICAL EXPLORERS PROGRAM TO INTRODUCE ADOLESCENTS TO HEALTHCARE CAREERS, UNITED WAY FUNDRAISERS, AS WELL AS CPR CLASSES. SCREENINGS/EVENTS- HEART DISEASE & STROKE - TO INCREASE THE SCOPE OF EDUCATIONAL OPPORTUNITIES FOR AWARENESS OF HEART DISEASE AND STROKE RISK FACTORS AND PREVENTIVE STRATEGIES, SOUTHEASTERN MED OFFERS CPR CLASSES AND FIRST AID CLASSES. IN 2018, TWELVE COMMUNITY CPR AND FIRST AID CLASSES WERE HELD WITH 40 PARTICIPANTS. THE CARDIAC HEALTH SCREENING WAS EXPANDED IN 2018 TO INCLUDE OHIOHEALTH CARDIOLOGY AND PROVIDE ONSITE EKG. IN 2018 THERE WERE 58 INDIVIDUALS WHO PARTICIPATED IN THE CARDIAC HEALTH SCREENING. PARTICIPANTS RECEIVED FREE EKG, BLOOD PRESSURE, BODY COMPOSITION, LIPID PANEL AND GLUCOSE LAB SCREENINGS, AS WELL AS ONSITE EDUCATION REGARDING THEIR RESULTS FROM NURSES, DIETITIANS, EXERCISE PHYSIOLOGIST AND CARDIOLOGIST.SOUTHEASTERN MED HOSTED THE BYESVILLE ROTARY'S HEALTH FAIR SEEING CLOSE TO 100 INDIVIDUALS, AND THE NEWCOMERSTOWN ROTARY'S HEALTH FAIR, SEEING CLOSE TO 90 INDIVIDUALS. IT ALSO HOSTED HEALTH SCREENINGS AT THE FOLLOWING LOCAL BUSINESSES:
SCHEDULE H, PART VI: CONTINUED QUANEX BUILDING PRODUCTS, COLGATE-PALMOLIVE, RIDGE TOOL, AND ASCENT RESOURCES. HEALTH SCREENINGS CONSISTED OF BASIC LAB WORK THAT CHECKED A1C, BLOOD PRESSURE, & A LIPID PROFILE. APPROXIMATELY 5% OF THOSE SCREENED HAD ABNORMAL FINDINGS AND WERE REFERRED TO THEIR PRIMARY CARE PROVIDER FOR FOLLOW UP.SOUTHEASTERN MED ALSO HOSTED LUNG CANCER SCREENINGS SIX TIMES THIS YEAR. EACH EVENT IS 5 HOURS IN LENGTH. EVENTS WERE HELD FEBRUARY 22, APRIL 19, JUNE 14, AUGUST 16, SEPTEMBER 20, AND DECEMBER 6 AT THE COMMUNITY HEALTHLINK. 40 PEOPLE WERE SCREENED IN 2018.SKIN AND COLON CANCER SCREENINGS WERE HELD TWO TIMES IN 2018; 21 PEOPLE WERE SCREENED.BREAST CANCER SCREENINGS ARE HELD ONCE A YEAR. SOUTHEASTERN MED ALSO HAD A PUBLIC BREAST CANCER AWARENESS EVENT AT RIESBECKS GROCERY STORE IN 2018. SOUTHEASTERN MED PROVIDED AN INFLATABLE BREAST AND DR. MICHAEL SARAP ANSWERED QUESTIONS AND EDUCATED GUESTS ON BREAST CANCER. OVER 100 PEOPLE STOPPED BY TO ASK QUESTIONS AND TOUR THE INFLATABLES.FUN 2B FIT - IN 2018, SOUTHEASTERN MED CONTINUED ITS "FUN 2B FIT" PROGRAM, A STUDENT FITNESS PROGRAM. THIS PROGRAM FOCUSES ON CHILDREN'S HEALTH, EXERCISE AND EATING HABITS AND IS OPEN TO THE LOCAL COMMUNITY. FUN 2B FIT TEACHES KIDS TO EXPLORE HEALTH-PROMOTING AND FUN ACTIVITIES, BUILDS SELF-ESTEEM AND EDUCATES ON HEALTHY LIFESTYLE CHOICES. FUN 2B FIT PROVIDES A SAFE AND SUPPORTIVE ENVIRONMENT FOR CHILDREN TO EXPLORE EXERCISE THROUGH SPORTS, GAMES, SWIMMING, ARTS, CRAFTS AND MUCH MORE. THEY ALSO LEARN ABOUT HEALTHY EATING AND MAKING THE RIGHT FOOD CHOICES. AT SOUTHEASTERN MED, IT IS OUR GOAL TO BUILD CHILDREN'S SELF-ESTEEM AND CONFIDENCE WHILE IMPROVING MUSCULAR STRENGTH AND INSTILLING A PASSION FOR EXERCISE AND NUTRITION, LEADING TO HEALTHY LIFESTYLE CHOICES. TWENTY-FOUR YOUTHS ATTENDED THE PROGRAM IN 2018.OLDER ADULT HEALTH FAIR - AREA INDIVIDUALS AGE 55 AND OLDER ATTENDED THE 2018 OLDER ADULT HEALTH FAIR AT THE GUERNSEY COUNTY SENIOR CITIZENS' CENTER. THE HEALTH FAIR PROVIDES AREA RESIDENTS THE OPPORTUNITY TO ACCESS LOW-COST HEALTH SCREENINGS, ENJOY A VARIETY OF EXHIBITS, WIN DOOR PRIZES AND ENJOY THEMSELVES IN A SAFE AND SECURE ENVIRONMENT. SOUTHEASTERN MED INVITES LOCAL BUSINESSES, AGENCIES, AND PHYSICIANS TO JOIN WITH SOUTHEASTERN MED DEPARTMENTS TO PARTICIPATE IN THE FAIR TO PROVIDE AREA RESIDENTS WITH A PLETHORA OF INFORMATION. AS A COMMUNITY BENEFIT, FOOT HEALTH, HEARING, BLOOD PRESSURE, VASCULAR, AND SKIN CANCER SCREENINGS ARE OFFERED FREE OF CHARGE. SOUTHEASTERN MED'S LABORATORY SERVICES ALSO PROVIDED BLOOD SCREENINGS AT THE EVENT FOR THE FOLLOWING: GLUCOSE AND LIPID PROFILE, THYROID AND PROSTATE. FLU VACCINES WERE AVAILABLE AT THE EVENT PROVIDED BY THE GUERNSEY COUNTY HEALTH DEPARTMENT. THE GUERNSEY COUNTY SHERIFF'S DEPARTMENT COLLECTED ANY EXPIRED OR UNUSED MEDICATIONS FOR PROPER DISPOSAL DURING THE FAIR. OVER 100 COMMUNITY MEMBERS ATTENDED THE EVENT. APRIL IS NATIONAL DONATE LIFE MONTH. TO PROMOTE ORGAN DONATION AWARENESS, SOUTHEASTERN MED ASSOCIATES PARTICIPATED IN LIFELINE OF OHIO'S NATIONAL BLUE AND GREEN DAY. SOUTHEASTERN MED'S PARTICIPATION INCLUDES VARIOUS DONATION STATIONS THROUGHOUT THE YEAR; FLAG RAISINGS; RADIO SPOTS ENCOURAGING ORGAN DONATION; LOCAL LIFELINE OF OHIO REPRESENTATIVE ATTENDS ALL NURSING ORIENTATION MEETINGS; PROVIDE EDUCATION FOR ALL NEW ASSOCIATES ON