TY 2019 Form 990

(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)	(E) Reportable compensation from related organizations (W-2/1099-MISC)
(1) EDWARD J ROTH III...................................................................... PRESIDENT/CEO	47.00 ................. 8.00	X	X	801,904	52,747
(2) MARK D WRIGHT...................................................................... TREASURER/CFO/ DIRECTOR - AHF	48.00 ................. 7.00	X	X	488,716	46,744
(3) BARBARA HAMMONTREE BENNETT...................................................................... PAST CHAIR - AHF	6.00 ................. 0.00	X	X	0	0
(4) DARRYL J DILLENBACK...................................................................... CHAIR - AHF	7.00 ................. 0.00	X	X	0	0
(5) EMIL ALECUSAN...................................................................... VICE CHAIR - AHF	8.00 ................. 0.00	X	X	0	0
(6) BRYAN RICE...................................................................... 2ND VICE CHAIR/SECRETARY	6.00 ................. 0.00	X	X	0	0
(7) BARBARA ABBOTT...................................................................... DIRECTOR - AHF	2.00 ................. 0.00	X		0	0
(8) BRIAN S BELDEN...................................................................... DIRECTOR - AHF	5.00 ................. 4.00	X		0	0
(9) ROGER BETTIS...................................................................... DIRECTOR -AHF	2.00 ................. 0.00	X		0	0
(10) PEGGY CLAYTOR...................................................................... DIRECTOR - AHF	3.00 ................. 0.00	X		0	0
(11) NATE J COOKS...................................................................... DIRECTOR - AHF	1.00 ................. 3.00	X		0	0
(12) STEPHEN G DEUBLE...................................................................... DIRECTOR - AHF	2.00 ................. 0.00	X		0	0
(13) MILAN R DOPIRAK MD...................................................................... DIRECTOR - AHF	1.00 ................. 1.00	X		0	0
(14) LEO DOYLE...................................................................... DIRECTOR - AHF	8.00 ................. 8.00	X		0	0
(15) DAVID M FINDLEY...................................................................... DIRECTOR - AHF	2.00 ................. 0.00	X		0	0
(16) RYAN FULMER...................................................................... DIRECTOR - AHF	2.00 ................. 0.00	X		0	0
(17) T STEPHEN GREGORY...................................................................... DIRECTOR - AHF	6.00 ................. 4.00	X		0	0

(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)	(E) Reportable compensation from related organizations (W-2/1099-MISC)	(F) Estimated amount of other compensation from the organization and related organizations
(18) PATRICIA A GRISCHOW........................................................................ DIRECTOR - AHF	2.00 .......................3.00	X				0	0	0
(19) RICK L HAINES........................................................................ DIRECTOR - AHF	4.00 .......................51.00	X				0	569,241	849,869
(20) JOSEPH E HALTER JR........................................................................ DIRECTOR - AHF	1.00 .......................2.00	X				0	0	0
(21) MICHAEL E HANKE........................................................................ DIRECTOR - AHF	3.00 .......................2.00	X				0	0	0
(22) JOHN B HUMPHREY JR MD........................................................................ DIRECTOR - AHF	6.00 .......................2.00	X				0	0	0
(23) BECKY L JEWELL........................................................................ DIRECTOR - AHF	1.00 .......................1.00	X				0	0	0
(24) GEOFF KARCHER........................................................................ DIRECTOR - AHF	4.00 .......................0.00	X				0	0	0
(25) JOANNE KRIVETZKY MD........................................................................ DIRECTOR - AHF; MED STAFF PRES-ELECT	2.00 .......................4.00	X				0	0	0
(26) BRIAN LAYMAN........................................................................ DIRECTOR - AHF	3.00 .......................1.00	X				0	0	0
(27) MICHAEL LYNCH MD........................................................................ DIRECTOR - AHF	48.00 .......................7.00	X				461,549	0	34,034
(28) RON LYONS........................................................................ DIRECTOR - AHF	1.00 .......................1.00	X				0	0	0
(29) LORI MARTINO........................................................................ DIRECTOR - AHF; AH WOMEN'S BOARD PRESIDENT	1.00 .......................3.00	X				0	0	0
(30) LORI L MERTES MD........................................................................ PRESIDENT - INNOVATIONS BOARD	1.00 .......................54.00	X				0	475,667	47,347
(31) JEFFREY MILLER MD........................................................................ DIRECTOR - AHF	2.00 .......................7.00	X				0	0	0
(32) PRABHCHARAN GILL MD........................................................................ DIRECTOR - AHF	2.00 .......................53.00	X				0	672,045	52,747
(33) MICHAEL RICH MD........................................................................ DIRECTOR - AHF	4.00 .......................51.00	X				0	462,586	52,747
(34) JESSE ROPER........................................................................ DIRECTOR - AHF	2.00 .......................0.00	X				0	0	0
(35) TIM SEIFERT........................................................................ DIRECTOR - AHF	1.00 .......................1.00	X				0	0	0
(36) LOUIS G SHAHEEN MD........................................................................ DIRECTOR - AHF	1.00 .......................3.00	X				0	0	0
(37) DOUGLAS J SIBILA........................................................................ DIRECTOR - AHF	2.00 .......................2.00	X				0	0	0
(38) JOHN A SIRPILLA........................................................................ DIRECTOR - AHF	4.00 .......................1.00	X				0	0	0
(39) TODD M SOMMER........................................................................ DIRECTOR - AHF	1.00 .......................2.00	X				0	0	0
(40) RYAN STENGAR........................................................................ DIRECTOR - AHF	2.00 .......................0.00	X				0	0	0
(41) GAIL STERLING........................................................................ DIRECTOR - AHF	1.00 .......................1.00	X				0	0	0
(42) R CLINT ZOLLINGER ESQ........................................................................ DIRECTOR - AHF	6.00 .......................0.00	X				0	0	0
(43) SHRUTI TREHAN MD........................................................................ DIRECTOR - AHF	2.00 .......................53.00	X				0	1,207,540	52,247
(44) WILLIAM WALLACE MD........................................................................ DIRECTOR - AHF	4.00 .......................6.00	X				0	0	0
(45) AKBAR SHAH MD........................................................................ CHAIR - ASH; PHYSICIAN	5.00 .......................50.00	X	X			0	1,184,206	51,967
(46) DANIEL RODRIGUEZ MD........................................................................ VICE CHAIR - ASH	5.00 .......................50.00	X	X			0	260,383	37,172
(47) DIANA BOYD........................................................................ SECRETARY & TREASURER - ASH	5.00 .......................0.00	X	X			0	0	0
(48) RYAN KUHARICH........................................................................ CEO - ASH	50.00 .......................5.00	X	X			160,763	0	39,393
(49) JACQUELINE DEGARMO........................................................................ DIRECTOR - ASH	3.00 .......................1.00	X				0	0	0
(50) DEANNA HATFIELD........................................................................ DIRECTOR - ASH	1.00 .......................0.00	X				0	0	0
(51) DENISE HILL........................................................................ DIRECTOR - ASH	1.00 .......................1.00	X				0	0	0
(52) ERIC JOHNSON........................................................................ DIRECTOR - ASH	1.00 .......................0.00	X				0	0	0
(53) GEORGE KEFALAS MD........................................................................ DIRECTOR - ASH	1.00 .......................2.00	X				0	0	0
(54) ELLEN LINZ........................................................................ DIRECTOR - ASH	1.00 .......................0.00	X				0	0	0
(55) DAVID MOTTS........................................................................ DIRECTOR - ASH	1.00 .......................0.00	X				0	0	0
(56) CHADI BOU SERHAL MD........................................................................ DIRECTOR - ASH	1.00 .......................1.00	X				0	0	0
(57) MELANIE MIRANDE MD........................................................................ CHAIR - IHC	1.00 .......................0.00	X	X			0	0	0
(58) BRIAN MCCLAIN MD........................................................................ VICE CHAIR - IHC	1.00 .......................2.00	X	X			0	0	0
(59) STEVE NAM MD........................................................................ TREASURER - IHC	1.00 .......................4.00	X	X			0	0	0
(60) DOUGLAS BLOCKER MD........................................................................ DIRECTOR - IHC	1.00 .......................0.00	X				0	0	0
(61) ANTHONY DEGENHARD DO........................................................................ DIRECTOR - IHC	2.00 .......................5.00	X				0	0	0
(62) ANDY R HART MD........................................................................ DIRECTOR - IHC	1.00 .......................0.00	X				0	0	0
(63) LEWIS HUMBLE MD........................................................................ DIRECTOR - IHC	1.00 .......................54.00	X				0	190,140	30,599
(64) JAMES JOHNS MD........................................................................ DIRECTOR - IHC	1.00 .......................0.00	X				0	0	0
(65) STEVEN KELLY MD........................................................................ DIRECTOR - IHC	4.00 .......................51.00	X				0	1,136,534	47,975
(66) ROGER MUSA MD........................................................................ DIRECTOR - IHC	5.00 .......................50.00	X				0	259,180	47,019
(67) TIMOTHY O'TOOLE MD........................................................................ DIRECTOR - IHC	1.00 .......................2.00	X				0	0	0
(68) JOHN PRODAFIKAS........................................................................ DIRECTOR - IHC	3.00 .......................52.00	X				0	1,030,740	52,747
(69) CHRISTOPHER E REMARK........................................................................ CEO - AH; DIRECTOR - IHC	7.00 .......................48.00	X				0	589,797	47,544
(70) ROBERT SABOTA MD........................................................................ DIRECTOR - IHC	1.00 .......................1.00	X				0	0	0
(71) JOHN WESTERBECK MD........................................................................ DIRECTOR - IHC	1.00 .......................3.00	X				0	0	0
(72) JAMES WILSON MD........................................................................ DIRECTOR - IHC	1.00 .......................0.00	X				0	0	0
(73) ANDREW ZURICK MD........................................................................ MEDICARE BENEFICIARY - IHC	1.00 .......................0.00	X				0	0	0
(74) DAVID MALLAMACI MD........................................................................ DIRECTOR - IHC	1.00 .......................0.00	X				0	0	0
(75) HOWARD METZGER MD........................................................................ DIRECTOR - IHC	55.00 .......................0.00	X				274,024	0	36,991
(76) CHARLES ZOLLINGER........................................................................ DIRECTOR - IHC	1.00 .......................0.00	X				0	0	0
(77) ALLISON M OPRANDI MD........................................................................ CEO - IHC	53.00 .......................2.00			X		482,042	0	44,285
(78) MATTHEW RITZERT........................................................................ VP - IHC	55.00 .......................0.00			X		177,161	0	16,895
(79) ELIZABETH A GETZ........................................................................ CIO	50.00 .......................5.00			X		376,122	0	52,747
(80) ROBERT C MOLNAR........................................................................ SVP, REGIONAL DEVELOPMENT	51.00 .......................4.00			X		279,225	0	46,336
(81) MARK N ROSE........................................................................ SVP - LEGAL SERVICES	50.00 .......................5.00			X		393,904	0	52,747
(82) JASON JUSTUS........................................................................ VP - POMERENE FINANCE	55.00 .......................0.00			X		254,577	0	35,417
(83) SUSAN E OLIVERA........................................................................ VP - HUMAN RESOURCES	53.00 .......................2.00			X		335,268	0	52,747
(84) FRANCIS SNYDER........................................................................ CEO - POMERENE	55.00 .......................0.00				X	374,767	0	46,422
(85) RONALD RUSNAK MD........................................................................ DIRECTOR OF CLINICAL INFORMATICS	55.00 .......................0.00				X	363,305	0	41,685
(86) KEVIN D PETE........................................................................ SVP	50.00 .......................5.00				X	337,830	0	41,747
(87) TIMOTHY TEYNOR........................................................................ VP - PUBLIC POLICY	50.00 .......................5.00				X	247,439	0	37,847
(88) TRACY SABO........................................................................ VP OF HUMAN RESOURCES	55.00 .......................0.00				X	220,027	0	32,606

(A) Name and business address	(B) Description of services	(C) Compensation
CERNER CORP 2800 ROCKCREEK PWKY KANSAS CITY,MO64117	SOFTWARE SUPPORT	7,509,807
DELL FINANCIAL SERVICES ONE DELL WAY ROUND ROCK,TX78682	SOFTWARE SUPPORT	1,334,280
CISCO SYSTEMS INC 170 W TASMAN DRIVE SAN JOSE,CA95134	SOFTWARE SUPPORT	884,646
HURON CONSULTING GROUP INC 550 W VAN BUREN STREET CHICAGO,IL60607	MANAGEMENT CONSULTING	344,658
MICROSOFT CORPORATION ONE MICROSOFT WAY REDMOND,WA98052	SOFTWARE SUPPORT	158,055
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 42

- TIN:

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.
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Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2019

Open to Public
Inspection

Name of the organization

AULTMAN HEALTH FOUNDATION

Employer identification number

34-1445390

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.)

A church, convention of churches, or association of churches described in section 170(b)(1)(A)(i).

A school described in section 170(b)(1)(A)(ii). (Attach Schedule E (Form 990 or 990-EZ).)

A hospital or a cooperative hospital service organization described in section 170(b)(1)(A)(iii).

A medical research organization operated in conjunction with a hospital described in section 170(b)(1)(A)(iii). Enter the hospital's name, city, and state:

An organization operated for the benefit of a college or university owned or operated by a governmental unit described in section 170(b)(1)(A)(iv). (Complete Part II.)

A federal, state, or local government or governmental unit described in section 170(b)(1)(A)(v).

An organization that normally receives a substantial part of its support from a governmental unit or from the general public described in section 170(b)(1)(A)(vi). (Complete Part II.)

A community trust described in section 170(b)(1)(A)(vi). (Complete Part II.)

An agricultural research organization described in 170(b)(1)(A)(ix) operated in conjunction with a land-grant college or university or a non-land grant college of agriculture. See instructions. Enter the name, city, and state of the college or university:

An organization that normally receives: (1) more than 331/3% of its support from contributions, membership fees, and gross receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 331/3% of its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)

An organization organized and operated exclusively to test for public safety. See section 509(a)(4).

An organization organized and operated exclusively for the benefit of, to perform the functions of, or to carry out the purposes of one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2). See section 509(a)(3). Check the box in lines 12a through 12d that describes the type of supporting organization and complete lines 12e, 12f, and 12g.

Type I. A supporting organization operated, supervised, or controlled by its supported organization(s), typically by giving the supported organization(s) the power to regularly appoint or elect a majority of the directors or trustees of the supporting organization. You must complete Part IV, Sections A and B.

Type II. A supporting organization supervised or controlled in connection with its supported organization(s), by having control or management of the supporting organization vested in the same persons that control or manage the supported organization(s). You must complete Part IV, Sections A and C.

Type III functionally integrated. A supporting organization operated in connection with, and functionally integrated with, its supported organization(s) (see instructions). You must complete Part IV, Sections A, D, and E.

Type III non-functionally integrated. A supporting organization operated in connection with its supported organization(s) that is not functionally integrated. The organization generally must satisfy a distribution requirement and an attentiveness requirement (see instructions). You must complete Part IV, Sections A and D, and Part V.

Check this box if the organization received a written determination from the IRS that it is a Type I, Type II, Type III functionally integrated, or Type III non-functionally integrated supporting organization.

Enter the number of supported organizations ...............................1

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)
(i) Name of supported organization	(ii) EIN		Yes	No	(v) Amount of monetary support (see instructions)	(vi) Amount of other support (see instructions)
(A) AULTMAN HOSPITAL	340714538	3	Yes		13,518,960	0

Total 1					13,518,960	0

For Paperwork Reduction Act Notice, see the Instructions for
Form 990 or 990-EZ.

Cat. No. 11285F

Schedule A (Form 990 or 990-EZ) 2019

Page 2

Part II

Support Schedule for Organizations Described in Sections 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi)
(Complete only if you checked the box on line 5, 7, or 8 of Part I or if the organization failed to qualify under Part III. If the organization failed to qualify under the tests listed below, please complete Part III.)

Section A. Public Support

Calendar year (or fiscal year beginning in)		(a) 2015	(b) 2016	(c) 2017	(d) 2018	(e) 2019	(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)		(a) 2015	(b) 2016	(c) 2017	(d) 2018	(e) 2019	(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

Gross receipts from related activities, etc. (see instructions) ..................

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

Public support percentage for 2019 (line 6, column (f) divided by line 11, column (f)) .........

Public support percentage for 2018 Schedule A, Part II, line 14 ...............

16a

33 1/3% support test—2019. If the organization did not check the box on line 13, and line 14 is 33 1/3% or more, check this box
and stop here. The organization qualifies as a publicly supported organization ....................... right arrow

33 1/3% support test—2018. If the organization did not check a box on line 13 or 16a, and line 15 is 33 1/3% or more, check this
box and stop here. The organization qualifies as a publicly supported organization ..................... right arrow

17a

10%-facts-and-circumstances test—2019. If the organization did not check a box on line 13, 16a, or 16b, and line 14
is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here. Explain
in Part VI how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported
organization ..................................................... right arrow

10%-facts-and-circumstances test—2018. If the organization did not check a box on line 13, 16a, 16b, or 17a, and line
15 is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here.
Explain in Part VI how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly
supported organization ................................................ right arrow

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) 2019

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)		(a) 2015	(b) 2016	(c) 2017	(d) 2018	(e) 2019	(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)		(a) 2015	(b) 2016	(c) 2017	(d) 2018	(e) 2019	(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.)..

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

Public support percentage for 2019 (line 8, column (f) divided by line 13, column (f)) .........

Public support percentage from 2018 Schedule A, Part III, line 15 ...............

Section D. Computation of Investment Income Percentage

Investment income percentage for 2019 (line 10c, column (f) divided by line 13, column (f)) ......

Investment income percentage from 2018 Schedule A, Part III, line 17 .............

