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)	(F) Estimated amount of other compensation from the organization and related organizations
(1) T Clifford Deveny MD...................................................................... CEO SHS, Director SHS & SF	4.00 ................. 46.00	X	X			0	1,473,583	36,083
(2) Derek Klaus MD...................................................................... CLINICAL PHYSICIAN - SHMG	50.00 .................				X	1,286,463	0	40,393
(3) MARK POZSGAY DO...................................................................... ClINICAL PHYSICIAN - SHMG	50.00 .................				X	1,254,395	0	39,256
(4) JOHN G ZOGRAFAKIS MD...................................................................... clinICAL PHYSICIAN - SHMG	50.00 .................				X	1,148,989	0	38,118
(5) Anand Desai MD...................................................................... CLINICAL PHYSICIAN - SHMG	50.00 .................				X	1,124,428	0	9,998
(6) KIEL PFEFFERIE MD...................................................................... CliniCAL PHYSICIAN - SHMG	50.00 .................				X	1,066,909	0	29,046
(7) Peter Bittenbender MD...................................................................... DIR. SHS & DIR. SHMG	52.00 ................. 2.00	X				751,590	0	17,013
(8) Lydia Cook MD...................................................................... President Summa Health Med	50.00 .................		X			735,253	0	18,722
(9) David Custodio MD...................................................................... President, SHS	50.00 .................		X			715,592	0	35,051
(10) ROBERT A GERBERRY...................................................................... SHS SEC./SR. VP G.Counsel,	4.00 ................. 46.00		X			0	693,493	26,935
(11) KEITH T COLEMAN...................................................................... SVP CFO, TR. SHS & SHMG, A	4.00 ................. 46.00		X			0	644,672	23,623
(12) THOMAS P O'NEILL...................................................................... VP, CFO SHS, Assistant Tre	46.00 ................. 4.00		X			0	622,216	28,943
(13) Michael Hughes MD...................................................................... President Summa Barberton	50.00 .................			X		613,856	0	30,776
(14) PHYLIS FERRARA...................................................................... PRESIDENT & CDO, SF	50.00 .................	X	X			581,539	0	21,218
(15) Tammy Scarborough...................................................................... President Ambulatory Care	46.00 ................. 4.00			X		0	571,056	17,679
(16) Lori Rhine RN...................................................................... VP, CNO Akron & St. Thomas	50.00 .................			X		445,831	0	32,971
(17) Lynn Hamrich MD...................................................................... DIRECTOR SHS	52.00 ................. 2.00	X				263,257	0	27,281

(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)
(18) NICHOLAS BROWNING........................................................................ DIR. SHS & DIR. SHMG	2.00 .......................2.00	X
(19) Stephen Comunale........................................................................ DIRECTOR SHS	2.00 .......................2.00	X
(20) Barbara Faciana........................................................................ DIRECTOR SHS	2.00 .......................2.00	X
(21) Philip Kaufmann........................................................................ DIRECTOR SHS	2.00 .......................2.00	X
(22) George Strickler........................................................................ DIRECTOR SHS	2.00 .......................2.00	X
(23) Costas Kefalas MD........................................................................ DIRECTOR & Vice Chair SHS	4.00 .......................4.00	X	X
(24) DARYL CAMERON........................................................................ DIRECTOR SHS	2.00 .......................2.00	X
(25) Jeffrey Copeland........................................................................ DIRECTOR SHS	2.00 .......................2.00	X
(26) JAMES KRAVEC MD........................................................................ DIRECTOR SHS	2.00 .......................2.00	X
(27) Jason Seigert........................................................................ DIRECTOR SHS	2.00 .......................2.00	X
(28) ROBERT SHRODER........................................................................ DIRECTOR SHS	2.00 .......................2.00	X
(29) ANTHONY LOCKHART........................................................................ DIRECTOR & CHAIRMAN SHS	4.00 .......................4.00	X	X
(30) JAMES MCILVAINE........................................................................ DIR. SHS & CHAIR/DIR. SHMG	4.00 .......................2.00	X	X
(31) MARK ALLIO........................................................................ DIRECTOR SF	2.00 .......................	X
(32) KEN BABBY........................................................................ DIRECTOR SF (End 12/2019)	2.00 .......................	X
(33) JULIA BIANCHI........................................................................ DIRECTOR SF	2.00 .......................	X
(34) Bill Bauman MD........................................................................ DIRECTOR SF (started 12/2019)	2.00 .......................	X
(35) Karen Budd PhD RN........................................................................ DIRECTOR SF	2.00 .......................	X
(36) JASON BUTTERWORTH........................................................................ DIRECTOR SF	2.00 .......................	X
(37) Betsy Clark........................................................................ DIRECTOR SF	2.00 .......................	X
(38) STEVE COX........................................................................ DIRECTOR SF (Started 12/2019)	2.00 .......................	X
(39) GEORGE DAVERIO JR........................................................................ DIRECTOR SF	2.00 .......................	X
(40) C GORDON EWERS........................................................................ DIRECTOR SF	2.00 .......................	X
(41) KAY FRANKS........................................................................ DIRECTOR SF (Started 12/2019)	2.00 .......................	X
(42) William Ginter........................................................................ DIRECTOR SF	2.00 .......................	X
(43) IRIS E HARVEY........................................................................ DIRECTOR SF	2.00 .......................	X
(44) MARY ANN JACKSON........................................................................ DIRECTOR SF	2.00 .......................	X
(45) BARB JONES........................................................................ DIRECTOR SF (Start 6/2019)	2.00 .......................	X
(46) LYN JONES........................................................................ DIRECTOR SF (End 6/2019)	2.00 .......................	X
(47) TOM KNOLL........................................................................ DIRECTOR SF (Started 12/2019)	2.00 .......................	X
(48) Julie L Pulk........................................................................ DIRECTOR SF (End 12/31/2019)	2.00 .......................	X
(49) PATTY WARTKO........................................................................ DIRECTOR SF (Started 1/2019)	2.00 .......................	X
(50) R Mark Wernig........................................................................ DIRECTOR SF	2.00 .......................	X
(51) Gary Williams MD........................................................................ DIRECTOR SF (started 8/2019)	2.00 .......................	X
(52) THOMAS CLARK........................................................................ DIRECTOR/CHAIR SF	4.00 .......................	X	X
(53) PAUL TESTA........................................................................ DIRECTOR & Vice Chair SF	4.00 .......................	X	X
(54) Patrick O'Neill........................................................................ DIRECTOR & Secretary SF	4.00 .......................	X	X
(55) JONATHON PAVLOFF........................................................................ DIRECTOR & Treas. SF	4.00 .......................	X	X

- 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.
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Attach to Form 990 or Form 990-EZ.
right arrow

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

SUMMA HEALTH GROUP RETURN

Employer identification number

90-0640432

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) Summa Health System	340714755	3	Yes		0	0

Total 1					0	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	(e) 2019	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grant.") ..	5,313,648	1,438,055	1	6,751,704
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	5,313,648	1,438,055	1	6,751,704
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)..				2,493,420
6	Public support. Subtract line 5 from line 4.				4,258,284

Section B. Total Support

Calendar year (or fiscal year beginning in)		(a) 2015	(b) 2016	(e) 2019	(f) Total
7	Amounts from line 4..	5,313,648	1,438,055	1	6,751,704
8	Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources...	212,488	98,245		310,733
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				7,062,437

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

1,483,177

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)) .........

60.290 %

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

81.490 %

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).

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?

Yes

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).

Yes

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.

Yes

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.

Yes

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.

Yes

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
Schedule A, Part I, Line 3, 7, 12:	SUMMA HEALTH SYSTEM, EIN 34-0714755, IS A SUBORDINATE MEMBER OF THE SUMMA HEALTH GROUP RULING. THE ORGANIZATION'S PUBLIC CHARITY STATUS IS AS A HOSPITAL ORGANIZATION DESCRIBED IN SECTION 170(B)(1)(A)(III). SUMMA PHYSICIANS, INC. DBA SUMMA HEALTH MEDICAL GROUP (SHMG), EIN 34-1790929, IS A SUBORDINATE MEMBER OF THE SUMMA HEALTH GROUP RULING. THE ORGANIZATION'S PUBLIC CHARITY STATUS IS SECTION 509(A)(3) TYPE III FUNCTIONALLY INTEGRATED AND MUST COMPLETE SCHEDULE A, PART IV, SECTIONS A, D, AND E. THE NUMBER OF SUPPORTING ORGANIZATIONS FOR LINE 12F IS 1. THE SUPPORTED ORGANIZATION FOR LINE 12G IS SUMMA HEALTH SYSTEM, EIN 34-0714755, WHOSE ORGANIZATION TYPE DESCRIBED ON LINES 1-10 IS 3, AND WHICH IS LISTED IN THE SHMG ORGANIZING DOCUMENTS. LISTING ZERO IN SUPPORT FOR LINE 12G COLUMN (V) AND (VI). SUMMA FOUNDATION, EIN 34-1219001, IS A SUBORDINATE MEMBER OF THE SUMMA HEALTH GROUP RULING. THE ORGANIZATION'S PUBLIC CHARITY STATUS IS 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) AND MUST COMPLETE SCHEDULE A PART II. PURSUANT TO THE INSTRUCTIONS FOR GROUP FILINGS, THE ABOVE LISTED ORGANIZATIONS HAVE SEPARATELY DOCUMENTED THEIR COMPLIANCE REQUIREMENTS ON SCHEDULE A, PART VI, SUPPLEMENTAL INFORMATION.
SCHEDULE A, PART II, SECTION A, PUBLIC SUPPORT:	SCHEDULE A PUBLIC SUPPORT SCHEDULE IS BEING PREPARED FOR SUMMA FOUNDATION, EIN 34-1219001. SUMMA FOUNDATION IS A SUBORDINATE MEMBER OF THE SUMMA HEALTH GROUP RULING. THE ORGANIZATION'S PUBLIC CHARITY STATUS IS 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) AND MUST COMPLETE SCHEDULE A PART II. THE ABOVE LISTED ORGANIZATION IS DOCUMENTING ITS PUBLIC SUPPORT PERCENTAGES AGGREGATED AS FOLLOWS: Part II, Section A. Public Support: Line 1 - column (a) 5,313,648, (b) 1,438,055, (c) 0, (d) 0, (e) 0, (f) 6,751,703; Line 4 - column (a) 5,313,648, (b) 1,438,055, (c) 0, (d) 0, (e) 0, (f) 6,751,703; Line 5 - column (f) 2,493,420; Line 6 - Public Support (f) 4,258,283 Part II, Section B. Total Support: Line 7 - column (a) 5,313,648, (b) 1,438,055, (c) 0, (d) 0, (e) 0, (f) 6,751,703; Line 8 - column (a) 212,488, (b) 98,245, (c) 0, (d) 0, (e) 0, (f) 310,733 Line 11 - Total support (f) 7,062,436 Line 12 Gross receipts from related activities (f) 1,483,177 Part II, Section C. Computation of Public Support Percentage: Line 14 - PUBLIC SUPPORT PERCENTAGE FOR 2019, SCHEDULE A, PART II, LINE 14 IS 60.29% Line 15 - PUBLIC SUPPORT PERCENTAGE FOR 2018, SCHEDULE A, PART II, LINE 15 IS 81.49% Line 16a Box = X
Schedule A, Part IV, Sections A, D, and E:	SHMG, EIN 34-1790929, IS A SUBORDINATE MEMBER OF THE SUMMA HEALTH GROUP RULING. THE ORGANIZATION'S PUBLIC CHARITY STATUS IS SECTION 509(A)(3) TYPE III FUNCTIONALLY INTEGRATED AND MUST COMPLETE SCHEDULE A, PART IV, SECTIONS A, D, AND E. THE ANSWERS PROVIDED ON SCHEDULE A, PART VI, FOR SCHEDULE A PART IV, SECTIONS A, D AND E ARE PROVIDED FOR SHMG.
Schedule A, Part IV, Section A, Line 1:	THE ANSWER TO FOR SCHEDULE A, PART IV, SECTION A, LINE 1 IS YES. SUPPORTED ORGANIZATIONS LISTED BY NAME: SHMG, EIN 34-1790929, WAS THE SUPPORTING ORGANIZATION TO THE FOLLOWING SUPPORTED ORGANIZATION - SUMMA HEALTH SYSTEM, INC. EIN 34-0714755. SUMMA HEALTH SYSTEM IS DESIGNATED AS A SUPPORTED ORGANIZATION BY NAME IN THE ARTICLES OF INCORPORATION OF SUMMA PHYSICIANS, INC. DBA SUMMA HEALTH MEDICAL GROUP. AN HISTORIC AND CONTINUING RELATIONSHIP OF SUPPORT EXISTS BETWEEN SUMMA PHYSICIANS, INC. DBA SUMMA HEALTH MEDICAL GROUP, AND SUMMA HEALTH SYSTEM, THE SUPPORTED HOSPITAL LISTED ON PART I LINE 12G.
Schedule A, Part IV, Section A, Lines 2 - 4a:	THE ANSWERS FOR SCHEDULE A, PART IV, SECTION A, LINES 2-4A ARE AS FOLLOWS: 2, NO 3A, NO 4A, NO
Schedule A, Part IV, Section A, Line 5a:	THE ANSWER FOR SCHEDULE A, PART IV, SECTION A, LINE 5A IS NO.
Schedule A, Part IV, Section A, Lines 6-11c :	THE ANSWERS FOR SCHEDULE A, PART IV, SECTION A, LINES 6 - 11C ARE AS FOLLOWS: 6, NO 7, NO 8, NO 9A-9C, NO 10A, NO 11A-11C, NO
Schedule A, Part IV, SECTION D, LINES 1-3:	THE ANSWERS FOR SCHEDULE A, PART IV, SECTION D, LINES 1 - 3 ARE AS FOLLOWS: 1, YES 2, YES 3, YES. Summa Health System has a significant voice in SHMG's investment policies and in directing the use of SHMG's income or assets at all time during the tax year through common board membership and through common control provided by Summa Health, the parent organization of Summa Health System, the supported organization.
Schedule A, Part IV, Section E, Line 1A:	SCHEDULE A, PART IV, SECTION E, LINE 1A IS "X"
Schedule A, Part IV, Section E, Line 2A:	THE ANSWER FOR SCHEDULE A, PART IV, SECTION E, LINE 2A IS YES: ORGANIZATION ACTIVITIES DIRECTLY FURTHER THE EXEMPT PURPOSES: SHMG PROMOTES THE STRONGER AFFILIATION AND EMPLOYMENT OF PHYSICIANS TO ENSURE THE SUPPORTED HOSPITALS LISTED IN PART I LINE 12G MEET COMMUNITY AND HOSPITAL NEEDS FOR PHYSICIAN SERVICES, AND ALSO DEVELOPS PHYSICIAN COVERAGE IN NEW MARKETS. SHMG DIRECTORS AND OFFICERS SERVE AS DIRECTORS AND OFFICERS ON THE BOARDS OF THE SUPPORTED ORGANIZATIONS, ENSURING RESPONSIVENESS. SHMG'S PROGRAM SERVICE ACCOMPLISHMENTS INCLUDE HOSPITAL-BASED PRACTICES, MISSION-BASED PRACTICES, AND STRATEGIC-BASED PRACTICES, ALL BASED EXCLUSIVELY IN THE IDENTIFIED SUPPORTED HOSPITAL AND CONSTITUTING SUBSTANTIALLY ALL OF SHMG'S ACTIVITIES.
Schedule A, Part IV, Section E, Line 2B:	THE ANSWER FOR SCHEDULE A, PART IV, SECTION E, LINE 2B IS YES. ACTIVITIES THAT ONE OR MORE SUPPORTED ORGANIZATIONS ENGAGED IN: BUT FOR SHMG'S WORK TO ENSURE A STRONG AFFILIATION AND EMPLOYMENT OF PHYSICIANS TO ENSURE THE SUPPORTED HOSPITAL LISTED IN PART I LINE 12G MEETS COMMUNITY AND HOSPITAL NEEDS FOR PHYSICIAN SERVICES, THE IMPORTANT RELATIONSHIPS BETWEEN THE SUPPORTED HOSPITAL AND ITS PHYSICIANS WOULD HAVE TO BE MANAGED BY THE HOSPITAL.

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

SUMMA HEALTH GROUP RETURN

Employer identification number

90-0640432

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

Yes

7,488

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

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

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

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

7,488

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:	The amount on Line 1(f) represents the portion of annual dues to the Ohio Hospital Association allocable to lobbying activities.

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

SUMMA HEALTH GROUP RETURN

Employer identification number

90-0640432

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 ....	21,923,498	22,691,956	20,437,936	19,720,810	19,966,435
b	Contributions ...	3,075,711	-86,257	426,808	66,105	313,575
c	Net investment earnings, gains, and losses	1,419,744	-682,201	1,827,212	651,021	-559,200
d	Grants or scholarships ...
e	Other expenditures for facilities and programs ...
f	Administrative expenses ....
g	End of year balance ......	26,418,953	21,923,498	22,691,956	20,437,936	19,720,810

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 .....	76,079,708		76,079,708
b	Buildings ....	856,462,656	470,166,603	386,296,053
c	Leasehold improvements	6,991,050	3,169,714	3,821,336
d	Equipment ....	510,199,482	405,515,765	104,683,717
e	Other .....	66,150,344	22,412,976	43,737,368
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).)..				614,618,182

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

(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)

Part IX

Other Assets.
Complete if the organization answered 'Yes' on Form 990, Part IV, line 11d. See Form 990, Part X, line 15.

(a) Description				(b) Book value
(1)Non-Perf Asset Air Rights				491,870
(2)Taxes receivable				758,198
(3)Other Accounts Receivable				68,571
(4)Beneficial Interest in Property				3,175,838
(5)Due from Related Organizations				597,512,570
(6)Right of Use Assets				23,879,918
(7)Interest rate swap				4,931,000
(8)
(9)
(10)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........				630,817,965

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
Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)	322,265,508
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:

Endowment funds provide income to be used to fulfill the tax-exempt purposes of Summa Foundation.

Part X, Line 2:

Summa and most of its subsidiaries are not-for-profit corporations as described in Section 501(c)(3) of the Internal Revenue Code (the Code) and are exempt from federal income taxes pursuant to Section 501(a) of the Code. Summa also has certain subsidiaries that are taxable for federal income tax purposes. SC, together with affiliates of SHSC, files a consolidated federal income tax return in accordance with a tax-sharing agreement dated January 1, 2010. The entities utilize a consolidated approach to the allocation of federal income taxes, whereas SHSC's tax-sharing agreement with its subsidiaries allows it to make certain Code elections in its consolidated federal tax return. In the event such Code elections are made, any benefit or liability is the responsibility of SHSC and is accrued and paid by the participating subsidiaries. SC is not subject to state income taxes as it is licensed as a health insurance company under Chapter 1751 of the Ohio Revised Code. Deferred tax assets and liabilities are recognized for the future tax consequences attributable to differences between the financial statement carrying amounts of existing assets and liabilities and the respective tax basis and operating loss and tax credit carryforwards. Deferred tax assets and liabilities are measured using enacted tax rates expected to apply to taxable income in the years in which those temporary differences are expected to be recovered or settled. The effect on deferred tax assets and liabilities of a change in tax rates is recognized in income in the period that includes the enactment date. Summa recognizes interest income, interest expense, and penalties related to uncertain tax positions within the provision for income tax.