ORGAN, TISSUE, AND EYE DONATION; PROVIDE EDUCATION TO CARDIAC REHAB PATIENTS ENCOURAGING DONATION; HOST THE "GREEN" CHAIR AT SOUTHEASTERN MED; DECORATE A SHOWCASE AT SOUTHEASTERN MED; AS WELL AS HOSTING A TREE AT CHRISTMAS TIME HONORING THOSE OHIO RESIDENTS WHO HAVE RECEIVED OR DONATED AN ORGAN. SOUTHEASTERN MED WAS AWARDED THE LIFELINE OF OHIO PLATINUM AWARD IN 2018.DIABETES EDUCATION PRESENTATION - THE DIABETES SUPPORT GROUP MET MONTHLY IN 2018. EACH MONTH A DIFFERENT PRESENTER DISCUSSES A TOPIC CONCERNING DIABETIC HEALTH. THE CLASS IS ATTENDED BY AN AVERAGE OF 14 PARTICIPANTS. DURING DIABETES MONTH IN NOVEMBER 2018, OVER 40 PEOPLE ATTENDED A PRESENTATION BY OUR COMMUNITY DIETITIAN INCLUDING DIET RECOMMENDATIONS AND A COOKING DEMONSTRATION BY THE HOSPITAL CHEF FOR HEALTHY DIABETIC MEALS.BREAST CANCER SCREENINGS - SOUTHEASTERN MED'S POWER ME PINK PROGRAM OFFERED 76 FREE BREAST CANCER SCREENINGS AND MAMMOGRAMS TO THOSE IN OUR COMMUNITY IN 2018. SPECIFICALLY, THIS SCREENING IS GEARED TOWARD THOSE OVER THE AGE OF 40 WITH LIMITED RESOURCES WHO ARE UNDERINSURED OR UNINSURED. SOUTHEASTERN MED'S POWER ME PINK PROGRAM PROVIDES WOMEN AND MEN WHO ARE UNINSURED AND UNDERINSURED WITH BREAST HEALTH EDUCATION, CLINICAL BREAST EXAMS, MAMMOGRAMS AND ADDITIONAL TESTING IF NECESSARY. THE PROGRAM SERVES MEN AND WOMEN 35-64 YEARS' OLD WHO EARN BELOW THE POVERTY LEVEL WITH BREAST HEALTH EDUCATION AND MAMMOGRAMS. THE PROJECT ALSO REACHES WOMEN YOUNGER THAN 35 YEARS OF AGE WHO HAVE A FAMILY HISTORY OF BREAST CANCER.SAFE SITTER COURSES - SOUTHEASTERN MED HOSTED THREE SAFE SITTER COURSES DURING 2018 WITH 30 PARTICIPANTS. SAFE SITTER IS A COURSE DESIGNED TO TEACH SAFE AND NURTURING BABYSITTING SKILLS TO YOUNG ADOLESCENTS BETWEEN THE AGES OF 11 AND 13. INSTRUCTION INCLUDES HOW TO ADMINISTER FIRST AID, HOW TO HANDLE MEDICAL EMERGENCIES AND WHAT TO DO FOR A CHOKING CHILD. SAFE SITTER ALSO TEACHES ORGANIZATIONAL SKILLS, SAFETY HABITS AND THE IMPORTANCE OF KNOWING WHEN TO CALL FOR HELP. AFTER COMPLETING THE SAFE SITTER CLASS, NEW SAFE SITTERS AND THEIR PARENTS WERE INVITED TO PARTICIPATE IN A FREE FAMILY AND FRIENDS CPR CLASS. THE SOUTHEASTERN MED AUXILIARY PROVIDES THE FUNDS FOR THE SAFE SITTER MANUALS AND BACKPACKS. THE REDUCED COST TO ATTEND IS $35.CHILDREN'S HEALTH FAIR - IN 2018, THE ANNUAL CHILDREN'S HEALTH FAIR WAS GIVEN A "FUN IN THE SUN" THEME. HELD AT THE CAMBRIDGE CITY PARK PAVILION, THE CHILDREN'S HEALTH FAIR WAS GEARED TO CHILDREN AGES 3-11 AND THEIR FAMILIES, TO LEARN ABOUT HEALTH AND SAFETY TOPICS, ENJOY DELICIOUS FOOD, PLAY GAMES AND SOCIALIZE. THE CHILDREN'S HEALTH FAIR IS A FREE COMMUNITY EVENT. THE GOAL OF THIS ANNUAL FAIR IS TO ENCOURAGE CHILDREN TO BECOME MORE AWARE OF HEALTHY INTERESTS, SUCH AS EXERCISE AND EATING PROPERLY, AND TO HELP KIDS ESTABLISH A COMFORT LEVEL WITH HEALTHCARE PROVIDERS AND SAFETY OFFICIALS. THE EVENT WAS ATTENDED BY MORE THAN 400 CHILDREN AGES 3-11 WITH THEIR PARENTS. MORE THAN 25 LOCAL ORGANIZATIONS AND BUSINESSES, IN ADDITION TO VARIOUS DEPARTMENTS FROM SOUTHEASTERN MED, DISPLAYED FUN AND INTERACTIVE EXHIBITS TO PROMOTE SAFETY AND HEALTH AT THE FAIR. MEDICAL EXPLORERS - HIGH SCHOOL STUDENTS INTERESTED IN LEARNING ABOUT CAREERS IN THE MEDICAL FIELD WERE INVITED TO ATTEND MEDICAL EXPLORERS AT SOUTHEASTERN MED. MEDICAL EXPLORERS PROVIDES YOUNG ADULTS WITH THE CHANCE TO LEARN ABOUT A VARIETY OF MEDICAL CAREERS FROM HEALTHCARE PROFESSIONALS, AS WELL AS PARTICIPATE IN HANDS-ON ACTIVITIES DESIGNED TO FAMILIARIZE THEM WITH A SPECIFIC ASPECT OF MEDICINE. EXPLORERS MUST BE AT LEAST 14 YEARS OLD IN GRADES 9-12 TO PARTICIPATE. DURING THE 2018 PROGRAM YEAR, THERE WERE APPROXIMATELY 45 PARTICIPANTS.ANNUAL FUNDRAISERS:THE UNITED WAY OF GUERNSEY AND NOBLE COUNTIES USES LOCALLY-RAISED MONEY TO HELP THOSE IN NEED IN GUERNSEY, MONROE AND NOBLE COUNTIES. SOUTHEASTERN MED IS A BIG SUPPORTER OF THE LOCAL UNITED WAY AGENCY. TWO HUNDRED SEVENTY-FIVE HOURS WERE SPENT TO RAISE THE $4,729.00, WHICH WAS DONATED TO THE UNITED WAY BY SOUTHEASTERN MED ASSOCIATES IN 2018. A PORTION OF THIS MONEY WAS RAISED THROUGH VOLUNTARY PAYROLL DEDUCTION FROM SOUTHEASTERN MED ASSOCIATES. ACCESS TO CARE SENIOR MANAGEMENT CONTINUED TO IMPLEMENT THE PHYSICIAN RECRUITMENT PLAN IN 2018. THIS PLAN WAS TO RECRUIT PHYSICIANS TO JOIN THE SUPERIOR MED MULTI-PHYSICIAN SPECIALTY GROUP OWNED BY SOUTHEASTERN MED OR TO JOIN INDEPENDENT LOCAL PHYSICIAN PRACTICES.FINANCIAL COUNSELORS ARE CAC (CERTIFIED