19a

331/3% support tests—2019. If the organization did not check the box on line 14, and line 15 is more than 33 1/3%, and line 17 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization ....... right arrow

33 1/3% support tests—2018. If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3% and line 18 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization .... right arrow

Private foundation. If the organization did not check a box on line 14, 19a, or 19b, check this box and see instructions .... right arrow

Schedule A (Form 990 or 990-EZ) 2019

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

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.

Yes

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).

Did the organization have a supported organization described in section 501(c)(4), (5), or (6)? If "Yes," answer (b) and (c) below.

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.

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.

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.

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.

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.

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).

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?

Substitutions only. Was the substitution the result of an event beyond the organization's control?

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.

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) .

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).

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.

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.

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.

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

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) 2019

Page 5

Part IV

Supporting Organizations (continued)

Yes

Has the organization accepted a gift or contribution from any of the following persons?

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

A family member of a person described in (a) above?

11b

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

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.

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.

Section C. Type II Supporting Organizations

Yes

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).

Yes

Section D. All Type III Supporting Organizations

Yes

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?

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).

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.

Section E. Type III Functionally-Integrated Supporting Organizations

Check the box next to the method that the organization used to satisfy the Integral Part Test during the year (see instructions):

The organization satisfied the Activities Test. Complete line 2 below.

The organization is the parent of each of its supported organizations. Complete line 3 below.

The organization supported a governmental entity. Describe in Part VI how you supported a government entity (see instructions)

Activities Test. Answer (a) and (b) below.

Yes

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.

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.

Parent of Supported Organizations. Answer (a) and (b) below.

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.

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.

Schedule A (Form 990 or 990-EZ) 2019

Page 6

Part V

Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations

Check here if the organization satisfied the Integral Part Test as a qualifying trust on Nov. 20, 1970 (explain in Part VI). See instructions. All other Type III non-functionally integrated supporting organizations must complete Sections A through E.

	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

Check here if the current year is the organization's first as a non-functionally-integrated Type III supporting organization (see instructions)

Schedule A (Form 990 or 990-EZ) 2019

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 2019 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-2019	(iii) Distributable Amount for 2019
1 Distributable amount for 2019 from Section C, line 6
2 Underdistributions, if any, for years prior to 2019 (reasonable cause required-- explain in Part VI). See instructions.
3 Excess distributions carryover, if any, to 2019:
a From 2014.......
b From 2015.......
c From 2016.......
d From 2017.......
e From 2018.......
fTotal of lines 3a through e
g Applied to underdistributions of prior years
h Applied to 2019 distributable amount
i Carryover from 2014 not applied (see instructions)
j Remainder. Subtract lines 3g, 3h, and 3i from 3f.
4Distributions for 2019 from Section D, line 7:
$
a Applied to underdistributions of prior years
b Applied to 2019 distributable amount
c Remainder. Subtract lines 4a and 4b from 4.
5 Remaining underdistributions for years prior to 2019, 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 2019. 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 2020. Add lines 3j and 4c.
8 Breakdown of line 7:
a Excess from 2015.....
b Excess from 2016.....
c Excess from 2017.....
d Excess from 2018.....
e Excess from 2019.....

Schedule A (Form 990 or 990-EZ) (2019)

Schedule A (Form 990 or 990-EZ) 2019

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
PART I, LINE 12G, COLUMN V:	AULTMAN HEALTH FOUNDATION (AHF) WAS FORMED TO HANDLE THE OVERALL MANAGEMENT FOR AULTMAN HOSPITAL (AH) AND AHF'S SUBSIDIARIES. THIS STRUCTURE IS COMMON TO MANY HEALTH CARE SYSTEMS. AHF PERFORMS ACTIVITIES THAT DIRECTLY AND INDIRECTLY IMPACT AH. THERE IS A CLOSE WORKING RELATIONSHIP BETWEEN AHF AND AH AND SUBSTANTIAL RESOURCES OF AHF ARE COMMITTED TO FURTHERING THE AH MISSION.

Schedule A (Form 990 or 990-EZ) 2019

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE C
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Political Campaign and Lobbying Activities

For Organizations Exempt From Income Tax Under section 501(c) and section 527

SchCMd Bullet

Complete if the organization is described below. SchCMd Bullet

Attach to Form 990 or Form 990-EZ.
SchCMd Bullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2019

Open to Public
Inspection

If the organization answered "Yes" on Form 990, Part IV, Line 3, or Form 990-EZ, Part V, line 46 (Political Campaign Activities), then
Round Bullet

Section 501(c)(3) organizations: Complete Parts I-A and B. Do not complete Part I-C.
Round Bullet

Section 501(c) (other than section 501(c)(3)) organizations: Complete Parts I-A and C below. Do not complete Part I-B.
Round Bullet

Section 527 organizations: Complete Part I-A only.
If the organization answered "Yes" on Form 990, Part IV, Line 4, or Form 990-EZ, Part VI, line 47 (Lobbying Activities), then
Round Bullet

Section 501(c)(3) organizations that have filed Form 5768 (election under section 501(h)): Complete Part II-A. Do not complete Part II-B.
Round Bullet

Section 501(c)(3) organizations that have NOT filed Form 5768 (election under section 501(h)): Complete Part II-B. Do not complete Part II-A.
If the organization answered "Yes" on Form 990, Part IV, Line 5 (Proxy Tax) (see separate instructions) or Form 990-EZ, Part V, line 35c (Proxy Tax) (see separate instructions), then
Round Bullet

Section 501(c)(4), (5), or (6) organizations: Complete Part III.

Name of the organization

AULTMAN HEALTH FOUNDATION

Employer identification number

34-1445390

Part I-A

Complete if the organization is exempt under section 501(c) or is a section 527 organization.

Provide a description of the organization’s direct and indirect political campaign activities in Part IV (see instructions for definition of “political campaign activities")

Political campaign activity expenditures (see instructions) .................................................................... SchCMd Bullet

Volunteer hours for political campaign activities (see instructions) ..................................................................

Part I-B

Complete if the organization is exempt under section 501(c)(3).

Enter the amount of any excise tax incurred by the organization under section 4955 ................................ SchCMd Bullet

Enter the amount of any excise tax incurred by organization managers under section 4955 ....................... SchCMd Bullet

If the organization incurred a section 4955 tax, did it file Form 4720 for this year? .........................................

Yes No

Was a correction made? ......................................................................................................................

Yes No

If "Yes," describe in Part IV.

Part I-C

Complete if the organization is exempt under section 501(c), except section 501(c)(3).

Enter the amount directly expended by the filing organization for section 527 exempt function activities ..... SchCMd Bullet

Enter the amount of the filing organization's funds contributed to other organizations for section 527 exempt function activities ............................................................................................................................ SchCMd Bullet

Total exempt function expenditures. Add lines 1 and 2. Enter here and on Form 1120-POL, line 17b........... SchCMd Bullet

Did the filing organization file Form 1120-POL for this year? ...................................................................

Yes No

Enter the names, addresses and employer identification number (EIN) of all section 527 political organizations to which the filing
organization made payments. For each organization listed, enter the amount paid from the filing organization’s funds. Also enter the amount of political contributions received that were promptly and directly delivered to a separate political organization, such as a separate segregated fund or a political action committee (PAC). If additional space is needed, provide information in Part IV.

(a) Name	(b) Address	(c) EIN	(d) Amount paid from filing organization's funds. If none, enter -0-.	(e) Amount of political contributions received and promptly and directly delivered to a separate political organization. If none, enter -0-.
1
2
3
4
5
6

For Paperwork Reduction Act Notice, see the instructions for Form 990 or 990-EZ.

Cat. No. 50084S

Schedule C (Form 990 or 990-EZ) 2019

Page 2

Part II-A

Complete if the organization is exempt under section 501(c)(3) and filed Form 5768 (election under section 501(h)).

A Check SchCMd Bullet

if the filing organization belongs to an affiliated group (and list in Part IV each affiliated group member's name, address, EIN, expenses, and share of excess lobbying expenditures).
B Check SchCMd Bullet

if the filing organization checked box A and "limited control" provisions apply.

Limits on Lobbying Expenditures (The term "expenditures" means amounts paid or incurred.)		(b) Affiliated group totals
1a	Total lobbying expenditures to influence public opinion (grass roots lobbying) ......................
b	Total lobbying expenditures to influence a legislative body (direct lobbying) ........................
c	Total lobbying expenditures (add lines 1a and 1b) ............................................................
d	Other exempt purpose expenditures ...............................................................................
e	Total exempt purpose expenditures (add lines 1c and 1d) ..................................................
f	Lobbying nontaxable amount. Enter the amount from the following table in both columns.
	If the amount on line 1e, column (a) or (b) is:The lobbying nontaxable amount is:
	Not over $500,00020% of the amount on line 1e.
	Over $500,000 but not over $1,000,000$100,000 plus 15% of the excess over $500,000.
	Over $1,000,000 but not over $1,500,000$175,000 plus 10% of the excess over $1,000,000.
	Over $1,500,000 but not over $17,000,000$225,000 plus 5% of the excess over $1,500,000.
	Over $17,000,000$1,000,000.

g	Grassroots nontaxable amount (enter 25% of line 1f) .................................................
h	Subtract line 1g from line 1a. If zero or less, enter -0-. ................................................
i	Subtract line 1f from line 1c. If zero or less, enter -0-. ................................................
j	If there is an amount other than zero on either line 1h or line 1i, did the organization file Form 4720 reporting section 4911 tax for this year? ...................................................................................................................	Yes No

4-Year Averaging Period Under Section 501(h) (Some organizations that made a section 501(h) election do not have to complete all of the five columns below. See the separate instructions for lines 2a through 2f.)
Lobbying Expenditures During 4-Year Averaging Period
	Calendar year (or fiscal year beginning in)	(a) 2016	(b) 2017	(c) 2018	(d) 2019	(e) Total

2a	Lobbying nontaxable amount

b	Lobbying ceiling amount (150% of line 2a, column(e))

c	Total lobbying expenditures

d	Grassroots nontaxable amount

e	Grassroots ceiling amount (150% of line 2d, column (e))

f	Grassroots lobbying expenditures

Schedule C (Form 990 or 990-EZ) 2019

Page 3

Part II-B

Complete if the organization is exempt under section 501(c)(3) and has NOT filed Form 5768 (election under section 501(h)).

For each "Yes" response on lines 1a through 1i below, provide in Part IV a detailed description of the lobbying activity.

(a)

Yes|No

(b)

Amount

During the year, did the filing organization attempt to influence foreign, national, state or local legislation, including any attempt to influence public opinion on a legislative matter or referendum, through the use of:

Volunteers? ...........................................................................................................

Paid staff or management (include compensation in expenses reported on lines 1c through 1i)? ........

Media advertisements? ...................................................................................................

Mailings to members, legislators, or the public? .............................................................................

Publications, or published or broadcast statements? ...........................................................

Grants to other organizations for lobbying purposes? ..........................................................

Direct contact with legislators, their staffs, government officials, or a legislative body? .......................

Yes

Rallies, demonstrations, seminars, conventions, speeches, lectures, or any similar means? ..................

Other activities? ...................................................................................................................

Yes

182,570

Total. Add lines 1c through 1i ....................................................................................................

182,570

Did the activities in line 1 cause the organization to be not described in section 501(c)(3)? .....

If "Yes," enter the amount of any tax incurred under section 4912 ...........................................

If "Yes," enter the amount of any tax incurred by organization managers under section 4912 ...................

If the filing organization incurred a section 4912 tax, did it file Form 4720 for this year? ........................

Part III-A

Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6).

Yes

Were substantially all (90% or more) dues received nondeductible by members? ...............................................

Did the organization make only in-house lobbying expenditures of $2,000 or less? ............................................

Did the organization agree to carry over lobbying and political expenditures from the prior year? .................................

Part III-B

Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6) and if either (a) BOTH Part III-A, lines 1 and 2, are answered "No" OR (b) Part III-A, line 3, is answered “Yes."

Dues, assessments and similar amounts from members ......................................................................

Section 162(e) nondeductible lobbying and political expenditures (do not include amounts of political expenses for which the section 527(f) tax was paid).

Current year .............................................................................................................................

Carryover from last year ............................................................................................................

Total ...........................................................................................................................................

Aggregate amount reported in section 6033(e)(1)(A) notices of nondeductible section 162(e) dues .

If notices were sent and the amount on line 2c exceeds the amount on line 3, what portion of the excess does the organization agree to carryover to the reasonable estimate of nondeductible lobbying and political expenditure next year? ......................................................................................................................

Taxable amount of lobbying and political expenditures (see instructions) .........................................

Part IV

Supplemental Information

Provide the descriptions required for Part l-A, line 1; Part l-B, line 4; Part l-C, line 5; Part II-A (affiliated group list); Part II-A, lines 1 and 2 (see instructions), and Part ll-B, line 1. Also, complete this part for any additional information.

Return Reference	Explanation
PART II-B, LINE 1:	THIS REPRESENTS PAYMENTS TO VARIOUS PROFESSIONAL ORGANIZATIONS FOR CONDUCTING FEDERAL AND STATE ADVOCACY, GOVERNMENT RELATIONS REPRESENTATION, AND GENERAL LEGISLATIVE COUNSELING AND BUSINESS REGULATIONS ON BEHALF OF THE ORGANIZATION.

Schedule C (Form 990 or 990EZ) 2019

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE D
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Financial Statements

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 instructions and the latest information.

OMB No. 1545-0047

2019

Open to Public Inspection

Name of the organization

AULTMAN HEALTH FOUNDATION

Employer identification number

34-1445390

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 ........

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? ............

Yes No

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? ...................................

Yes No

Part II

Conservation Easements.
Complete if the organization answered "Yes" on Form 990, Part IV, line 7.

Purpose(s) of conservation easements held by the organization (check all that apply).

Preservation of land for public use (e.g., recreation or education) Preservation of an historically important land area

Protection of natural habitat Preservation of a certified historic structure

Preservation of open space

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.


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

Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during the
tax year SchDMd Bullet

Number of states where property subject to conservation easement is located SchDMd Bullet

Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and enforcement of the conservation easements it holds? ............

Yes No

Staff and volunteer hours devoted to monitoring, inspecting, handling of violations, and enforcing conservation easements during the year
SchDMd Bullet

Amount of expenses incurred in monitoring, inspecting, handling of violations, and enforcing conservation easements during the year
SchDMd Bullet

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)? .............................

Yes No

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.

If the organization elected, as permitted under FASB 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.

If the organization elected, as permitted under FASB 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

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 FASB ASC 958 relating to these items:

Revenue included on Form 990, Part VIII, line 1 .......................... SchDMd Bullet

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) 2019

Page 2

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)

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):

Public exhibition

Loan or exchange programs

Scholarly research

Other

Preservation for future generations

Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIII.

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?...

Yes No

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.

Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................

Yes No


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

Did the organization include an amount on Form 990, Part X, line 21, for escrow or custodial account liability? ...

Yes No

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 ....	733,598	734,605	727,562	718,271	719,326
b	Contributions ...				25,000
c	Net investment earnings, gains, and losses	46,769	4,643	13,033	15,263	5,815
d	Grants or scholarships ...
e	Other expenditures for facilities and programs ...
f	Administrative expenses ....	4,000	5,650	5,990	30,972	6,870
g	End of year balance ......	776,367	733,598	734,605	727,562	718,271

Provide the estimated percentage of the current year end balance (line 1g, column (a)) held as:

Board designated or quasi-endowment SchDMd Bullet

Permanent endowment SchDMd Bullet

100.000 %

Term endowment SchDMd Bullet

The percentages on lines 2a, 2b, and 2c should equal 100%.

Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes

(i) Unrelated organizations .................

3a(i)

(ii) Related organizations .................

3a(ii)

Yes

If "Yes" on 3a(ii), are the related organizations listed as required on Schedule R? .........

Yes

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 .....	1,877,417		1,877,417
b	Buildings ....	3,260,935	2,178,529	1,082,406
c	Leasehold improvements
d	Equipment ....	2,656,105	2,217,794	438,311
e	Other .....	111,570	106,476	5,094
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).)..				3,403,228

Schedule D (Form 990) 2019

Page 3

Part VII

InvestmentsOther 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
(B)
(C)
(D)
(E)
(F)
(G)
(H)
(I)
Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)

Part VIII

InvestmentsProgram 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)INVESTMENT IN AFFILIATES	366,299,190	C
(2)ASSETS LIMITED AS TO USE	29,043,510	C
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)	395,342,700

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

(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........

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
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)	654,395
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) 2019

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
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
e	Add lines 2a through 2d .....................		2e
3	Subtract line 2e from line 1..................		3
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
c	Add lines 4a and 4b....................		4c
5	Total revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ......		5

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
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
e	Add lines 2a through 2d....................		2e
3	Subtract line 2e from line 1...................		3
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
c	Add lines 4a and 4b.....................		4c
5	Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ......		5

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:

THE INTENDED USE OF THE ENDOWMENT FUNDS IS TO SUPPORT THE CHAPLANCY PROGRAM.