Schedule D (Form 990) 2019

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE F(Form 990)

Department of the Treasury
Internal Revenue Service

Statement of Activities Outside the United States

Complete if the organization answered "Yes" to Form 990, Part IV, line 14b, 15, or 16. Right pointing arrow large image

Attach to Form 990. Right pointing arrow large image

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
SUMMA HEALTH GROUP RETURN

Employer identification number

90-0640432

Part I

General Information on Activities Outside the United States. Complete if the organization answered "Yes" on Form 990, Part IV, line 14b.

For grantmakers. Does the organization maintain records to substantiate the amount of its grants and

other assistance, the grantees’ eligibility for the grants or assistance, and the selection criteria used

to award the grants or assistance? . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

For grantmakers. Describe in Part V the organization’s procedures for monitoring the use of its grants and other assistance outside the United States.

Activites per Region. (The following Part I, line 3 table can be duplicated if additional space is needed.)

(a) Region		(b) Number of offices in the region	(c) Number of employees, agents, and independent contractors in the region	(d) Activities conducted in region (by type) (such as, fundraising, program services, investments, grants to recipients located in the region)	(e) If activity listed in (d) is a program service, describe specific type of service(s) in the region	(f) Total expenditures for and investments in the region
	Central America and the Caribbean	1	0	Program services	Self insurance	9,962,846
















3a	Sub-total ....	1	0			9,962,846
b	Total from continuation sheets to Part I ...	0	0			0
c	Totals (add lines 3a and 3b)	1	0			9,962,846

For Paperwork Reduction Act Notice, see the Instructions for Form 990.Cat. No. 50082W Schedule F (Form 990) 2019

Schedule F (Form 990) 2019

Page 2

Part II

Grants and Other Assistance to Organizations or Entities Outside the United States. Complete if the organization answered "Yes" on Form 990, Part IV, line 15, for any recipient who received more than $5,000. Part II can be duplicated if additional space is needed.

1 (a) Name of organization		(b) IRS code section and EIN (if applicable)	(c) Region	(d) Purpose of grant	(e) Amount of cash grant	(f) Manner of cash disbursement	(g) Amount of noncash assistance	(h) Description of noncash assistance	(i) Method of valuation (book, FMV, appraisal, other)

2	Enter total number of recipient organizations listed above that are recognized as charities by the foreign country, recognized as tax-exempt by the IRS, or for which the grantee or counsel has provided a section 501(c)(3) equivalency letter .......
3	Enter total number of other organizations or entities .......................

Schedule F (Form 990) 2019

Schedule F (Form 990) 2019Page 3

Part III

Grants and Other Assistance to Individuals Outside the United States. Complete if the organization answered "Yes" on Form 990, Part IV, line 16.

Part III can be duplicated if additional space is needed.

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

Schedule F (Form 990) 2019

Page 4

Part IV

Foreign Forms

Schedule F (Form 990) 2019

Page 5

Part V

Supplemental Information
Provide the information required by Part I, line 2 (monitoring of funds); Part I, line 3, column (f) (accounting method; amounts of investments vs. expenditures per region); Part II, line 1 (accounting method); Part III (accounting method); and Part III, column (c) (estimated number of recipients), as applicable. Also complete this part to provide any additional information. See instructions.

ReturnReference	Explanation
Part I, line 3:	Central American and the Caribbean: Accrual
Part III Accounting Method:
SCHEDULE F, PART I, LINE 3(F)	EXPENDITURES: INSURANCE PREMIUMS PAID $9,962,846

Schedule F (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

SUMMA HEALTH GROUP RETURN

Employer identification number

90-0640432

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 25000.0000000000 %

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: . . . . . . . .

Yes

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? . . . . . .

Yes

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) . . .	45,484,370	30,264,891	15,219,479	1.400 %
b	Medicaid (from Worksheet 3, column a) . . . . .	171,770,205	131,465,628	40,304,577	3.710 %
c	Costs of other means-tested government programs (from Worksheet 3, column b) . .
d	Total Financial Assistance and Means-Tested Government Programs . . . . .	217,254,575	161,730,519	55,524,056	5.110 %
Other Benefits
e	Community health improvement services and community benefit operations (from Worksheet 4).	10,192,587	116,975	10,075,612	0.930 %
f	Health professions education (from Worksheet 5) . . .	38,648,386	11,195,403	27,452,983	2.520 %
g	Subsidized health services (from Worksheet 6) . . . .	36,018,540	0	36,018,540	3.310 %
h	Research (from Worksheet 7) .	7,926,445	521,961	7,404,484	0.680 %
i	Cash and in-kind contributions for community benefit (from Worksheet 8) . . . .	2,016,075		2,016,075	0.190 %
j	Total. Other Benefits . .	94,802,033	11,834,339	82,967,694	7.630 %
k	Total. Add lines 7d and 7j .	312,056,608	173,564,858	138,491,750	12.740 %

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)	(c) Total community building expense	(e) Net community building expense	(f) Percent of total expense
1	Physical improvements and housing
2	Economic development	1	12,630	12,630	0 %
3	Community support
4	Environmental improvements
5	Leadership development and training for community members
6	Coalition building
7	Community health improvement advocacy	1	350	350	0 %
8	Workforce development	1	12,526	12,526	0 %
9	Other
10	Total	3	25,506	25,506	0 %

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. ......

17,068,000

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).....

152,605,644

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

155,188,239

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

-2,582,595

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 %
11 Digestive Health Center LLC	Digestive Disease	5.000 %	0 %	44.000 %
22 Medina-Summit ASC LLC	Ambulatory Surgery Center	21.280 %	0 %	70.000 %
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?2Name, 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	Summa Health System 525 East Market Street Akron,OH44304 www.summahealth.org 1275	X	X	X	X	X
2	Summa Rehab Hospital LLC 29 North Adams Street Akron,OH44304 www.summarehabhospital.com 1503	X		X			Rehabilitation

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)

	Summa Health System
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, PAGE 8

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 17

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

Yes

If "Yes" (list url): SEE PART V, PAGE 8

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)

	Summa Health System
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 250.000000000000%
and FPG family income limit for eligibility for discounted care of 400.000000000000%

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

	Summa Health System
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)

	Summa Health System
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 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)

	Summa Rehab Hospital LLC
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?........................

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

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, PAGE 8

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 17

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

Yes

If "Yes" (list url): SEE PART V, PAGE 8

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

10b

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)

	Summa Rehab Hospital LLC
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 250.000000000000%
and FPG family income limit for eligibility for discounted care of 400.000000000000%

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

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)

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

	Summa Rehab Hospital LLC
Name of hospital facility or letter of facility reporting group

Yes

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

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

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)

	Summa Rehab Hospital LLC
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 prospective Medicare or Medicaid method