APPLICATION COUNSELOR) CERTIFIED BY HEALTHCARE MARKETPLACE AND CONTINUE TO ASSIST PATIENTS WITH APPLICATION FOR MEDICAID ONSITE AT SOUTHEASTERN MED AND TO PROVIDE GUIDANCE REGARDING THEIR MEDICAL INSURANCE. SOUTHEASTERN MED IS A QUALIFIED ENTITY FOR MEDICAID ENROLLMENT.KEEPING CANCER PATIENTS CLOSE TO HOMESOUTHEASTERN MED EXPANDED ITS SUCCESSFUL CANCER SERVICE LINE IN 2012 BY PURCHASING THE CAMBRIDGE REGIONAL CANCER CENTER, LOCATED ACROSS THE STREET FROM SOUTHEASTERN MED.THE CAMBRIDGE REGIONAL CANCER CENTER OFFERS ADVANCED HEMATOLOGY AND MEDICAL ONCOLOGY SERVICES FOR PATIENTS WITH MANY DIFFERENT TYPES OF CANCER, INCLUDING BREAST, LUNG, COLON AND GENITOURINARY CANCERS, AS WELL AS BENIGN AND MALIGNANT BLOOD DISORDERS, SUCH AS ANEMIA, LYMPHOMA, LEUKEMIA AND MYELOMA.CANCER WAS IDENTIFIED AS THE SECOND HEALTH NEED IN THE COMMUNITY THROUGH THE 2016 CHNA. SOUTHEASTERN MED CONTINUES TO PROVIDE SERVICES TO THE COMMUNITY FIVE DAYS A WEEK.SOUTHEASTERN MED'S CANCER REGISTRY, BREAST HEALTH NAVIGATOR, AND DR. MICHAEL SARAP, SURGEON WITH SOUTHEASTERN OHIO PHYSICIANS, INC. AND SOUTHEASTERN MED MEDICAL STAFF MEMBER, CONTINUE THE VIRTUAL BREAST CARE CLINIC.
SCHEDULE H, PART VI: CONTINUED THE IDEAL ARRANGEMENT FOR QUALITY BREAST CARE IS A CENTER OR CLINIC HOUSING MULTIPLE SPECIALISTS THAT ACT AS A TEAM TO CARE FOR BENIGN AND MALIGNANT BREAST DISEASE. THE SPECIALISTS INVOLVED IN SUCH A CLINIC INCLUDE SURGEONS, RADIOLOGISTS, ONCOLOGISTS, GENETICS COUNSELORS AND BREAST NAVIGATORS. AN ALL-ENCOMPASSING BREAST CENTER IS NOT FEASIBLE IN RESOURCE-LIMITED AREAS. IN MOST SMALL TOWNS AND RURAL AREAS, THERE IS NO ORGANIZED TEAM APPROACH TO BREAST CARE. SCREENING AND DIAGNOSTIC MAMMOGRAMS, ULTRASOUNDS AND MRI SCANS, AND EVEN BREAST BIOPSIES MAY BE ORDERED BY PRIMARY CARE PHYSICIANS, GYNECOLOGISTS AND EVEN NURSE PRACTITIONERS AND PHYSICIAN ASSISTANTS. CERTAINLY, IT IS VITALLY IMPORTANT FOR EVERY WOMAN TO BE INVOLVED IN A SCREENING PROGRAM, BUT IT IS JUST AS IMPORTANT FOR ALL WOMEN TO GET THE BEST RETURN ON INVESTMENT IN TERMS OF PROPER INTERPRETATION OF THE FINDINGS AND APPROPRIATE FOLLOW-UP. IN 2016, SOUTHEASTERN MED PURCHASED AND BEGAN OFFERING 3D MAMMOGRAPHY TO OUR COMMUNITY. ALL PRIMARY CARE PROVIDERS CAN AND DO ORDER BREAST IMAGING AND BREAST BIOPSIES WHEN SUGGESTED BY THE INTERPRETING RADIOLOGIST. MANY PRACTITIONERS WILL IMMEDIATELY REFER THE PATIENT TO A SURGEON AT THE TIME OF THE INITIAL ABNORMAL IMAGING. INDIVIDUAL PRACTITIONERS RECEIVE THE RESULTS OF ALL IMAGING AND BIOPSY RESULTS. IN ADDITION, THE BREAST NAVIGATOR COLLECTS RESULTS OF ALL ABNORMAL MAMMOGRAMS, ULTRASOUND STUDIES AND MRI STUDIES AND ALL BIOPSY REPORTS. THE INFORMATION IS COLLATED IN A NOTEBOOK ALONG WITH OTHER PERTINENT PATIENT INFORMATION REGARDING SYMPTOMS AND PHYSICAL EXAMINATIONS. THE LEADERSHIP OF THE BREAST CARE TEAM (BCT) THEN REVIEWS EVERY BIRADS CATEGORY IV AND V MAMMOGRAM AND EACH BIOPSY PERFORMED BY RADIOLOGY OR OTHER PRACTITIONERS. OUR PROGRAM CARES FOR 20-30 NEW BREAST CANCER PATIENTS PER YEAR. OUR RADIOLOGY DEPARTMENT PERFORMS AN AVERAGE OF 89 BIOPSIES PER YEAR. THE BREAST HEALTH NAVIGATOR AND BCT ACT AS A TEAM TO REVIEW AND TRACK EVERY PATIENT THAT HAS HAD A BIOPSY OR WHO NEEDS RADIOLOGIC FOLLOW-UP FOR ABNORMAL IMAGES. ANY DISCORDANCE OR IRREGULARITY TRIGGERS CONTACT WITH THE PRIMARY CARE PROVIDER, RADIOLOGIST, PATHOLOGIST OR SURGEON TO RESOLVE THE ISSUE. THERE IS NO COST TO THE PATIENT FOR THIS QUALITY ASSURANCE ACTIVITY ORGANIZED BY THE BREAST TEAM LEADERSHIP.THE SOUTHEASTERN MED BREAST HEALTH NAVIGATOR SAW 20 WOMEN IN 2018 AND PROVIDED ONE-ON-ONE EDUCATIONAL TRAINING REGARDING THEIR LUMPECTOMY AND OR MASTECTOMY, RESOURCES NEEDED TO NAVIGATE APPOINTMENTS, FINANCIAL RESOURCES AND EMOTIONAL SUPPORT.SOUTHEASTERN MED SPONSORS THE BREAST CANCER SUPPORT GROUP AND POSITIVELY PINK. POSITIVELY PINK IS A GROUP THAT MEETS MONTHLY AND IS GEARED TOWARD THOSE WHO HAVE OR ARE CURRENTLY BATTLING BREAST CANCER. THE BREAST CANCER SUPPORT GROUP APPROACHES CANCER IN AN ACTIVE, POSITIVE WAY AND HELPS PARTICIPANTS GAIN A SENSE OF CONTROL OVER THEIR DISEASE. FOR OVER 30 YEARS, SOUTHEASTERN MED HAS ALSO SPONSORED A SURVIVOR'S DAY CELEBRATION. CANCER SURVIVORS, CAREGIVERS, FAMILY MEMBERS AND FRIENDS ARE INVITED TO ATTEND THIS FREE EVENT. LUNCH, SPEAKERS, AND ENTERTAINMENT ARE PROVIDED AT NO COST TO PARTICIPANTS. IN 2018, SOUTHEASTERN MED HELD 19 COMMUNITY BREAST SCREENING CLINICS, WHICH WERE OFFERED TO WOMEN IN THE COMMUNITY