PART X, LINE 2:

WHEN TAX RETURNS ARE FILED, IT IS HIGHLY CERTAIN THAT SOME POSITIONS TAKEN WOULD BE SUSTAINED UPON EXAMINATION BY THE TAXING AUTHORITIES, WHILE OTHERS ARE SUBJECT TO UNCERTAINTY ABOUT THE MERITS OF THE POSITION TAKEN OR THE AMOUNT OF THE POSITION THAT WOULD BE ULTIMATELY SUSTAINED. IN ACCORDANCE WITH THE INCOME TAXES TOPIC OF THE FINANCIAL ACCOUNTING STANDARDS BOARD ACCOUNTING STANDARDS CODIFICATION, THE BENEFIT OF A TAX POSITION IS RECOGNIZED IN THE FINANCIAL STATEMENTS IN THE PERIOD DURING WHICH, BASED ON ALL AVAILABLE EVIDENCE, MANAGEMENT BELIEVES IT IS MORE LIKELY THAN NOT THAT THE POSITION WILL BE SUSTAINED UPON EXAMINATION, INCLUDING THE RESOLUTION OF APPEALS OR LITIGATION PROCESSES, IF ANY. TAX POSITIONS TAKEN ARE NOT OFFSET OR AGGREGATED WITH OTHER POSITIONS. TAX POSITIONS THAT MEET THE MORE-LIKELY-THAN-NOT RECOGNITION THRESHOLD ARE MEASURED AS THE LARGEST AMOUNT OF TAX BENEFIT THAT IS MORE THAN 50% LIKELY OF BEING REALIZED UPON SETTLEMENT WITH THE APPLICABLE TAXING AUTHORITY. THE PORTION OF THE BENEFITS ASSOCIATED WITH TAX POSITIONS TAKEN THAT EXCEEDS THE AMOUNT MEASURED AS DESCRIBED ABOVE IS RECORDED AS A LIABILITY FOR UNRECOGNIZED TAX BENEFITS ALONG WITH ANY ASSOCIATED INTEREST AND PENALTIES THAT WOULD BE PAYABLE TO THE TAXING AUTHORITIES UPON EXAMINATION.

Schedule D (Form 990) 2019

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE H
(Form 990)

Department of the Treasury
Internal Revenue Service

Hospitals

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

2019

Open to Public Inspection

Name of the organization

AULTMAN HEALTH FOUNDATION

Employer identification number

34-1445390

Part I

Financial Assistance and Certain Other Community Benefits at Cost

Yes

Did the organization have a financial assistance policy during the tax year? If "No," skip to question 6a . . . .

Yes

If "Yes," was it a written policy? ......................

Yes

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.

Applied uniformly to all hospital facilities Applied uniformly to most hospital facilities Generally tailored to individual hospital facilities

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.

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:

Yes

100% 150% 200% Other %

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: . . . . . . . .

200% 250% 300% 350% 400% Other %

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.

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"? . . . . . . . . . . . . .

Yes

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

Yes

If "Yes," did the organization's financial assistance expenses exceed the budgeted amount? . . . . . .

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? . . . . . . . . . . . . .

Did the organization prepare a community benefit report during the tax year? . . . . . . . . .

Yes

If "Yes," did the organization make it available to the public? . . . . . . . . . . . . .

Yes

Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.

Financial Assistance and Certain Other Community Benefits at Cost

Financial Assistance and Means-Tested Government Programs		(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) . . .	1,465	0	1,465	0 %
b	Medicaid (from Worksheet 3, column a) . . . . .	709,437	635,749	73,688	0.130 %
c	Costs of other means-tested government programs (from Worksheet 3, column b) . .
d	Total Financial Assistance and Means-Tested Government Programs . . . . .	710,902	635,749	75,153	0.130 %
Other Benefits
e	Community health improvement services and community benefit operations (from Worksheet 4).
f	Health professions education (from Worksheet 5) . . .
g	Subsidized health services (from Worksheet 6) . . . .
h	Research (from Worksheet 7) .
i	Cash and in-kind contributions for community benefit (from Worksheet 8) . . . .
j	Total. Other Benefits . .
k	Total. Add lines 7d and 7j .	710,902	635,749	75,153	0.130 %

For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2019

Schedule H (Form 990) 2019

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
2	Economic development
3	Community support
4	Environmental improvements
5	Leadership development and training for community members
6	Coalition building
7	Community health improvement advocacy
8	Workforce development
9	Other
10	Total

Part III

Bad Debt, Medicare, & Collection Practices

Section A. Bad Debt Expense

Yes

Did the organization report bad debt expense in accordance with Healthcare Financial Management Association Statement No. 15? ..........................

Yes

Enter the amount of the organization's bad debt expense. Explain in Part VI the methodology used by the organization to estimate this amount. ......

104,076

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. ......

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

Enter total revenue received from Medicare (including DSH and IME).....

2,534,820

Enter Medicare allowable costs of care relating to payments on line 5.....

2,169,936

Subtract line 6 from line 5. This is the surplus (or shortfall)........

364,884

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:

Cost accounting system Cost to charge ratio Other

Section C. Collection Practices

Did the organization have a written debt collection policy during the tax year? ..........

Yes

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 .........................

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) 2019

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)			Other (describe)
1	AULTMAN SPECIALTY HOSPITAL 2600 SIXTH ST SW CANTON,OH44710 HTTP://WWW.AULTMAN.ORG 1454 AULTMAN SPECIALTY HOSPITAL 134246188	X	LONG-TERM ACUTE CARE

Schedule H (Form 990) 2019

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)

	AULTMAN SPECIALTY HOSPITAL
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):

Yes

Community Health Needs Assessment

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?........................

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...............

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......................

Yes

If "Yes," indicate what the CHNA report describes (check all that apply):

A definition of the community served by the hospital facility

Demographics of the community

Existing health care facilities and resources within the community that are available to respond to the health needs of the community

How data was obtained

The significant health needs of the community

Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups

The process for identifying and prioritizing community health needs and services to meet the community health needs

The process for consulting with persons representing the community’s interests

The impact of any actions taken to address the significant health needs identified in the hospital facility's prior CHNA(s)

Other (describe in Section C)

Indicate the tax year the hospital facility last conducted a CHNA: 20 19

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 .................

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..................................

Yes

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. ............................

Yes

Did the hospital facility make its CHNA report widely available to the public?..............

Yes

If "Yes," indicate how the CHNA report was made widely available (check all that apply):

Hospital facility’s website (list url): SEE PART V, SECTION B, LINE 7D

Other website (list url):

Made a paper copy available for public inspection without charge at the hospital facility

Other (describe in Section C)

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. ..............

Yes

Indicate the tax year the hospital facility last adopted an implementation strategy: 20 16

Is the hospital facility's most recently adopted implementation strategy posted on a website?.........

Yes

If "Yes" (list url): SEE PART V, SECTION B, LINE 7D

If "No," is the hospital facility’s most recently adopted implementation strategy attached to this return? ......

10b

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

If "Yes" on line 12a, did the organization file Form 4720 to report the section 4959 excise tax?........

12b

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) 2019

Page 5

Part VFacility Information (continued)

Financial Assistance Policy (FAP)

	AULTMAN SPECIALTY HOSPITAL
Name of hospital facility or letter of facility reporting group

Yes

Did the hospital facility have in place during the tax year a written financial assistance policy that:

Explained eligibility criteria for financial assistance, and whether such assistance included free or discounted care?

Yes

If “Yes,” indicate the eligibility criteria explained in the FAP:

Federal poverty guidelines (FPG), with FPG family income limit for eligibility for free care of 100.000000000000%
and FPG family income limit for eligibility for discounted care of %

Income level other than FPG (describe in Section C)

Asset level

Medical indigency

Insurance status

Underinsurance discount

Residency

Other (describe in Section C)

Explained the basis for calculating amounts charged to patients?.................

Yes

Explained the method for applying for financial assistance?...................

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):

Described the information the hospital facility may require an individual to provide as part of his or her application

Described the supporting documentation the hospital facility may require an individual to submit as part of his or
her application

Provided the contact information of hospital facility staff who can provide an individual with information about the
FAP and FAP application process

Provided the contact information of nonprofit organizations or government agencies that may be sources of
assistance with FAP applications

Other (describe in Section C)

Was widely publicized within the community served by the hospital facility?........

Yes

If "Yes," indicate how the hospital facility publicized the policy (check all that apply):

The FAP was widely available on a website (list url):

SEE PART V, PAGE 8

The FAP application form was widely available on a website (list url):

SEE PART V, PAGE 8

A plain language summary of the FAP was widely available on a website (list url):
SEE PART V, PAGE 8

The FAP was available upon request and without charge (in public locations in the hospital facility and by mail)

The FAP application form was available upon request and without charge (in public locations in the hospital facility
and by mail)

A plain language summary of the FAP was available upon request and without charge (in public locations in the
hospital facility and by mail)

Individuals were notified about the FAP by being offered a paper copy of the plain language summary of the FAP, by
receiving a conspicuous written notice about the FAP on their billing statements, and via conspicuous public displays or
other measures reasonably calculated to attract patients' attention

Notified members of the community who are most likely to require financial assistance about availability of the FAP

The FAP, FAP application form, and plain language summary of the FAP were translated into the primary language(s)
spoken by LEP populations

Other (describe in Section C)

Schedule H (Form 990) 2019

Page 6

Part VFacility Information (continued)

Billing and Collections

	AULTMAN SPECIALTY HOSPITAL
Name of hospital facility or letter of facility reporting group

Yes

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?..................................

Yes

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:

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Deferring, denying, or requiring a payment before providing medically necessary care due to nonpayment of a previous
bill for care covered under the hospital facility's FAP

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

None of these actions or other similar actions were permitted

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?............

If "Yes," check all actions in which the hospital facility or a third party engaged:

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Deferring , denying, or requiring a payment before providing medically necessary care due to nonpayment of a previous
bill for care covered under the hospital facility's FAP

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

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):

Provided a written notice about upcoming ECAs (Extraordinary Collection Action) and a plain language summary of the
FAP at least 30 days before initiating those ECAs (if not, describe in Section C)

Made a reasonable effort to orally notify individuals about the FAP and FAP application process (if not, describe in
Section C)

Processed incomplete and complete FAP applications (if not, describe in Section C)

Made presumptive eligibility determinations (if not, describe in Section C)

Other (describe in Section C)

None of these efforts were made

Policy Relating to Emergency Medical Care

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?..................

Yes

If "No," indicate why:

The hospital facility did not provide care for any emergency medical conditions

The hospital facility’s policy was not in writing

The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Section C)

Other (describe in Section C)

Schedule H (Form 990) 2019

Page 7

Part VFacility Information (continued)

Charges to Individuals Eligible for Assistance Under the FAP (FAP-Eligible Individuals)

	AULTMAN SPECIALTY HOSPITAL
Name of hospital facility or letter of facility reporting group

Yes

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.

The hospital facility used a look-back method based on claims allowed by Medicare fee-for-service during a prior 12-month period

The hospital facility used a look-back method based on claims allowed by Medicare fee-for-service and all private health insurers that pay claims to the hospital facility during a prior 12-month period

The hospital facility used a look-back method based on claims allowed by Medicaid, either alone or in combination with
Medicare fee-for-service and all private health insurers that pay claims to the hospital facility during a prior 12-month
period

The hospital facility used a prospective Medicare or Medicaid method

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? ...............................

If "Yes," explain in Section C.

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? ...........................

If "Yes," explain in Section C.