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
Summa Health System	Part V, Section B, Line 5: Input from persons who represent broad interests of community served:Summa Health System:IN 2019 SUMMA HEALTH PARTNERED WITH SUMMIT COUNTY PUBLIC HEALTH (SCPH) AND THE SUMMIT COALITION FOR COMMUNITY HEALTH IMPROVEMENT (SCCHI) TO CONDUCT THE 2019 CHNA. DURING THE PROCESS, OVER 200 INDICATORS WERE REVIEWED, AND COMMUNITY LEADERS AND RESIDENTS WERE CONSULTED. THE 2019 CHNA WAS COMPLETED USING THE NATIONAL ASSOCIATION OF COUNTY AND CITY HEALTH OFFICIALS (NACCHO) MODIFIED-MOBILIZING ACTION THROUGH PARTNERSHIP AND PLANNING (MAPP) PROCESS. THIS PROCESS WAS FACILITATED BY SCPH AND CONDUCTED WITH THE SCCHI. SCCHI IS A 40+ MEMBER COLLABORATIVE WITH THE MISSION OF IDENTIFYING KEY HEALTH PRIORITIES IN SUMMIT COUNTY AND COORDINATING ACTION TO IMPROVE POPULATION HEALTH AND PROMOTE HEALTH EQUITY FOR ALL. THESE COMMUNITY LEADERS PROVIDE A PERSPECTIVE ON THE BROAD INTERESTS OF THE GROUPS SERVED BY THE HOSPITAL FACILITY, INCLUDING THE MEDICALLY UNDERSERVED, LOW-INCOME PERSONS, MINORITY GROUPS. SCPH EPIDEMIOLOGY GATHERED DATA FROM A VARIETY OF SOURCES INCLUDING COUNTY HEALTH RANKINGS, AMERICAN COMMUNITY SURVEY, AND COMMUNITY HEALTH STATUS INDICATORS. SCPH ALSO UTILIZED THE 2018 YOUTH RISK BEHAVIORAL SURVEY, THE OHIO DEPARTMENTS OF HEALTH BIRTH AND DEATH DATA, AND EPICENTER. QUALITATIVE DATA COLLECTED THROUGH SURVEYS, FOCUS GROUPS AND COMMUNITY MEETINGS WERE ALSO UTILIZED TO GATHER INFORMATION ABOUT HOW SUMMIT COUNTY LEADERS AND RESIDENTS EXPERIENCE THE HEALTH OUTCOMES AND COMMUNITY CONDITIONS THAT AFFECT QUALITY OF LIFE. THIS INFORMATION CAN PROVIDE ADDITIONAL CONTEXT TO QUANTITATIVE DATA AND HEALTH TO STRATEGICALLY INFORM IMPROVEMENTS. SCCHI AND SCPH ALSO COMPLETED TWO QUALITATIVE MAPP ASSESSMENTS: COMMUNITY THEMES, STRENGTHS, AND THE FORCES OF CHANGE. FOCUS GROUPS AND SURVEYS WERE CONDUCTED AND DISTRIBUTED THROUGHOUT THE COMMUNITY IN 2019 TO IDENTIFY BARRIERS AND OPPORTUNITIES THROUGH THE LENS OF THE COMMUNITY MEMBER. LEADERS FROM THE FOLLOWING COMMUNITY ORGANIZATIONS WERE CONSULTED DURING THIS CHNA: AKRON AREA YMCAAKRON CANTON REGIONAL FOODBANKAKRON CHILDREN'S HOSPITALAKRON METROPOLITAN AREA TRANSPORTATION STUDYAKRON METROPOLITAN HOUSING AUTHORITY AKRON PUBLIC SCHOOLSAKRON REGION INTERPROFESSIONAL AREA HEALTH EDUCATION CENTERAKRON SUMMIT COMMUNITY ACTION, INCAKRON SUMMIT COUNTY PUBLIC LIBRARYAMERICAN CANCER SOCIETYASIAN SERVICES IN ACTION, INCAXESSPOINTE COMMUNITY HEALTH CENTERCHILD GUIDANCE AND FAMILY SOLUTIONSCITY OF AKRONCLEVELAND CLINIC AKRON GENERALCOMMUNITY HEALTH CENTERCOMMUNITY LEGAL AIDCOUNTY OF SUMMITCOUNTY OF SUMMIT ALCOHOL DRUG ADDICTION AND MENTAL HEALTH SERVICES BOARDGREATER AKRON CHAMBER OF COMMERCE HATTIE LARLHAMHAVEN OF REST MINISTRIESINFOLINE, INCINTERNATIONAL INSTITUTE OF AKRONLOVE AKRONMATURE SERVICESMUSTARD SEED MARKET AND CAFNOTHEAST OHIO MEDICAL UNIVERSITYOHIO GUIDESTONEOPEN M MINISTRIESOSU EXTENSIONPROJECT LEARN OF SUMMIT COUNTYSUMMIT COUNTY DD BOARDSUMMIT COUNTY PUBLIC HEALTH THE BLICK CENTERTHE OHIO AFFILIATE OF PREVENT BLINDNESSU.S. REPRESENTATIVE MARCIA FUDGEU.S. SENATOR SHERROD BROWNUNITED WAY OF SUMMIT COUNTYADDITIONAL DETAIL CAN BE FOUND ON THE SUMMA HEALTH WEBSITE AT HTTPS://WWW.SUMMAHEALTH.ORG/ABOUT-US/ABOUT-SUMMA/COMMUNITY-BENEFIT-AND-DIVERSITY/COMMUNITYNEEDSASSESSMENTS/COMMUNITYNEEDSASSESSMENT2019.
Summa Rehab Hospital, LLC	Part V, Section B, Line 5: Input from persons who represent broad interests of community served:Summa Rehabilitation Hospital:IN 2019 SUMMA HEALTH PARTNERED WITH SUMMIT COUNTY PUBLIC HEALTH (SCPH) AND THE SUMMIT COALITION FOR COMMUNITY HEALTH IMPROVEMENT (SCCHI) TO CONDUCT THE 2019 CHNA. DURING THE PROCESS, OVER 200 INDICATORS WERE REVIEWED, AND COMMUNITY LEADERS AND RESIDENTS WERE CONSULTED. THE 2019 CHNA WAS COMPLETED USING THE NATIONAL ASSOCIATION OF COUNTY AND CITY HEALTH OFFICIALS (NACCHO) MODIFIED-MOBILIZING ACTION THROUGH PARTNERSHIP AND PLANNING (MAPP) PROCESS. THIS PROCESS WAS FACILITATED BY SCPH AND CONDUCTED WITH THE SCCHI. SCCHI IS A 40+ MEMBER COLLABORATIVE WITH THE MISSION OF IDENTIFYING KEY HEALTH PRIORITIES IN SUMMIT COUNTY AND COORDINATING ACTION TO IMPROVE POPULATION HEALTH AND PROMOTE HEALTH EQUITY FOR ALL. THESE COMMUNITY LEADERS PROVIDE A PERSPECTIVE ON THE BROAD INTERESTS OF THE GROUPS SERVED BY THE HOSPITAL FACILITY, INCLUDING THE MEDICALLY UNDERSERVED, LOW-INCOME PERSONS, MINORITY GROUPS. SCPH EPIDEMIOLOGY GATHERED DATA FROM A VARIETY OF SOURCES INCLUDING COUNTY HEALTH RANKINGS, AMERICAN COMMUNITY SURVEY, AND COMMUNITY HEALTH STATUS INDICATORS. SCPH ALSO UTILIZED THE 2018 YOUTH RISK BEHAVIORAL SURVEY, THE OHIO DEPARTMENTS OF HEALTH BIRTH AND DEATH DATA, AND EPICENTER. QUALITATIVE DATA COLLECTED THROUGH SURVEYS, FOCUS GROUPS AND COMMUNITY MEETINGS WERE ALSO UTILIZED TO GATHER INFORMATION ABOUT HOW SUMMIT COUNTY LEADERS AND RESIDENTS EXPERIENCE THE HEALTH OUTCOMES AND COMMUNITY CONDITIONS THAT AFFECT QUALITY OF LIFE. THIS INFORMATION CAN PROVIDE ADDITIONAL CONTEXT TO QUANTITATIVE DATA AND HEALTH TO STRATEGICALLY INFORM IMPROVEMENTS. SCCHI AND SCPH ALSO COMPLETED TWO QUALITATIVE MAPP ASSESSMENTS: COMMUNITY THEMES, STRENGTHS, AND THE FORCES OF CHANGE. FOCUS GROUPS AND SURVEYS WERE CONDUCTED AND DISTRIBUTED THROUGHOUT THE COMMUNITY IN 2019 TO IDENTIFY BARRIERS AND OPPORTUNITIES THROUGH THE LENS OF THE COMMUNITY MEMBER. LEADERS FROM THE FOLLOWING COMMUNITY ORGANIZATIONS WERE CONSULTED DURING THIS CHNA: AKRON AREA YMCAAKRON CANTON REGIONAL FOODBANKAKRON CHILDREN'S HOSPITALAKRON METROPOLITAN AREA TRANSPORTATION STUDYAKRON METROPOLITAN HOUSING AUTHORITY AKRON PUBLIC SCHOOLSAKRON REGION INTERPROFESSIONAL AREA HEALTH EDUCATION CENTERAKRON SUMMIT COMMUNITY ACTION, INCAKRON SUMMIT COUNTY PUBLIC LIBRARYAMERICAN CANCER SOCIETYASIAN SERVICES IN ACTION, INCAXESSPOINTE COMMUNITY HEALTH CENTERCHILD GUIDANCE AND FAMILY SOLUTIONSCITY OF AKRONCLEVELAND CLINIC AKRON GENERALCOMMUNITY HEALTH CENTERCOMMUNITY LEGAL AIDCOUNTY OF SUMMITCOUNTY OF SUMMIT ALCOHOL DRUG ADDICTION AND MENTAL HEALTH SERVICES BOARDGREATER AKRON CHAMBER OF COMMERCE HATTIE LARLHAMHAVEN OF REST MINISTRIESINFOLINE, INCINTERNATIONAL INSTITUTE OF AKRONLOVE AKRONMATURE SERVICESMUSTARD SEED MARKET AND CAFNOTHEAST OHIO MEDICAL UNIVERSITYOHIO GUIDESTONEOPEN M MINISTRIESOSU EXTENSIONPROJECT LEARN OF SUMMIT COUNTYSUMMIT COUNTY DD BOARDSUMMIT COUNTY PUBLIC HEALTH THE BLICK CENTERTHE OHIO AFFILIATE OF PREVENT BLINDNESSU.S. REPRESENTATIVE MARCIA FUDGEU.S. SENATOR SHERROD BROWNUNITED WAY OF SUMMIT COUNTYADDITIONAL DETAIL CAN BE FOUND ON THE SUMMA HEALTH WEBSITE AT HTTPS://WWW.SUMMAHEALTH.ORG/ABOUT-US/ABOUT-SUMMA/COMMUNITY-BENEFIT-AND-DIVERSITY/COMMUNITYNEEDSASSESSMENTS/COMMUNITYNEEDSASSESSMENT2019.
Summa Health System	Part V, Section B, Line 6a: CHNA conducted with one or more other hospital facilities:Summa Health System: SUMMA HEALTH CONDUCTED THE CHNA ON BEHALF OF EACH OF ITS HOSPITAL FACILITIES LISTED IN PART V, SECTION A.
Summa Rehab Hospital, LLC	Part V, Section B, Line 6a: CHNA conducted with one or more other hospital facilities:Summa Rehabilitation Hospital:SUMMA HEALTH CONDUCTED THE CHNA ON BEHALF OF EACH OF ITS HOSPITAL FACILITIES LISTED IN PART V, SECTION A.
Summa Health System	Part V, Section B, Line 6b: CHNA conducted with one or more organizations other than hospital facilities:Summa Health System:SUMMIT COUNTY PUBLIC HEALTH SUMMIT COALITION FOR COMMUNITY HEALTH IMPROVEMENT
Summa Rehab Hospital, LLC	Part V, Section B, Line 6b: CHNA conducted with one or more organizations other than hospital facilities:Summa Rehabilitation Hospital:SUMMIT COUNTY PUBLIC HEALTH SUMMIT COALITION FOR COMMUNITY HEALTH IMPROVEMENT
Summa Health System	Part V, Section B, Line 11: How the hospital facility is addressing needs identified in its CHNA:Summa Health System:THIS ASSESSMENT BUILDS UPON THE WORK THAT WAS COMPLETED IN THE IMPLEMENTATION PLAN THAT WAS PUBLISHED IN MAY OF 2017. ALTHOUGH SUMMA HEALTH SYSTEM (SHS) HAS MADE SIGNIFICANT STRIDES IN ADDRESSING THE 2017 PRIORITIES, IT HAS BEEN DECIDED THAT TO TRULY AFFECT HEALTH OUTCOMES, SHS, WITH THE HELP OF COMMUNITY PARTNERS HAS TO COMMIT TO A LONG-TERM STRATEGY THAT ADDRESSES THE FOLLOWING PRIORITIES FOR ANOTHER THREE YEARS AND BEYOND. THESE PRIORITY AREAS ARE AS FOLLOWS: CHRONIC DISEASE MANAGEMENT, ACCESS AND BARRIERS TO HEALTH CARE, HEALTH DISPARITIES, PREVENTION AND WELLNESS. THE PRIORITIES ARE IN ALIGNMENT WITH CURRENT COMMUNITY HEALTH NEEDS IDENTIFIED BY THE SUMMIT COUNTY PUBLIC HEALTH 2019 COMMUNITY HEALTH ASSESSMENT AND THE OHIO DEPARTMENT OF HEALTH'S 2019 STATE HEALTH ASSESSMENT.PRIORITY HEALTH NEEDS IDENTIFIED IN THE 2019 SUMMA CHNA:PRIORITY HEALTH ISSUE, PLAN TO ADDRESSACCESS TO HEALTH CARE, YESCHRONIC DISEASE, YESENVIRONMENTAL FACTORS, NOHEALTH DISPARITIES, YESINJURY AND ACCIDENTS, NOQUALITY OF HEALTH CARE, YESMATERNAL AND CHILD HEALTH, YESMENTAL HEALTH, YESPREVENTION AND WELLNESS, YESSUBSTANCE ABUSE, YESSIGNIFICANT HEALTH NEEDS ADDRESSED:PRIORITY HEALTH OUTCOME: IMPROVING PREVENTION AND WELLNESSAT SUMMA HEALTH, OUR POPULATION HEALTH STRATEGY IS EVOLVING THE WAY WE DELIVER CARE. OUR VISION FOR CARE PUTS THE PATIENT AT THE CENTER OF THIS MODEL BY CREATING A COLLABORATION BETWEEN THE PATIENT AND THEIR CAREGIVERS THAT IS FOCUSED ON PREVENTION AND WELLNESS (P&W). P&W FOCUSES ON IMPROVING THE WHOLE PERSON, BODY AND MIND AND REDUCING LIFESTYLE RISK FACTORS AND "EVERYDAY" BEHAVIORS THAT CAN NEGATIVELY IMPACT HEALTH. P&W STRATEGIES CROSS ALL THE PRIORITY HEALTH OUTCOMES, AND ARE EMBEDDED IN EACH OBJECTIVE.PRIORITY HEALTH OUTCOME: IMPROVING ACCESS TO HEALTH CARETHE HEALTH NEEDS PERTAINING TO ACCESS ARE BEING ADDRESSED BY INCORPORATING COMMUNITY HEALTH WORKERS IN COMMUNITY BASED SETTINGS, AND INCREASING THE NUMBER OF INDIVIDUALS WHO HAVE ACCESS TO PRIMARY CARE MEDICAL HOMES AND COMPREHENSIVE PRIMARY CARE PLUS PRACTICES THEREBY INCREASING THE OPPORTUNITIES FOR PREVENTATIVE AND EARLY INTERVENTIONS FOR INDIVIDUALS REQUIRING PRIMARY CARE, DENTAL, AND BEHAVIORAL HEALTH PROVIDERS.PRIORITY HEALTH OUTCOME: PROVIDING CHRONIC DISEASE MANAGEMENTTHE HEALTH NEEDS PERTAINING TO CHRONIC DISEASE ARE BEING ADDRESSED THROUGH INCREASING CONSUMER KNOWLEDGE BASE OF RISK FACTORS, RISK BEHAVIORS, AND GENETIC CONSIDERATIONS, WHICH LEAD TO CANCER, CARDIOVASCULAR DISEASE AND DIABETES (P&W). THE HEALTH NEEDS PERTAINING TO SUBSTANCE ABUSE ARE BEING ADDRESSED BY DECREASING ALCOHOL AND OPIATE RELATED OVERDOSES AND DEATHS (P&W). THE HEALTH NEEDS PERTAINING TO LIFESTYLE FACTORS ARE BEING ADDRESSED BY DECREASING SMOKING AND TOBACCO USE IN ADULTS. PRIORITY HEALTH OUTCOME: REDUCING HEALTH DISPARITIESTHE HEALTH NEEDS PERTAINING TO HEALTH DISPARITIES ARE BEING ADDRESSED THROUGH REDUCING INFANT MORTALITY BY PROVIDING PROGRAMS AND SERVICES THAT PROVIDE OUTREACH, EDUCATION, COORDINATION AND FOCUS ON REDUCING THE IMPACTS OF THE SOCIAL DETERMINANTS OF HEALTH FOR LOW INCOME MOTHERS(P&W). PRIORITY HEALTH OUTCOME: IMPROVING QUALITY OF HEALTH CARETHE HEALTH NEEDS PERTAINING TO QUALITY OF CARE FACTORS ARE BEING ADDRESSED BY DECREASING HOSPITAL READMISSIONS AND INCREASING CONSUMER KNOWLEDGE OF PREOPERATIVE CARE. SIGNIFICANT HEALTH NEEDS NOT ADDRESSEDTHE LIST ABOVE INDICATES SEVERAL PRIORITIZED HEALTH NEEDS IDENTIFIED IN THE 2019 CHNA THAT SUMMA WILL NOT ADDRESS IN THE PLAN. POOR HEALTH STATUS CAN RESULT THROUGH A COMPLEX INTERACTION OF CHALLENGING SOCIAL, ECONOMIC, ENVIRONMENTAL AND BEHAVIORAL FACTORS, COMBINED WITH LACK OF ACCESS TO CARE. ADDRESSING THE MORE COMMON "ROOT" CAUSES OF POOR COMMUNITY HEALTH CAN SERVE TO IMPROVE A COMMUNITY'S QUALITY OF LIFE AND TO REDUCE MORTALITY AND MORBIDITY. HOWEVER, SUMMA RECOGNIZES THAT NO HOSPITAL FACILITY CAN ADDRESS ALL OF THE ROOT CAUSES AND HEALTH NEEDS PRESENT IN ITS COMMUNITY. THEREFORE, IT WAS DETERMINED THAT THE HEALTH SYSTEM WILL COLLABORATE WITH OTHER ORGANIZATIONS AS NEEDED TO ADDRESS THE HEALTH NEEDS NOT SELECTED. INJURIES, ACCIDENTS AND ENVIRONMENTAL FACTORS INCLUDING VIOLENCE, CRIME, AND POVERTY WILL NOT BE ADDRESSED DIRECTLY THROUGH OUR PLAN. RESOURCES, AS WELL AS AVAILABLE EXPERTISE, LIMIT OUR SELECTION OF PRIORITIES. SUMMA HEALTH WILL, HOWEVER, LOOK FOR OPPORTUNITIES TO COLLABORATE WITH SAFE COMMUNITIES OF SUMMIT COUNTY, SUMMIT COUNTY SAFE KIDS COALITION, COMMUNITY DEVELOPMENT CORPORATIONS, LOCAL SERVICES AGENCIES AND OTHER ORGANIZATIONS TO ADDRESS THESE IMPORTANT HEALTH ISSUES WHENEVER POSSIBLE. THE PLAN IS ALSO IN ALIGNMENT WITH CURRENT COMMUNITY HEALTH NEEDS AND PRIORITIES IDENTIFIED BY THE SUMMIT COUNTY PUBLIC HEALTH 2019 COMMUNITY HEALTH ASSESSMENT AND THE OHIO DEPARTMENT OF HEALTH'S 2020-2022 STATE HEALTH IMPROVEMENT PLAN.A DETAILED DESCRIPTION OF THE ACTIONS BEING TAKEN TO ADDRESS THE HEALTH NEEDS IDENTIFIED ABOVE CAN BE FOUND ON THE 2020-2022 SUMMA HEALTH COMMUNITY HEALTH NEEDS ASSESSMENT IMPLEMENTATION PLAN FOUND ON THE SUMMA HEALTH WEBSITE AT HTTPS://WWW.SUMMAHEALTH.ORG/ABOUT-US/ABOUT-SUMMA/COMMUNITY-BENEFIT-AND-DIVERSITY/COMMUNITYNEEDSASSESSMENTS/COMMUNITYNEEDSASSESSMENT2019.
Summa Rehab Hospital, LLC	Part V, Section B, Line 11: How the hospital facility is addressing needs identified in its CHNA:Summa Rehabilitation Hospital:DUE TO THE NATURE OF THE ADULT REHABILITATION SPECIALTY SERVICES PROVIDED BY SUMMA REHAB HOSPITAL, LLC, THE IDENTIFIED HEALTH NEED IN WHICH THEY HAVE THE OPPORTUNITY TO ADDRESS IN THIS COMMUNITY HEALTH NEEDS ASSESSMENT FOR THE GREATEST IMPACT IS ACCESS TO HEALTH CARE. THE COMMUNITY RESOURCES PROVIDED BY A VARIETY OF INSTITUTIONS AND AGENCIES, INCLUDING SHS LED TO THE DETERMINATION BY SUMMA REHAB HOSPITAL, LLC TO NOT ADDRESS ANY OTHER IDENTIFIED HEALTH NEEDS AS DESCRIBED IN THE CHNA. PRIORITY HEALTH OUTCOME: IMPROVING ACCESS TO HEALTH CARETHE HEALTH NEEDS PERTAINING TO ACCESS ARE BEING ADDRESSED BY ENHANCING ACCESS TO APPROPRIATE MEDICATIONS AND IMPROVE COMPLIANCE WITH MEDICATION PRESCRIPTIONS FOR PATIENTS THAT ARE DISCHARGED FROM SUMMA REHABILITATION HOSPITAL(SRH). SRH IS ALSO IMPROVING ACCESS BY ENHANCING ACCESS TO DIAGNOSIS SPECIFIC SUPPORT GROUPS FOR COMMUNITY MEMBERS TO INCREASE PATIENT KNOWLEDGE. SUPPORT GROUPS FOCUS ON STROKE, AMPUTEE, PARKINSON'S AND TRAMATIC BRAIN INJURY(TBI). IN ADDITION, SRH WILL ALSO PARTICIPATE IN ADVOCACY AND SUPPORT GROUP ACTIVITIES THROUGH NORTHEAST OHIO BRAIN INJURY FOUNDATION/ SUMMIT COUNTY TBI COLLABORATION. A DETAILED DESCRIPTION OF THE ACTIONS BEING TAKEN TO ADDRESS THE HEALTH NEEDS IDENTIFIED ABOVE CAN BE FOUND ON THE 2020-2022 SUMMA HEALTH COMMUNITY HEALTH NEEDS ASSESSMENT IMPLEMENTATION PLAN FOUND ON THE SUMMA HEALTH WEBSITE AT HTTPS://WWW.SUMMAHEALTH.ORG/ABOUT-US/ABOUT-SUMMA/COMMUNITY-BENEFIT-AND-DIVERSITY/COMMUNITYNEEDSASSESSMENTS/COMMUNITYNEEDSASSESSMENT2019.
PART V SECTION C LINE 3e Facility Reporting Summa Health & Summa Rehab	The significant health needs are a prioritized description of the significant health needs of the community and identified through the CHNA.
Part V, Section B, line 7a Facility Reporting Summa Health & Summa Rehab	Summa Health System: https://www.summahealth.org/about-us/about-summa/community-benefit-and-diversity/communityneedsassessments/communityneedsassessment2019Summa Rehab Hospital:http://www.summarehabhospital.com/about-us/community-health-needs-assessments/
Part V, Section B, line 10a Facility Reporting Summa Health and Summa Rehab	Summa Health System:https://www.summahealth.org/about-us/about-summa/community-benefit-and-diversity/communityneedsassessments/communityneedsassessment2016Summa Rehab Hospital:https://www.summahealth.org/about-us/about-summa/community-benefit-and-diversity/communityneedsassessments/communityneedsassessment2016
PART V SECTION B LINE 16a: Facility Reporting Summa Health & Summa Rehab	Summa Health System: https://www.summahealth.org/patientvisitor/insuranceandbilling/financialassistanceSumma Rehab Hospital: http://www.summarehabhospital.com/patient-resources/financial-assistance-policy/
PART V SECTION B LINE 16B Facility Reporting Summa Health & Summa Rehab	Summa Health System: https://www.summahealth.org/patientvisitor/insuranceandbilling/financialassistanceSumma Rehab Hospital: http://www.summarehabhospital.com/patient-resources/financial-assistance-policy/
PART V SECTION B LINE 16C Facility Reporting Summa Health & Summa Rehab	Summa Health System: https://www.summahealth.org/patientvisitor/insuranceandbilling/financialassistanceSumma Rehab Hospital: http://www.summarehabhospital.com/patient-resources/financial-assistance-policy/
PART V SECTION B LINE 20a: Extraordinary Collection Action	Summa Rehab Hospital:Summa Rehab Hospital does not take ECAs and therefore written notices are not necessary