WHO DO NOT HAVE HEALTH CARE COVERAGE AND DID NOT HAVE ACCESS TO A PHYSICIAN. THE SCREENING IS SPONSORED BY SUSAN G. KOMEN FOR THE CURE AND SOUTHEASTERN MED'S POWER ME PINK PROGRAM. SPECIFICALLY, THIS SCREENING IS GEARED TOWARD THOSE OVER THE AGE OF 40 WITH LIMITED RESOURCES, WHO ARE UNDERINSURED OR UNINSURED. SOUTHEASTERN MED'S POWER ME PINK PROGRAM PROVIDES WOMEN AND MEN WHO ARE UNINSURED AND UNDERINSURED WITH BREAST HEALTH EDUCATION, CLINICAL BREAST EXAMS, MAMMOGRAMS AND ADDITIONAL TESTING IF NECESSARY. THE PROGRAM SERVES MEN AND WOMEN 35-64 YEARS OLD, WHO EARN BELOW THE POVERTY LEVEL, WITH BREAST HEALTH EDUCATION AND MAMMOGRAMS. THE PROJECT ALSO REACHES WOMEN YOUNGER THAN 35 YEARS OF AGE WHO HAVE A FAMILY HISTORY OF BREAST CANCER. THE PROGRAM INCLUDED A MAMMOGRAM AND CLINICAL BREAST EXAM BY A LOCAL PHYSICIAN. IN 2018, 79 WOMEN TOOK PART IN THE PROGRAM. SOUTHEASTERN MED AND PHYSICIANS CONTINUE TO OFFER A FREE OR LOW-COST COLONOSCOPY TO ALL PERSONS WHO NEED THE PROCEDURE BUT DO NOT HAVE HEALTH CARE INSURANCE. IN 2018, 1,607 COLONOSCOPIES WERE PERFORMED AT SOUTHEASTERN MED. DR. MICHAEL SARAP, ALONG WITH HIS PARTNERS, DONATES HIS TIME TO PROVIDE FREE EDUCATION AND COLONOSCOPIES TO THE COMMUNITY ON AN AS-NEEDED BASIS. SOUTHEASTERN MED PHYSICIANS ALSO REGULARLY HOSTS FREE SKIN CANCER SCREENINGS TO COMMUNITY MEMBERS. OBESITY AND FITNESS PHYSICAL ACTIVITYSOUTHEASTERN MED OFFERED GROUP LIFESTYLE BALANCE, A WEIGHT LOSS PROGRAM WHICH MET INITIALLY FOR 12 WEEKS AND PROVIDED 10 FOLLOW-UP SESSIONS THROUGHOUT THE YEAR AND WAS OFFERED AT VERY LOW COST TO THE COMMUNITY AT MULTIPLE LOCATIONS INCLUDING SOUTHEASTERN MED AND THE PUBLIC LIBRARY. IN 2018, THIS PROGRAM WAS HELD 4 TIMES FOR 18 PEOPLE. SOUTHEASTERN MED OFFERS A FREE SMOKING CESSATION PROGRAM TO THE COMMUNITY INSTRUCTED BY AN RN. PROGRAMS ARE DESIGNED FOR BOTH EXPECTANT MOTHERS AS WELL AS THE COMMUNITY AT LARGE. PERSONAL TRAINING "COUPONS" WERE GIVEN AWAY IN 2018 AS GIFTS/PRIZES, AT THE ST. BENEDICT SCHOOL ANNUAL FUNDRAISING EVENT. EACH "COUPON" WAS FOR 4 FREE 30-MINUTE SESSIONS WITH AN ATHLETIC TRAINER FROM THE PHYSICAL THERAPY DEPARTMENT. THE PURPOSE OF EACH SESSION WAS TO PROVIDE INCENTIVE TO EXERCISE AND HELP PEOPLE REALIZE HOW BENEFICIAL EXERCISE IS FOR THEIR PHYSICAL AND MENTAL HEALTH.DISASTER PREPAREDNESS PLAN THE EMERGENCY MANAGEMENT COORDINATOR FOR SOUTHEASTERN MED IS APPOINTED TO THE LOCAL EMERGENCY PLANNING COMMITTEE (LEPC) BY THE COUNTY COMMISSIONERS. IT IS THE JOB OF THE LEPC TO DEVELOP AN EMERGENCY RESPONSE PLAN FOR THE COUNTY AND REVIEW IT EVERY YEAR. THE LEPC IS MADE UP OF: ELECTED STATE AND LOCAL OFFICIALS POLICE, FIRE, CIVIL DEFENSE, AND PUBLIC HEALTH PROFESSIONALS ENVIRONMENTAL, TRANSPORTATION, AND HOSPITAL OFFICIALS FACILITY REPRESENTATIVES REPRESENTATIVES FROM COMMUNITY GROUPS AND THE MEDIASOUTHEASTERN MED SHARES ITS OWN EMERGENCY OPERATIONS PLAN (EOP) AND HAZARD VULNERABILITY ANALYSIS (HVA) WITH OUR COMMUNITY PARTNERS.THE EMERGENCY MANAGEMENT COORDINATOR IS A MEMBER OF THE GUERNSEY AND NOBLE COUNTY LEPC. THE LEPC MEETS AT LEAST QUARTERLY. SOUTHEASTERN MED PARTICIPATES IN BOTH GUERNSEY AND NOBLE COUNTY DISASTER DRILLS.SOUTHEASTERN MED IS A PART OF THE OHIO HOSPITAL ASSOCIATION (OHA) REGIONAL HOSPITAL COALITION. THE REGIONAL COALITION MEETS MONTHLY TO DISCUSS AND SHARE IDEAS FOR DISASTER PREPAREDNESS. HOSPITALS THAT PARTICIPATE IN THE REGIONAL COALITION CAN OBTAIN GRANTS FOR EMERGENCY PREPAREDNESS EQUIPMENT, WHICH REMAIN AVAILABLE TO OTHER HOSPITALS IN THE STATE IN THE EVENT OF A SIGNIFICANT DISASTER IN THEIR SERVICE AREA. PART VI LINE 6 SOUTHEASTERN OHIO REGIONAL MEDICAL CENTER, INC. WHICH OPERATES A NOT-FOR-PROFIT GENERAL ACUTE CARE HOSPITAL, IS A SUBSIDIARY OF GUERNSEY HEALTH SYSTEMS, A NOT-FOR-PROFIT OHIO CORPORATION. GUERNSEY HEALTH SYSTEMS IS INVOLVED IN FUNDRAISING, THE OWNERSHIP AND OPERATION OF MEDICAL OFFICE BUILDINGS AND OTHER HEALTHCARE RELATED FACILITIES, AND THE EXECUTIVE-LEVEL MANAGEMENT OF ITS RELATED CORPORATIONS. GUERNSEY HEALTH ENTERPRISES, INC., A SUBSIDIARY OF GUERNSEY HEALTH SYSTEMS, IS A FOR-PROFIT HEALTH SERVICES CORPORATION AND IS THE PARENT COMPANY OF UNITED AMBULANCE SERVICE OF CAMBRIDGE, INC., AN EMERGENCY RESPONSE AND TRANSPORT AMBULANCE SERVICE. SOUTHEASTERN OHIO REGIONAL MEDICAL CENTER, INC. IS THE SOLE MEMBER OF SUPERIOR MED, LLC, A DISREGARDED TAX-EXEMPT ORGANIZATION THAT OPERATES PHYSICIAN OFFICES IN THE COMMUNITY.
Schedule H (Form 990) 2018
Additional Data