Schedule H (Form 990) 2019

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, 20a, 20b, 20c, 20d, 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
AULTMAN SPECIALTY HOSPITAL	PART V, SECTION B, LINE 5: IN CONDUCTING ITS MOST RECENT CHNA AULTMAN SPECIALTY HOSPITAL USED THE STARK COUNTY COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) ADVISORY COMMITTEE. THE CHNA ADVISORY COMMITTEE IS MADE UP OF A VARIETY OF HEALTH AND SOCIAL SERVICES AGENCIES AND VOLUNTEERS IN THE COMMUNITY. THE FOLLOWING AGENCIES HAVE BEEN INVOLVED IN THE COMMITTEE: STARK COUNTY HEALTH DEPARTMENT, CANTON CITY HEALTH DEPARTMENT, ALLIANCE COMMUNITY HOSPITAL, PEGASUS FARM, PRESCRIPTION ASSISTANCE NETWORK, MERCY MEDICAL CENTER, SISTERS OF CHARITY FOUNDATION OF CANTON, AUSTIN BAILEY HEALTH AND WELLNESS FOUNDATION, MENTAL HEALTH AND RECOVERY SERVICES BOARD OF STARK COUNTY, COMMUNITY ADVOCATES, STARK COUNTY FAMILY COUNCIL, HEALTH FOUNDATION OF GREATER MASSILLON, ACCESS HEALTH STARK COUNTY, STARK COUNTY MEDICAL SOCIETY, UNITED WAY OF GREATER STARK COUNTY, THE AULTMAN HEALTH FOUNDATION, STARK PARKS/LIVE WELL STARK COUNTY, STARK COUNTY COMMUNITY ACTION AGENCY, ALLIANCE CITY HEALTH DEPARTMENT, MASSILLON CITY HEALTH DEPARTMENT, AND THE OHIO STATE UNIVERSITY EXTENSION OFFICE. PERSONS REPRESENTING THE BROAD INTERESTS OF THE COMMUNITY, INCLUDING THOSE WITH KNOWLEDGE OF OR EXPERTISE IN PUBLIC HEALTH, PARTICIPATED IN THE CHNA PROCESS THROUGH THE COMMUNITY SURVEY AND COMMUNITY LEADER WEB SURVEY, AS MEMBERS OF THE ADVISORY COMMITTEE AND AS SUMMIT PARTICIPANTS. THE COMMUNITY SURVEY INCLUDED A RANDOM SAMPLE TELEPHONE SURVEY OF STARK COUNTY HOUSEHOLDS THAT INCLUDED A REPRESENTATIVE SAMPLE OF STARK COUNTY RESIDENTS AS WELL AS AN OVERSAMPLE OF AFRICAN-AMERICAN AND CANTON HOUSEHOLDS. TELEPHONE INTERVIEWS WERE UTILIZED TO ENSURE REPRESENTATIVENESS OF THE POPULATION. THE FINAL SAMPLE CONSISTED OF 1065 RESPONDENTS. DATA COLLECTION FROM TELEPHONE INTERVIEWS BEGAN ON JUNE 1 AND ENDED ON JULY 10, 2015. THE OVERSAMPLE OF AFRICAN-AMERICAN AND CANTON HOUSEHOLDS BEGAN JULY 5,2018 AND ENDED AUG. 7, 2018. THE COMMUNITY LEADER SURVEY WAS A WEB-BASED SURVEY WITH 101 SURVEYS COMPLETED FROM A TOTAL OF 476 INVITEES WITH VALID EMAIL ADDRESSES. INVITATIONS WERE SENT ON OCT 25, 2018 AND NOV 12, 2018. THE ADVISORY COMMITTEE GUIDED THE DEVELOPMENT OF THE SURVEY AND APPROVED THE HEALTH INFORMATION PROVIDED.THE ADVISORY COMMITTEE HELD FIVE MEETINGS THROUGHOUT 2015 TO REVIEW INDICATORS, IDENTIFY SIGNIFICANT HEALTH NEEDS OF THE COMMUNITY AND IDENTIFY EXISTING HEALTH CARE FACILITIES AND RESOURCES WHICH ARE POTENTIALLY AVAILABLE TO ADDRESS THE SIGNIFICANT NEEDS IDENTIFIED. DURING THE EARLIER MEETINGS, THE ADVISORY COMMITTEE REVIEWED PRELIMINARY RESEARCH FINDINGS, DISCUSSED CONTENT FOR THE COMMUNITY LEADER WEB SURVEY, AND DISCUSSED THE NEED FOR ADDITIONAL DATA FOR THE ASSESSMENT, INCLUDING DATA ON CULTURAL COMPETENCY, GAPS IN SERVICE AND YOUTH. THE ADVISORY COMMITTEE AGREED TO USE THE COMMUNITY HEALTH IMPROVEMENT CYCLE PROCESS AS THE ASSESSMENT MODEL FOR THE CHNA. THE ADVISORY COMMITTEE DISCUSSED THE TIMING FOR UPDATING THE INDICATORS REPORT AND IDENTIFIED DATA SETS TO BE USED FOR COMPLETING THE STARK COUNTY HEALTH NEEDS ASSESSMENT. INDIVIDUAL HOSPITALS DISCUSSED THEIR PRIORITIES AND PROGRAMS THAT ARE ADDRESSING THOSE PRIORITIES. THE LATER MEETINGS INCLUDED DISCUSSIONS OF COMMUNITY HEALTH IMPROVEMENT PLANS AND PROGRAMS ADDRESSING COMMUNITY NEEDS.IN FEBRUARY, 2018, DURING THE STARK COUNTY ANNUAL HEALTH IMPROVEMENT SUMMIT, THE FIVE SIGNIFICANT HEALTH NEEDS OF THE COMMUNITY WERE DISCUSSED AND PRIORITIZED FOLLOWED BY A DISCUSSION OF EXISTING RESOURCES AND ACTIVITIES WITHIN THE COMMUNITY ADDRESSING THOSE SIGNIFICANT HEALTH NEEDS. SUMMIT PARTICIPANTS, WHICH INCLUDED MORE THAN 50 HEALTH AND SOCIAL SERVICES AGENCIES AND VOLUNTEERS IN THE COMMUNITY, IDENTIFIED THE TOP THREE NEEDS AS THOSE NEEDS TO BE INCLUDED IN THE COMMUNITY HEALTH IMPROVEMENT PLAN. ALL REQUIRED SOURCES FROM THOSE REPRESENTING THE BROAD INTERESTS OF THE COMMUNITY PARTICIPATED IN THE CHNA PROCESS.
AULTMAN SPECIALTY HOSPITAL	PART V, SECTION B, LINE 6A: THE CHNA WAS CONDUCTED IN COLLABORATION WITH THE FOLLOWING HOSPITAL FACILITIES: AULTMAN HOSPITAL, AULTMAN ALLIANCE COMMUNITY HOSPITAL, AND MERCY MEDICAL CENTER.
AULTMAN SPECIALTY HOSPITAL	PART V, SECTION B, LINE 6B: THE CHNA WAS CONDUCTED IN COLLABORATION WITH THE FOLLOWING NON-HOSPITAL FACILITIES: ACCESS HEALTH STARK COUNTY; ALLIANCE CITY HEALTH DEPARTMENT; ALLIANCE FAMILY HEALTH CENTER; BEACON CHARITABLE PHARMACY; CANTON CITY PUBLIC HEALTH; COMMQUEST; MASSILLON CITY HEALTH DEPARTMENT; MY COMMUNITY HEALTH CENTER; OHIO STATE UNIVERSITY EXTENSION; PARAMOUNT ADVANTAGE; PEGASUS FARM; SISTERS OF CHARITY FOUNDATION OF CANTON; STARKFRESH; STARK COUNTY HEALTH DEPARTMENT; STARK COUNTY COMMUNITY ACTION AGENCY; STARK COUNTY FAMILY COUNCIL; STARK COUNTY JOBS AND FAMILY SERVICES; STARK COUNTY DISTRICT LIBRARY; STARK MENTAL HEALTH & ADDICTION RECOVERY; STARK PARKS; STARK COUNTY TASC; UNITED WAY OF GREATER STARK COUNTY; YMCA OF CENTRAL STARK COUNTY.IN ADDITION, THE COLLABORATION CONTRACTED WITH CENTER FOR MARKETING & OPINION RESEARCH TO CONDUCT THE 2018 STARK COUNTY HEALTH NEEDS ASSESSMENT AS THEY DID FOR PREVIOUS CYCLES. CMOR PROVIDES PUBLIC OPINION RESEARCH SERVICES TO COLLEGES AND UNIVERSITIES, HOSPITALS AND HEALTH CARE ORGANIZATIONS, BUSINESSES AND COMMUNITY-BASED ORGANIZATIONS AND GOVERNMENT AGENCIES. THEY HAVE EXPERTISE IN ASKING THE RIGHT QUESTIONS TO THE RIGHT PEOPLE THE RIGHT WAY USING TELEPHONE, WEB AND MAIL SURVEYS, FIELD, INTERCEPT AND KEY INFORMANT INTERVIEWS AND FOCUS GROUP ADMINISTRATION, AS WELL AS A WIDE RANGE OF CONSULTING SERVICES.
AULTMAN SPECIALTY HOSPITAL	PART V, SECTION B, LINE 7D: THE CHNA AND CHNA IMPLEMENTATION PLAN CAN BE FOUND AT THE FOLLOWING URL:AULTMAN.ORG/HOME/ABOUT/AULTMAN-HOSPITAL/COMMUNITY-HEALTH-NEEDS-ASSESSMENT/
AULTMAN SPECIALTY HOSPITAL	PART V, SECTION B, LINE 11: THE 2018 CHNA IDENTIFIED ACCESS TO HEALTH CARE, MENTAL HEALTH SERVICES (SPECIFICALLY ACCESS, YOUTH SUICIDE, AND HEROIN/OPIOID USE); INFANT MORTALITY, AND OBESITY AND HEALTHY LIFESTYLE AS THE FOUR MOST SIGNIFICANT COMMUNITY HEALTH NEEDS. THE FOLLOWING IDENTIFIES THE NEED, ACTIONS TAKEN TO ADDRESS THE NEED, AND IMPACT OF THE ACTION IN ADDRESSING THE NEED.NEED 1: ACCESS TO HIGH-QUALITY, AFFORDABLE, HOLISTIC, AND CULTURALLY RELEVANT CAREAULTMAN IS COMMITTED TO A VARIETY OF STRATEGIES TO ADDRESS THE NEED FOR ACCESSIBLE CARE. AULTMAN ALIGNS SERVICES TO PROVIDE RESIDENTS OF STARK COUNTY, AND SURROUNDING AREAS, WITH EQUITABLE ACCESS TO HEALTHCARE SERVICES BY REDUCING BARRIERS TO CARE FOR VULNERABLE POPULATIONS AND DECREASING THE PERCENTAGE OF RESPONDENTS FROM VULNERABLE POPULATIONS WHO REPORT NOT HAVING A PRIMARY CARE PROVIDER. AULTMAN SPECIALTY HOSPITAL PROVIDES LONG-TERM ACUTE CARE SERVICES TO MEDICALLY COMPLEX PATIENTS IN A SAFE AND PATIENT-CENTERED ENVIRONMENT. PATIENTS CAN RECEIVE CARE IN THEIR LOCAL COMMUNITY FOR COMPLEX WOUNDS, COMPLEX RESPIRATORY DISEASES OR VENTILATOR WEANING BEYOND A SHORT-TERM ACUTE CARE HOSPITAL STAY. PRIOR TO DISCHARGE, AULTMAN SPECIALTY HOSPITAL ARRANGES NECESSARY SERVICES (E.G., FOLLOW-UP APPOINTMENTS, THERAPY SERVICES, HOME HEALTH CARE OR CARE AT ANOTHER NURSING FACILITY AND TRANSPORTATION SERVICES AVAILABLE AT FREE OR REDUCED COST). A FULL-TIME REGISTERED NURSE DISCHARGE PLANNER FACILITATES THE PLAN OF CARE FOR THE PATIENT UPON DISCHARGE. AULTMAN SPECIALTY HOSPITAL COLLABORATES WITH AREA TRANSITIONAL CARE UNITS, SKILLED NURSING FACILITIES AND HOME HEALTH AGENCIES FOR COORDINATION OF CARE TO ASSURE APPROPRIATE HANDOFF COMMUNICATION AND SAFE PATIENT TRANSFERS TO MEET COMMUNITY HEALTH NEEDS. AULTMAN SPECIALTY HOSPITAL EXPANDED THIRD-PARTY PAYER COVERAGE TO INCLUDE MANY COMMERCIAL PAYERS AS IN-NETWORK PROVIDERS TO INCREASE COMMUNITY ACCESS TO AFFORDABLE, QUALITY LONG-TERM ACUTE CARE SERVICES. A HOSPITAL REPRESENTATIVE COLLABORATES WITH AREA HOSPITALS WITH OUTREACH TO
AULTMAN SPECIALTY HOSPITAL	PART V, SECTION B, LINE 13H: AULTMAN HEALTH FOUNDATION IS THE PARENT COMPANY OF AULTMAN SPECIALTY HOSPITAL (ASH). ASH HAS A FINANCIAL ASSISTANCE POLICY (FAP) WHICH HAS THE SAME PROVISIONS AS THE POLICY FOR AULTMAN HOSPITAL AND OTHER FACILITIES WITHIN AULTMAN HEALTH FOUNDATION. ACCORDING TO THE POLICY ALL MEDICALLY NECESSARY SELF-PAY PATIENTS ARE ELIGIBLE FOR FINANCIAL ASSISTANCE. ELIGIBILITY CRITERIA IS BASED ON THE FEDERAL POVERTY GUIDELINES (FPG) AND ARE UPDATED ANNUALLY BASED ON THE UPDATES PUBLISHED BY THE UNITED STATES HEALTH AND HUMAN SERVICES DEPARTMENT. THE PERCENT OF ASSISTANCE PROVIDED IS DETERMINED ON A SLIDING SCALE AS FOLLOWS: 0% - 100% OF FPG RECEIVES A 100% DISCOUNT, 101% - 150% OF FPG RECEIVES A 90% DISCOUNT, 151% - 200% OF FPG RECEIVES A 80% DISCOUNT, 201% - 300% OF FPG RECEIVES A 65% DISCOUNT, 301% AND ABOVE IS DISCOUNTED AT 58%.
AULTMAN SPECIALTY HOSPITAL	PART V, SECTION B, LINE 16J: THE FINANCIAL ASSISTANCE INFORMATION CAN BE FOUND AT THE FOLLOWING URL:AULTMAN.ORG/HOME/PATIENTS-AND-VISITORS/INSURANCE-AND-BILLING/ FINANCIAL-ASSISTANCE/
PART V, SECTION B, LINE 13A:	ALL MEDICALLY NECESSARY SELF-PAY PATIENTS ARE ELIGIBLE FOR FINANCIAL ASSISTANCE. ELIGIBILITY CRITERIA IS BASED ON THE UPDATES PUBLISHED BY THE UNITED STATES DEPARTMENT OF HEALTH AND HUMAN SERVICES. THE PERCENT OF ASSISTANCE PROVIDED IS DETERMINED ON A SLIDING SCALE AS FOLLOWS: 0% - 100% OF FPG RECEIVES A 100% DISCOUNT, 101% - 150% OF FPG RECEIVES A 90% DISCOUNT, 151% - 200% OF FPG RECEIVES A 80% DISCOUNT, 201% - 300% OF FPG RECEIVES A 65% DISCOUNT, 301% AND ABOVE IS DISCOUNTED AT 58%.

Schedule H (Form 990) 2019

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?
Name and address		Type of Facility (describe)
1
2
3
4
5
6
7
8
9
10