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?106
Name and address		Type of Facility (describe)
1	1 - SUMMA HEALTH EQUITY CENTER 1493 S HAWKINS AVENUE AKRON,OH44320	CHRONIC DISEASE MANAGEMENT, HEALTH, NUTRITION, EXERCISE AND EDUCATION SERVIC
2	2 - PARKVIEW CENTER 155 FIFTH STREET NE BARBERTON,OH44203	CANCER CENTER AND CANCER CARE
3	3 - SUMMA HEALTH COOPER PAVILION 161 NORTH FORGE STREET AKRON,OH44304	CANCER CENTER AND CANCER CARE
4	4 - SUMMA HEALTH CENTER AT GREEN - SLEEP LAB 1700 BOETTLER ROAD STE 215 UNIONTOWN,OH44685	SLEEP AND NEUROLOGY SERVICES, OBSTETRICS AND GYNECOLOGY
5	5 - SUMMA HEALTH IGNATIA HALL SOUTH 3730 WHIPPLE AVE NW STE 5 CANTON,OH44718	OUTPATIENT ADDICTION MEDICINES
6	6 - Professional Center South 55 Arch AKRON,OH44304	Family medicine, internal medicine
7	7 - Summa Health Medical Group 1 Park West Blvd Suite 350 Akron,OH44320	Physician office
8	8 - Summa Health Medical Group 1 Park West Blvd Suite 200 Akron,OH44320	Physician office
9	9 - Summa Health Medical Group 1 Park West Suite 330 Akron,OH44320	Physician office
10	10 - Summa Health Medical Group 1 Park West Suite 330 Akron,OH44320	Physician office
11	11 - Summa Health Medical Group 1260 Independence Ave Akron,OH44310	Physician office
12	12 - Summa Health Medical Group 1305 Corporate Dr Suite A Hudson,OH44236	Physician office
13	13 - Summa Health Medical Group 1320 Mercy Drive NW Canton,OH44708	Physician office
14	14 - Summa Health Medical Group 1463 Canton Rd Akron,OH44312	Physician office
15	15 - Summa Health Medical Group 1493 South Hawkins Ave Akron,OH44320	Physician office
16	16 - Summa Health Medical Group 155 Fifth Street NE Barberton,OH44203	Physician office
17	17 - Summa Health Medical Group 161 N Forge St Suite G90 Akron,OH44304	Physician office
18	18 - Summa Health Medical Group 161 N Forge St Suite 190 Akron,OH44304	Physician office
19	19 - Summa Health Medical Group 161 North Forge St Suite 298 Akron,OH44304	Physician office
20	20 - Summa Health Medical Group 161 North Forge StSuite 198 Akron,OH44304	Physician office
21	21 - Summa Health Medical Group 1700 Boettler Rd Suite 225 Uniontown,OH44685	Physician office
22	22 - Summa Health Medical Group 1700 Boettler Rd Suite 150 Uniontown,OH44685	Physician office
23	23 - Summa Health Medical Group 1835 Franks Parkway Uniontown,OH44685	Physician office
24	24 - Summa Psychiatry Associates 1835 Franks Parkway Uniontown,OH44685	Physician office
25	25 - Summa Health Medical Group 1860 State Rd Suite D Cuyahoga Falls,OH44223	Physician office
26	26 - Summa Health Medical Group 1900 23rd St Suite 1000 Cuyahoga Falls,OH44223	Physician office
27	27 - Summa Health Medical Group 195 Wadsworth Rd Wadsworth,OH44281	Physician office
28	28 - Summa Health Medical Group 195 Wadsworth Rd Suite 301 Wadsworth,OH44256	Physician office
29	29 - Summa Health Medical Group 195 Wadsworth Rd Suite 305 Wadsworth,OH44281	Physician office
30	30 - Summa Health Medical Group 201 5th St NESuite 16 Barberton,OH44203	Physician office
31	31 - Summa Health Medical Group 201 5th St Suite 2 Barberton,OH44203	Physician office
32	32 - Summa Health Medical Group 201 5th St Suite 6 Barberton,OH44203	Physician office
33	33 - Summa Health Medical Group 201 5th Street NE Suite 3 Barberton,OH44203	Physician office
34	34 - Summa Health Medical Group 201 Fifth St NE Suite 10 Barberton,OH44203	Physician office
35	35 - Summa Health Medical Group 201 Fifth Street NE Suite 8 Barberton,OH44203	Physician office
36	36 - Summa Health Medical Group 223 N Main St Rittman,OH44270	Physician office
37	37 - Summa Health Medical Group 242 Portage Trail Ext W Cuyahoga Falls,OH442233613	Physician office
38	38 - Summa Health Medical Group 25 S Main Street Suite B Rittman,OH44270	Physician office
39	39 - Summa Health Medical Group 275 Graham Road Suite 11 Cuyahoga Falls,OH44223	Physician office
40	40 - Summa Health Medical Group 28 Conservatory Dr Suite C Akron,OH44314	Physician office
41	41 - Summa Health Medical Group 2875 West Market St Suite A Fairlawn,OH44333	Physician office
42	42 - Summa Health Medical Group 2875 West Market St Suite B Fairlawn,OH44333	Physician office
43	43 - Summa Health Medical Group 328 Hines Hill Road Boston Heights,OH44236	Physician office
44	44 - Summa Health Medical Group 3378 W Market St Fairlawn,OH44333	Physician office
45	45 - Summa Health Medical Group 3593 S Arlington Road Suite D Akron,OH44312	Physician office
46	46 - Summa Health Medical Group 3780 Medina Rd Suite 250 Medina,OH44256	Physician office
47	47 - Summa Health Medical Group 3780 Medina Rd Suite 220 Medina,OH44256	Physician office
48	48 - Summa Health Medical Group 3780 Medina Rd Suite 210 Medina,OH44256	Physician office
49	49 - Summa Health Medical Group 3780 Medina Road Suite 150 Medina,OH44256	Physician office
50	50 - Summa Health Medical Group 3780 Medina Road Suite 200 Medina,OH44256	Physician office
51	51 - Summa Health Medical Group 3780 Medina Road Suite 310 Medina,OH44256	Physician office
52	52 - Summa Health Medical Group 3838 Massillon Rd Suite 350 Uniontown,OH44685	Physician office
53	53 - Summa Health Medical Group 4055 Embassy Parkway Suite 110 Fairlawn,OH44333	Physician office
54	54 - Summa Health Medical Group 4211 St Rt 44 Rootstown,OH44272	Physician office
55	55 - Summa Health Medical Group 444 N Main St Suite 201 Akron,OH443092090	Physician office
56	56 - Summa Psychiatry Associates 444 North Main St 6th Floor Akron,OH44310	Physician office
57	57 - Summa Psychiatry Associates 444 North Main St 4th Floor Akron,OH44310	Physician office
58	58 - Summa Psychiatry Associates 444 North Main StSuite 420 Akron,OH44310	Physician office
59	59 - Summa Health Medical Group 500 Portage Lakes Drive Suite B Akron,OH44319	Physician office
60	60 - Summa Health Medical Group 51 Park West Blvd Suite 200 Akron,OH44320	Physician office
61	61 - Summa Health Medical Group 525 E Market St Suite 400 Akron,OH44304	Physician office
62	62 - Summa Health Medical Group 525 E Market St Suite 3E Akron,OH44304	Physician office
63	63 - Summa Health Medical Group 525 East Market StSuite 1-N Akron,OH44304	Physician office
64	64 - Summa Health Medical Group 55 Arch St Suite 2A Akron,OH44304	Physician office
65	65 - Summa Health Medical Group 55 Arch St Suite 3A Akron,OH44304	Physician office
66	66 - Summa Health Medical Group 55 Arch St Suite 1A Akron,OH44304	Physician office
67	67 - Summa Health Medical Group 55 Arch St Suite 1B Akron,OH44304	Physician office
68	68 - Summa Health Medical Group 55 Arch Street Suite 2A Akron,OH44304	Physician office
69	69 - Summa Psychiatry Associates 5655 Hudson Drive Suite 305 Hudson,OH44236	Physician office
70	70 - Summa Health Medical Group 5655 Hudson Dr Suite 315 Hudson,OH44236	Physician office
71	71 - Summa Health Medical Group 60 North Ave Tallmadge,OH44278	Physician office
72	72 - Summa Health Medical Group 621 School Dr Wadsworth,OH44281	Physician office
73	73 - Summa Health Medical Group 75 Arch St Suite 103 Akron,OH44304	Physician office
74	74 - Summa Health Medical Group 75 Arch St Suite 104 Akron,OH44304	Physician office
75	75 - Summa Health Medical Group 75 Arch St Suite 201 Akron,OH44304	Physician office
76	76 - Summa Health Medical Group 75 Arch St Suite 202 Akron,OH44304	Physician office
77	77 - Summa Health Medical Group 75 Arch St Suite 301 Akron,OH44304	Physician office
78	78 - Summa Health Medical Group 75 Arch St Suite 302 Akron,OH44304	Physician office
79	79 - Summa Health Medical Group 75 Arch St Suite 302 Akron,OH44304	Physician office
80	80 - Summa Health Medical Group 75 Arch St Suite 402 Akron,OH44304	Physician office
81	81 - Summa Health Medical Group 75 Arch St Suite 406 Akron,OH44304	Physician office
82	82 - Summa Psychiatry Associates 75 Arch St Suite 410 Akron,OH44304	Physician office
83	83 - Summa Health Medical Group 75 Arch St Suite 501 Akron,OH44304	Physician office
84	84 - Summa Health Medical Group 75 Arch St Suite 506 Akron,OH44304	Physician office
85	85 - Summa Health Medical Group 75 Arch St Suite 514 Akron,OH44304	Physician office
86	86 - Summa Health Medical Group 75 Arch St Suite B1 Akron,OH44304	Physician office
87	87 - Summa Health Medical Group 75 Arch St Suite B1 Akron,OH44304	Physician office
88	88 - Summa Health Medical Group 75 Arch St Suite G2 Akron,OH44304	Physician office
89	89 - Summa Dental Center 75 Arch St Suite 303 Akron,OH44304	Full-service outpatient dental facility
90	90 - Summa Health Medical Group 75 Arch StSuite 206 Akron,OH44304	Physician office
91	91 - Summa Health Medical Group 75 Arch StSuite 407 Akron,OH44304	Physician office
92	92 - Summa Health Medical Group 75 Arch Suite 201 Akron,OH44304	Physician office
93	93 - Summa Health Medical Group 91 5th Street Barberton,OH44203	Physician office
94	94 - Summa Health Medical Group 95 Arch St Suite 150 Akron,OH44304	Physician office
95	95 - Summa Health Medical Group 95 Arch St Suite 165 Akron,OH44304	Physician office
96	96 - Summa Health Medical Group 95 Arch St Suite 175 Akron,OH44304	Physician office
97	97 - Summa Health Medical Group 95 Arch St Suite 215 Akron,OH44304	Physician office
98	98 - Summa Health Medical Group 95 Arch StSuite 220 Akron,OH44304	Physician office
99	99 - Summa Health Medical Group 95 Arch St Suite 240 Akron,OH44304	Physician office
100	100 - Summa Health Medical Group 95 Arch St Suite 270 Akron,OH44304	Physician office
101	101 - Summa Health Medical Group 95 Arch St Suite 280 Akron,OH44304	Physician office
102	102 - Summa Health Medical Group 95 Arch StSuite 260 Akron,OH44304	Physician office
103	103 - Summa Psychiatry Associates 95 Arch StSuite 260 Akron,OH44304	Physician office
104	104 - Summa Health Medical Group 95 Arch StSuite 300 Akron,OH44304	Physician office
105	105 - Summa Health Medical Group 95 Arch StSuite 350 Akron,OH44304	Physician office
106	106 - Summa Health Medical Group AES Building 388 South Main Suite 201 Akron,OH44311	Physician office

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 6a:	Name of related organization that prepared the community benefit report:Summa Health
Part I, Line 7:	Explanation of cost methodology used for calculating Line 7 table:Cost of financial assistance at cost was calculated with a cost to charge ratio using Worksheet 2. The cost related to Medicaid patients was determined using Summa Health's cost accounting system. For subsidized services Summa Health's cost accounting system is used to determine cost related to specific services excluding traditional Medicaid and Medicaid managed care patients. Costs for charity and bad debt accounts are deducted using a ratio of cost to charge specific to that subsidized service. Costs for other programs reflect the direct and indirect costs of providing those programs.
Part I, Line 7g:	Describe subsidized health service costs from physician clinic on line 7G:The amount of subsidized health services reported on Line 7(g) attributable to Summa Physicians, Inc. dba Summa Health Medical Group is $31,554,449.
Part II, Community Building Activities:	Describe how Community Building Activities promote the health of the community:Summa Health addresses various community concerns including health improvement, poverty, workforce development, and access to health care.Summa Health hospitals conduct community health education and support groups, health fairs and screenings for the communities served. Summa Health hospitals work with state and local leadership to address community needs and provide healthcare services to the poor and underserved.Summa Health hospitals provide programs to improve the physical surroundings in the communities served. A robust economy positively impacts residents covered by health insurance and improves the capacity of the community to support health services.
Part III, Line 2:	AN ESTIMATED PROVISION FOR DOUBTFUL ACCOUNTS IS RECORDED THAT RESULTS IN NET PATIENT SERVICE REVENUE BEING REPORTED AT THE NET AMOUNT EXPECTED TO BE RECEIVED. SUMMA HAS DETERMINED, BASED ON AN ASSESSMENT AT THE CONSOLIDATED LEVEL, THAT PATIENT SERVICE REVENUE IS PRIMARILY RECORDED PRIOR TO ASSESSING THE PATIENT'S ABILITY TO PAY AND AS SUCH, THE ENTIRE PROVISION FOR DOUBTFUL ACCOUNTS RELATED TO PATIENT REVENUE IS RECORDED AS A DEDUCTION FROM PATIENT SERVICE REVENUE IN THE ACCOMPANYING CONSOLIDATED STATEMENTS OF OPERATIONS. AT THE POINT IN TIME THAT A CHARGE IS BELIEVED TO BE UNCOLLECTIBLE, THE RELATED RECEIVABLE IS WRITTEN OFF AS A DOUBTFUL ACCOUNT.SUMMA MAINTAINS AN ALLOWANCE FOR DOUBTFUL ACCOUNTS BASED ON THE EXPECTED COLLECTABILITY OF PATIENT ACCOUNTS RECEIVABLE. THE PROVISION FOR DOUBTFUL ACCOUNTS IS BASED UPON MANAGEMENT'S ASSESSMENT OF HISTORICAL AND EXPECTED NET COLLECTIONS CONSIDERING HISTORICAL BUSINESS AND ECONOMIC CONDITIONS, TRENDS IN HEALTH CARE COVERAGES, AND OTHER COLLECTION INDICATORS. PERIODICALLY THROUGH THE YEAR, MANAGEMENT ASSESSES THE ADEQUACY OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS BASED UPON HISTORICAL WRITE-OFF EXPERIENCE BY PAYOR CATEGORY. THE RESULTS OF THIS REVIEW ARE THEN USED TO MAKE MODIFICATIONS TO THE PROVISION FOR DOUBTFUL ACCOUNTS TO ESTABLISH AN APPROPRIATE ALLOWANCE FOR THE UNCOLLECTIBLE RECEIVABLES.
Part III, Line 4:	Footnote in organization's financial statements describing bad debt expense:Summa Health's audited financial statements Notes to consolidated financial statements, 13. Patient Service Revenue, page 37.
Part III, Line 8:	Describe extent any shortfall from Line 7 is treated as community benefit and Costing methodology or source used to determine amount on line 6:Any Medicare shortfall incurred by Summa Health is not reported as a community benefit.Costing method used was total allowable cost less all costs deemed non-allowable by Medicare regulations. Medicare allowable cost are based on information provided on worksheet B, Part I, Column 26, Line 118 from the various hospitals' Medicare cost reports.
Part III, Line 9b:	Did collection policy contain provisions on collection practices for patients who are known to qualify for assistance:SUMMA WILL NOT PURSUE LEGAL ACTION FOR NON-PAYMENT OF BILLS AGAINST ANY PATIENT WHO IS WITHOUT ACCESS TO HEALTH INSURANCE AND WITHOUT OTHER SIGNIFICANT INCOME OR NET WORTH. BEFORE INITIATING LEGAL ACTION FOR NON-PAYMENT, OUR HOSPITALS WILL, IN CONJUNCTION WITH THE PATIENT, MAKE SURE THAT THE PATIENT IS NOT ELIGIBLE FOR ANY ASSISTANCE PROGRAM AND DOES NOT QUALIFY UNDER THE HOSPITALS' CHARITY CARE POLICY.
Part VI, Line 2:	Needs assessment:IN ADDITION TO THE CHNA DESCRIBED IN PART V, SECTION B, THE HEALTH CARE NEEDS OF THE COMMUNITY ARE COLLABORATIVELY ASSESSED BY SURVEY PROCESSES CONDUCTED BY SUMMA HEALTH, SUMMIT COUNTY PUBLIC HEALTH, AND SUMMIT COALITION FOR COMMUNITY HEALTH IMPROVEMENT.
Part VI, Line 3:	Patient Education:IN ACCORDANCE WITH THE RULES SET FORTH BY OHIO ADMINISTRATIVE CODE SECTION 2101:3-2-07.17 NOTICES, SUMMA HEALTH SYSTEM'S HOSPITALS HAVE NOTICES POSTED IN THE EMERGENCY ROOMS, ADMISSION AREAS, CASHIER'S OFFICE, AND OTHER APPROPRIATE AREAS. THE NOTICES SPECIFY THE RIGHTS OF INDIVIDUALS TO RECEIVE WITHOUT CHARGE, MEDICALLY NECESSARY HOSPITAL-LEVEL SERVICES. A FINANCIAL COUNSELOR WHO IS ASSIGNED TO PATIENTS AT THE POINT OF ADMISSION REVIEWS THE AVAILABILITY OF FINANCIAL ASSISTANCE PROGRAMS AND ASSISTS WITH THE APPLICATION IF REQUESTED. THE SUMMA WEBSITE PROVIDES INFORMATION REGARDING FINANCIAL ASSISTANCE. CUSTOMER SERVICE REPRESENTATIVES PROVIDE FINANCIAL COUNSELING WITH EXPLANATION OF ASSISTANCE PROGRAMS TO PATIENTS WHO CALL. EVERY PATIENT BILLING STATEMENT CONTAINS CONTACT INFORMATION AND INSTRUCTIONS TO LEARN ABOUT AND APPLY FOR FINANCIAL ASSISTANCE, AND INCLUDES AN APPLICATION FOR FINANCIAL ASSISTANCE.
Part VI, Line 4:	Community information:Community information: BASED ON 2019 PATIENT ADMISSION DATA, SUMMA HEALTH CARE DELIVERY IS PRIMARILY IN SUMMIT COUNTY. SUMMIT COUNTY REPRESENTS 71.5% OF THE 2019 ADMISSIONS FROM SUMMA HEALTH. WHILE SUMMA ALSO TREATS PATIENTS FROM MEDINA, NORTHERN STARK, AND WAYNE COUNTIES, MOST PATIENTS COME FROM SUMMIT COUNTY. THERE WERE 541,918 PEOPLE LIVING IN SUMMIT COUNTY IN 2018, THE MOST CURRENT CENSUS DATA AVAILABLE . THERE ARE 31 CITIES, VILLAGES, AND TOWNSHIPS IN SUMMIT COUNTY, WITH THE LARGEST BEING THE CITY OF AKRON. COMPARED TO THE STATE OF OHIO, SUMMIT COUNTY HAS A SLIGHTLY SMALLER PROPORTION OF CHILDREN (UNDER 18 YEARS OLD) AND A SLIGHTLY HIGHER PROPORTION OF OLDER ADULTS. IN SUMMIT COUNTY 22% PERCENT OF THE POPULATION IS NON WHITE, COMPARED TO 18.1% IN THE STATE. EDUCATIONAL ATTAINMENT IS SLIGHTLY HIGHER IN SUMMIT COUNTY THAN THE STATE OF OHIO, WITH 92% HAVING A HIGH SCHOOL DIPLOMA OR HIGHER AND 34.3% HAVING A BACHELOR'S DEGREE OR HIGHER. SIMILARLY, ANNUAL PER CAPITA INCOME IN SUMMIT COUNTY IS SLIGHLTY HIGHER THAN THE STATE OF OHIO, THE PERCENT OF SUMMIT COUNTY RESIDENTS LIVING IN POVERTY DECREASED FROM THE PREVIOUS CHNA TO NEARLY 12%. OF THE HOUSEHOLDS IN SUMMIT COUNTY 43% MAKE LESS THAN $50,000 ANNUALLY. FOR THE CALENDAR YEAR 2018, THE AVERAGE MONTHLY UNEMPLOYMENT RATE FOR SUMMIT COUNTY WAS 4.7% RESPECTIVELY. LOW INCOMES AND AN ESSENTIALLY STAGNANT UNEMPLOYMENT RATE ADD TO SUMMA'S BURDEN FOR CHARITY CARE. DESPITE THESE CHALLENGES, DEMAND FOR SUMMA'S SERVICES IN THESE COMMUNITIES IS PROJECTED TO GROW. MORE IMPORTANTLY, THE AGE GROUP THAT DEMAND HEALTHCARE SERVICES THE MOST (AGE 65 AND OLDER) IS EXPECTED TO GROW SIGNIFICANTLY. THIS AGE GROUP IS EXPECTED TO INCREASE 16.0% IN SUMMIT COUNTY OVER THE FIVE YEAR PERIOD.
Part VI, Line 5:	Promotion of community health:AMONG THE WAYS THE HOSPITALS WITHIN SUMMA HEALTH PROMOTE THE HEALTH OF THE COMMUNITY ARE BY MAINTAINING AN OPEN MEDICAL STAFF AND A COMMUNITY ENGAGEMENT COMMITTEE (COMMUNITY BENEFIT COMMITTEE). SUMMA'S HOSPITALS ADDRESS HEALTH DISPARITIES THROUGH PRACTICE, RESEARCH, EDUCATION AND COLLABORATION WITH OTHER COMMUNITY ORGANIZATIONS. CONTRIBUTIONS, BOTH FINANCIAL AND IN-KIND, ARE MADE TO INITIATIVES AND PROGRAMMING (I.E. FEDERALLY QUALIFIED HEALTH CENTER, OPEN M, CENTER FOR COMMUNITY HEALTH IMPROVEMENT) THAT ARE DEEMED TO PROMOTE THE HEALTH, WELLNESS AND IMPROVED QUALITY OF LIFE FOR THE COMMUNITIES SUMMA HEALTH SERVES.
Part VI, Line 6:	Description of affiliated group:SUMMA HEALTH, EIN 34-1887844, IS THE PARENT ORGANIZATION OF SUMMA HEALTH SYSTEM. SUMMA HEALTH IS ONE OF THE LARGEST INTEGRATED DELIVERY SYSTEMS IN OHIO, ENCOMPASSING A NETWORK OF HOSPITALS, COMMUNITY-BASED HEALTH CENTERS, A HEALTH PLAN, A PHYSICIAN-HOSPITAL ORGANIZATION, RESEARCH AND MEDICAL EDUCATION AND A FOUNDATION. SUMMA HEALTH IS RENOWNED FOR EXCELLENCE IN PATIENT CARE AND FOR EXCEPTIONAL APPROACHES TO HEALTHCARE DELIVERY. DURING 2019, SUMMA HEALTH PROVIDED INPATIENT CARE THROUGH FACILITIES LOCATED ON THREE MAIN CAMPUSES AND IN ADDITION, OUTPATIENT CARE IS EXTENDED THROUGHOUT THE REGION IN A NUMBER OF OUTPATIENT CENTERS, BOTH HOSPITAL-BASED AND FREESTANDING. SUMMA HEALTH SYSTEM'S AKRON TERTIARY CAMPUS IS LOCATED IN DOWNTOWN AKRON, OHIO AND HAS SERVED, TOGETHER WITH SUMMA HEALTH, AS THE LARGEST SAFETY-NET HOSPITAL IN THE COMMUNITY FOR MANY YEARS. THE BARBERTON CAMPUS IS A 251-BED HOSPITAL FACILITY THAT OFFERS INPATIENT SERVICES, OUTPATIENT SERVICES AND COMMUNITY OUTREACH PROGRAMS. THE BARBERTON CAMPUS IS LOCATED IN THE CITY OF BARBERTON IN SOUTHERN SUMMIT COUNTY. SUMMA REHAB HOSPITAL, LLC, A JOINT VENTURE BETWEEN SUMMA HEALTH SYSTEM AND VIBRA HEALTHCARE, OPENED ON THE CAMPUS OF SUMMA AKRON CITY HOSPITAL IN 2012. THIS 60-BED FACILITY PROVIDES INPATIENT REHABILITATION CARE AND SERVICES AND ADHERES TO SUMMA'S CHARITY CARE POLICY. ESTABLISHED IN 1993, SUMMACARE OFFERS HEALTH CARE COVERAGE TO MEMBERS including members insured through ITS STATUS AS A MEDICARE ADVANTAGE ORGANIZATION. SUMMACARE IS RECOGNIZED BY THE HEALTH INDUSTRY RESEARCH COMPANY AS A HEALTH PLAN WITH EFFECTIVE DISEASE MANAGEMENT PROGRAMS FOR ASTHMA, HEALTH FAILURE AND DIABETES. SUMMACARE, ALONG WITH ITS THIRD PARTY ADMINISTRATIVE SERVICES PRODUCTS COVERS APPROXIMATELY 63,000 MEMBERS. SUMMA FOUNDATION IS A NONPROFIT ORGANIZATION ADVANCING TRANSFORMATIONAL PHILANTHROPY, COMMUNITY UNDERSTANDING AND GOODWILL FOR THE PROGRAMS AND PRIORITIES OF SUMMA HEALTH. SUMMA HEALTH NETWORK, LLC IS THE INTEGRATED PHYSICIAN-HOSPITAL ORGANIZATION AFFILIATED WITH SUMMA HEALTH. WITH MORE THAN 2,300 PHYSICIANS PARTICIPATING, SUMMA HEALTH NETWORK OVERSEES MUTUALLY BENEFICIAL CONTRACTS WITH INSURANCE COMPANIES, PREFERRED PROVIDER ORGANIZATIONS, THIRD-PARTY ADMINISTRATORS AND OTHER PAYORS ON BEHALF OF ITS PHYSICIANS AND HOSPITAL MEMBERS. SUMMA ACCOUNTABLE CARE ORGANIZATION (D/B/A NEWHEALTH COLLABORATIVE ("NHC")) IS A CLINICIAN-LED COLLABORATIVE, ORGANIZED TO COMPASSIONATELY CARE FOR AND SERVE PATIENTS IN AN ACCOUNTABLE, VALUE AND EVIDENCE-BASED MANNER. IN ACCORDANCE WITH THE AFFORDABLE CARE ACT, NHC CREATES INCENTIVES FOR PROVIDERS TO FURTHER ENHANCE THE QUALITY OF CARE. OHIO HEALTH CHOICE, INC. (OHC) IS OHIO'S OLDEST PREFERRED PROVIDER ORGANIZATION (PPO) NETWORK IN THE STATE. OHC IS CO-OWNED BY SUMMA HEALTH AND MERCY MEDICAL CENTER, AND IS COMPRISED OF approximately 200 HOSPITALS, 14,000 PRIMARY CARE PROVIDERS, 25,000 SPECIALISTS, COVERING MEMBERS ACROSS ALL 88 COUNTIES IN OHIO. SUMMA PHYSICIANS, INC. (D/B/A SUMMA HEALTH MEDICAL GROUP ("SHMG")) IS A MULTI-SPECIALTY PHYSICIAN PRACTICE EMPLOYING OVER 300 PHYSICIANS IN MULTIPLE SPECIALTIES. SHMG PROMOTES STRONGER AFFILIATION AND EMPLOYMENT OF PHYSICIANS TO ENSURE COMMUNITY AND HOSPITAL NEEDS FOR PHYSICIANS SERVICES ARE MET.
Schedule H, Part VI, line 7 Facility Reporting Summa Health & Summa Rehab	State filing of community benefit report:The State of Ohio does not require the filing of the community benefit report for 2019. However, Ohio requires all tax-exempt hospitals to submit to the Ohio Department of Health (ODH)existing community health needs assessments and plans. Additionally, hospitals are required to submit to ODH a copy of the hospital's schedule H (form 990), corresponding attachments and reporting on financial assistance and means-tested government programs and community building activities in parts I and II of Schedule H.