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Schedule J
(Form 990)
Department of the Treasury
Internal Revenue Service
Compensation Information
For certain Officers, Directors, Trustees, Key Employees, and Highest
Compensated Employees
SchJMediumBullet Complete if the organization answered "Yes" on Form 990, Part IV, line 23.
SchJMediumBullet Attach to Form 990.
SchJMediumBullet Go to www.irs.gov/Form990 for instructions and the latest information.
OMB No. 1545-0047
2018
Open to Public Inspection
Name of the organization
SOUTHEASTERN OHIO REGIONAL MEDICAL
CENTER INC
Employer identification number

31-4391798
Part I
Questions Regarding Compensation
Yes
No
1a
Check the appropiate box(es) if the organization provided any of the following to or for a person listed on Form
990, Part VII, Section A, line 1a. Complete Part III to provide any relevant information regarding these items.
b
If any of the boxes in line 1a are checked, did the organization follow a written policy regarding payment or reimbursement or provision of all of the expenses described above? If "No," complete Part III to explain .........
1b
 
 
2
Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all
directors, trustees, officers, including the CEO/Executive Director, regarding the items checked in line 1a? ..
2
 
 
3
Indicate which, if any, of the following the filing organization used to establish the compensation of the
organization's CEO/Executive Director. Check all that apply. Do not check any boxes for methods
used by a related organization to establish compensation of the CEO/Executive Director, but explain in Part III.
4
During the year, did any person listed on Form 990, Part VII, Section A, line 1a, with respect to the filing organization or a related organization:
a
Receive a severance payment or change-of-control payment? .............
4a
Yes
 
b
Participate in, or receive payment from, a supplemental nonqualified retirement plan? .........
4b
 
No
c
Participate in, or receive payment from, an equity-based compensation arrangement? .........
4c
 
No
If "Yes" to any of lines 4a-c, list the persons and provide the applicable amounts for each item in Part III.
Only 501(c)(3), 501(c)(4), and 501(c)(29) organizations must complete lines 5-9.
5
For persons listed on Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the revenues of:
a
The organization? ....................
5a
 
No
b
Any related organization? .......................
5b
 
No
If "Yes," on line 5a or 5b, describe in Part III.
6
For persons listed on Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the net earnings of:
a
The organization? ..................
6a
 
No
b
Any related organization? ......................
6b
 
No
If "Yes," on line 6a or 6b, describe in Part III.
7
For persons listed on Form 990, Part VII, Section A, line 1a, did the organization provide any nonfixed
payments not described in lines 5 and 6? If "Yes," describe in Part III ............
7
 
No
8
Were any amounts reported on Form 990, Part VII, paid or accured pursuant to a contract that was
subject to the initial contract exception described in Regulations section 53.4958-4(a)(3)? If "Yes," describe
in Part III ..........................
8
 
No
9
If "Yes" on line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................
9
 
 
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50053T
Schedule J (Form 990) 2018

Schedule J (Form 990) 2018
Page 2
Part II
Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees. Use duplicate copies if additional space is needed.
For each individual whose compensation must be reported on Schedule J, report compensation from the organization on row (i) and from related organizations, described in the
instructions, on row (ii). Do not list any individuals that are not listed on Form 990, Part VII.
Note. The sum of columns (B)(i)-(iii) for each listed individual must equal the total amount of Form 990, Part VII, Section A, line 1a, applicable column (D) and (E) amounts for that individual.
(A) Name and Title (B) Breakdown of W-2 and/or 1099-MISC compensation (C) Retirement and other deferred compensation (D) Nontaxable
benefits
(E) Total of columns
(B)(i)-(D)
(F) Compensation in column (B) reported as deferred on prior Form 990
(i) Base
compensation
(ii) Bonus & incentive
compensation
(iii) Other reportable compensation
1RAYMOND M CHOREY
PRESIDENT & CEO
(i)

(ii)
0
-------------
237,162
0
-------------
54,285
0
-------------
56,042
0
-------------
0
0
-------------
25,318
0
-------------
372,807
0
-------------
0
2TIMOTHY R EVANCHO
V.P. FINANCE & CFO/ASST TREASURER
(i)

(ii)
0
-------------
170,240
0
-------------
15,640
0
-------------
280
0
-------------
0
0
-------------
19,800
0
-------------
205,960
0
-------------
0
3ANGELA S LONG
V.P. NURSING SERVICES
(i)

(ii)
0
-------------
144,313
0
-------------
14,260
0
-------------
24,126
0
-------------
0
0
-------------
16,665
0
-------------
199,364
0
-------------
0
4STEVEN M BROOKS
V.P. HUMAN RESOURCES
(i)

(ii)
0
-------------
123,537
0
-------------
16,948
0
-------------
0
0
-------------
0
0
-------------
23,259
0
-------------
163,744
0
-------------
0
5E EDWIN CONAWAY
VP MEDICAL AFFAIRS
(i)

(ii)
0
-------------
138,167
0
-------------
12,604
10,000
-------------
280
0
-------------
0
0
-------------
23,452
10,000
-------------
174,503
0
-------------
0
6ELAINE BEED MD
PHYSICIAN
(i)

(ii)
515,008
-------------
0
0
-------------
0
40,848
-------------
0
0
-------------
0
0
-------------
0
555,856
-------------
0
0
-------------
0
7KARL W KUMLER MD
PHYSICIAN
(i)

(ii)
600,018
-------------
0
0
-------------
0
32,268
-------------
0
0
-------------
0
21,111
-------------
0
653,397
-------------
0
0
-------------
0
8CARL F JUENG MD
PHYSICIAN
(i)

(ii)
536,515
-------------
0
0
-------------
0
3,323
-------------
0
0
-------------
0
26,279
-------------
0
566,117
-------------
0
0
-------------
0
9EYAD MAHAYRI MD
PHYSICIAN
(i)

(ii)
435,011
-------------
0
23,125
-------------
0
42,982
-------------
0
0
-------------
0
26,279
-------------
0
527,397
-------------
0
0
-------------
0
10CLIFFORD B MAXIMO MD
PHYSICIAN
(i)

(ii)
452,632
-------------
0
0
-------------
0
507
-------------
0
0
-------------
0
26,279
-------------
0
479,418
-------------
0
0
-------------
0
Schedule J (Form 990) 2018

Schedule J (Form 990) 2018
Page 3
Part III
Supplemental Information
Provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 3, 4a, 4b, 4c, 5a, 5b, 6a, 6b, 7, and 8, and for Part II. Also complete this part for any additional information.
Return Reference Explanation
PART I, LINE 4A RAYMOND CHOREY RECEIVED $55,772 IN SEVERANCE PAY IN 2018 FROM GUERNSEY HEALTH SYSTEMS, A RELATED ORGANIZATION . ANGELA LONG RECEIVED $23,846 IN SEVERANCE PAY IN 2018 FROM GUERNSEY HEALTH SYSTEMS, A RELATED ORGANIZATION.
Schedule J (Form 990) 2018
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Schedule K
(Form 990)
Department of the Treasury
Internal Revenue Service
Supplemental Information on Tax-Exempt Bonds
SchKMediumBullet Complete if the organization answered "Yes" to Form 990, Part Ⅵ, line 24a. Provide descriptions,
explanations, and any additional information in Part Ⅵ.
SchKMediumBullet Attach to Form 990.