Schedule H (Form 990) 2019

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 3C:	AULTMAN HEALTH FOUNDATION IS THE PARENT COMPANY OF AULTMAN SPECIALTY HOSPITAL (ASH). ASH HAS A FINANCIAL ASSISTANCE POLICY (FAP) WHICH HAS THE SAME PROVISIONS AS THE POLICY FOR AULTMAN HOSPITAL AND OTHER FACILITIES WITHIN AULTMAN HEALTH FOUNDATION. ACCORDING TO THE POLICY ALL MEDICALLY NECESSARY SELF-PAY PATIENTS ARE ELIGIBLE FOR FINANCIAL ASSISTANCE. ELIGIBILITY CRITERIA IS BASED ON THE FEDERAL POVERTY GUIDELINES (FPG) AND ARE UPDATED ANNUALLY BASED ON THE UPDATES PUBLISHED BY THE UNITED STATES HEALTH AND HUMAN SERVICES DEPARTMENT. THE PERCENT OF ASSISTANCE PROVIDED IS DETERMINED ON A SLIDING SCALE AS FOLLOWS: 0% - 100% OF FPG RECEIVES A 100% DISCOUNT, 101% - 150% OF FPG RECEIVES A 90% DISCOUNT, 151% - 200% OF FPG RECEIVES A 80% DISCOUNT, 201% - 300% OF FPG RECEIVES A 65% DISCOUNT, 301% AND ABOVE IS DISCOUNTED AT 58%.
PART I, LINE 7:	THE ORGANIZATION USED THE COST TO CHARGE RATIO CALCULATED IN WORKSHEET 2 OF SCHEDULE H.
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 $ 22,565.
PART I, LINE 6A:	AULTMAN HEALTH FOUNDATION, THE PARENT COMPANY, PUBLISHES ANNUALLY ITS ANNUAL REPORT WHICH INCLUDES ALL RELATED ORGANIZATIONS' PROGRAMS AND SERVICES DESIGNED TO LEAD THE COMMUNITY TO IMPROVED HEALTH AND PROMOTE HEALTHY LIFESTYLES. THIS REPORT IS AVAILABLE ON AULTMAN'S WEBSITE (SEE AULTMAN.ORG/HOME/ABOUT/AULTMAN-HOSPITAL/ANNUAL-REPORT/).
PART III, LINE 2:	BAD DEBT EXPENSE CONSISTS OF AMOUNTS DEEMED UNCOLLECTIBLE AND REFERRED TO COLLECTION AGENCY, PER THE ORGANIZATION'S WRITTEN DEBT COLLECTION POLICY.
PART III, LINE 3:	METHODOLOGY FOR BAD DEBT RELATED TO CHARITY CARE:PATIENTS REFERRED TO THE ASH ARE REFERRED HERE BECAUSE THEIR ILLNESSES ARE COMPLEX AND WILL REQUIRE LONG-TERM ACUTE CARE SERVICES. MOST OF THE PATIENTS WITH SUCH MEDICALLY COMPLEX ILLNESSES ARE ELDERLY AND HAVE CHRONIC AS WELL AS ACUTE ILLNESS AND ARE ABLE TO QUALIFY FOR MEDICARE OR MEDICAID. IF THE PATIENT MEETS THE HEALTH CRITERIA FOR ADMISSIONS INTO A LONG TERM ACUTE CARE FACILITY, ASH ACCEPTS THE PATIENT REGARDLESS OF THEIR ABILITY TO PAY. PATIENTS ARE OFTEN CONSIDERED SELF-PAY PATIENTS AT THE TIME OF ADMISSION AND THEN THROUGH OUR OUTREACH PROGRAM THESE PATIENTS ARE USUALLY ABLE TO QUALIFY FOR MEDICAID OR SOME OTHER FORM OF ASSISTANCE. BECAUSE OF THIS, ASH HAD NO BAD DEBT EXPENSE ATTRIBUTABLE TO CHARITY CARE IN 2019. THE ORGANIZATION DOES HAVE A FINANCIAL ASSISTANCE POLICY WHICH HAS THE SAME PROVISIONS AS THE POLICY FOR ANY OTHER FACILITY WITHIN THE AULTMAN HEALTH FOUNDATION.
PART III, LINE 4:	SEE THE "PATIENT SERVICE REVENUE AND PATIENT RECEIVABLES" PARAGRAPHS IN NOTE 3 ON PAGES 21-22 OF THE ATTACHED AUDITED FINANCIAL STATEMENTS.
PART III, LINE 8:	ASH HAS A SURPLUS OF $364,844 WITH ITS MEDICARE PATIENTS. 100% OF THIS SURPLUS SHOULD BE TREATED AS COMMUNITY BENEFIT, SINCE ASH IS PROVIDING SERVICES TO ELDERLY INDIVIDUALS WHO MAY OTHERWISE STRUGGLE TO RECEIVE CARE. THE COSTING METHODOLOGY USED IN DETERMINING THE AMOUNT REPORTED IN LINE 6 IS THE MEDICARE COST REPORT.
PART III, LINE 9B:	ASH FOLLOWS THE SAME COLLECTION PROCEDURES OUTLINED IN THE PARENT COMPANY'S COLLECTION POLICY. FOR THOSE PATIENTS KNOWN TO QUALIFY FOR CHARITY CARE OR FINANCIAL ASSISTANCE, THE ORGANIZATION REPEATEDLY OFFERS PATIENTS ACCESS TO FINANCIAL HELP DURING THEIR HOSPITAL STAY AND AFTER AS WELL AS WITH EACH BILLING NOTICE. BILLS ARE SENT TO A COLLECTION AGENCY AS A LAST RESORT AND ONLY: WHEN PATIENTS HAVE THE ABILITY TO PAY SOME PORTION OF THEIR HEALTHCARE EXPENSES BUT DECLINE TO DO SO; WHEN PATIENTS DECLINE TO WORK WITH THE ORGANIZATION TO DETERMINE IF THEY QUALIFY FOR FREE OR DISCOUNTED CARE VIA FEDERAL, STATE, LOCAL OR HOSPITAL ASSISTANCE PROGRAMS; OR WHEN THE ORGANIZATION IS UNABLE TO LOCATE THE PATIENT OR PERSON RESPONSIBLE FOR THE BILL.
PART VI, LINE 2:	NEEDS ASSESSMENT:AULTMAN SPECIALTY HOSPITAL (ASH) ASSESSES THE COMMUNITY'S HEALTH CARE NEEDS IN A VARIETY OF WAYS. IT STUDIES PROTOCOL VOLUME AND PATIENT SATISFACTION SURVEYS. IT DOCUMENTS MEDICAL CONDITIONS THAT THOUSANDS OF COMMUNITY MEMBERS AND MEDICAL STAFF MEMBERS CAN INQUIRE ABOUT IN THE SHARON LANE HEALTH CENTER HEALTH LIBRARY. IT TRACKS ATTENDANCE AT THE MORE THAN 100 "HEALTH TALK" PRESENTATIONS HELD EACH YEAR TO DETERMINE WHAT TOPICS ARE OF MOST INTEREST TO THE COMMUNITY. IN 2016, ASH COLLABORATED WITH AREA HOSPITALS AND HEALTH CARE FACILITIES TO CONDUCT A COMMUNITY HEALTH SURVEY. THE GOAL WAS TO GAUGE THE HEALTH STATUS AND HEALTH HABITS OF STARK COUNTY RESIDENTS - AND IDENTIFY AREAS WHERE AULTMAN CAN IMPROVE THE HEALTH OF OUR COMMUNITY. FIFTEEN QUESTIONS WERE INCLUDED ON THE POLL OF 1,276 STARK COUNTY HOUSEHOLDS. THE SURVEY SHOWED ACCESS TO HEALTH INSURANCE COVERAGE AND HEALTH CARE AS THE TOP PRIORITY; ALONG WITH OBESITY AND LACK OF HEALTHY LIFESTYLE CHOICE; OTHER AREAS OF CONCERN WERE PRESCRIPTION DRUG MISUSE, LARGER NEED FOR MENTAL HEALTH SERVICES, AND GREATER ACCESS TO DENTAL CARE. THE HOSPITAL IS CURRENTLY IN THE PROCESS OF DEVELOPING ITS IMPLEMENTATION PLAN.
PART VI, LINE 3:	PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE:IF ABLE, AT THE TIME OF REGISTRATION PATIENTS ARE ASKED TO FILL OUT THE HOSPITAL CARE ASSURANCE PROGRAM APPLICATION WHICH INCLUDES CONTACT INFORMATION FOR QUESTIONS AND ASSISTANCE IN COMPLETING THE FORMS. SIGNS AND APPLICATIONS ARE POSTED AT ALL POINTS OF ADMISSIONS INFORMING PATIENTS OF THE FREE CARE PROGRAMS WHICH ARE AVAILABLE. IN 2010, THE APPLICATION WAS ADDED TO THE INTERNET FOR EASY PATIENT ACCESS. ASH STAFF ASSISTS SELF-PAY INPATIENTS WITH THE MEDICAID PROCESS AND OTHER PROGRAMS UNDER WHICH THEY ARE ELIGIBLE FOR ASSISTANCE. PATIENTS WHO ARE UNABLE TO BE SCREENED DURING THEIR STAY RECEIVE FOLLOW UP ASSISTANCE WITH QUALIFYING FOR THE ASSISTANCE PROGRAM THAT MOST APPROPRIATELY FITS THEIR FINANCIAL NEEDS. THE APPLICATION AND CONTACT INFORMATION FOR THE OUTREACH DEPARTMENT IS PRINTED ON THE BACK OF EVERY STATEMENT.
PART VI, LINE 4:	COMMUNITY INFORMATION:ASH ENCOURAGES ITS EMPLOYEES AND BOARD MEMBERS TO BE ACTIVELY INVOLVED IN THE COMMUNITY.THE ORGANIZATION HAS ELEVEN BOARD MEMBERS WHO ARE ACTIVELY INVOLVED IN THE COMMUNITY TO BE REPRESENTATIVES OF THE COMMUNITY'S INTERESTS IN HEALTH CARE SERVICES.THE MEDICAL STAFF IS COMPRISED OF 202 PHYSICIANS. ANY PHYSICIAN IN GOOD STANDING WITHIN AULTMAN HOSPITAL'S MEDICAL STAFF AND WITH AN APPROPRIATE SPECIALTY TO CARE FOR MEDICALLY COMPLEX PATIENTS MAY APPLY FOR PRIVILEGES AT ASH.ASH'S SERVICE AREA INCLUDES STARK, WAYNE, HOLMES, CARROLL AND TUSCARAWAS COUNTIES. THE CORE MARKET FOR THE HOSPITAL IS STARK COUNTY. THE UNITED STATES CENSUS BUREAU ESTIMATED THE 2017 POPULATION OF OUR FIVE COUNTY AREAS TO BE OVER 650,690. THE ORGANIZATION IS ONE OF ONLY 2 FACILITIES WITHIN THE 5 COUNTY AREAS WHO ARE CONSIDERED LONG-TERM ACUTE CARE FACILITIES AND WHO PROVIDE THE SPECIALIZATION NEEDED TO CARE FOR PATIENTS WITH SUCH COMPLEX MEDICAL CONDITIONS.
PART VI, LINE 5:	AULTMAN SPECIALTY HOSPITAL (ASH) IS A WHOLLY OWNED SUBSIDIARY OF AULTMAN HEALTH FOUNDATION. AULTMAN HEALTH FOUNDATION SUPPORTS AND PROMOTES THE HEALTH OF ITS COMMUNITY MEMBERS IN A VARIETY OF WAYS. FROM EDUCATIONAL PROGRAMS TO HEALTH SCREENINGS, AULTMAN ACTIVELY PROMOTES HEALTH AND WELLNESS IN THE COMMUNITY. EDUCATIONAL PROGRAMS INCLUDE MORE THAN 100 FREE HEALTH TALK PRESENTATIONS EACH YEAR, FEATURING LOCAL PHYSICIANS AND HEALTH CARE PROFESSIONALS. THE AULTMAN WEBSITE HAS ADDITIONAL HEALTH CARE RESOURCES, INCLUDING A HEALTH LIBRARY, SYMPTOM CHECKER, VIDEOS AND RISK ASSESSMENTS.AULTMAN'S WORKING ON WELLNESS (WOW) MOBILE HEALTH-FAIR UNIT DEBUTED IN FEBRUARY 2009. STAFFED BY MEDICAL PROFESSIONALS, THE WOW VAN VISITS SCHOOLS, COMMUNITY CENTERS, CHURCHES, SENIOR CENTERS AND BLOCK PARTIES TO PROVIDE FREE SCREENINGS AND HEALTH EDUCATION. SCREENINGS SUCH AS BLOOD PRESSURE CHECKS, HEIGHT, WEIGHT AND BODY MASS INDEX/PERCENTAGE OF BODY FAT ARE PROVIDED. IN 2018, THE WOW STAFF REACHED MORE THAN 17,000 PEOPLE.ADDITIONAL OUTREACH EFFORTS INCLUDED AULTMAN REPRESENTATIVES ATTENDING HEALTH FAIRS THROUGHOUT THE YEAR. THESE EVENTS INCLUDE SENIOR DAY AT THE PRO FOOTBALL HALL OF FAME, THE CANTON FARMERS' MARKET AND HEALTH FAIRS AT LOCAL SCHOOLS.2018 MARKED THE ELEVENTH YEAR AULTMAN HOSTED THE CAREERS IN HEALTH CARE SUMMER PROGRAM FOR HIGH SCHOOL SENIORS AND COLLEGE STUDENTS INTERESTED IN HEALTH CARE CAREERS. SYMPOSIUM PRESENTERS INCLUDED AULTMAN DOCTORS, NURSES, STAFF AND ADMINISTRATORS WHO SHARED INSIGHT ON THE CHALLENGES AND OPPORTUNITIES OF WORKING IN HEALTH CARE. THE EVENT ALSO INCLUDED A HEALTH CARE CAREER FAIR WITH MORE THAN A DOZEN DEPARTMENTS AND SERVICES REPRESENTED. JOB SHADOWING EXPERIENCES WITH DOCTORS, NURSES AND OTHER HEALTH CARE PROFESSIONALS WERE AVAILABLE.CRITICALLY INJURED PATIENTS WHO NEED SPECIALIZED CARE ARE BROUGHT TO AULTMAN'S LEVEL II TRAUMA CENTER. AULTMAN HOSPITAL HAS THE ONLY LEVEL II TRAUMA CENTER FOR ADULT AND PEDIATRIC PATIENTS IN ITS FIVE-COUNTY SERVICE AREA. THE LEVEL II DESIGNATION FROM THE AMERICAN COLLEGE OF SURGEONS CERTIFIES AULTMAN HAS THE FACILITIES, TECHNOLOGY AND SPECIALLY TRAINED CLINICAL STAFF TO TREAT TRAUMA PATIENTS. IN 2018, AULTMAN HEALTH FOUNDATION CONTRIBUTED TO THE BETTERMENT OF THE STARK COUNTY COMMUNITY WITH THE FOLLOWING ACTIVITIES.THROUGH THE SAFETY FIRST PROGRAM, AULTMAN STRIVES TO KEEP OUR COMMUNITY'S KIDS SAFE BY PREVENTING HEAD TRAUMA AND OTHER BIKE-RELATED INJURIES. IN 2017, HUNDREDS OF AULTMAN EMPLOYEES VOLUNTEERED TO TEACH MORE THAN 5,000 LOCAL FIRST-GRADE STUDENTS ABOUT BIKE SAFETY. TOPICS INCLUDED THE IMPORTANCE OF WEARING A BIKE HELMET AND OTHER SAFETY GEAR; OBEYING TRAFFIC SIGNS AND SIGNALS; AND USING HAND SIGNALS. IN ADDITION TO THE IN-CLASS EDUCATION, EACH STUDENT RECEIVED A FREE BICYCLE SAFETY BOOKLET AND BIKE HELMET. SINCE THE PROGRAM'S INCEPTION IN 2005, SAFETY FIRST HAS REACHED ABOUT 30,000 STUDENTS WITH THE IMPORTANT MESSAGE OF BICYCLE SAFETY.THE AULTMAN WORKING ON WELLNESS (WOW) TEAM PROVIDES HEALTH SCREENINGS AND EDUCATION AT NO COST TO LEAD OUR COMMUNITY TO IMPROVED HEALTH. THE WOW TEAM VISITED 450 SITES IN 2019 RANGING FROM SCHOOLS, COMMUNITY/OUTREACH CENTERS, CHURCHES, HEALTH FAIRS AND MORE. THE WOW TEAM IS STAFFED BY REGISTERED NURSES WHO PROVIDE HEALTH EDUCATION, RESOURCES AND REFERRALS, AS NEEDED. HEALTH INFORMATION IS AVAILABLE ON A VARIETY OF MEDICAL TOPICS AND CAN BE CUSTOMIZED TO FIT AN INDIVIDUAL'S NEEDS. THE WOW TEAM PROVIDED HEALTH EDUCATION TO MORE THAN 19,000 COMMUNITY MEMBERS IN 2019.THE AULTMAN CANCER PROGRAM CONTINUES TO PLACE A HIGH PRIORITY ON COMMUNITY OUTREACH. IN 2017, 5 FREE CANCER SCREENING EVENTS WERE OFFERED IN CANTON, CARROLLTON, AND TUSCARAWAS PROVIDING 361 CANCER SCREENINGS TO OVER 200 UNINSURED OR UNDERINSURED INDIVIDUALS. THE CANCER TEAM ALSO PARTICIPATED IN MORE THAN 20 COMMUNITY EVENTS THAT FOCUSED ON CANCER PREVENTION, EDUCATION, AND AWARENESS. THE HEALTHY U PROGRAM, A COLLABORATION BETWEEN AULTMAN CANCER CENTER AND STARK COUNTY SCHOOLS, EDUCATED 200 6TH GRADE STUDENTS ON CANCER BASICS AND HOW LIFETIME CANCER RISK CAN BE REDUCED THROUGH HEALTHY LIFESTYLE HABITS. A NEW PARTNERSHIP WITH STARK COUNTY FIREFIGHTERS WAS ESTABLISHED TO EDUCATE THE FIREFIGHTERS IN OUR COMMUNITY ON THEIR INCREASED RISK FOR CANCER AND HOW TO LOWER THOSE RISKS. IN 2018 20 EDUCATIONAL SESSIONS WERE HELD. 370 FIREFIGHTERS ATTENDED THE EDUCATIONAL SESSIONS. WE WOULD LIKE TO EXPLORE FURTHER OPPORTUNITIES TO EDUCATE HEALTH CARE PROVIDERS ON THE INCREASED RISK OF FIREFIGHTERS AND GIVING THEM CURRENT GUIDELINES THAT MAY HELP INSURE THAT ADEQUATE SCREENING IS DONE THROUGH LONG-TERM CAREGIVERS OVER THE FIREFIGHTER'S LIFETIME.FOOD INSECURITY IS A CRITICAL ISSUE IN NORTHEASTERN OHIO, AND AULTMAN TEAM MEMBERS GIVE GENEROUSLY TO THE ANNUAL HARVEST FOR HUNGER CAMPAIGN. IN 2019, AULTMAN EMPLOYEES PROVIDED 5,503 POUNDS OF NONPERISHABLE FOOD DONATIONS AND $10,600 IN MONETARY GIFTS THAT HELPED THOUSANDS OF FAMILIES AND INDIVIDUALS IN NEED.AULTMAN MEDICAL EDUCATION HOSTED THE TENTH ANNUAL CAREERS IN HEALTH CARE PROGRAM, DESIGNED FOR STUDENTS 18 AND OLDER WITH INTERESTS IN HEALTH CARE CAREERS. THE PROGRAM INCLUDED PRESENTATIONS FROM DOCTORS, NURSES AND HOSPITAL ADMINISTRATORS, PROVIDING A GLIMPSE AT HOW A HOSPITAL RUNS. THE SYMPOSIUM ALSO FEATURED A CAREER FAIR THAT ENABLE THE STUDENTS TO TALK WITH EMPLOYEES FROM MORE THAN A DOZEN AULTMAN DEPARTMENTS. SUMMER JOB SHADOWING EXPERIENCES WERE ALSO AVAILABLE FOR SYMPOSIUM PARTICIPANTS.FOR WOMEN WHO CANNOT AFFORD BASIC CLOTHING ITEMS SUCH AS BRAS, EACH DAY PRESENTS EMOTIONAL AND UNCOMFORTABLE SITUATIONS. WHILE AULTMAN EMPLOYEES CONTINUE TO DONATE TOWARDS THIS BASIC NEED, AND DONATIONS HAVE BEEN DISTRIBUTED TO LOCAL BATTERED WOMEN AND HOMELESS SHELTERS AS WELL AS THE STARK COUNTY YWCA.AULTMAN HEALTH FOUNDATION TEAM MEMBERS AND THEIR LOVED ONES SUPPORT ANNUAL FUNDRAISING WALKS FOR ORGANIZATIONS INCLUDING THE MARCH OF DIMES AND JUVENILE DIABETES RESEARCH FOUNDATION. AULTMAN NOT ONLY PARTICIPATES IN THE AMERICAN CANCER SOCIETY'S RELAY FOR LIFE AND MAKING STRIDES AGAINST BREAST CANCER WALK - ALONG WITH THE AMERICAN HEART ASSOCIATION'S HEART WALK - BUT CLINICIANS ARE ON HAND TO PROVIDE EDUCATIONAL INFORMATION ABOUT REDUCING RISKS OF CANCER AND HEART DISEASE.EVERY YEAR, AULTMAN ORGANIZES A FUNDRAISING CAMPAIGN TO BENEFIT UNITED WAY. IN 2017, AULTMAN EMPLOYEES AND PHYSICIANS GENEROUSLY DONATED $250,552 TO FUND PROGRAMS TO BENEFIT COMMUNITY MEMBERS OF ALL AGES AND FROM ALL WALKS OF LIFE.AS PART OF AULTMAN HEALTH FOUNDATION'S MISSION TO LEAD OUR COMMUNITY TO IMPROVED HEALTH, THE AULTMAN AMBASSADOR PROGRAM (AAP) PROVIDES AN OPPORTUNITY TO EMPOWER HIGH SCHOOL STUDENTS TO BE "AULTMAN AMBASSADORS" TO ENGAGE THEIR PEERS, FAMILIES AND COMMUNITIES IN PROMOTING HEALTHY LIFESTYLE CHANGES. AAP IS PARTNERED WITH THE ALLIANCE FOR A HEALTHIER GENERATION HEALTHY SCHOOLS PROGRAM TO PROVIDE EVIDENCE-BASED RESOURCES ON THE CORE PRINCIPLES OF THE AAP: NUTRITION, HYDRATION, PHYSICAL ACTIVITY, SLEEP AND STRESS. THE AAP IS CURRENTLY PARTNERED WITH SIXTEEN HIGH SCHOOLS AND FIVE COLLEGE/UNIVERSITIES IN THREE COUNTIES; STARK, MAHONING, AND WAYNE. FOR THE 2019/2020 SCHOOL YEAR THE PROGRAM INVOLVED 201 TOTAL STUDENT AMBASSADORS WITH 51 SENIORS. AULTMAN CONTINUES TO EXPAND THE AMBASSADOR PROGRAM IN THE GREATER STARK COUNTY AREAS. IN ADDITION TO PROVIDING CARE FOR PATIENTS WITH NO INSURANCE, AULTMAN ALSO SERVES THOUSANDS OF PATIENTS COVERED BY PROGRAMS SUCH AS MEDICAID. PAYMENTS FROM THESE FEDERALLY FUNDED PROGRAMS DO NOT ALWAYS COVER THE TOTAL COST OF SERVICE.THROUGH ITS RESIDENT TEACHING PROGRAMS, AULTMAN DELIVERS A SIGNIFICANT LEVEL OF QUALITY OUTPATIENT AND INPATIENT HEALTH CARE TO INSURED, UNDERINSURED AND UNINSURED INDIVIDUALS IN OUR MARKET. FOR MEMBERS OF THE AMISH COMMUNITY, AULTMAN OFFERS FREE TRANSPORTATION TO AND FROM DOCTORS' APPOINTMENTS AND AULTMAN HOSPITAL. AN AMISH HOUSE IS ALSO LOCATED ADJACENT TO THE AULTMAN CAMPUS, GIVING VISITORS A FREE PLACE TO STAY WHEN LOVED ONES ARE HOSPITALIZED.
PART VI, LINE 6:	AULTMAN'S BOARD OF DIRECTORS HAS 50 NON-EMPLOYED MEMBERS. A TOTAL OF 70 OF THE 75 VOTING BOARD MEMBERS RESIDE IN THE CORE MARKET AREA. 4 RESIDE IN THE TERTIARY MARKET AND 1 LIVES OUT OF STATE.COMMUNITY PHYSICIANS REQUESTING AND ULTIMATELY QUALIFYING FOR MEDICAL STAFF PRIVILEGES WOULD BE GRANTED PRIVILEGES IN THEIR RESPECTIVE MEDICAL DEPARTMENTS.
PART VI, LINE 7, REPORTS FILED WITH STATES	OH

Schedule H (Form 990) 2019

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Schedule I
(Form 990)

Department of the Treasury
Internal Revenue Service

Grants and Other Assistance to Organizations,
Governments and Individuals in the United States

Complete if the organization answered "Yes," on Form 990, Part IV, line 21 or 22.
lBullet

Attach to Form 990.
lBullet

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2019

Open to Public
Inspection

Name of the organization
AULTMAN HEALTH FOUNDATION

Employer identification number
34-1445390

Part I

General Information on Grants and Assistance

Does the organization maintain records to substantiate the amount of the grants or assistance, the grantees' eligibility for the grants or assistance, and
the selection criteria used to award the grants or assistance? ........................

Yes No

Describe in Part IV the organization's procedures for monitoring the use of grant funds in the United States.

Part II

Grants and Other Assistance to Domestic Organizations and Domestic Governments. Complete if the organization answered "Yes" on Form 990, Part IV, line 21, for any recipient

that received more than $5,000. Part II can be duplicated if additional space is needed.