Schedule H (Form 990) 2019

Additional Data

Software ID:
Software Version:

- TIN:

Note: To capture the full content of this document, please select landscape mode (11" x 8.5") when printing.

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
SUMMA HEALTH GROUP RETURN

Employer identification number
90-0640432

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) AMERICAN HEART ASSOCIATION 3505 EMBASSY PARKWAY STE 100 AKRON,OH44333	13-5613797	501(C)(3)	37,500	Prevention, Wellness, Access to Care and Health Disparities, RESEARCH AND EDUCATION
(2) Summit County 550 East Market St AKRON,OH44304	34-1807135	Governmental	8,000	HEALTH EQUITY
(3) THE UNIVERSITY OF AKRON 302 BUCHTEL COMMON AKRON,OH44301	34-6002924	Governmental	6,000	EDUCATIONAL
(4) SUSAN G KOMEN FOR THE CURE 26210 EMERY ROAD CLEVELAND,OH44128	75-1835298	501(C)(3)	20,000	Prevention, Wellness, Access to Care and Health Disparities, CANCER WELLNESS SUPPORT
(5) AKRON COMMUNITY FOUNDATION 345 WEST CEDAR STREET AKRON,OH44307	34-1087615	501(C)(3)	8,000	Prevention, Wellness and Health Disparities
(6) STEWARTS CARING PLACE 2955 WEST MARKET STREET AKRON,OH44333	20-0181338	501(C)(3)	10,000	Prevention, Wellness, Access to Care and Health Disparities
(7) AMERICAN CANCER SOCIETY 525 NORTH BROAD STREET CANFIELD,OH44406	25-1798733	501(C)(3)	10,000	PREVENTION, WELLNESS, ACCESS TO CARE, HEALTH DISPARITIES AND CANCER RESEARCH
(8) YMCA of Akron 50 SOUTH MAIN STREET STE LL 100 AKRON,OH44308	34-0714727	501(C)(3)	130,000	Prevention, Wellness and Health Disparities
(9) AKRON URBAN LEAGUE 440 VERNON ODOM BOULEVARD AKRON,OH44307	34-0714520	501(C)(3)	10,000	Prevention, Wellness, Access to Care and Health Disparities
(10) HABITAT FOR HUMANITY 2301 ROMIG ROAD AKRON,OH44320	34-1518873	501(C)(3)	9,750	Prevention, Wellness and Health Disparities

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:	The procedures for monitoring the use of grant funds is based on the criteria established prior to awarding the grant or assistance. Once the criteria is met a payment will be made to the organization utilizing the funds.

Schedule I (Form 990) 2019

Additional Data

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Software Version:

- TIN:

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

SUMMA HEALTH GROUP RETURN

Employer identification number

90-0640432

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

Yes

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)
1T Clifford Deveny MD CEO SHS, Director SHS & SF	(i) (ii)	0 ------------- 981,973	0 ------------- 259,399	0 ------------- 232,211	0 ------------- 8,993	0 ------------- 27,090	0 ------------- 1,509,666	0 ------------- 0
2Derek Klaus MD CLINICAL PHYSICIAN - SHMG	(i) (ii)	672,748 ------------- 0	612,545 ------------- 0	1,170 ------------- 0	8,400 ------------- 0	31,993 ------------- 0	1,326,856 ------------- 0	0 ------------- 0
3MARK POZSGAY DO ClINICAL PHYSICIAN - SHMG	(i) (ii)	983,422 ------------- 0	269,773 ------------- 0	1,200 ------------- 0	4,200 ------------- 0	35,056 ------------- 0	1,293,651 ------------- 0	0 ------------- 0
4JOHN G ZOGRAFAKIS MD clinICAL PHYSICIAN - SHMG	(i) (ii)	871,400 ------------- 0	276,239 ------------- 0	1,350 ------------- 0	7,768 ------------- 0	30,350 ------------- 0	1,187,107 ------------- 0	0 ------------- 0
5Anand Desai MD CLINICAL PHYSICIAN - SHMG	(i) (ii)	605,732 ------------- 0	517,526 ------------- 0	1,170 ------------- 0	4,132 ------------- 0	5,866 ------------- 0	1,134,426 ------------- 0	0 ------------- 0
6KIEL PFEFFERIE MD CliniCAL PHYSICIAN - SHMG	(i) (ii)	698,480 ------------- 0	367,259 ------------- 0	1,170 ------------- 0	0 ------------- 0	29,046 ------------- 0	1,095,955 ------------- 0	0 ------------- 0
7Peter Bittenbender MD DIR. SHS & DIR. SHMG	(i) (ii)	705,274 ------------- 0	45,146 ------------- 0	1,170 ------------- 0	8,400 ------------- 0	8,613 ------------- 0	768,603 ------------- 0	0 ------------- 0
8Lydia Cook MD President Summa Health Med	(i) (ii)	427,824 ------------- 0	202,103 ------------- 0	105,326 ------------- 0	9,800 ------------- 0	8,922 ------------- 0	753,975 ------------- 0	0 ------------- 0
9David Custodio MD President, SHS	(i) (ii)	415,432 ------------- 0	199,108 ------------- 0	101,052 ------------- 0	9,800 ------------- 0	25,251 ------------- 0	750,643 ------------- 0	0 ------------- 0
10ROBERT A GERBERRY SHS SEC./SR. VP G.Counsel,	(i) (ii)	0 ------------- 365,068	0 ------------- 242,103	0 ------------- 86,322	0 ------------- 9,800	0 ------------- 17,135	0 ------------- 720,428	0 ------------- 0
11KEITH T COLEMAN SVP CFO, TR. SHS & SHMG, A	(i) (ii)	0 ------------- 455,149	0 ------------- 79,061	0 ------------- 110,462	0 ------------- 1,798	0 ------------- 21,825	0 ------------- 668,295	0 ------------- 0
12THOMAS P O'NEILL VP, CFO SHS, Assistant Tre	(i) (ii)	0 ------------- 356,732	0 ------------- 172,335	0 ------------- 93,149	0 ------------- 7,146	0 ------------- 21,797	0 ------------- 651,159	0 ------------- 0
13Michael Hughes MD President Summa Barberton	(i) (ii)	364,682 ------------- 0	159,693 ------------- 0	89,481 ------------- 0	9,800 ------------- 0	20,976 ------------- 0	644,632 ------------- 0	0 ------------- 0
14PHYLIS FERRARA PRESIDENT & CDO, SF	(i) (ii)	334,123 ------------- 0	160,007 ------------- 0	87,409 ------------- 0	9,800 ------------- 0	11,418 ------------- 0	602,757 ------------- 0	0 ------------- 0
15Tammy Scarborough President Ambulatory Care	(i) (ii)	0 ------------- 334,338	0 ------------- 158,573	0 ------------- 78,145	0 ------------- 8,313	0 ------------- 9,366	0 ------------- 588,735	0 ------------- 0
16Lori Rhine RN VP, CNO Akron & St. Thomas	(i) (ii)	295,701 ------------- 0	146,681 ------------- 0	3,449 ------------- 0	8,750 ------------- 0	24,221 ------------- 0	478,802 ------------- 0	0 ------------- 0
17Lynn Hamrich MD DIRECTOR SHS	(i) (ii)	261,970 ------------- 0	0 ------------- 0	1,287 ------------- 0	8,032 ------------- 0	19,249 ------------- 0	290,538 ------------- 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	Tax indemnification and gross-up payments: Summa Health System grossed up taxes for supplemental executive retirement programs paid to seven officers, and two key employees. The amount of the gross up is recognized as additional taxable compensation. Health or social club dues or initiation fees: Social Club dues were paid on behalf of one officer. Any personal use is recognized as additional taxable compensation.
Part I, Line 3	Arrangements used to establish the top management official's compensation: The compensation of the President and CEO is established by Summa Health, the related parent organization for all members in the Summa Health System group return. Summa Health has a compensation committee that uses an independent compensation consultant, market surveys, and an annual review process to establish compensation for the position of president and CEO.
Part I, Line 4b	Part 1, Line 4b Supplemental non-qualified retirement plan A Supplemental executive retirement plan is to provide key employees with additional compensation to supplement their retirement benefits and mitigate effects of qualified retirement plan limits. The following listed persons received benefits from the organization or from a related organization: T. Clifford Deveny, MD $226,709, Phylis Ferrara $77,233, Lydia Cook, MD $98,309, Keith T. Coleman $102,957, Robert A. Gerberry $83,821, Thomas P. O'Neill $82,278, David Custodio, MD $96,358, Michael Hughes, MD $83,431, Tammy Scarborough $76,423.
Part I, Line 7	Non-fixed payments: The Summa Health System management incentive program is designed to reward employees for meeting quality, performance and financial targets. These targets include clinical quality, patient satisfaction, employee/physician satisfaction, operating margin, and the strengthening of the balance sheet. Payment is based on a factor of base compensation and is subject to review and approval by Summa's compensation committee.

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
SUMMA HEALTH GROUP RETURN

Employer identification number
90-0640432

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	67756AY89	05-11-2010	180,125,341	See Part VI	X			X		X
B	Akron Bath and Copley Jt Twp Hosp Dist	34-1448680		07-25-2012	32,509,635	see Part VI		X		X		X
C	See Schedule K Part VI	34-1448680		10-02-2014	145,250,000	see Part VI		X		X		X
D	Akron Bath and Copley Jt Twp Hosp Dist	34-1448680	009730NX6	12-16-2016	204,934,207	see Part VI		X		X		X
	Akron Bath and Copley Jt Twp Hosp Dist	34-1448680		12-22-2017	140,000,000	see Part VI		X		X		X
	Akron Bath and Copley Jt Twp Hosp Dist	34-1448680		05-15-2018	16,252,805	see Part VI		X		X		X

Part Ⅱ

Proceeds

	A		B		C		D
	1 Amount of bonds retired ..................			19,050,927		57,295,000		6,725,000
2 Amount of bonds legally defeased ..............	24,495,000
3 Total proceeds of issue ..................	180,162,106		32,509,635		145,250,000		205,384,474
4 Gross proceeds in reserve funds .............	17,210,123
5 Capitalized interest from proceeds .............	3,004,911				795,890		1,874,244
6 Proceeds in refunding escrows ...............							26,625,195
7 Issuance costs from proceeds ...............							201,939
8 Credit enhancement from proceeds .............	4,929,857
9 Working capital expenditures from proceeds .............
10 Capital expenditures from proceeds .............	154,030,731						100,525,342
11 Other spent proceeds .............			32,509,635		144,454,110		76,157,754
12 Other unspent proceeds .............	18,194		16,252,805
13 Year of substantial completion .............	2012		2012		2008		2019
	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		X		X		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		X		X	X
16 Has the final allocation of proceeds been made? ..........	X		X		X		X
17 Does the organization maintain adequate books and records to support the final allocation of proceeds? ..................	X		X		X		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		X		X
2 Are there any lease arrangements that may result in private business use of bond-financed property? ...............	X		X		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		X		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		X		X
c Are there any research agreements that may result in private business use of bond-financed property? .............	X		X		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?	X		X		X
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 ....	1.100 %		3.500 %		0.600 %
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 .........	0.200 %		0.500 %		0.100 %
6 Total of lines 4 and 5 .............	1.300 %		4.000 %		0.700 %
7 Does the bond issue meet the private security or payment test? ...		X		X		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		X	X
b If "Yes" to line 8a, enter the percentage of bond-financed property sold or disposed of. ..					5.800 %
c If "Yes" to line 8a, was any remedial action taken pursuant to Regulations sections 1.141-12 and 1.145-2? .............					X
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		X		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		X		X		X
2 If "No" to line 1, did the following apply? ....
a Rebate not due yet? .......		X		X		X	X
b Exception to rebate? ........		X	X		X			X
c No rebate due? .........	X			X		X		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	X		X			X
4a Has the organization or the governmental issuer entered into a qualified hedge with respect to the bond issue?		X	X		X			X
b Name of provider ..........			RBS Citizens Bank		See Schedule K VI
c Term of hedge .........			1200.0000000000 %		2000.0000000000 %
d Was the hedge superintegrated? ......				X		X
e Was the hedge terminated? ........				X		X

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			X		X	X
b Name of provider ..........	Morgan Stanley & Company						See Schedule K VI
c Term of GIC .........	220.0000000000 %						100.0000000000 %
d Was the regulatory safe harbor for establishing the fair market value of the GIC satisfied? ........	X						X
6 Were any gross proceeds invested beyond an available temporary period?		X		X		X		X
7 Has the organization established written procedures to monitor the requirements of section 148? ...	X		X		X		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		X		X		X

Part Ⅵ

Supplemental Information. Provide additional information for responses to questions on Schedule K. (See instructions).