SchKMediumBulletGo to www.irs.gov/Form990 for the latest information.
OMB No. 1545-0047
2018
Open to Public
Inspection
Name of the organization
SOUTHEASTERN OHIO REGIONAL MEDICAL
CENTER INC
Employer identification number
31-4391798
Part Ⅰ
Bond Issues
(a) Issuer name (b) Issuer EIN (c) CUSIP # (d) Date issued (e) Issue price (f) Description of purpose (g) Defeased (h) On
behalf of
issuer
(i) Pool
financing
Yes No Yes No Yes No
A CITY OF CAMBRIDGE OHIO
 
31-6400220 NONEAVAIL 05-15-2015 15,000,000 SEE PART VI SUPPLEMENTAL INFORMATION   X   X   X
Part Ⅱ
Proceeds
A B C D
1 Amount of bonds retired .................. 8,117,627      
2 Amount of bonds legally defeased ..............        
3 Total proceeds of issue .................. 15,000,000      
4 Gross proceeds in reserve funds .............        
5 Capitalized interest from proceeds .............        
6 Proceeds in refunding escrows ...............        
7 Issuance costs from proceeds ............... 118,400      
8 Credit enhancement from proceeds .............        
9 Working capital expenditures from proceeds .............        
10 Capital expenditures from proceeds ............. 4,596,600      
11 Other spent proceeds ............. 10,285,000      
12 Other unspent proceeds .............        
13 Year of substantial completion ............. 2016
Yes No Yes No Yes No Yes No
14 Were the bonds issued as part of a current refunding issue? .... X              
15 Were the bonds issued as part of an advance refunding issue? .....   X            
16 Has the final allocation of proceeds been made? .......... X              
17 Does the organization maintain adequate books and records to support the final allocation of proceeds? .................. X              
Part Ⅲ
Private Business Use
A B C D
Yes No Yes No Yes No Yes No
1 Was the organization a partner in a partnership, or a member of an LLC, which owned property financed by tax-exempt bonds? .............   X            
2 Are there any lease arrangements that may result in private business use of bond-financed property? ...............   X            
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50193E
Schedule K (Form 990) 2018

Schedule K (Form 990) 2018
Page 2
Part Ⅲ
Private Business Use (Continued)
A B C D
Yes No Yes No Yes No Yes No
3a Are there any management or service contracts that may result in private business use of bond-financed property? .............   X            
b If "Yes" to line 3a, does the organization routinely engage bond counsel or other outside counsel to review any management or service contracts relating to the financed property?                
c Are there any research agreements that may result in private business use of bond-financed property? .............   X            
d If "Yes" to line 3c, does the organization routinely engage bond counsel or other outside counsel to review any research agreements relating to the financed property?                
4 Enter the percentage of financed property used in a private business use by entities other than a section 501(c)(3) organization or a state or local government ....SchKMediumBullet 0 %      
5 Enter the percentage of financed property used in a private business use as a result of unrelated trade or business activity carried on by your organization, another section 501(c)(3) organization, or a state or local government ......... SchKMediumBullet 0 %      
6 Total of lines 4 and 5 ............. 0 %      
7 Does the bond issue meet the private security or payment test? ...   X            
8a Has there been a sale or disposition of any of the bond-financed property to a nongovernmental person other than a 501(c)(3) organization since the bonds were issued?.............   X            
b If "Yes" to line 8a, enter the percentage of bond-financed property sold or disposed of. ..        
c If "Yes" to line 8a, was any remedial action taken pursuant to Regulations sections 1.141-12 and 1.145-2? .............                
9 Has the organization established written procedures to ensure that all nonqualified bonds of the issue are remediated in accordance with the requirements under
Regulations sections 1.141-12 and 1.145-2? ........
X              
Part Ⅳ
Arbitrage
A B C D
Yes No Yes No Yes No Yes No
1 Has the issuer filed Form 8038-T, Arbitrage Rebate, Yield Reduction and Penalty in Lieu of Arbitrage Rebate? ...   X            
2 If "No" to line 1, did the following apply? ....
a Rebate not due yet? .......   X            
b Exception to rebate? ........   X            
c No rebate due? .........   X            
If "Yes" to line 2c, provide in Part Ⅵ the date the rebate
computation was performed ......
3 Is the bond issue a variable rate issue? .....   X            
4a Has the organization or the governmental issuer entered into a qualified hedge with respect to the bond issue?   X            
b Name of provider ..........  
 
 
 
 
 
 
 
c Term of hedge .........        
d Was the hedge superintegrated? ......                
e Was the hedge terminated? ........                
Schedule K (Form 990) 2018

Schedule K (Form 990) 2018
Page 3
Part Ⅳ
Arbitrage (Continued)
A B C D
Yes No Yes No Yes No Yes No
5a Were gross proceeds invested in a guaranteed investment contract (GIC)?   X            
b Name of provider ..........  
 
 
 
 
 
 
 
c Term of GIC .........        
d Was the regulatory safe harbor for establishing the fair market value of the GIC satisfied? ........                
6 Were any gross proceeds invested beyond an available temporary period?   X            
7 Has the organization established written procedures to monitor the requirements of section 148? ... X              
Part Ⅴ
Procedures To Undertake Corrective Action
--------------------------------------------------------------------------------------------------------------- A B C D
Yes No Yes No Yes No Yes No
Has the organization established written procedures to ensure that violations of federal tax requirements are timely identified and corrected through the voluntary closing agreement program if self-remediation is not available under applicable regulations? X              
Part Ⅵ
Supplemental Information. Provide additional information for responses to questions on Schedule K (see instructions).
Return Reference Explanation
PT I-A COL (F): 10,285,000 FOR CURRENT REFUNDING OF 2001 AND 2002 BOND ISSUES, 118,400 FOR BOND ISSUANCE COSTS, AND 4,596,600 FOR CAPITAL IMPROVEMENTS.
Schedule K (Form 990) 2018

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Schedule L
(Form 990 or 990-EZ)
Department of the Treasury
Internal Revenue Service
Transactions with Interested Persons
MediumBullet Complete if the organization answered "Yes" on Form 990, Part IV, lines 25a, 25b, 26, 27, 28a, 28b, or 28c, or Form 990-EZ, Part V, line 38a or 40b.
MediumBullet Attach to Form 990 or Form 990-EZ.
MediumBulletGo to www.irs.gov/Form990 for the latest information.
OMB No. 1545-0047
2018
Open to Public Inspection
Name of the organization
SOUTHEASTERN OHIO REGIONAL MEDICAL
CENTER INC
Employer identification number

31-4391798
Part I
Excess Benefit Transactions (section 501(c)(3), section 501(c)(4), and 501(c)(29) organizations only).
Complete if the organization answered "Yes" on Form 990, Part IV, line 25a or 25b, or Form 990-EZ, Part V, line 40b.
1(a) Name of disqualified person (b) Relationship between disqualified person and organization (c) Description of transaction (d) Corrected?
Yes No
2
Enter the amount of tax incurred by organization managers or disqualified persons during the year under section 4958. ........................... Bullet Image$
 
3
Enter the amount of tax, if any, on line 2, above, reimbursed by the organization ........ Bullet Image$
 

Part II
Loans to and/or From Interested Persons.
Complete if the organization answered "Yes" on Form 990-EZ, Part V, line 38a, or Form 990, Part IV, line 26; or if the organization reported an amount on Form 990, Part X, line 5, 6, or 22
(a) Name of interested person (b) Relationship with organization (c) Purpose of loan (d) Loan to or from the organization? (e)Original principal amount (f)Balance due (g) In default? (h) Approved by board or committee? (i)Written agreement?
To From Yes No Yes No Yes No
Total ...............Small Bullet $  
Part III
Grants or Assistance Benefiting Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 27.
(a) Name of interested person (b) Relationship between interested person and the organization (c) Amount of assistance (d) Type of assistance (e) Purpose of assistance
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 50056A
Schedule L (Form 990 or 990-EZ) 2018
Schedule L (Form 990 or 990-EZ) 2018
Page 2
Part IV
Business Transactions Involving Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 28a, 28b, or 28c.
(a) Name of interested person (b) Relationship between interested person and the organization (c) Amount of transaction (d) Description of transaction (e) Sharing of organization's revenues?
Yes No
(1) SOUTHEASTERN OHIO PHYSICIANS INC
 