(a) Name and address of organization or government	(b) EIN	(c) IRC section (if applicable)	(d) Amount of cash grant	(h) Purpose of grant or assistance
(1) STARK ECONOMIC DEVELOPMENT BOARD 400 3RD ST STE 310 CANTON,OH44702	34-1476938	501(C)(3)	100,000	2021 CAMPAIGN
(2) CANTON REGIONAL CHAMBER OF COMMERCE 222 MARKET AVE N CANTON,OH44702	34-0129930	501(C)(6)	67,737	ECONOMIC DEVELOPMENT - ANNUAL DINNER - BALLOON CLASSIC - CHAMBER WEBSITE - ETC.
(3) ARTS IN STARK 1001 MARKET AVE N CANTON,OH44702	34-6609771	501(C)(3)	67,500	SUPPORT ARTS PROGRAMS IN STARK COUNTY SCHOOLS AND COMMUNITIES
(4) YMCA OF CENTRAL STARK 1201 30TH STREET NW CANTON,OH44709	34-0714392	501(C)(3)	53,000	SCHALMO FAMILY YMCA CAPITAL PROJECT, TO SUPPORT MEYERS LAKE YMCA, PAUL AND CAAROL DAVID YMCA, NORTH CANTON YMCA
(5) PRO FOOTBALL HALL OF FAME 2121 GEORGE HALAS DR NW CANTON,OH44708	34-0898576	501(C)(3)	46,250	SOVEREIGN HEALTH CONSULTING AGREEMENT
(6) ACCESS HEALTH STARK COUNTY 408 NINTH STREET SW CANTON,OH44707	46-2949527	501(C)(3)	40,000	GRANT TO ACCESS HEALTH STARK COUNTY TO CONTINUE TO PROVIDE SERVICES FOR 2019
(7) ALLIANCE AREA DEVELOPMENT FOUNDATION 2500 W STATE STREET SUITE E11 ALLIANCE,OH44601	31-1652174	501(C)(3)	20,000	2019 AAD CHARITABLE CONTRIBUTION
(8) MASSILLON MUSEUM 121 LINCOLN WAY E MASSILLON,OH44646	34-6001833	501(C)(3)	20,000	CAPITAL CAMPAIGN PLEDGE
(9) UNIVERSITY OF MOUNT UNION 1972 CLARK AVE ALLIANCE,OH44601	34-0714687	501(C)(3)	20,000	THE UNIVERSITY OF MOUNT UNION HEALTH AND MEDICAL SUPPORT
(10) STARK EDUCATION PARTNERSHIP INC 400 MARKET AVE N CANTON,OH44702	34-1625250	501(C)(3)	15,000	2017 - 2020 CAMPAIGN
(11) AMERICAN HEART ASSOCIATION 4682 DOUGLAS COURT NW CANTON,OH44718	13-5613797	501(C)(3)	14,000	2019 CANTON GO RED FOR WOMEN - 2019 CANTON HEART BALL - 2019 CANTON HEART WALK
(12) J BABE STERN COMMUNITY CENTER 2628 13TH STREET SW CANTON,OH44710	34-0828418	501(C)(3)	10,000	BABES KIDS LEARNING TODAY CAPITAL CAMPAIGN 2019
(13) TEAM NEO FOUNDATION 1111 SUPERIOR AVE SUITE 1600 CLEVELAND,OH44114	34-1885407	501(C)(3)	10,000	SUPPORT 2019 TEAM NEO CLEVELAND PLUS
(14) OHIO FOUNDATION OF INDEPENDENT COLLEGES 250 E BROAD ST STE 1700 COLUMBUS,OH43215	31-4441082	501(C)(3)	10,000	SCHOLARSHIP FUNDS
(15) STARK COUNTY MENTAL HEALTH & ADDICTION RECOVERY 121 CLEVELAND AVE SW CANTON,OH44702			10,000	"STARK CARES"
(16) AMERICAN CANCER SOCIETY 525 NORTH BROAD STREET CANFIELD,OH44406	24-0726080	501(C)(3)	9,000	RELAY FOR LIFE, AND MAKING STRIDES AGAINST BREAST CANCER
(17) MALONE UNIVERSITY 2600 CLEVELAND AVE NW CANTON,OH44709	34-0737794		5,215	TO PURCHASE MALONE ATHLETICS DEPARTMENT EQUIPMENT
(18) THE AULTMAN FOUNDATION 2600 SIXTH ST SW CANTON,OH44710	20-8090459	501(C)(3)	104,148	TO SUPPORT VARIOUS ORGANIZATIONS IN THE COMMUNITY

Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................. Bullet Image

Enter total number of other organizations listed in the line 1 table ........................ . Bullet Image

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50055P

Schedule I (Form 990) 2019

Page 2

Part III

Grants and Other Assistance to Domestic Individuals. Complete if the organization answered "Yes" on Form 990, Part IV, line 22.
Part III can be duplicated if additional space is needed.

(a) Type of grant or assistance	(b) Number of recipients	(c) Amount of cash grant	(d) Amount of noncash assistance	(e) Method of valuation (book, FMV, appraisal, other)	(f) Description of noncash assistance

(1)
(2)
(3)
(4)
(5)
(6)
(7)

Part IV

Supplemental Information. Provide the information required in Part I, line 2; Part III, column (b); and any other additional information.

Return Reference

Explanation

PART I, LINE 2:

AULTMAN HEALTH FOUNDATION'S (AHF) COMMUNITY SUPPORT POLICY/PROCEDURE PROVIDES GUIDANCE IN RESPONSE TO COMMUNITY ORGANIZATION REQUESTS FOR SUPPORT. AHF DEEMS IT BENEFICIAL AND NECESSARY TO BE A GOOD CORPORATE CITIZEN AND WILL CONSIDER SUPPORT OF COMMUNITY ENDEAVORS AND PROJECTS THAT WILL IMPROVE THE LIVES AND LIVELIHOOD OF THE COMMUNITY IT SERVES. A SPONSORSHIP COMMITTEE MEETS REGULARLY TO REVIEW REQUESTS FOR SUPPORT FROM VARIOUS COMMUNITY ORGANIZATIONS.

Schedule I (Form 990) 2019

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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

2019

Open to Public Inspection

Name of the organization

AULTMAN HEALTH FOUNDATION

Employer identification number

34-1445390

Part I

Questions Regarding Compensation

Yes

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.

First-class or charter travel Housing allowance or residence for personal use

Travel for companions Payments for business use of personal residence

Tax idemnification and gross-up payments Health or social club dues or initiation fees

Discretionary spending account Personal services (e.g., maid, chauffeur, chef)

If any of the boxes on 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 .........

Yes

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 on Line 1a? ..

Yes

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.

Compensation committee Written employment contract

Independent compensation consultant Compensation survey or study

Form 990 of other organizations Approval by the board or compensation committee

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:

Receive a severance payment or change-of-control payment? .............

Participate in, or receive payment from, a supplemental nonqualified retirement plan? .........

Yes

Participate in, or receive payment from, an equity-based compensation arrangement? .........

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.

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:

The organization? ....................

Any related organization? .......................

If "Yes," on line 5a or 5b, describe in Part III.

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:

The organization? ..................

Any related organization? ......................

If "Yes," on line 6a or 6b, describe in Part III.

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 ............

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 ..........................

If "Yes" on line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50053T

Schedule J (Form 990) 2019

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
(A) Name and Title		(i) Base compensation	(ii) Bonus & incentive compensation	(iii) Other reportable compensation	(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)
1EDWARD J ROTH III PRESIDENT/CEO	(i) (ii)	713,244 ------------- 0	74,439 ------------- 0	14,221 ------------- 0	33,400 ------------- 0	19,347 ------------- 0	854,651 ------------- 0	0 ------------- 0
2MARK D WRIGHT TREASURER/CFO/ DIRECTOR - AHF	(i) (ii)	425,501 ------------- 0	62,096 ------------- 0	1,119 ------------- 0	27,400 ------------- 0	19,344 ------------- 0	535,460 ------------- 0	0 ------------- 0
3RICK L HAINES DIRECTOR - AHF	(i) (ii)	0 ------------- 457,501	0 ------------- 106,149	0 ------------- 5,591	0 ------------- 839,013	0 ------------- 10,856	0 ------------- 1,419,110	0 ------------- 0
4MICHAEL LYNCH MD DIRECTOR - AHF	(i) (ii)	419,198 ------------- 0	40,750 ------------- 0	1,601 ------------- 0	33,400 ------------- 0	634 ------------- 0	495,583 ------------- 0	0 ------------- 0
5LORI L MERTES MD PRESIDENT - INNOVATIONS BOARD	(i) (ii)	0 ------------- 385,744	0 ------------- 88,411	0 ------------- 1,512	0 ------------- 28,000	0 ------------- 19,347	0 ------------- 523,014	0 ------------- 0
6PRABHCHARAN GILL MD DIRECTOR - AHF	(i) (ii)	0 ------------- 600,094	0 ------------- 65,000	0 ------------- 6,951	0 ------------- 33,400	0 ------------- 19,347	0 ------------- 724,792	0 ------------- 0
7MICHAEL RICH MD DIRECTOR - AHF	(i) (ii)	0 ------------- 226,266	0 ------------- 188,038	0 ------------- 48,282	0 ------------- 33,400	0 ------------- 19,347	0 ------------- 515,333	0 ------------- 0
8SHRUTI TREHAN MD DIRECTOR - AHF	(i) (ii)	0 ------------- 854,706	0 ------------- 349,419	0 ------------- 3,415	0 ------------- 32,900	0 ------------- 19,347	0 ------------- 1,259,787	0 ------------- 0
9AKBAR SHAH MD CHAIR - ASH; PHYSICIAN	(i) (ii)	0 ------------- 718,044	0 ------------- 367,361	0 ------------- 98,801	0 ------------- 33,400	0 ------------- 18,567	0 ------------- 1,236,173	0 ------------- 0
10DANIEL RODRIGUEZ MD VICE CHAIR - ASH	(i) (ii)	0 ------------- 227,832	0 ------------- 31,104	0 ------------- 1,447	0 ------------- 17,825	0 ------------- 19,347	0 ------------- 297,555	0 ------------- 0
11RYAN KUHARICH CEO - ASH	(i) (ii)	133,379 ------------- 0	27,134 ------------- 0	250 ------------- 0	20,046 ------------- 0	19,347 ------------- 0	200,156 ------------- 0	0 ------------- 0
12LEWIS HUMBLE MD DIRECTOR - IHC	(i) (ii)	0 ------------- 167,581	0 ------------- 22,130	0 ------------- 429	0 ------------- 25,307	0 ------------- 5,292	0 ------------- 220,739	0 ------------- 0
13STEVEN KELLY MD DIRECTOR - IHC	(i) (ii)	0 ------------- 590,691	0 ------------- 434,409	0 ------------- 111,434	0 ------------- 33,400	0 ------------- 14,575	0 ------------- 1,184,509	0 ------------- 0
14ROGER MUSA MD DIRECTOR - IHC	(i) (ii)	0 ------------- 222,943	0 ------------- 35,830	0 ------------- 407	0 ------------- 26,875	0 ------------- 20,144	0 ------------- 306,199	0 ------------- 0
15JOHN PRODAFIKAS DIRECTOR - IHC	(i) (ii)	0 ------------- 679,681	0 ------------- 345,288	0 ------------- 5,771	0 ------------- 33,400	0 ------------- 19,347	0 ------------- 1,083,487	0 ------------- 0
16CHRISTOPHER E REMARK CEO - AH; DIRECTOR - IHC	(i) (ii)	0 ------------- 494,648	0 ------------- 93,840	0 ------------- 1,309	0 ------------- 27,400	0 ------------- 20,144	0 ------------- 637,341	0 ------------- 0
17HOWARD METZGER MD DIRECTOR - IHC	(i) (ii)	231,165 ------------- 0	40,582 ------------- 0	2,277 ------------- 0	26,517 ------------- 0	10,474 ------------- 0	311,015 ------------- 0	0 ------------- 0
18ALLISON M OPRANDI MD CEO - IHC	(i) (ii)	372,341 ------------- 0	107,060 ------------- 0	2,641 ------------- 0	33,400 ------------- 0	10,885 ------------- 0	526,327 ------------- 0	0 ------------- 0
19MATTHEW RITZERT VP - IHC	(i) (ii)	156,482 ------------- 0	20,416 ------------- 0	263 ------------- 0	16,895 ------------- 0	0 ------------- 0	194,056 ------------- 0	0 ------------- 0
20ELIZABETH A GETZ CIO	(i) (ii)	306,147 ------------- 0	68,796 ------------- 0	1,179 ------------- 0	33,400 ------------- 0	19,347 ------------- 0	428,869 ------------- 0	0 ------------- 0
21ROBERT C MOLNAR SVP, REGIONAL DEVELOPMENT	(i) (ii)	236,982 ------------- 0	41,800 ------------- 0	443 ------------- 0	26,989 ------------- 0	19,347 ------------- 0	325,561 ------------- 0	0 ------------- 0
22MARK N ROSE SVP - LEGAL SERVICES	(i) (ii)	329,060 ------------- 0	60,820 ------------- 0	4,024 ------------- 0	33,400 ------------- 0	19,347 ------------- 0	446,651 ------------- 0	0 ------------- 0
23JASON JUSTUS VP - POMERENE FINANCE	(i) (ii)	237,013 ------------- 0	17,000 ------------- 0	564 ------------- 0	16,705 ------------- 0	18,712 ------------- 0	289,994 ------------- 0	0 ------------- 0
24SUSAN E OLIVERA VP - HUMAN RESOURCES	(i) (ii)	280,081 ------------- 0	54,117 ------------- 0	1,070 ------------- 0	33,400 ------------- 0	19,347 ------------- 0	388,015 ------------- 0	0 ------------- 0
25FRANCIS SNYDER CEO - POMERENE	(i) (ii)	344,201 ------------- 0	27,000 ------------- 0	3,566 ------------- 0	27,075 ------------- 0	19,347 ------------- 0	421,189 ------------- 0	0 ------------- 0
26RONALD RUSNAK MD DIRECTOR OF CLINICAL INFORMATICS	(i) (ii)	331,216 ------------- 0	29,633 ------------- 0	2,456 ------------- 0	30,800 ------------- 0	10,885 ------------- 0	404,990 ------------- 0	0 ------------- 0
27KEVIN D PETE SVP	(i) (ii)	282,999 ------------- 0	53,760 ------------- 0	1,071 ------------- 0	22,400 ------------- 0	19,347 ------------- 0	379,577 ------------- 0	0 ------------- 0
28TIMOTHY TEYNOR VP - PUBLIC POLICY	(i) (ii)	238,530 ------------- 0	0 ------------- 0	8,909 ------------- 0	31,753 ------------- 0	6,094 ------------- 0	285,286 ------------- 0	0 ------------- 0
29TRACY SABO VP OF HUMAN RESOURCES	(i) (ii)	188,824 ------------- 0	30,744 ------------- 0	459 ------------- 0	26,591 ------------- 0	6,015 ------------- 0	252,633 ------------- 0	0 ------------- 0

Schedule J (Form 990) 2019

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 1A	ALL EMPLOYEES ARE ELIGIBLE TO RECEIVE REIMBURSEMENT FOR HEALTH CLUB COSTS UP TO $120 ANNUALLY AS PART OF THE ORGANIZATION'S EFFORT TO PROMOTE HEALTHY LIFESTYLES. THIS AMOUNT WAS INCLUDED AS TAXABLE COMPENSATION FOR ALL EMPLOYEES THAT RECEIVED THE BENEFIT.
PART I, LINE 3	SEE SCHEDULE O FOR THE NARRATIVE RELATED TO FORM 990, PART VI, LINE 15 FOR AN EXPLANATION OF EXECUTIVE COMPENSATION REVIEW.
PART I, LINE 4B	EDWARD J ROTH II, VIVIAN LEGGETT, MARK ROSE, TIM TEYNOR, FRANCIS SNYDER, MARK WRIGHT, AND CHRIS REMARK ARE PARTICIPANTS IN THE ORGANIZATION'S 457 (F) PLAN. THERE WERE NO CONTRIBUTIONS IN 2019.