Return Reference	Explanation
Date Rebate Computation Performed	Issuer Name: Ohio Higher Educational Facility Commission Date the Rebate Computation was Performed: 05/11/2013
Schedule K	Akron, Bath and Copley Joint Township Hospital District Series 2017 Bonds: An additional Schedule K is included to provide for the issuance of the Series 2017 Bonds and the Series 2018 Bonds.
Schedule K, Part I, Line A, Column (f)	Ohio Higher Educational Facility Commission Series 2010 Bonds: The purposes of the Series 2010 Bonds were to (1) currently refund a taxable loan to Summa Barberton Citizens Hospital under a line of credit, the proceeds of which were used to acquire hospital facilities, (2) currently refund a taxable loan to Summa Akron City and St. Thomas Hospitals, the proceeds of which were used for certain capital expenditures, (3) construct and equip hospital facilities, (4) acquire, construct, and equip parking facilities, nursing facilities, administrative facilities, ambulatory care facilities, and medical equipment, and (5) pay issuance costs.
Schedule K, Part I, Line B, Column (f)	Akron, Bath and Copley Joint Township Hospital District Series 2012 Bonds: The purposes of the Series 2012 Bonds were to (1) currently refund the hospital facilities revenue bonds, Series 1998A issued on December 23, 1998 in the original principal amount of $50,000,000, and (2) pay issuance costs.
Schedule K, Part I, Line C, Column (a)	Akron, Bath and Copley Joint Township Hospital District Series 2014 Bonds: The 2014 Bonds consisted of the following three series of Bonds, which were treated as a single issue of bonds for federal income tax purposes: (1) Akron, Bath and Copley Joint Township Hospital District, Ohio Hospital Facilities Refunding Revenue Bonds, Series 2014A (Summa Health System Obligated Group) issued in the original principal amount of $93,685,000 (the "Series 2014A Bonds"), (2) Akron, Bath and Copley Joint Township Hospital District, Ohio Hospital Facilities Refunding Revenue Bonds, Series 2014B (Summa Health System Obligated Group) issued in the original principal amount of $37,890,000 (the "Series 2014B Bonds"), and (3) Development Finance Authority of Summit County Port Facilities Revenue Refunding Bonds, Series 2014 (Summa Health System Obligated Group Project) issued in the original principal amount of $13,675,000 (the "Development Finance Authority Bonds"). The Series 2014A Bonds and the Development Finance Authority Bonds were each issued on October 2, 2014, and the Series 2014B Bonds were issued on November 18, 2014. The Akron, Bath and Copley Joint Township Hospital District's EIN is 34-1448680, and the Development Finance Authority's EIN is 34-1765940.
Schedule K, Part I, Line C, Column (f)	Series 2014A Bonds, Series 2014B Bonds, and Series 2014 Bonds: The purpose of the Series 2014A Bonds was to currently refund the Series 2004B Bonds, which were issued to (1) construct and equip a critical care pavilion, (2) construct and equip other hospital facilities, (3) refund prior issues with the following issue dates: (a) December 22, 1992 and (b) June 10, 1993, (4) pay the initial costs of a liquidity facility, and (5) pay issuance costs. The purposes of the Series 2014B Bonds were to (1) currently refund the Series 2004A Bonds, which were issued to (a) construct and equip a critical care pavilion, (b) construct and equip other hospital facilities, (c) refund prior issues with the following issue dates: (I) July 1, 1999, (II) July 28, 2000, and (iii) March 12, 2002, (d) fund a debt service reserve for Series 2004A Bonds, and (e) pay issuance costs, (2) fund capitalized interest on the Series 2014B Bonds. The purpose of the Development Finance Authority Series 2014 Bonds was to currently refund the Series 2006 Bonds, which were issued to (1) acquire a project site for and construct and equip a wellness institute, and (2) pay issuance costs.
Schedule K, Part I, Line D, Column (f)	Akron, Bath and Copley Joint Township Hospital District Series 2016 Bonds: The purpose of the Series 2016 Bonds was to (1) acquire, construct, improve, and equip certain hospital facilities, (2) currently refund all of the outstanding Series 2014B Bonds, (3) currently refund all of the outstanding Akron, Bath and Copley Joint Township Hospital District, Ohio Hospital Facilities Revenue Bonds, Series 2015 (Summa Health Obligated Group) issued in the original principal amount of $42,255,000, which were issued to acquire, construct, improve, and equip certain hospital facilities and pay issuance costs, and (4) advance refund $24,495,000 of the outstanding principal amount of the Series 2010 Bonds.
Schedule K, Part II, Column A, Line 3	Total Proceeds of Issue - Column A: The difference between the total proceeds of the issue and the issue price provided in Part I, Line A, Column (e) is due to investment proceeds of the issue.
Schedule K, Part II, Column A, Line 4	Total Proceeds of Issue - Column A: A portion of the reserve fund of this issue was deposited into an escrow fund in connection with the advance refunding of a portion of this issue with the Series 2016 Bonds.
Schedule K, Part II, Column D, Line 3	Total Proceeds of Issue - Column D: The difference between the total proceeds of the issue and the issue price provided in Part I, Line 4, Column (e) is due to investment proceeds of the issue. This amount is smaller than the amount reported in the 2017 Schedule K because certain disposition proceeds included as proceeds of the Series 2016 Bonds were part of a remedial action under Treasury Regulations Section 1.141-12. Those disposition proceeds are included in the additional Schedule K as the Series 2018 Bonds.
Schedule K, Part II, Column D, Line 7	Issuance Costs from Proceeds - Column D: The issuance costs of the issue provided in Part II, Line 7, Column D is less than the issuance costs provided in the Form 8038 for this issue because of the transfer of unexpended money in the expense fund to the project fund for this issue.
Schedule K, Part III, Column D, Line 8a	Sale of Bond-Financed Property: Summa elected to use the alternative use of disposition proceeds under Regulations Section 1.141-12. An IRS Form 8038 was filed in connection with that remedial action and, accordingly, Summa has reported that remedial action as a reissued bond for purposes of Schedule K.
Schedule K, Part IV, Column C, Line 4b	Name of Hedge Provider: Series 2014A Bonds: Goldman Sachs Bank USA. Development Finance Authority Series 2014 Bonds: PNC Bank, National Association.
Schedule K, Part IV, Column C, Line 4c	Term of Hedge: The term of the hedge with Goldman Sachs Bank USA is 20 years. The term of the hedge with PNC Bank, National Association is 30 years.
Schedule K, Part IV, Column A, Line 2c	Rebate Calculation: The calculation for computing no rebate due was performed on 05/08/2018.
SCHEDULE K, PART IV, COLUMN A, LINE 5B	Name of GIC Provider: Morgan Stanley & Company Incorporated
Schedule K, Part I, Line A, Column (a)	Akron, Bath and Copley Joint Township Hospital District Series 2017A Bond, Series 2017B Bonds, and Series 2017C Bonds: The 2017 Bonds consisted of the following three series of Bonds, which were treated as a single issue of bonds for federal income tax purposes: (1) Akron, Bath and Copley Joint Township Hospital District, Ohio Hospital Facilities Improvement Revenue Bonds, Series 2017A (Summa Health Obligated Group) issued in the original principal amount of $15,000,000, (2) Akron, Bath and Copley Joint Township Hospital District, Ohio Hospital Facilities Improvement Revenue Bonds, Series 2017B (Summa Health Obligated Group) issued in the original principal amount of $75,000,000, and (3) Akron, Bath and Copley Joint Township Hospital District, Ohio Hospital Facilities Improvement Revenue Bonds, Series 2017C (Summa Health Obligated Group) issued in the original principal amount of $50,000,000.
Schedule K, Part I, Line B	Akron, Bath and Copley Joint Township Hospital District Series 2018 Bonds: The Series 2018 Bonds were an alternative disposition of sale proceeds of a portion of property that was financed with the proceeds of the Series 2016 Bonds. The alternative disposition of bond proceeds was a remedial action done in accordance with Regulations Section 1.141-12.
Schedule K, Part II, Column A, Line 3	Akron, Bath and Copley Joint Township Hospital District Series 2018 Bonds: Total Proceeds of Issue - Column A The difference between the total proceeds of the issue and the issue price provided in Part I, Line A, Column (e) is due to investment proceeds of the issue.

Schedule K (Form 990) 2019

Additional Data

Software ID:
Software Version:

- TIN:

Note: To capture the full content of this document, please select landscape mode (11" x 8.5") when printing.

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
SUMMA HEALTH GROUP RETURN

Employer identification number
90-0640432

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	67756AY89	05-11-2010	180,125,341	See Part VI	X			X		X
B	Akron Bath and Copley Jt Twp Hosp Dist	34-1448680		07-25-2012	32,509,635	see Part VI		X		X		X
C	See Schedule K Part VI	34-1448680		10-02-2014	145,250,000	see Part VI		X		X		X
D	Akron Bath and Copley Jt Twp Hosp Dist	34-1448680	009730NX6	12-16-2016	204,934,207	see Part VI		X		X		X
	Akron Bath and Copley Jt Twp Hosp Dist	34-1448680		12-22-2017	140,000,000	see Part VI		X		X		X
	Akron Bath and Copley Jt Twp Hosp Dist	34-1448680		05-15-2018	16,252,805	see Part VI		X		X		X

Part Ⅱ

Proceeds

	A		B		C		D
	1 Amount of bonds retired ..................			19,050,927		57,295,000		6,725,000
2 Amount of bonds legally defeased ..............	24,495,000
3 Total proceeds of issue ..................	180,162,106		32,509,635		145,250,000		205,384,474
4 Gross proceeds in reserve funds .............	17,210,123
5 Capitalized interest from proceeds .............	3,004,911				795,890		1,874,244
6 Proceeds in refunding escrows ...............							26,625,195
7 Issuance costs from proceeds ...............							201,939
8 Credit enhancement from proceeds .............	4,929,857
9 Working capital expenditures from proceeds .............
10 Capital expenditures from proceeds .............	154,030,731						100,525,342
11 Other spent proceeds .............			32,509,635		144,454,110		76,157,754
12 Other unspent proceeds .............	18,194		16,252,805
13 Year of substantial completion .............	2012		2012		2008		2019
	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		X		X		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		X		X	X
16 Has the final allocation of proceeds been made? ..........	X		X		X		X
17 Does the organization maintain adequate books and records to support the final allocation of proceeds? ..................	X		X		X		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		X		X
2 Are there any lease arrangements that may result in private business use of bond-financed property? ...............	X		X		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		X		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		X		X
c Are there any research agreements that may result in private business use of bond-financed property? .............	X		X		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?	X		X		X
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 ....	1.100 %		3.500 %		0.600 %
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 .........	0.200 %		0.500 %		0.100 %
6 Total of lines 4 and 5 .............	1.300 %		4.000 %		0.700 %
7 Does the bond issue meet the private security or payment test? ...		X		X		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		X	X
b If "Yes" to line 8a, enter the percentage of bond-financed property sold or disposed of. ..					5.800 %
c If "Yes" to line 8a, was any remedial action taken pursuant to Regulations sections 1.141-12 and 1.145-2? .............					X
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		X		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		X		X		X
2 If "No" to line 1, did the following apply? ....
a Rebate not due yet? .......		X		X		X	X
b Exception to rebate? ........		X	X		X			X
c No rebate due? .........	X			X		X		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	X		X			X
4a Has the organization or the governmental issuer entered into a qualified hedge with respect to the bond issue?		X	X		X			X
b Name of provider ..........			RBS Citizens Bank		See Schedule K VI
c Term of hedge .........			1200.0000000000 %		2000.0000000000 %
d Was the hedge superintegrated? ......				X		X
e Was the hedge terminated? ........				X		X

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			X		X	X
b Name of provider ..........	Morgan Stanley & Company						See Schedule K VI
c Term of GIC .........	220.0000000000 %						100.0000000000 %
d Was the regulatory safe harbor for establishing the fair market value of the GIC satisfied? ........	X						X
6 Were any gross proceeds invested beyond an available temporary period?		X		X		X		X
7 Has the organization established written procedures to monitor the requirements of section 148? ...	X		X		X		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		X		X		X

Part Ⅵ

Supplemental Information. Provide additional information for responses to questions on Schedule K. (See instructions).

Return Reference	Explanation
Date Rebate Computation Performed	Issuer Name: Ohio Higher Educational Facility Commission Date the Rebate Computation was Performed: 05/11/2013
Schedule K	Akron, Bath and Copley Joint Township Hospital District Series 2017 Bonds: An additional Schedule K is included to provide for the issuance of the Series 2017 Bonds and the Series 2018 Bonds.
Schedule K, Part I, Line A, Column (f)	Ohio Higher Educational Facility Commission Series 2010 Bonds: The purposes of the Series 2010 Bonds were to (1) currently refund a taxable loan to Summa Barberton Citizens Hospital under a line of credit, the proceeds of which were used to acquire hospital facilities, (2) currently refund a taxable loan to Summa Akron City and St. Thomas Hospitals, the proceeds of which were used for certain capital expenditures, (3) construct and equip hospital facilities, (4) acquire, construct, and equip parking facilities, nursing facilities, administrative facilities, ambulatory care facilities, and medical equipment, and (5) pay issuance costs.
Schedule K, Part I, Line B, Column (f)	Akron, Bath and Copley Joint Township Hospital District Series 2012 Bonds: The purposes of the Series 2012 Bonds were to (1) currently refund the hospital facilities revenue bonds, Series 1998A issued on December 23, 1998 in the original principal amount of $50,000,000, and (2) pay issuance costs.
Schedule K, Part I, Line C, Column (a)	Akron, Bath and Copley Joint Township Hospital District Series 2014 Bonds: The 2014 Bonds consisted of the following three series of Bonds, which were treated as a single issue of bonds for federal income tax purposes: (1) Akron, Bath and Copley Joint Township Hospital District, Ohio Hospital Facilities Refunding Revenue Bonds, Series 2014A (Summa Health System Obligated Group) issued in the original principal amount of $93,685,000 (the "Series 2014A Bonds"), (2) Akron, Bath and Copley Joint Township Hospital District, Ohio Hospital Facilities Refunding Revenue Bonds, Series 2014B (Summa Health System Obligated Group) issued in the original principal amount of $37,890,000 (the "Series 2014B Bonds"), and (3) Development Finance Authority of Summit County Port Facilities Revenue Refunding Bonds, Series 2014 (Summa Health System Obligated Group Project) issued in the original principal amount of $13,675,000 (the "Development Finance Authority Bonds"). The Series 2014A Bonds and the Development Finance Authority Bonds were each issued on October 2, 2014, and the Series 2014B Bonds were issued on November 18, 2014. The Akron, Bath and Copley Joint Township Hospital District's EIN is 34-1448680, and the Development Finance Authority's EIN is 34-1765940.
Schedule K, Part I, Line C, Column (f)	Series 2014A Bonds, Series 2014B Bonds, and Series 2014 Bonds: The purpose of the Series 2014A Bonds was to currently refund the Series 2004B Bonds, which were issued to (1) construct and equip a critical care pavilion, (2) construct and equip other hospital facilities, (3) refund prior issues with the following issue dates: (a) December 22, 1992 and (b) June 10, 1993, (4) pay the initial costs of a liquidity facility, and (5) pay issuance costs. The purposes of the Series 2014B Bonds were to (1) currently refund the Series 2004A Bonds, which were issued to (a) construct and equip a critical care pavilion, (b) construct and equip other hospital facilities, (c) refund prior issues with the following issue dates: (I) July 1, 1999, (II) July 28, 2000, and (iii) March 12, 2002, (d) fund a debt service reserve for Series 2004A Bonds, and (e) pay issuance costs, (2) fund capitalized interest on the Series 2014B Bonds. The purpose of the Development Finance Authority Series 2014 Bonds was to currently refund the Series 2006 Bonds, which were issued to (1) acquire a project site for and construct and equip a wellness institute, and (2) pay issuance costs.
Schedule K, Part I, Line D, Column (f)	Akron, Bath and Copley Joint Township Hospital District Series 2016 Bonds: The purpose of the Series 2016 Bonds was to (1) acquire, construct, improve, and equip certain hospital facilities, (2) currently refund all of the outstanding Series 2014B Bonds, (3) currently refund all of the outstanding Akron, Bath and Copley Joint Township Hospital District, Ohio Hospital Facilities Revenue Bonds, Series 2015 (Summa Health Obligated Group) issued in the original principal amount of $42,255,000, which were issued to acquire, construct, improve, and equip certain hospital facilities and pay issuance costs, and (4) advance refund $24,495,000 of the outstanding principal amount of the Series 2010 Bonds.
Schedule K, Part II, Column A, Line 3	Total Proceeds of Issue - Column A: The difference between the total proceeds of the issue and the issue price provided in Part I, Line A, Column (e) is due to investment proceeds of the issue.
Schedule K, Part II, Column A, Line 4	Total Proceeds of Issue - Column A: A portion of the reserve fund of this issue was deposited into an escrow fund in connection with the advance refunding of a portion of this issue with the Series 2016 Bonds.
Schedule K, Part II, Column D, Line 3	Total Proceeds of Issue - Column D: The difference between the total proceeds of the issue and the issue price provided in Part I, Line 4, Column (e) is due to investment proceeds of the issue. This amount is smaller than the amount reported in the 2017 Schedule K because certain disposition proceeds included as proceeds of the Series 2016 Bonds were part of a remedial action under Treasury Regulations Section 1.141-12. Those disposition proceeds are included in the additional Schedule K as the Series 2018 Bonds.
Schedule K, Part II, Column D, Line 7	Issuance Costs from Proceeds - Column D: The issuance costs of the issue provided in Part II, Line 7, Column D is less than the issuance costs provided in the Form 8038 for this issue because of the transfer of unexpended money in the expense fund to the project fund for this issue.
Schedule K, Part III, Column D, Line 8a	Sale of Bond-Financed Property: Summa elected to use the alternative use of disposition proceeds under Regulations Section 1.141-12. An IRS Form 8038 was filed in connection with that remedial action and, accordingly, Summa has reported that remedial action as a reissued bond for purposes of Schedule K.
Schedule K, Part IV, Column C, Line 4b	Name of Hedge Provider: Series 2014A Bonds: Goldman Sachs Bank USA. Development Finance Authority Series 2014 Bonds: PNC Bank, National Association.
Schedule K, Part IV, Column C, Line 4c	Term of Hedge: The term of the hedge with Goldman Sachs Bank USA is 20 years. The term of the hedge with PNC Bank, National Association is 30 years.
Schedule K, Part IV, Column A, Line 2c	Rebate Calculation: The calculation for computing no rebate due was performed on 05/08/2018.
SCHEDULE K, PART IV, COLUMN A, LINE 5B	Name of GIC Provider: Morgan Stanley & Company Incorporated
Schedule K, Part I, Line A, Column (a)	Akron, Bath and Copley Joint Township Hospital District Series 2017A Bond, Series 2017B Bonds, and Series 2017C Bonds: The 2017 Bonds consisted of the following three series of Bonds, which were treated as a single issue of bonds for federal income tax purposes: (1) Akron, Bath and Copley Joint Township Hospital District, Ohio Hospital Facilities Improvement Revenue Bonds, Series 2017A (Summa Health Obligated Group) issued in the original principal amount of $15,000,000, (2) Akron, Bath and Copley Joint Township Hospital District, Ohio Hospital Facilities Improvement Revenue Bonds, Series 2017B (Summa Health Obligated Group) issued in the original principal amount of $75,000,000, and (3) Akron, Bath and Copley Joint Township Hospital District, Ohio Hospital Facilities Improvement Revenue Bonds, Series 2017C (Summa Health Obligated Group) issued in the original principal amount of $50,000,000.
Schedule K, Part I, Line B	Akron, Bath and Copley Joint Township Hospital District Series 2018 Bonds: The Series 2018 Bonds were an alternative disposition of sale proceeds of a portion of property that was financed with the proceeds of the Series 2016 Bonds. The alternative disposition of bond proceeds was a remedial action done in accordance with Regulations Section 1.141-12.
Schedule K, Part II, Column A, Line 3	Akron, Bath and Copley Joint Township Hospital District Series 2018 Bonds: Total Proceeds of Issue - Column A The difference between the total proceeds of the issue and the issue price provided in Part I, Line A, Column (e) is due to investment proceeds of the issue.