PARITAL OWNERSHIP BY TRUSTEE 260,391 MEDICAL TRANSACTIONS   No
(2) AMBER E PAULEY
 
FAMILY MEMBER OF OFFICER 54,474 EMPLOYMENT   No
(3) JOSEPH OHANLON DO
 
FAMILY MEMBER OF TRUSTEE 23,250 PHYSICIAN SERVICES   No
(4) KENDRA D BROOKS
 
SPOUSE OF OFFICER 49,752 EMPLOYMENT   No
(5) KAITLIN MICHELLE CHOREY
 
FAMILY MEMBER OF OFFICER 46,815 EMPLOYMENT   No
(6) MARK GOGGIN MD
 
FAMILY MEMBER OF TRUSTEE 19,250 PHYSICIAN SERVICES   No
(7) DOMINIC D CROCK
 
FAMILY MEMBER OF TRUSTEE 98,047 EMPLOYMENT   No
Part V
Supplemental Information
Provide additional information for responses to questions on Schedule L (see instructions).
Return Reference Explanation
Schedule L (Form 990 or 990-EZ) 2018


Additional Data


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SCHEDULE O
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service
Supplemental Information to Form 990 or 990-EZ

Complete to provide information for responses to specific questions on
Form 990 or 990-EZ or to provide any additional information.
MediumBullet Attach to Form 990 or 990-EZ.
MediumBullet Go to www.irs.gov/Form990 for the latest information.
OMB No. 1545-0047
2018
Open to Public
Inspection
Name of the organization
SOUTHEASTERN OHIO REGIONAL MEDICAL
CENTER INC
Employer identification number

31-4391798
Return Reference Explanation
FORM 990, PART VI, SECTION A, LINE 2 BOARD MEMBERS DONALD J. CROCK AND THOMASINA CROCK ARE BROTHER IN-LAW AND SISTER IN-LAW
FORM 990, PART VI, SECTION A, LINE 3 EFFECTIVE OCTOBER 10, 2018 GUERNSEY HEALTH SYSTEMS AND THE SOUTHEASTERN OHIO REGIONAL MEDICAL CENTER ENTERED INTO A MANAGEMENT AGREEMENT WITH OHIO HEALTH CORPORATION TO PROVIDE SENIOR LEVEL MANAGEMENT FOR GUERNSEY HEALTH SYSTEMS AND THE SOUTHEASTERN OHIO REGIONAL MEDICAL CENTER BY PROVIDING THE PRESIDENT & CEO, VICE PRESIDENT OF FINANCE, AND CHIEF NURSING OFFICER OF THE ORGANIZATION. THESE OFFICERS ARE LISTED IN PART VII, SECTION A. THE MANAGEMENT DUTIES PERFORMED INCLUDED HIRING, FIRING, AND SUPERVISING PERSONNEL, PLANNING AND EXECUTING BUDGETS AND FINANCIAL OPERATIONS, AND SUPERVISING EXEMPT AND NON EXEMPT OPERATIONS. NEITHER GUERNSEY HEALTH SYSTMES NOR SOUTHEASTERN OHIO REGIONAL MEDICAL CENTER, INC. MADE ANY PAYMENTS TO OHIO HEALTH CORPORATION RELATED TO CHERYL L. HERBERT, PRESIDENT & CEO. ALL AMOUNTS OF REPORTABLE COMPENSATION PAID TO CHERYL L. HERBERT WERE MADE DIRECTLY BY OHIO HEALTH CORPORATION AND WOULD BE REPORTED ON OHIO HEALTH CORPORATION'S FORM 990. 2018 2018 REPORTABLE COMPENSATION AMOUNTS PAID BY OHIO HEALTH THAT WERE REIMBURSED BY GUERNSEY HEALTH SYSTEMS TOTALED APPROXIMATELY $40,705 FOR TIMOTHY R. EVANCHO, VICE PRESIDENT OF FINANCE, AND $20,352 FOR GINA F. WOODS, CHIEF NURSING OFFICER.
FORM 990, PART VI, SECTION A, LINE 7A BOARD MEMBERS ARE ELECTED BY BOARD MEMBERS OF GUERNSEY HEALTH SYSTEMS, THE NOT-FOR-PROFIT PARENT COMPANY OF SOUTHEASTERN OHIO REGIONAL MEDICAL CENTER, INC.
FORM 990, PART VI, SECTION B, LINE 11B FORM 990 IS REVIEWED BY THE AUDIT COMMITTEE OF THE BOARD BEFORE FILING. A COMPLETE COPY OF THE FORM 990 IS PROVIDED TO ALL BOARD MEMBERS BEFORE FILING.
FORM 990, PART VI, SECTION B, LINE 12C DIRECTORS COMPLETE AN ANNUAL STATEMENT DISCLOSING ALL CONFLICTS OF INTEREST.
FORM 990, PART VI, SECTION B, LINE 15 THE EXECUTIVE COMMITTEE OF THE BOARD OF DIRECTORS PERFORMS A COMPENSATION STUDY OF MANAGEMENT POSITIONS.
FORM 990, PART VI, SECTION C, LINE 19 ALL SUCH ITEMS ARE AVAILABLE UPON REQUEST
FORM 990, PART IX, LINE 11G MEDICAL SERVICES: PROGRAM SERVICE EXPENSES 6,858,781. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 6,858,781. OTHER SERVICES: PROGRAM SERVICE EXPENSES 1,861,375. MANAGEMENT AND GENERAL EXPENSES 1,436,644. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,298,019. RADIOLOGY FEES: PROGRAM SERVICE EXPENSES 104,301. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 104,301. ANETHESIA FEES: PROGRAM SERVICE EXPENSES 1,150,698. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,150,698. LINEN SERVICE FEE: PROGRAM SERVICE EXPENSES 206,929. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 206,929. COLLECTION FEES: PROGRAM SERVICE EXPENSES 312,758. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 312,758. SECURITY: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 190,539. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 190,539. PHYSICIAN LOAN LOSSES: PROGRAM SERVICE EXPENSES 190,245. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 190,245. PURCHASE SERVICES: PROGRAM SERVICE EXPENSES 652,347. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 652,347. ANSWERING SERVICES: PROGRAM SERVICE EXPENSES 5,344. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 5,344. BILLING SERVICES: PROGRAM SERVICE EXPENSES 375,603. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 375,603.
FORM 990, PART XI, LINE 9: CHANGE IN PENSION LIABILITY -631,285. TRANSFERS FROM AFFILIATES 1,353,000.
FORM 990, PART XII, LINE 2C THIS PROCESS HAS NOT CHANGED SINCE THE PRIOR YEAR.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 51056K
Schedule O (Form 990 or 990-EZ) 2018


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SCHEDULE R
(Form 990)

Department of the Treasury
Internal Revenue Service
Related Organizations and Unrelated Partnerships
MediumBulletComplete if the organization answered "Yes" on Form 990, Part IV, line 33, 34, 35b, 36, or 37.
MediumBulletAttach to Form 990.
MediumBullet Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047
2018
Open to Public Inspection
Name of the organization
SOUTHEASTERN OHIO REGIONAL MEDICAL
CENTER INC
Employer identification number