Schedule J (Form 990) 2019

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Schedule K
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Information on Tax-Exempt Bonds

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.
SchKMediumBullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2019

Open to Public
Inspection

Name of the organization
AULTMAN HEALTH FOUNDATION

Employer identification number
34-1445390

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
(a) Issuer name		(b) Issuer EIN	(c) CUSIP #	(d) Date issued	(e) Issue price	(f) Description of purpose	Yes	No	Yes	No	Yes	No
A	OHIO HIGHER EDUCATIONAL FACILITY COMMISSION	34-6849674	67756CDM7	11-02-2018	135,145,347	TO REFUND SERIES 2017 BONDS, REFINANCE PRIOR DEBTS AND NEW MONEY		X		X		X

Part Ⅱ

Proceeds

	A		B		C		D
	1 Amount of bonds retired ..................
2 Amount of bonds legally defeased ..............
3 Total proceeds of issue ..................	135,145,347
4 Gross proceeds in reserve funds .............	8,972,310
5 Capitalized interest from proceeds .............
6 Proceeds in refunding escrows ...............
7 Issuance costs from proceeds ...............
8 Credit enhancement from proceeds .............
9 Working capital expenditures from proceeds .............
10 Capital expenditures from proceeds .............
11 Other spent proceeds .............	106,069,026
12 Other unspent proceeds .............	20,104,011
13 Year of substantial completion .............
	Yes	No	Yes	No	Yes	No	Yes	No
14 Were the bonds issued as part of a current refunding issue of tax-exempt bonds (or, if issued prior to 2018, a current refunding issue)? ........	X
15 Were the bonds issued as part of an advance refunding issue of taxable bonds (or, if issued prior to 2018, 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) 2019

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?		X
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 ....	2.290 %
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 .........	0.190 %
6 Total of lines 4 and 5 .............	2.480 %
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) 2019

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

Schedule K (Form 990) 2019

Additional Data

Software ID:
Software Version:

- TIN:

Schedule L
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Transactions with Interested Persons

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.
MediumBullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2019

Open to Public Inspection

Name of the organization

AULTMAN HEALTH FOUNDATION

Employer identification number

34-1445390

Part I

Excess Benefit Transactions (section 501(c)(3), section 501(c)(4), and section 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	(c) Description of transaction	(d) Corrected?
1(a) Name of disqualified person	(c) Description of transaction	Yes	No

Enter the amount of tax incurred by the organization managers or disqualified persons during the year under section 4958. ........................... Bullet Image

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?
(a) Name of interested person	(b) Relationship with organization	(c) Purpose of loan	To	From	(e) Original principal amount	(f) Balance due	Yes	No	Yes	No	Yes	No






Total ............... $

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) 2019

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?
(a) Name of interested person		(c) Amount of transaction	(d) Description of transaction	Yes	No
(1) RICE'S NURSERY	BRYAN RICE, AHF BOARD MEMBER,OWNS RICE'S NURSERY	116,331	LANDSCAPING SERVICES FOR AULTMAN HEALTH FOUNDATION		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) 2019

Additional Data

Software ID:
Software Version:

- TIN:

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

2019

Open to Public
Inspection

Name of the organization

AULTMAN HEALTH FOUNDATION

Employer identification number

34-1445390

Return Reference	Explanation
FORM 990, PART III, LINE 1 (CONTINUED);	THE MISSION OF AULTMAN HEALTH FOUNDATION IS TO "LEAD OUR COMMUNITY TO IMPROVED HEALTH." THE VERTICALLY INTEGRATED HEALTH SYSTEM OF AULTMAN HOSPITAL AND AULTCARE HEALTH PLANS ENABLE AULTMAN TO BE ONE OF THE LOWEST-COST HEALTH CARE PROVIDERS IN NORTHEASTERN OHIO. LOWER COSTS HELP LOCAL BUSINESSES STAY FINANCIALLY HEALTHY AND MAINTAIN GOOD JOBS IN OUR COMMUNITY. IN ADDITION TO PROVIDING HIGH-QUALITY, LOW-COST HEALTH CARE, AULTMAN HEALTH FOUNDATION PROVIDES HEALTH EDUCATION FOR THE COMMUNITY. FOR EXAMPLE, THE AULTMAN WORKING ON WELLNESS (WOW) TEAM PROVIDES HEALTH SCREENINGS AND EDUCATION AT NO COST TO LEAD OUR COMMUNITY TO IMPROVED HEALTH. THE WOW TEAM VISITED 450 SITES IN 2019 RANGING FROM SCHOOLS, COMMUNITY/OUTREACH CENTERS, CHURCHES, HEALTH FAIRS AND MORE. THE WOW TEAM IS STAFFED BY REGISTERED NURSES WHO PROVIDE HEALTH EDUCATION, RESOURCES AND REFERRALS, AS NEEDED. HEALTH INFORMATION IS AVAILABLE ON A VARIETY OF MEDICAL TOPICS AND CAN BE CUSTOMIZED TO FIT AN INDIVIDUAL'S NEEDS. THE WOW TEAM PROVIDED HEALTH EDUCATION TO MORE THAN 19,000 COMMUNITY MEMBERS IN 2019.
PART V, LINE 2	AULTMAN HEALTH FOUNDATION'S EMPLOYEES ARE PAID BY A COMMON PAYMASTER. AULTMAN HEALTH FOUNDATION IS A PARENT COMPANY WITH THE FOLLOWING SUBSIDIARIES: - AULTMAN SPECIALTY HOSPITAL LLC - AULTMAN NORTH CANTON MEDICAL GROUP - MICKINLEY ASSURANCE SEGREGATED PORTFOLIO CO. - AULTMAN HOSPITAL AND SUBSIDIARIES - THE AULTMAN FOUNDATION - THE ORRVILLE HOSPITAL FOUNDATION DBA AULTMAN ORRVILLE HOSPITAL - AULTCARE CORPORATION - INTEGRATED HEALTH COLLABORATIVE LLC - AULTMAN INNOVATIONS LLC - ALLIANCE COMMUNITY HOSPITAL AND SUBSIDIARIES - CARING HANDS, INC. - AULTCARE HOLDING COMPANY AND SUBSIDIARIES
FORM 990, PART VI, SECTION A, LINE 1	THE BOARD OF DIRECTORS HAS AN EXECUTIVE COMMITTEE THAT CONSISTS OF THE CHAIR, VICE CHAIR, PRESIDENT/CEO, SECRETARY, TREASURER, PRESIDENT OF THE MEDICAL STAFF AT AULTMAN HOSPITAL, AND THE PAST CHAIR. THE EXECUTIVE COMMITTEE MEETS ONLY AS NECESSARY BETWEEN MEETINGS OF THE BOARD OF DIRECTORS AND HAS AND EXERCISES THE AUTHORITY OF THE BOARD IN THE MANAGEMENT OF THE ORGANIZATION, EXCEPT IN MATTERS IN WHICH THE BOARD IS REQUIRED TO ACT BY LAW, BY THE ARTICLES OF INCORPORATION, OR BY THE CODE OF REGULATIONS.
FORM 990, PART VI, SECTION A, LINE 2	GEOFF KARCHER AND BRYAN RICE ARE BOARD MEMBERS OF THE AULTMAN HEALTH FOUNDATION AND AULTMAN HOSPITAL AND HAVE A BUSINESS RELATIONSHIP. JOSEPH HALTER AND GEOFF KARCHER ARE BOARD MEMBERS OF THE AULTMAN HEALTH FOUNDATION AND AULTMAN HOSPITAL AND HAVE A BUSINESS RELATIONSHIP.
FORM 990, PART VI, SECTION A, LINE 7A	ONE AHF BOARD MEMBER IS APPOINTED BY ALLIANCE COMMUNITY HOSPITAL, ONE BOARD MEMBER IS APPOINTED BY AULTMAN ORRVILLE HOSPITAL. IN ADDITION, THE AULTMAN HOSPITAL MEDICAL STAFF PRESIDENT, THE AULTMAN HOSPITAL MEDICAL STAFF PRESIDENT-ELECT, AND THE PHYSICIAN CHAIRMAN OF THE BOARD OF AULTCARE CORPORATION ARE EX -OFFICIO VOTING MEMBERS OF THE AHF BOARD.
FORM 990, PART VI, SECTION B, LINE 11B	THE FORM 990 WAS PREPARED BY AN INDEPENDENT CPA FIRM BASED ON INFORMATION PROVIDED BY AULTMAN HEALTH FOUNDATION'S FINANCE DEPARTMENT. AHF'S FINANCE DEPARTMENT CAREFULLY REVIEWED AND ANALYZED THE TAX RETURN. THE DEPARTMENT RECONCILED THE GENERAL LEDGER AMOUNTS TO THE APPROPRIATE SCHEDULES ON THE FORM 990 AND COMPARED THOSE AMOUNTS TO THE AUDITED FINANCIAL STATEMENTS. IN ADDITION, THE FINANCE DEPARTMENT DID A COMPARATIVE ANALYSIS TO THE PRIOR YEAR RETURN. THE ANALYSIS AND RECONCILIATION SCHEDULES, ALONG WITH A COMPLETE COPY OF THE 990, WERE PROVIDED TO THE CHIEF FINANCIAL OFFICER FOR REVIEW AND APPROVAL. A COMPLETE COPY OF THE 990 WAS THEN MADE AVAILABLE TO THE BOARD OF DIRECTORS THROUGH A SECURED INTERNET PORTAL PRIOR TO THE FILING DATE.
FORM 990, PART VI, SECTION B, LINE 12C	THE AULTMAN HEALTH FOUNDATION'S BOARD OF DIRECTORS HAS A CONFLICT OF INTEREST POLICY. AS A RESULT OF THIS POLICY, EACH YEAR BOARD MEMEBERS, OFFICERS, AND SENIOR STAFF COMPLETE A FORM DISCLOSING ANY CONFLICTS OF INTEREST THEY MAY HAVE. THE COMPLIANCE OFFICE REVIEWS THESE DISCLOSURE FORMS AND INFORMS THE BOARD CHAIRMAN, AND OTHER APPROPRIATE OFFICERS, OF NOTABLE CONFLICTS, IF ANY. THOSE WITH CONFLICTS ARE ASKED TO RECUSE THEMSELVES FROM DISCUSSIONS RELATING TO THE CONFLICT.
FORM 990, PART VI, SECTION B, LINE 15	THE AULTMAN HEALTH FOUNDATION AND ITS AFFILIATED ENTITIES USE THE FOLLOWING REFERENCE MATERIALS FOR THE DEVELOPMENT OF EXECUTIVE COMPENSATION: OHIO HOSPITAL ASSOCIATION (OHA), MERCER INTEGRATED HEALTH NETWORK, INCLUDING SURVEY DATA FOR BOTH HOSPITALS AND HEALTH PLANS, AND SULLIVAN COTTER AND ASSOCIATES (SCA). ADDITIONAL SOURCES OF SALARY SURVEY DATA ARE AVAILABLE FOR USE WHERE APPROPRIATE INCLUDING COMPDATASURVEYS.COM, SALARY.COM, AND CHAMPS. IN THESE CASES, THE SURVEY IS REFERENCED WHERE APPLICABLE. EXECUTIVE PERFORMANCE, WAGE RECOMMENDATIONS AND BONUS PAYMENTS ARE REVIEWED BY THE CEO PRIOR TO REVIEW AND APPROVAL BY THE COMPENSATION COMMITTEE OF THE AULTMAN HEALTH FOUNDATION BOARD OF DIRECTORS. THE CEO'S COMPENSATION IS ALSO REVIEWED AND APPROVED BY THE COMPENSATION COMMITTEE. THE COMPENSATION COMMITTEE OF THE AULTMAN HEALTH FOUNDATION BOARD OF DIRECTORS HAS ENGAGED SULLIVAN COTTER & ASSOCIATES, INC., AN INDEPENDENT COMPENSATION CONSULTING FIRM FOR REVIEW OF EXECUTIVE COMPENSATION PRACTICES. THE AULTMAN HEALTH FOUNDATION AND ITS AFFILIATED ENTITIES USE THE FOLLOWING REFERENCE MATERIALS FOR THE DEVELOPMENT OF PHYSICIAN COMPENSATION: MEDICAL GROUP MANAGEMENT ASSOCIATES (MGMA), AMERICAN MEDICAL GROUP ASSOCIATION (AMGA), HOSPITAL AND HEALTHCARE COMPENSATION SERVICE (HHCS) AND SULLIVAN COTTER AND ASSOCIATES (SCA). IN ADDITION TO SALARY SURVEYS, AULTMAN HOSPITAL ALSO RETAINS AN INDEPENDENT CONSULTING FIRM FOR PHYSICIANS COMPENSATION SERVICES. ALL PHYSICIAN COMPENSATION RECOMMENDATIONS ARE SENT TO THE CEO, VP OF PHYSICIAN SERVICES, COO, AND CNO FOR FINAL APPROVAL.
FORM 990, PART VI, SECTION C, LINE 19	AULTMAN HEALTH FOUNDATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST.
PART VI, SECTION A, LINE 2	EDWARD ROTH III IS A PAID EMPLOYEE OF THE ORGANIZATION. CHRISTOPHER REMARK, RICK HAINES, MILAN DOPIRAK MD, MICHAEL LYNCH MD, AND MICHAEL RICH MD ARE PAID EMPLOYEES OF A RELATED ORGANIZATION.
FORM 990, PART IX, LINE 11G	CONSULTING FEES: PROGRAM SERVICE EXPENSES 1,104,643. MANAGEMENT AND GENERAL EXPENSES 259,114. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,363,757. PURCHASED MAINTENANCE: PROGRAM SERVICE EXPENSES 1,566,992. MANAGEMENT AND GENERAL EXPENSES 367,566. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,934,558. ASH PATIENT SERVICES: PROGRAM SERVICE EXPENSES 881,186. MANAGEMENT AND GENERAL EXPENSES 206,698. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,087,884. OTHER CONTRACTED SERVICES: PROGRAM SERVICE EXPENSES 2,760,675. MANAGEMENT AND GENERAL EXPENSES 647,565. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,408,240. PROFESSIONAL FEES - PHYSICIAN : PROGRAM SERVICE EXPENSES 165,418. MANAGEMENT AND GENERAL EXPENSES 38,802. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 204,220. PROFESSIONAL FEES - NONPHYSICIAN : PROGRAM SERVICE EXPENSES 24,690. MANAGEMENT AND GENERAL EXPENSES 5,791. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 30,481. HOSPITAL FRANCHISE FEE: PROGRAM SERVICE EXPENSES 82,354. MANAGEMENT AND GENERAL EXPENSES 19,318. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 101,672.
FORM 990, PART XI, LINE 9:	INTERFUND TRANSFERS 51,581,011. SUBPART F INCOME -442,774. CHANGE IN VALUE OF INVESTMENT IN IHC 1,952,084.
FEDERAL ELECTIONS	SECTION 1.263(A)-1(F) DE MINIMIS SAFE HARBOR ELECTION AULTMAN HEALTH FOUNDATION 2600 SIXTH STREET SW CANTON, OH 44710 EMPLOYER IDENTIFICATION NUMBER: 34-1445390 FOR THE YEAR ENDING DECEMBER 31, 2019 AULTMAN HEALTH FOUNDATION IS MAKING THE DE MINIMIS SAFE HARBOR ELECTION UNDER REG. SEC. 1.263(A)-1(F).

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.

Cat. No. 51056K

Schedule O (Form 990 or 990-EZ) 2019

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE R
(Form 990)

Department of the Treasury
Internal Revenue Service

Related Organizations and Unrelated Partnerships

Complete if the organization answered "Yes" on Form 990, Part IV, line 33, 34, 35b, 36, or 37.
MediumBullet

Attach to Form 990.
MediumBullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2019

Open to Public Inspection

Name of the organization

AULTMAN HEALTH FOUNDATION

Employer identification number

34-1445390

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) AULTMAN SPECIALTY HOSPITAL 2600 SIXTH ST SW CANTON,OH44710 13-4246188	LONG-TERM ACUTE CARE	OH	7,172,919	4,623,017	AULTMAN HEALTH FOUNDATION
(2) INTEGRATED HEALTH COLLABORATIVE LLC 2600 SIXTH ST SW CANTON,OH44710 45-4325320	HEALTH COLLABORATIVE	OH	1,682,558	63,128	AULTMAN HEALTH FOUNDATION
(3) AULTMAN INNOVATIONS LLC 2600 SIXTH ST SW CANTON,OH44710 81-0847842	IP HOLDING AND MARKETING	OH	0	1,877	AULTMAN HEALTH FOUNDATION

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?
(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	Yes	No
(1)AULTMAN HOSPITAL 2600 SIXTH ST SW CANTON,OH44710 34-0714538	HOSPITAL	OH	501(C)(3)	LINE 3	AULTMAN HEALTH FOUNDATION	Yes
(2)THE AULTMAN FOUNDATION 2600 SIXTH ST SW CANTON,OH44710 20-8090459	FUNDRAISING	OH	501(C)(3)	LINE 7	AULTMAN HEALTH FOUNDATION	Yes
(3)ORRVILLE HOSPITAL FOUNDATION (DBA AULTMAN ORRVILLE HOSPITAL) 832 S MAIN ST ORRVILLE,OH44667 34-0733138	HOSPITAL	OH	501(C)(3)	LINE 3	AULTMAN HEALTH FOUNDATION	Yes
(4)AULTMAN COLLEGE OF NURSING AND HEALTH 2600 SIXTH ST SW CANTON,OH44710 20-1359433	COLLEGE	OH	501(C)(3)	LINE 2	AULTMAN HOSPITAL		No
(5)AULTMAN NORTH CANTON MEDICAL GROUP 2600 SIXTH ST SW CANTON,OH44710 34-1088530	HEALTHCARE	OH	501(C)(3)	LINE 10	AULTMAN HEALTH FOUNDATION	Yes
(6)TUSCARAWAS VALLEY REGIONAL CANCER CENTER 300 MEDICAL PARK DRIVE DOVER,OH44622 31-1689698	MEDICAL SERVICE	OH	501(C)(3)	LINE 3	N/A		No
(7)DARTMOUTH CHILD CARE CENTER CONTRACTING SERVICES INC 125 DARTMOUTH AVE SW CANTON,OH44710 34-1652364	SUPPORT ORGANIZATION	OH	501(C)(3)	LINE 12C, III-FI	AULTMAN HOSPITAL	Yes
(8)AULTMAN RADIATION ONCOLOGY OF ALLIANCE COMMUNITY HOSPITAL 885 S SAWBURG AVE ALLIANCE,OH44601 81-4224503	MEDICAL SERVICE	OH	501(C)(3)	LINE 3	AULTMAN HOSPTIAL	Yes
(9)ALLIANCE COMMUNITY HOSPITAL 200 E STATE STREET ALLIANCE,OH44601 34-0714581	HOSPITAL	OH	501(C)(3)	LINE 3	AULTMAN HEALTH FOUNDATION	Yes
(10)CARING HANDS INC 885 S SAWBURG AVE ALLIANCE,OH44601 34-1505340	PRIVATE DUTY NURSING	OH	501(C)(3)	LINE 10	ALLIANCE COMMUNITY HOSPITAL	Yes
(11)ALLIANCE COMMUNITY HOSPITAL AUXILIARY 200 E STATE STREET ALLIANCE,OH44601 34-0777659	SUPPORT ORGANIZATION	OH	501(C)(3)	LINE 12C, III-FI	ALLIANCE COMMUNITY HOSPITAL	Yes
(12)IHN SOURCING GROUP 2600 SIXTH ST SW CANTON,OH44710 45-1731318	SUPPORT ORGANIZATION	OH	501(C)(3)	LINE 12C, III-FI	AULTMAN HOSPITAL	Yes

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50135Y

Schedule R (Form 990) 2019

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
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity		(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No
(1) WEST TUSCARAWAS PROPERTY MANAGEMENT LLC 2600 SIXTH ST SW CANTON,OH44710 20-0090246	PROPERTY MGMT	OH	AULTCARE INSURANCE COMPANY	EXCLUDED	928,902	21,487,903		No			No	100.000 %
(2) AULTMAN ONCOLOGY CENTER OF EXCELLENCE LLC 2600 SIXTH ST SW CANTON,OH44710 45-4215510	HEALTHCARE	OH	AULTMAN HOSPITAL	RELATED	164,156	3,429		No			No	81.030 %
(3) IHN POST-ACUTE NETWORK LLC 2821 WOODLAWN AVE NW CANTON,OH44708 81-3136598	HEALTHCARE	OH	AULTMAN HOSPITAL	RELATED	-68,845	100,329		No			No	73.400 %