Schedule K (Form 990) 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

SUMMA HEALTH GROUP RETURN

Employer identification number

90-0640432

Return Reference	Explanation
Form 990, Part V, Line 2a and 2b	The parent organization, Summa Health, EIN 34-1887844, is the employer of record for employees working for Group Return entities.
Form 990, Part VI, Section A, line 1	Lines 1A and 1B: The director count information is presented in the following format: Entity name - Number of Voting Members - Number of independent voting members Summa Health System ("SHS") - 16 - 13 Summa Foundation ("SF") - 26 - 24 Summa Physicians, Inc. dba Summa Health Medical Group ("SHMG") - 3 - 2 Totals for Group return - 45 - 39 All of the organizations listed above are subordinates under the control of Summa Health ("SH"). As of December 31, 2019, SH had 16 voting directors, 13 of whom were independent voting directors.
Form 990, Part VI, Section A, line 2	Family/Business relationships amongst interested persons: Summa Health System: The following individuals have a business relationship as board members of an entity in which Summa Health System has an ownership interest: Aris Teleradiology Holdings, Inc.: Thomas O'Neill, Tammy Scarborough Select Specialty Hospital, LLC: Thomas O'Neill, Mark Terpylak, DO, Lori Rhine, RN Summa Rehab Hospital: Thomas O'Neill, Mark Terpylak, DO, Tammy Scarborough, David Custodio, MD The following individuals have a business relationship as board members of a Summa Health owned entity: Middlebury Assurance Company: T. Clifford Deveny, MD, James McIlvaine, Robert Gerberry, Thomas O'Neill Summa ACO dba NewHealth Collaborative: T. Clifford Deveny, MD, Keith Coleman, Robert Gerberry, Lydia Cook, MD, Michael Hughes, MD Summa Health System Corp: T. Clifford Deveny, MD, Keith Coleman, Robert Gerberry The following individuals have a business relationship as board members of a Summa Health System Corp., a Summa Health owned entity: Ohio Health Choice: Robert Gerberry, Thomas O'Neill, Mark Terpylak, DO Summa Management Services Org.: Keith Coleman, Robert Gerberry SummaCare and Summa Insurance Company: T. Clifford Deveny, MD, Anthony Lockhart, Jeffrey Copeland, Robert Gerberry, Thomas O'Neill, Lydia Cook, MD Summa Foundation: T. Clifford Deveny, M.D., Paul Testa business relationship
Form 990, Part VI, Section A, line 6	Classes of members or stockholders: Summa Health System: Summa Health is the sole member of Summa Health System. Summa Foundation: Summa Health is the sole member of Summa Foundation Summa Physicians, Inc. dba Summa Health Medical Group: Summa Physicians, Inc. has stockholders; the stock is held in trust for the benefit of Summa Health.
Form 990, Part VI, Section A, line 7a	Members or stockholders electing members of governing body: Summa Health System: The Code of Regulations of Summa Health System provides that those Directors of Summa Health, the sole member of Summa Health System, would be the Directors of Summa Health System. Summa Foundation: In addition to directors elected by the Summa Health Board as the sole member of Summa Foundation, the President and CEO of Summa Health, the President of Summa Foundation, the President of the Women's Board of Summa Health and the President of the Women's Board of St. Thomas Hospital shall serve as directors of Summa Foundation. Summa Physicians, Inc. dba Summa Health Medical Group: The sole shareholder of Summa Physicians, Inc. is subject to a Share Control Agreement wherein which she may elect only persons approved by Summa Health as directors of Summa Physicians, Inc. To ensure Summa Health System maintains a significant voice in the investment policies, grant-making policies, and otherwise in the use of income and assets of Summa Physicians, Inc., at least one director of Summa Physicians, Inc. must also be a member of Summa Health System's Board of Directors.
Form 990, Part VI, Section A, line 7b	Decisions Requiring Approval by members or stockholders: Summa Health System: Summa Health is the sole member of Summa Health System. As the sole member, Summa Health has the power and authority to approve or disapprove of each of the following on behalf of Summa Health System: (i)Any modification of the essential nature, purpose, mission or operations of the Corporation; (ii)Adoption of a Code of Regulations, Bylaws or other constitutive document of the Corporation and any and all amendments thereto; (iii)Adoption of any amendments to the Articles of Incorporation or similar charter or organizational document or agreement and/or any other change in the corporate structure or governance of the Corporation; (iv)Establishment of qualifications for the selection of Directors, Directors or Managers of the Corporation; (v)Appointment or election and removal of members of the governing body of the Corporation; (vi)Appointment or election and removal of the President and/or Chief Executive Officer or similar officer(s) of the Corporation; (vii)Adoption of annual operating and capital budgets of the Corporation; (viii)The borrowing of money or other incurring or creating of any indebtedness of the Corporation, including by way of a guaranty of the debt of another, in an amount greater than $1,000,000 or that will increase the amount of indebtedness incurred in the current calendar year, in the aggregate, to more than $3,500,000; (ix)Adoption of the long range plans of the Corporation; (x)Determinations as to the use and occupancy of any building owned or leased by the Corporation; (xi)The sale, encumbrance, lease or disposition of real property of the Corporation other than in the ordinary course of the operations of the Corporation; and (xii)The merger, reorganization, dissolution or other corporate action of a similar nature, including participation in a joint venture, proposed by the Corporation. Summa Foundation: Summa Health is the sole member ("Member") of Summa Foundation. The following are the matters ("Reserved Powers") which must be submitted to, and receive the approval of both the Board of Directors of Summa Foundation and the Member: (i)Any modification of the essential nature, purpose, mission or operations of the Corporation; (ii)Adoption of a Code of Regulations, Bylaws or other constitutive document of the Corporation and any and all amendments thereto; (iii)Adoption of any amendments to the Articles of Incorporation or similar charter or organizational document or agreement and/or any other change in the corporate structure or governance of the Corporation; (iv)Establishment of qualifications for the selection of Directors, Directors or Managers of the Corporation; (v)Appointment or election and removal of members of the governing body of the Corporation; (vi)Appointment or election and removal of the President and/or Chief Executive Officer or similar officer(s) of the Corporation; (vii)Adoption of annual operating and capital budgets of the Corporation; (viii)The borrowing of money or other incurring or creating of any indebtedness of the Corporation, including by way of a guaranty of the debt of another, in an amount greater than $1,000,000 or that will increase the amount of indebtedness incurred in the current calendar year, in the aggregate, to more than $3,500,000; (ix)Adoption of the long range plans of the Corporation; (x)Determinations as to the use and occupancy of any building owned or leased by the Corporation; (xi)The sale, encumbrance, lease or disposition of real property of the Corporation other than in the ordinary course of the operations of the Corporation; and (xii)The merger, reorganization, dissolution or other corporate action of a similar nature, including participation in a joint venture, proposed by the Corporation. Summa Physicians, Inc. dba Summa Health Medical Group: A Share Control Agreement among Summa Health, Summa Physicians, Inc. and the sole shareholder of Summa Physicians, Inc. provides that the sole shareholder shall vote each share of Summa Physicians, Inc.'s capital stock now or hereafter owned by the shareholder on any matter submitted for a vote to the shareholders of such stock, only as approved in advance by Summa Health, including, but not limited to the matters listed below: (a) lease, sell, exchange, transfer or otherwise dispose of all or substantially all of the Summa Physicians, Inc.'s assets; (b) be merged, consolidated or otherwise reorganized with or into any other corporation or trade or business; (c) issue any shares of any class of Summa Physicians, Inc.'s capital stock (whether from treasury or from authorized but unissued shares); (d) amend or otherwise modify its articles of incorporation or code of regulations; (e) dissolve (other than by action of a court of competent jurisdiction); or enter into any agreement with any person to do any of the foregoing.
Form 990, Part VI, Section B, line 11b	Review of Form 990 by governing body: The return was reviewed in detail by a committee consisting of internal legal counsel, financial management, and an external tax advisor. The review committee included the Senior Vice President, Finance & CFO and the Senior Vice President, Legal Services & General Counsel. This detailed review occurred October 8, 2020. Following this review and incorporation of changes recommended by this committee, the return was provided to the Summa Health Committee on Governance prior to its October 2020 meeting for further review. The Committee on Governance is a standing committee appointed by the Summa Health Board of Directors and includes members of the Board of Directors. Schedule H of the return was also reviewed by the Summa Health Community Benefits Committee. After these reviews by the Committee on Governance and the Community Benefits Committee, and prior to filing with the IRS, an email was sent to each voting member of the Boards of Directors. This email included instructions and a link to a password-protected web site on which the entire Form 990 was available for viewing.
Form 990, Part VI, Section B, line 12c	Conflict of interest policy: A conflict of interest questionnaire is sent annually to all Summa Health entities' boards of directors, key employees, senior managers, medical directors, administrative directors, executive directors, department heads, managers, supervisors, and members of purchasing committees for completion. Responses are individually reviewed for determination of potential conflicts. Those responses deemed to present potential conflicts are then presented to the governance committee (sub-committee of the Summa Health board of directors). The governance committee reviews each response that presents a potential conflict and determines whether additional action is required to eliminate or mitigate the potential conflict. This annual conflict of interest questionnaire process is managed by the corporate compliance department pursuant to the Summa Health policy on conflict of interest as approved by the Summa Health Board of Directors. In addition to the annual conflict of interest questionnaire, the conflict of interest policy imposes a duty to disclose conflicting interests on an ongoing basis.
Form 990, Part VI, Section B, line 15	Process to establish compensation of top management official and other employees: Compensation review is delegated to Summa Health, which shares a common Board with members of the Group. Executive Compensation: The Compensation Committee of the Summa Health Board of Directors meets at least twice each year to review and approve base compensation and total remuneration for executive staff. Each voting member of the Compensation Committee is an independent director and is not affiliated with management. The Compensation Committee engages outside consulting support to provide independent market data, advice and counsel to the Compensation Committee. The Compensation Committee has used Korn Ferry, a nationally recognized consulting firm, to assist their efforts. Korn Ferry provides the following services to the Compensation Committee: (a) education of Committee members regarding executive compensation trends and best practices in healthcare organizations; (b) assessment of the market competitiveness and reasonableness of Summa's executive compensation programs including base salary, incentive compensation, core and executive benefits, as well as their alignment with the mission and future performance expectations; (c) written, detailed evaluation of the market reasonableness of Summa's executive compensation and benefits program; and (d) ongoing support and independent advice to the Compensation Committee on matters related to executive compensation. The Compensation Committee contemporaneously documents its deliberations and decisions regarding compensation arrangements for each position listed below. Each year the Compensation Committee reviews and approves the compensation for the following positions: Summa Health: President & CEO Senior Vice President, Finance & CFO Senior Vice President, Legal Services & General Counsel Senior Vice President, Strategy & Performance Management Senior Vice President, IT&S & CIO Senior Vice President, Human Resources President, SummaCare Senior Vice President, Population Health, President, ACO/NHC Summa Health System: President, Akron & St. Thomas President, Summa Barberton President, Ambulatory Care and Clinical Service Lines Vice President & CFO Summa Health System Summa Foundation: President Summa Physicians, Inc. dba Summa Health Medical Group: President
Form 990, Part VI, Section C, line 19	Required documents available to the public: Summa Health makes its Conflicts of Interest policy available upon request. The Articles of Incorporation of Summa Health and its related entities are available on the website of the Ohio Secretary of State (www.sos.state.oh.us). Summa Health makes its financial statements available on its website (www.summahealth.org). The financial statements are also available through the Electronic Municipal Market Access (www.emma.msrb.org) and on Summa's website (www.summahealth.org).
Form 990, Part VII, Section B, Line 1	Beginning with the 2014 tax year all independent contractors were paid by Summa Health (EIN 34-1887844) which is the parent organization of the filing organization.
Form 990, Part XI, line 9:	Pension Liability Adjustment -5,117,000. Post Retirement Benefit Adjustment -192,000. Net assets released from restriction 235,000. Net asset contribution to(from) affiliated organization 39,451,000. Change in Permanently restricted net assets -38,919. Other Changes in Net Assets - adjustments 231,020.

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:

1	Briefly describe the organization’s mission or most significant activities: THE MISSION OF SUMMA HEALTH IS TO PROVIDE THE HIGHEST QUALITY, COMPASSIONATE CARE TO OUR PATIENTS AND TO CONTRIBUTE TO A HEALTHIER COMMUNITY.
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a) ........	3	45
4	Number of independent voting members of the governing body (Part VI, line 1b) .....	4	39
5	Total number of individuals employed in calendar year 2019 (Part V, line 2a) ......	5	7,492
6	Total number of volunteers (estimate if necessary) .............	6	2,282
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ........	7a	10,402,835
b	Net unrelated business taxable income from Form 990-T, line 39 .........	7b	320,227

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	1,059,909	2,059,556
9	Program service revenue (Part VIII, line 2g) .........	1,008,429,386	1,078,618,120
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	16,248,192	4,886,995
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	16,219,303	18,379,297
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)	1,041,956,790	1,103,943,968
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	250,271	390,500
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)	459,853,972	490,991,960
16a	Professional fundraising fees (Part IX, column (A), line 11e) .....	0	0
b	Total fundraising expenses (Part IX, column (D), line 25) 2,378,370
17	Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e)....	532,152,144	585,809,805
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	992,256,387	1,077,192,265
19	Revenue less expenses. Subtract line 18 from line 12.......	49,700,403	26,751,703
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	1,378,833,024	1,440,382,447
21	Total liabilities (Part X, line 26).............	977,480,290	978,723,790
22	Net assets or fund balances. Subtract line 21 from line 20.....	401,352,734	461,658,657

Sign Here

	Signature of officer	Date

	Type or print name and title


4a	(Code: ) (Expenses $ 446,047,674 including grants of $ ) (Revenue $ 555,583,055 )
	OUTPATIENT SERVICES FOR 2019: SUMMA HEALTH SYSTEM, AND SUMMA PHYSICIANS, INC. DBA SUMMA HEALTH MEDICAL GROUP, PROVIDED MORE THAN 1.7 MILLION OCCASIONS OF SERVICE, INCLUDING 160,234 EMERGENCY DEPARTMENT VISITS, 13,247 OBSERVATION PATIENTS, 14,377 SURGICAL OPERATIONS, AND NEARLY 1.6 MILLION OTHER OUTPATIENT VISITS.

4b	(Code: ) (Expenses $ 344,095,084 including grants of $ ) (Revenue $ 428,594,093 )
	INPATIENT SERVICES FOR 2019: SUMMA HEALTH SYSTEM HAD APPROXIMATELY 649 BEDS IN SERVICE, ADMITTED 33,114 ADULT PATIENTS, AND DELIVERED 3,834 NEWBORNS. THE ADULT PATIENTS RECEIVED 159,499 DAYS OF CARE, INPATIENT SURGERIES TOTALED 6,520, EMERGENCY ADMISSIONS TOTALED 23,830 AND THE AVERAGE LENGTH OF STAY WAS 4.82 DAYS.

4c	(Code: ) (Expenses $ 41,901,103 including grants of $ ) (Revenue $ 11,336,271 )
	RESEARCH/EDUCATION FOR 2019: SUMMA HEALTH HAS A HISTORY OF SPONSORING AND SUPPORTING BASIC AND CLINICAL RESEARCH TO UNDERSTAND DISEASES AND TREATMENT. CENTERS, PROGRAMS AND LABS FACILITATE RESEARCH IN A NUMBER OF MEDICAL FIELDS. SUMMA HEALTH FOSTERS A LEARNING ENVIRONMENT FOR THE NEXT GENERATION OF CAREGIVERS. AT SUMMA HEALTH'S HOSPITALS, APPROXIMATELY 241 MEDICAL SCHOOL GRADUATES TRAIN IN 19 ACCREDITED RESIDENCY PROGRAMS. SUMMA HEALTH PROVIDES CLINICAL LEARNING EXPERIENCES TO MORE THAN 2,599 NURSING, MEDICAL, PHARMACY, EMERGENCY MEDICAL TECHNICIAN, PARAMEDIC, AND ALLIED HEALTH STUDENTS.