31-4391798
Part I
Identification of Disregarded Entities Complete if the organization answered "Yes" on Form 990, Part IV, line 33.
(a)
Name, address, and EIN (if applicable) of disregarded entity


(b)
Primary activity


(c)
Legal domicile (state
or foreign country)

(d)
Total income


(e)
End-of-year assets


(f)
Direct controlling
entity

(1) SUPERIOR MED LLC
1341 CLARK STREET
CAMBRIDGE,OH43725
31-1311881
PHYSICIAN OFFICES OH 5,036,876 1,796,684 SOUTHEASTERN OHIO REGIONAL MEDICAL CENTER
 










Part II
Identification of Related Tax-Exempt Organizations Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related tax-exempt organizations during the tax year.
(a)
Name, address, and EIN of related organization


(b)
Primary activity


(c)
Legal domicile (state
or foreign country)

(d)
Exempt Code section


(e)
Public charity status
(if section 501(c)(3))

(f)
Direct controlling
entity

(g)
Section 512(b)(13) controlled entity?
Yes No
(1)GUERNSEY HEALTH SYSTEMS
1341 CLARK STREET

CAMBRIDGE,OH43725
31-1148352
MANAGEMENT & FUNDRAISING OH 501(C)(3) 12 TYPE II N/A
 
No












For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50135Y
Schedule R (Form 990) 2018
Schedule R (Form 990) 2018
Page 2
Part III
Identification of Related Organizations Taxable as a Partnership Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a partnership during the tax year.
(a)
Name, address, and EIN of
related organization



(b)
Primary activity




(c)
Legal
domicile
(state or foreign
country)


(d)
Direct controlling
entity



(e)
Predominant income(related, unrelated, excluded from tax under sections 512-514)

(f)
Share of total income




(g)
Share of end-of-year
assets



(h)
Disproprtionate allocations?




(i)
Code V-UBI
amount in box 20 of
Schedule K-1
(Form 1065)
(j)
General or
managing
partner?



(k)
Percentage
ownership


Yes No Yes No
(1) SOUTHEASTERN HOME CARE LLC

170 EDISON DRIVE
MILFORD,OH45150
27-1219638
HOME HEALTH SERVICES OH N/A
RELATED 1,026,312 521,362   No     No 40.000 %












Part IV
Identification of Related Organizations Taxable as a Corporation or Trust Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a corporation or trust during the tax year.
(a)
Name, address, and EIN of
related organization
(b)
Primary activity
(c)
Legal
domicile
(state or foreign
country)
(d)
Direct controlling
entity
(e)
Type of entity
(C corp, S corp,
or trust)
(f)
Share of total income
(g)
Share of end-of-year
assets
(h)
Percentage
ownership
(i)
Section 512(b)(13) controlled entity?
Yes No
(1) GUERNSEY HEALTH ENTERPRISES INC

1341 CLARK STREET
CAMBRIDGE,OH43725
31-1191428
AMBULANCE SERVICE OH GUERNSEY HEALTH SYSTEMS
 
C         No
(2) UNITED AMBULANCE SERVICE OF CAMBRIDGE INC

1341 CLARK STREET
CAMBRIDGE,OH43725
31-1086097
AMBULANCE SERVICE OH GUERNSEY HEALTH SYSTEMS
 
C         No










Schedule R (Form 990) 2018
Schedule R (Form 990) 2018
Page 3
Part V
Transactions With Related Organizations Complete if the organization answered "Yes" on Form 990, Part IV, line 34, 35b, or 36.
Note. Complete line 1 if any entity is listed in Parts II, III, or IV of this schedule.
Yes
No
1 During the tax year, did the orgranization engage in any of the following transactions with one or more related organizations listed in Parts II-IV?
a Receipt of (i) interest, (ii) annuities, (iii) royalties, or (iv) rent from a controlled entity .....................
1a
 
No
b Gift, grant, or capital contribution to related organization(s) ............................
1b
 
No
c Gift, grant, or capital contribution from related organization(s) ............................
1c
 
No
d Loans or loan guarantees to or for related organization(s) ............................
1d
Yes
 
e Loans or loan guarantees by related organization(s) ............................
1e
Yes
 
f Dividends from related organization(s) ............................
1f
 
No
g Sale of assets to related organization(s) ............................
1g
 
No
h Purchase of assets from related organization(s) ............................
1h
 
No
i Exchange of assets with related organization(s) ............................
1i
 
No
j Lease of facilities, equipment, or other assets to related organization(s) .......................
1j
 
No
k Lease of facilities, equipment, or other assets from related organization(s) ......................
1k
Yes
 
l Performance of services or membership or fundraising solicitations for related organization(s) .....................
1l
Yes
 
m Performance of services or membership or fundraising solicitations by related organization(s) .................
1m
Yes
 
n Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) ...................
1n
Yes
 
o Sharing of paid employees with related organization(s) ............................
1o
Yes
 
p Reimbursement paid to related organization(s) for expenses ............................
1p
 
No
q Reimbursement paid by related organization(s) for expenses ............................
1q
 
No
r Other transfer of cash or property to related organization(s) ............................
1r
 
No
s Other transfer of cash or property from related organization(s) ............................
1s
 
No
2
If the answer to any of the above is "Yes," see the instructions for information on who must complete this line, including covered relationships and transaction thresholds.
(a)
Name of related organization
(b)
Transaction
type (a-s)
(c)
Amount involved
(d)
Method of determining amount involved
(1) UNITED AMBULANCE SERVICE OF CAMBRIDGE

D 6,660 CASH OWED
(2) GUERNSEY HEALTH SYSTEMS

D 109,901 CASH OWED
(3) GUERNSEY HEALTH SYSTEMS

E 6,817,536 LOANS GUARANTEED
(4) GUERNSEY HEALTH SYSTEMS

K 521,319 CASH PAID
(5) GUERNSEY HEALTH ENTERPRISES INC

L 42,000 CASH PAID
(6) GUERNSEY HEALTH SYSTEMS

M 1,500,000 CASH PAID
(7) GUERNSEY HEALTH SYSTEMS

N 100,000 ESTIMATED
(8) GUERNSEY HEALTH SYSTEMS

O 1,046,790 CASH PAID
Schedule R (Form 990) 2018
Schedule R (Form 990) 2018
Page 4
Part VI
Unrelated Organizations Taxable as a Partnership Complete if the organization answered "Yes" on Form 990, Part IV, line 37.
Provide the following information for each entity taxed as a partnership through which the organization conducted more than five percent of its activities (measured by total assets or gross revenue) that was not a related organization. See instructions regarding exclusion for certain investment partnerships.
(a)
Name, address, and EIN of entity
(b)
Primary activity
(c)
Legal domicile
(state or foreign
country)
(d)
Predominant income (related, unrelated, excluded from tax under sections 512-514)

(e)
Are all partners
section
501(c)(3)
organizations?
(f)
Share of total income




(g)
Share of
end-of-year
assets
(h)
Disproprtionate allocations?
(i)
Code V-UBI
amount in box 20
of Schedule K-1
(Form 1065)
(j)
General or
managing
partner?
(k)
Percentage
ownership


Yes No Yes No Yes No






























Schedule R (Form 990) 2018
Schedule R (Form 990) 2018
Page 5
Part VII
Supplemental Information
Provide additional information for responses to questions on Schedule R (see instructions).
Return Reference Explanation
Schedule R (Form 990) 2018

Additional Data


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