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?
(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		Yes	No
(1) MCKINLEY ASSURANCE SPC PO BOX 1051 GEORGE TOWN,GRAND CAYMANS CJ 98-0468384	PORTFOLIO	CJ	AULTMAN HEALTH FOUNDATION	C	9,959,571	24,043,606	100.000 %	Yes
(2) AULTCARE CORPORATION 2600 SIXTH ST SW CANTON,OH44710 34-1488123	PREF. PROVIDER ORG.	OH	N/A	C					No
(3) AULTCARE HOLDING COMPANY 2600 SIXTH ST SW CANTON,OH44710 47-1165287	HOLDING COMPANY	OH	AULTMAN HEALTH FOUNDATION	C			100.000 %	Yes
(4) NORTH CENTRAL MEDICAL RESOURCES INC 2600 SIXTH ST SW CANTON,OH44710 34-1610344	MEDICAL EQUIPMENT RENTAL	OH	AULTCARE HOLDING COMPANY	C	5,107,332	238,410,989	100.000 %	Yes
(5) OHIO SPECIALTY PHYSICIANS CORPORATION 2600 SIXTH ST SW CANTON,OH44710 34-1853300	HEALTH SERVICES	OH	NORTH CENTRAL MEDICAL RESOURCES	C	2,286,589	238,728	100.000 %	Yes
(6) OHIO HOSPITAL BASED PHYSICIANS CORP 2600 SIXTH ST SW CANTON,OH44710 34-1871647	HEALTH SERVICES	OH	NORTH CENTRAL MEDICAL RESOURCES	C	18,298,510	1,671,044	100.000 %	Yes
(7) OHIO PHYSICIANS PROFESSIONAL CORP 2600 SIXTH ST SW CANTON,OH44710 31-1509897	HEALTH SERVICES	OH	NORTH CENTRAL MEDICAL RESOURCES	C	31,199,852	2,840,788	100.000 %	Yes
(8) AULTMAN MSO 2600 SIXTH ST SW CANTON,OH44710 31-1509904	ADMIN SERVICES	OH	NORTH CENTRAL MEDICAL RESOURCES	C	898,681	249,201	100.000 %	Yes
(9) AULTCARE HEALTH INSURING CORPORATION 2600 SIXTH ST SW CANTON,OH44710 46-3305099	INSURANCE	OH	AULTCARE HOLDING COMPANY	C	253,532,283	123,839,036	100.000 %	Yes
(10) AULTCARE INSURANCE COMPANY 2600 SIXTH ST SW CANTON,OH44710 34-1624818	INSURANCE	OH	AULTCARE HEALTH INSURING CORPORATION	C	271,922,494	95,809,699	100.000 %	Yes
(11) AULTRA ADMINISTRATIVE GROUP 2600 SIXTH ST SW CANTON,OH44710 20-4951704	ADMIN SERVICE	OH	AULTCARE HOLDING COMPANY	C	2,551,468	476,082	100.000 %	Yes
(12) AULTCOMP MCO INC 2600 SIXTH ST SW CANTON,OH44710 27-4379962	HEALTH SERVICES	OH	AULTRA ADMINISTRATIVE GROUP	C	2,500,462	67,469	100.000 %	Yes
(13) WAYNE HEALTH SERVICES & SUPPLIES 2600 SIXTH ST SW CANTON,OH44710 34-1501390	MEDICAL SUPPLIES	OH	NORTH CENTRAL MEDICAL RESOURCES	C	-250,240	114,173	100.000 %	Yes
(14) AULTMAN MEDICAL GROUP 2600 SIXTH ST SW CANTON,OH44710 45-3166014	HEALTH SERVICES	OH	AULTCARE HOLDING COMPANY	C	20,703,464	9,199,033	100.000 %	Yes
(15) MAINSITE ASO LLC 2600 SIXTH ST SW CANTON,OH44710 47-3587655	HEALTH SERVICES	OH	AULTCARE HOLDING COMPANY	C	33,600	25,427	100.000 %	Yes
(16) HEALTH ALLIANCE INC 2600 SIXTH ST SW CANTON,OH44710 34-1531993	HEALTH SERVICES	OH	NORTH CENTRAL MEDICAL RESOURCES	C	1,112,371	257,573	100.000 %	Yes

Schedule R (Form 990) 2019

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

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 .....................

b Gift, grant, or capital contribution to related organization(s) ............................

Yes

c Gift, grant, or capital contribution from related organization(s) ............................

d Loans or loan guarantees to or for related organization(s) ............................

Yes

e Loans or loan guarantees by related organization(s) ............................

f Dividends from related organization(s) ............................

g Sale of assets to related organization(s) ............................

h Purchase of assets from related organization(s) ............................

i Exchange of assets with related organization(s) ............................

j Lease of facilities, equipment, or other assets to related organization(s) .......................

Yes

k Lease of facilities, equipment, or other assets from related organization(s) ......................

Yes

l Performance of services or membership or fundraising solicitations for related organization(s) .....................

Yes

m Performance of services or membership or fundraising solicitations by related organization(s) .................

Yes

n Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) ...................

Yes

o Sharing of paid employees with related organization(s) ............................

Yes

p Reimbursement paid to related organization(s) for expenses ............................

Yes

q Reimbursement paid by related organization(s) for expenses ............................

Yes

r Other transfer of cash or property to related organization(s) ............................

Yes

s Other transfer of cash or property from related organization(s) ............................

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) THE AULTMAN FOUNDATION	B	104,148	FMV
(2) AULTMAN HOSPITAL	K	352,621	FMV
(3) AULTMAN HOSPITAL	P	1,284,198	FMV
(4) AULTCARE INSURANCE COMPANY	Q	1,312,106	FMV
(5) AULTMAN HOSPITAL	Q	39,044,067	FMV
(6) ORRVILLE HOSPITAL FOUNDATION (DBA AULTMAN ORRVILLE HOSPITAL)	Q	223,452	FMV

Schedule R (Form 990) 2019

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)	(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?
(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	Yes	No	(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No

Schedule R (Form 990) 2019

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) 2019

Additional Data

Software ID:
Software Version:

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	0	530
9	Program service revenue (Part VIII, line 2g) .........	47,979,263	51,060,546
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	7,708,145	4,057,898
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	716,068	0
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)	56,403,476	55,118,974
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	1,025,804	1,102,393
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)	27,190,989	29,026,556
16a	Professional fundraising fees (Part IX, column (A), line 11e) .....	0	0
b	Total fundraising expenses (Part IX, column (D), line 25) 0
17	Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e)....	23,614,716	25,700,699
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	51,831,509	55,829,648
19	Revenue less expenses. Subtract line 18 from line 12.......	4,571,967	-710,674
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	433,220,948	485,704,990
21	Total liabilities (Part X, line 26).............	149,079,203	148,054,830
22	Net assets or fund balances. Subtract line 21 from line 20.....	284,141,745	337,650,160

Sign Here

	Signature of officer	Date

	Type or print name and title


4a	(Code: ) (Expenses $ 21,456,214 including grants of $ 0 ) (Revenue $ 22,917 )
	WITH 120 EMPLOYEES, THE AULTMAN SYSTEMS AND TECHNOLOGY DEPARTMENT PROVIDES THE TECHNICAL INFRASTRUCTURE FOR BUSINESS AND CLINICAL SYSTEMS THROUGHOUT AHF, ITS SATELLITE FACILITIES AND SUBSIDIARIES. THE SYSTEMS AND TECHNOLOGY TEAM HANDLES EVERYTHING RELATED TO INFORMATION TECHNOLOGY AT AULTMAN HEALTH FOUNDATION - INCLUDING HARDWARE, SOFTWARE DATA SECURITY AND INTERNAL CUSTOMER SUPPORT.

4b	(Code: ) (Expenses $ 5,139,212 including grants of $ 0 ) (Revenue $ 7,195,449 )
	THE AULTMAN SPECIALTY HOSPITAL, LOCATED ON THE MAIN AULTMAN CAMPUS, PROVIDES LONG-TERM ACUTE CARE FOR PATIENTS WITH MEDICALLY COMPLEX CONDITIONS. PATIENTS' AVERAGE LENGTH OF STAY IS 25 DAYS, AND THEY ARE TYPICALLY TRANSFERRED FROM AULTMAN ICU OR STEP-DOWN UNITS OR OTHER LOCAL HOSPITALS. IN 2019, 201 PATIENTS WERE CARED FOR AT THE AULTMAN SPECIALTY HOSPITAL. THE FACILITY'S QUALITY PROGRAM HAS BEEN ENHANCED IN THE AREAS OF IMPROVED PREVENTION OF SKIN BREAKDOWN, VENTILATOR-ASSOCIATED PNEUMONIA, LINE SEPSIS, AND CLOSTRIDIUM DIFFICILE.

4c	(Code: ) (Expenses $ 5,317,087 including grants of $ 0 ) (Revenue $ 200 )
	THE 29-MEMBER AULTMAN HEALTH FOUNDATION HUMAN RESOURCES DEPARTMENT PROVIDES SUPPORT SERVICES RELATIVE TO EMPLOYEE BENEFITS, COMPENSATION, EDUCATION AND DEVELOPMENT, EMPLOYEE RECRUITING, NEW-HIRE ORIENTATION, DIVERSITY AND INCLUSION, AND EMPLOYEE EVENTS ACROSS AHF FACILITIES.

	(Code: ) (Expenses $ 13,727,880 including grants of $ 1,102,393 ) (Revenue $ 43,841,980 )
	AULTMAN HEALTH FOUNDATION (AHF) WAS FORMED AS A SUPPORT ENTITY AULTMAN HOSPITAL (AH) AND AHF'S SUBSIDIARIES. THIS STRUCTURE IS COMMON TO MANY HEALTH CARE SYSTEMS. AHF PERFORMS ACTIVITIES THAT DIRECTLY AND INDIRECTLY IMPACT AH. THERE IS A CLOSE WORKING RELATIONSHIP BETWEEN AHF AND AH AND SUBSTANTIAL RESOURCES OF AHF ARE COMMITTED TO FURTHERING THE AH MISSION.

4d	Other program services (Describe in Schedule O.)
	(Expenses $ 13,727,880 including grants of $ 1,102,393 ) (Revenue $ 43,841,980 )
4e	Total program service expenses45,640,393

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)...........	6,028,623	8,038,059	2,081,370

		Business Code
2a	HEALTH SYSTEM ADMINISTRATION	561000	40,643,974	40,643,974
b	PATIENT SERVICE REVENUE	624100	7,195,449	7,195,449
c	OTHER INCOME	561000	2,201,134	2,201,134
d	PROPERTY MANAGEMENT REVENUE	561000	1,019,989	1,019,989
e
f	All other program service revenue.
g	Total. Add lines 2a–2f .....		51,060,546

1	Briefly describe the organization’s mission or most significant activities: THE MISSION OF AULTMAN HEALTH FOUNDATION IS TO "LEAD OUR COMMUNITY TO IMPROVED HEALTH."
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a) ........	3	75
4	Number of independent voting members of the governing body (Part VI, line 1b) .....	4	60
5	Total number of individuals employed in calendar year 2019 (Part V, line 2a) ......	5	481
6	Total number of volunteers (estimate if necessary) .............	6	40
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 39 .........	7b	0

1a	Federated campaigns..		1a
b	Membership dues..		1b
c	Fundraising events..		1c
d	Related organizations		1d
e	Government grants (contributions)		1e

f	All other contributions, gifts, grants, and similar amounts not included above		1f	530

g	Noncash contributions included in lines 1a - 1f:$		1g

h Total. Add lines 1a-1f.......		530

3 Investment income (including dividends, interest, and othersimilar amounts) ......			4,109,303			4,109,303
4 Income from investment of tax-exempt bond proceeds
5 Royalties...........
		(ii) Personal	(i) Real
6a	Gross rents			6a
b	Less: rental expenses			6b
c	Rental income or (loss)			6c
d	Net rental income or (loss).......
		(ii) Other	(i) Securities
7a	Gross amount from sales of assets other than inventory		1,406,825	7a
b	Less: cost or other basis and sales expenses		1,458,230	7b
c	Gain or (loss)		-51,405	7c
d	Net gain or (loss).........			-51,405			-51,405
8a	Gross income from fundraising events (not including $ of contributions reported on line 1c). See Part IV, line 18 ....
			8a
b	Less: direct expenses ...		8b
c	Net income or (loss) from fundraising events..
9a	Gross income from gaming activities. See Part IV, line 19 ...
			9a
b	Less: direct expenses ...		9b
c	Net income or (loss) from gaming activities..
10a	Gross sales of inventory, less returns and allowances ..
			10a
b	Less: cost of goods sold ..		10b
c	Net income or (loss) from sales of inventory..
Business Code			Miscellaneous Revenue
11a
b
c
d	All other revenue ....
e	Total. Add lines 11a–11d ......
12	Total revenue. See instructions.....			55,118,974	51,060,546	0	4,057,898

1	Grants and other assistance to domestic organizations and domestic governments. See Part IV, line 21 ....	1,081,893	1,081,893
2	Grants and other assistance to domestic individuals. See Part IV, line 22 ...........	20,500	20,500
3	Grants and other assistance to foreign organizations, foreign governments, and foreign individuals. See Part IV, lines 15 and 16. .............
4	Benefits paid to or for members .......
5	Compensation of current officers, directors, trustees, and key employees ...........	5,027,924	4,072,618	955,306
6	Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) .........
7	Other salaries and wages........	19,081,765	15,456,230	3,625,535
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	690,645	559,423	131,222
9	Other employee benefits .......	2,460,737	1,993,197	467,540
10	Payroll taxes ...........	1,765,485	1,430,042	335,443
11	Fees for services (non-employees):
a	Management ......	54,624	44,245	10,379
b	Legal .........	31,700	25,677	6,023
c	Accounting ...........	147,248	119,271	27,977
d	Lobbying ...........
e	Professional fundraising services. See Part IV, line 17
f	Investment management fees ......
g	Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O)	8,130,812	6,585,958	1,544,854
12	Advertising and promotion ....	61,517	49,829	11,688
13	Office expenses .......	371,179	300,655	70,524
14	Information technology ......	10,982,479	8,895,808	2,086,671
15	Royalties ..
16	Occupancy ...........	1,791,043	1,450,745	340,298
17	Travel ............	215,051	174,191	40,860
18	Payments of travel or entertainment expenses for any federal, state, or local public officials .
19	Conferences, conventions, and meetings ....	25,113	20,342	4,771
20	Interest ...........
21	Payments to affiliates .......
22	Depreciation, depletion, and amortization ..	601,939	487,571	114,368
23	Insurance ...	39,257	31,798	7,459
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	ALL OTHER EXPENSES	1,312,950	1,063,490	249,460
b	MEDICAL SUPPLIES	607,715	607,715
c	EDUCATION	580,088	469,871	110,217
d	MEDICATION	491,878	491,878
e	All other expenses	256,106	207,446	48,660
25	Total functional expenses. Add lines 1 through 24e	55,829,648	45,640,393	10,189,255	0
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 if following SOP 98-2 (ASC 958-720).

1	Cash–non-interest-bearing ........				1
2	Savings and temporary cash investments .........			2,190,126	2	573,943
3	Pledges and grants receivable, net ......				3
4	Accounts receivable, net .............			1,285,722	4	1,392,630
5	Loans and other payables to any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons .......
					5
6	Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), and persons described in section 4958(c)(3)(B) ...
					6
7	Notes and loans receivable, net ...........			1,107,916	7	1,107,916
8	Inventories for sale or use ............				8
9	Prepaid expenses and deferred charges ......			1,692,303	9	2,367,526
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	7,906,027
b	Less: accumulated depreciation	10b	4,502,799	3,589,945	10c	3,403,228
11	Investments—publicly traded securities .			50,090,181	11	75,268,014
12	Investments—other securities. See Part IV, line 11 .....				12
13	Investments—program-related. See Part IV, line 11 ..			372,029,657	13	395,342,700
14	Intangible assets ...............			0	14	1,716,667
15	Other assets. See Part IV, line 11 ...........			1,235,098	15	4,532,366
16	Total assets. Add lines 1 through 15 (must equal line 33)...			433,220,948	16	485,704,990

17	Accounts payable and accrued expenses .....	9,961,737	17	10,876,281
18	Grants payable ...		18
19	Deferred revenue .........	613,891	19	651,731
20	Tax-exempt bond liabilities .........	131,554,573	20	131,606,087
21	Escrow or custodial account liability. Complete Part IV of Schedule D		21
22	Loans and other payables to any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons .........
			22
23	Secured mortgages and notes payable to unrelated third parties ..	6,621,745	23	4,266,336
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	327,257	25	654,395
26	Total liabilities. Add lines 17 through 25..	149,079,203	26	148,054,830

	Organizations that follow FASB ASC 958, check here and complete lines 27, 28, 32, and 33.
27	Net assets without donor restrictions ..........	284,141,745	27	337,650,160
28	Net assets with donor restrictions ...........		28
	Organizations that do not follow FASB ASC 958, check here and complete lines 29 through 33.
29	Capital stock or trust principal, or current funds .....		29
30	Paid-in or capital surplus, or land, building or equipment fund ...		30
31	Retained earnings, endowment, accumulated income, or other funds		31
32	Total net assets or fund balances ...........	284,141,745	32	337,650,160
33	Total liabilities and net assets/fund balances ........	433,220,948	33	485,704,990