	(Code: ) (Expenses $ 66,720,283 including grants of $ 390,500 ) (Revenue $ 83,104,701 )
	Part III Line 4D - Other Program Services: SUMMA HEALTH IS AN INTEGRATED HEALTHCARE DELIVERY SYSTEM THAT PROVIDES COORDINATED, VALUE-BASED CARE ACROSS THE CONTINUUM FOR THE PEOPLE AND POPULATIONS WE SERVE. WE HOLD OURSELVES CLINICALLY AND FINANCIALLY ACCOUNTABLE FOR HEALTH OUTCOMES IN OUR COMMUNITIES.SUMMA HEALTH SERVES HUNDREDS OF THOUSANDS OF PATIENTS EACH YEAR IN COMPREHENSIVE EMERGENCY, ACUTE, CRITICAL, OUTPATIENT AND LONG-TERM/HOMECARE SETTINGS AND REPRESENTS 1,005 REGISTERED, INPATIENT BEDS ON THE CAMPUSES OF SUMMA HEALTH SYSTEM AND SUMMA REHAB HOSPITAL. IN ADDITION, OUTPATIENT CARE IS PROVIDED IN NEARLY 20 COMMUNITY HEALTH CENTERS, URGENT CARE FACILITIES AND EMERGENCY DEPARTMENTS (EDS), SOME INTEGRATED IN THE HEALTHCARE FACILITIES, AND OTHERS ARE FREESTANDING. SUMMA REHAB HOSPITAL IS A JOINT VENTURE IN WHICH SUMMA HEALTH SYSTEM HAS AN INTEREST, AND IS REFERENCED IN THIS DOCUMENT FOR THE PURPOSE OF IDENTIFYING ALL ENTITIES AFFILIATED WITH SUMMA HEALTH. SUMMA'S PROPORTIONATE INTEREST OF THIS JOINT VENTURE'S CHARITY CARE AND OTHER COMMUNITY BENEFITS IS INCLUDED ON SCHEDULE H OF SUMMA HEALTH'S IRS FORM 990 GROUP RETURN.PROVIDING SUPERIOR, MULTI-SPECIALTY PATIENT CARE, MEDICAL RESEARCH AND CONTINUING MEDICAL EDUCATION, SUMMA HEALTH RANKS AS A HIGHLY RECOGNIZED HEALTHCARE PROVIDER IN SEVERAL DISCIPLINES INCLUDING: WEIGHT MANAGEMENT, CARDIOVASCULAR, EMERGENCY, ONCOLOGY, ORTHOPAEDIC, SURGERY, PRIMARY CARE, SPORTS MEDICINE, STROKE, UROLOGY, WOMEN'S SERVICES AND NURSING BY PRESTIGIOUS ORGANIZATIONS SUCH AS:AMERICAN COLLEGE OF SURGEONS COMMISSION ON CANCERAMERICAN HEART ASSOCIATIONAMERICAN STROKE ASSOCIATIONNATIONAL ACCREDITATION PROGRAM FOR BREAST CENTERSAMERICAN NURSING CREDENTIALING CENTERCENTERS FOR MEDICARE AND MEDICAID SERVICESOHIO PATIENT SAFETY INSTITUTEUS NEWS AND WORLD REPORTAMERICAN COLLEGE OF RADIATIONNURSES IMPROVING CARE FOR HEALTH SYSTEM ELDERSAMERICAN SOCIETY FOR METABOLIC AND BARIATRIC SURGERYMETABOLIC AND BARIATRIC SURGERY ACCREDITATION AND QUALITY IMPROVEMENT PROGRAM- COMPREHENSIVE CENTERTHE JOINT COMMISSIONHEALTHGRADES THE LEAPFROG GROUPSUMMA HEALTH IS SUMMIT COUNTY'S LARGEST EMPLOYER AND A LEADING ECONOMIC ENGINE FOR THE REGION. SUMMA HEALTH INCLUDES THE FOLLOWING:SUMMA HEALTH SYSTEM:SUMMA HEALTH SYSTEM IS A SINGLE LEGAL ENTITY THAT INCLUDES THREE INPATIENT HOSPITAL CAMPUSES AND SEVERAL AMBULATORY LOCATIONS. SUMMA HEALTH SYSTEM OPERATES THE INPATIENT HOSPITAL LOCATIONS AS WELL AS THE HOSPITAL-BASED OFF-SITE LOCATIONS UNDER THE SAME MEDICARE PROVIDER NUMBER.SUMMA HEALTH EMPLOYS MORE THAN 7,000 INDIVIDUALS WITH SUMMA HEALTH SYSTEM ACCOUNTING FOR THE VAST MAJORITY OF THESE EMPLOYEES. SUMMA HEALTH SYSTEM HAS A MEDICAL STAFF OF MORE THAN 1,000 PROFESSIONALS WORKING ON ITS CAMPUSES. SUMMA HEALTH SYSTEM HAS 1,005 REGISTERED BEDS. THE BUILDINGS AND FACILITIES ON ALL CAMPUSES TOTAL MORE THAN 3 MILLION SQUARE FEET.SUMMA HEALTH SYSTEM- AKRON CAMPUS OFFERS GENERAL MEDICAL, SURGICAL, OBSTETRICAL, TRAUMA AND CRITICAL CARE SERVICES. THE AKRON CAMPUS PROVIDES ACUTE CARE SERVICES AND A WIDE RANGE OF OUTPATIENT SERVICES ON A CAMPUS OF APPROXIMATELY 60 ACRES. SUMMA HEALTH SYSTEM- ST. THOMAS CAMPUS PROVIDES VARIOUS DIAGNOSTIC SERVICES ALONG WITH BEHAVIORAL HEALTH AND SUBSTANCE ABUSE CARE. SUMMA HEALTH SYSTEM- ST. THOMAS CAMPUS WAS ONE OF THE FIRST IN THE COUNTRY TO RECOGNIZE THE MEDICAL ASPECTS OF ALCOHOLISM AS A DISEASE AND IS THE FOUNDING LOCATION OF ALCOHOLICS ANONYMOUS. THE HOSPITAL OPENED THE NATION'S FIRST ALCOHOLISM TREATMENT WARD AND CONTINUES ITS LONGSTANDING DEDICATION TO THIS PROGRAM TODAY.AS A LEADER IN MEDICAL EDUCATION, SUMMA HEALTH SYSTEM SUPPORTS THE EDUCATION OF ITS PHYSICIANS AND HEALTHCARE PROFESSIONALS. THE AKRON AND ST. THOMAS CAMPUSES ARE TEACHING AFFILIATES OF THE NORTHEAST OHIO MEDICAL UNIVERSITY (NEOMED) AND INCLUDE A STAFF OF PHYSICIANS AND ACCREDITED RESIDENCY AND FELLOWSHIP PROGRAMS THAT FOSTER A DYNAMIC MEDICAL ENVIRONMENT. APPROXIMATELY 91 RESIDENTS AND FELLOWS GRADUATE FROM THE AKRON CAMPUS'S MEDICAL EDUCATION PROGRAMS EACH YEAR. THE BARBERTON CAMPUS HAS A FAMILY PRACTICE RESIDENCY PROGRAM AFFILIATED WITH NEOMED ALONG WITH PROVIDING EDUCATIONAL ROTATIONS FOR MEDICAL STUDENTS.SUMMA HEALTH SYSTEM- BARBERTON CAMPUSSUMMA HEALTH SYSTEM- BARBERTON CAMPUS IS A 500,000 SQUARE FOOT ACUTE CARE TEACHING HOSPITAL LOCATED ON NEARLY 16 ACRES, LOCATED APPROXIMATELY 10 MILES SOUTHWEST OF AKRON, OHIO. THE HOSPITAL HAS 271 LICENSED BEDS. THE BARBERTON CAMPUS PROVIDES THE COMMUNITY WITH EASY ACCESS TO COMPREHENSIVE, HIGH-QUALITY CANCER SERVICES AT THE COMMISSION ON CANCER ACCREDITED PARKVIEW PAVILION, AS WELL AS THE FULL SPECTRUM OF CARDIOVASCULAR DISEASE CARE INCLUDING DIAGNOSTIC, INTERVENTIONAL AND SURGICAL SERVICES, ALONG WITH A VARIETY OF OUTPATIENT SERVICES.

	(Code: ) (Expenses $ including grants of $ ) (Revenue $ )
	Part III Line 4D - Other Program Services - Continued:CHARITY CAREIN 2019, SUMMA HEALTH PROVIDED CHARITY CARE AT AN ESTIMATED NET COST OF OVER $15.2 MILLION. THIS AMOUNT REPRESENTS THE NET COST ASSOCIATED WITH PROVIDING THE CARE AND DOES NOT INCLUDE BAD DEBT. PATIENTS WITH INCOME UP TO 250% OF THE FEDERAL POVERTY INCOME GUIDELINES OR WHO HAVE A HOSPITAL BILL THAT EXCEEDS 25% OF THEIR GROSS ANNUAL FAMILY INCOME ARE ELIGIBLE TO APPLY FOR FULLY DISCOUNTED CHARITY CARE ASSISTANCE. IN ADDITION, THERE IS A SLIDING SCALE DISCOUNT PROGRAM FOR THOSE WITH INCOMES BETWEEN 250% AND 400% OF THE FEDERAL POVERTY INCOME GUIDELINES. IN 2019, THE CHARITY CARE PROGRAM (INCLUDING HOSPITAL CARE ASSURANCE PROGRAM) BENEFITED OVER 22,157 PATIENT ENCOUNTERS.MEDICAID SHORTFALLHISTORICALLY, OHIO MEDICAID REIMBURSEMENTS HAVE NOT COVERED THE COST OF PROVIDING THE CARE TO PROGRAM BENEFICIARIES, CREATING A BUDGETARY SHORTFALL. AS ONE OF NORTHEAST OHIO'S TOP PROVIDERS OF HOSPITAL CARE FOR MEDICAID PATIENTS, SUMMA HEALTH'S UNPAID COSTS FOR MEDICAID TOTALED MORE THAN $40 MILLION.BAD DEBTSUMMA HEALTH IS COMMITTED TO PROVIDING QUALITY AND ACCESSIBLE HEALTHCARE. THIS INCLUDES COVERING THE EXPENSE OF PAYMENTS THAT WERE EXPECTED BUT NOT RECEIVED. WHILE SUMMA HEALTH RECOGNIZES BAD DEBT IS PART OF DOING BUSINESS, IT AGREES WITH THE OHIO HOSPITAL ASSOCIATION THAT IT IS IMPORTANT TO REPORT THESE COSTS TO SHOW THE TOTAL PICTURE OF CARE SUMMA HEALTH PROVIDES TO THE COMMUNITY WITHOUT FULL REIMBURSEMENT. IN 2019, THE COST FOR PROVIDING CARE WRITTEN OFF AS A BAD DEBT EXPENSE WAS APPROXIMATELY $17.1 MILLION.COMMUNITY HEALTH IMPROVEMENT SERVICESAN IMPORTANT PART OF SUMMA HEALTH'S MISSION IS OFFERING A PREVENTION AND WELLNESS PROGRAM TO BUILD A HEALTHIER COMMUNITY. IN 2019, SUMMA HEALTH PROVIDED MORE THAN $10 MILLION TO HELP FUND HEALTH IMPROVEMENT ACTIVITIES SUCH AS FREE AND LOW-COST HEALTH SCREENING, HEALTH EDUCATION SERVICES AND WELLNESS PROGRAMMING. SUBSIDIZED HEALTH SERVICES SUMMA HEALTH IS COMMITTED TO PROVIDING SUBSIDIZED HEALTH SERVICES - CLINICAL SERVICES THAT MEET AN IDENTIFIED COMMUNITY NEED AND ARE PROVIDED DESPITE FINANCIAL LOSS. VITAL SERVICES SUCH AS THE SUMMA HEALTH SENIOR HEALTH CENTER, SUMMA HEALTH TRAUMATIC STRESS CENTER, THE SUMMA HEALTH DENTAL CLINIC AND DIABETES EDUCATION ARE OFFERED, EVEN THOUGH THEY ARE NOT PROFITABLE. INCOME FROM OTHER SERVICES IS USED TO COVER THESE COSTS. IN 2019, THE COST FOR SUBSIDIZED SERVICES WAS MORE THAN $36 MILLION.FINANCIAL AND IN-KIND DONATIONSANNUALLY, SUMMA HEALTH CONTRIBUTES FINANCIAL ASSISTANCE AND IN-KIND SERVICES TO SUPPORT COMMUNITY ORGANIZATIONS THAT PROMOTE HEALTH, WELLNESS AND AN IMPROVED QUALITY OF LIFE. FROM NEIGHBORHOOD HEALTH FACILITIES SUCH AS OPEN M AND FAITHFUL SERVANTS CARE CENTER, TO MEDICAL SERVICES AT ATHLETIC EVENTS THROUGHOUT THE COMMUNITY, SUMMA HEALTH PARTICIPATES IN NUMEROUS COMMUNITY PROGRAMS AND HELPS OTHER NONPROFITS FULFILL THEIR MISSIONS. IN 2019, THESE CONTRIBUTIONS WERE MORE THAN $2 MILLION.RESEARCH AND INNOVATIONSUMMA HEALTH'S QUALITY MEDICAL CARE IS DERIVED IN PART FROM ITS ABILITY TO TRANSLATE RESULTS FROM CAREFULLY PLANNED AND EXECUTED RESEARCH INTO EFFECTIVE PATIENT CARE STRATEGIES. RESEARCH AND INNOVATION IS AN INTEGRAL FOCUS OF THE ACADEMIC AND CLINICAL ENVIRONMENT AT SUMMA HEALTH AND HELPS SET THE HIGHEST STANDARDS FOR MEDICAL CARE IN THE COMMUNITY. SUMMA HEALTH'S REPUTATION FOR EXCELLENCE IN SUCH CRITICAL SPECIALTIES AS CARDIOLOGY, DIABETES, EMERGENCY SERVICES, ORTHOPAEDICS, ONCOLOGY, SENIOR HEALTH, SURGERY, AND WOMEN'S HEALTH CONTINUES TO GROW THROUGH RESEARCH AND INNOVATION. SUMMA HEALTH INVESTED MORE THAN $7.4 MILLION IN RESEARCH IN 2019.EDUCATION SUMMA HEALTH SUPPORTS THE EDUCATION OF PHYSICIANS AND OTHER HEALTHCARE PROFESSIONALS. SUMMA HEALTH SYSTEM IS THE LARGEST OF THE MAJOR TEACHING AFFILIATES OF THE NORTHEST OHIO MEDICAL UNIVERSITY (NEOMED, A CONSORTIUM OF THE UNIVERSITY OF AKRON, KENT STATE UNIVERSITY AND YOUNGSTOWN STATE UNIVERSITY), AND OFFERS EDUCATION TO NEOMED'S COLLEGES OF MEDICINE AND PHARMACY STUDENTS, AS WELL AS TO MEDICAL STUDENTS FROM SCHOOLS AROUND THE COUNTRY. IN ADDITION, SUMMA HEALTH OFFERS 15 ACCREDITED RESIDENCY TRAINING PROGRAMS IN NUMEROUS SPECIALTIES, TRAINING THE NEXT GENERATION OF PRIMARY CARE AND SPECIALTY PHYSICIANS FOR THE REGION AND BEYOND. NURSING EDUCATION ALSO IS OFFERED IN COLLABORATION WITH LOCAL AND NATIONAL UNIVERSITY PARTNERS. IN 2019, APPROXIMATELY 250 RESIDENTS AND FELLOWS TRAINED AT SUMMA HEALTH'S THREE MAIN HOSPITALS. ON AVERAGE, APPROXIMATELY 53% OF THESE RESIDENTS REMAIN IN OUR LOCAL AND SURROUNDING COMMUNITIES. SUMMA HEALTH'S 2019 INVESTMENT IN HEALTH PROFESSIONAL EDUCATION TOTALED APPROXIMATELY $27.5 MILLION.

	(Code: ) (Expenses $ including grants of $ ) (Revenue $ )
	SUMMA HEALTH SERVICES:FOLLOWING IS A DESCRIPTION OF SUMMA HEALTH'S NOTABLE ACCOMPLISHMENTS BY PRIMARY SERVICE LINES IN 2019: WEIGHT MANAGEMENT- SUMMA'S BARIATRIC CARE CENTER IS DESIGNATED BY THE AMERICAN SOCIETY FOR METABOLIC AND BARIATRIC SURGERY (ASMBS) AS A MBSAQIP ACCREDITED - COMPREHENSIVE CENTER. THE MBSAQIP ACCREDITED - COMPREHENSIVE CENTER DESIGNATION IS ONLY AWARDED TO SURGICAL PROGRAMS THAT: SUCCESSFULLY UNDERGO A RIGOROUS SITE SURVEY TO VERIFY COMPLIANCE WITH A SET OF NATIONALLY RECOGNIZED STANDARDS AND REQUIREMENTS. DEMONSTRATE A COMPREHENSIVE COMMITMENT TO A HIGH LEVEL OF CARE. SUBMIT INFORMATION FOR INCLUSION IN THE LARGEST REPOSITORY OF DEDICATED WEIGHT LOSS SURGERY PATIENT STATISTICAL DATA IN THE WORLD. MEASURE AND REPORT SURGICAL OUTCOMES THAT ARE DEEMED FAVORABLE BY THE ASMBS, AN ORGANIZATION DEDICATED TO EXCELLENCE IN SURGICAL OUTCOMES. CARDIOVASCULAR: SUMMA HEALTH HAS BEEN RECOGNIZED BY THE AMERICAN HEART ASSOCIATION FOR MANY AWARDS, INCLUDING GET WITH THE GUIDELINES GOLD PLUS- STROKE AND HEART FAILURE, LIFELINE HEART ATTACK REFERRING/RECEIVING CENTER ACCREDITATION AND STEMI (HEART ATTACK) ACCREDITATION. SUMMA HEALTH SYSTEM AKRON CAMPUS WAS RANKED AMONG THE TOP 50 CARDIOVASCULAR HOSPITALS IN THE U.S. BY IBM WATSON HEALTH. THE ANNUAL STUDY IDENTIFIES TOP PERFORMING U.S. HOSPITALS FOR INPATIENT CARDIOVASCULAR SERVICES BASED ON A BALANCED NATIONAL SCORECARD OF HOSPITAL PERFORMANCE METRICS. THE STUDY INCLUDED 989 U.S. HOSPITALS WITH CARDIOVASCULAR SERVICE LINES. SUMMA WAS NAMED AMONG THE TEACHING HOSPITALS WITH CARDIOVASCULAR RESIDENCY PROGRAMS.NEUROSCIENCE - SUMMA HEALTH STROKE CARE CENTER HAS BEEN NATIONALLY RECOGNIZED FOR EARNING THE AMERICAN HEART ASSOCIATION (AHA) AND AMERICAN STROKE ASSOCIATION'S GET WITH THE GUIDELINES STROKE GOLD PLUS QUALITY ACHIEVEMENT AWARD. SUMMA IS THE ONLY HOSPITAL IN THE AKRON AREA TO HAVE RECEIVED THE AMERICAN STROKE ASSOCIATION GET WITH THE GUIDELINES GOLD PLUS AWARD CONSECUTIVELY SINCE 2010. IN 2019, SUMMA HEALTH SYSTEM-AKRON CAMPUS WAS AWARDED THE THROMBECTOMY-CAPABLE STROKE CENTER CERTIFICATION FROM THE JOINT COMMISSION, IN COLLABORATION WITH THE AMERICAN HEART ASSOCIATION/AMERICAN STROKE ASSOCIATION. BY EARNING THIS HONOR, SUMMA HEALTH BECAME THE FIRST HOSPITAL IN OHIO TO BE AWARDED THIS CERTIFICATION.HEALTHGRADES AWARDED THE 2019 SPECIALTY EXCELLENCE AWARD FOR THE TREATMENT OF STROKE TO OUR AKRON CAMPUS, MAKING US THE ONLY HOSPITAL IN SUMMIT COUNTY TO EARN THIS HIGH HONOR.NURSING:SUMMA HEALTH SYSTEM- AKRON AND ST. THOMAS CAMPUSES HAVE MAGNET RECOGNITION FOR EXCELLENCE IN NURSING FROM THE AMERICAN NURSES CREDENTIALING CENTER (ANCC). SUMMA SHARES MAGNET STATUS WITH JUST EIGHT PERCENT OF HOSPITALS IN THE COUNTRY. ONCOLOGY:SUMMA HEALTH IS A LEADER IN CANCER TREATMENT WITH NATIONALLY RECOGNIZED CANCER CENTERS THROUGHOUT NORTHEAST OHIO. SUMMA TREATS MORE THAN 100 CANCER TYPES, SPECIALIZING IN LUNG, BREAST, COLORECTAL, GYNECOLOGICAL AND ORTHOPEDIC. SUMMA HEALTH'S CANCER CENTERS ARE FULLY ACCREDITED BY THE AMERICAN COLLEGE OF SURGEONS COMMISSION ON CANCER (COC). WOMEN'S SERVICES:THE WOMEN'S HEALTH PROGRAM HAS EARNED SEVERAL BEST PRACTICE AWARDS FROM THE OHIO PATIENT SAFETY INSTITUTE (OPSI) FOR INCORPORATING REGIONAL AND NATIONAL PATIENT SAFETY BENCHMARKS, DEMONSTRATING A CLEAR FOCUS ON IMPROVING PATIENT SAFETY IN A HEALTHCARE SETTING, AND MOST IMPORTANTLY, BEING INNOVATIVE AND UNIQUE TO THE OHIO HEALTHCARE MARKET.BARBERTON CAMPUS WAS AWARDED RECOGNITION AND TWO MORE STARS FROM THE OHIO FIRST STEPS FOR HEALTHY BABIES REVIEW COMMITTEE REGARDING WORK RELATED TO THE TEN STEPS TO SUCCESSFUL BREASTFEEDING. THIS EARNED BARBERTON CAMPUS FOUR-STAR FACILITY STATUS. OHIO FIRST STEPS IS A VOLUNTARY BREASTFEEDING DESIGNATION PROGRAM THAT RECOGNIZES MATERNITY CENTERS IN OHIO FOR TAKING STEPS TO PROMOTE, PROTECT AND SUPPORT BREASTFEEDING IN THEIR ORGANIZATION.SYSTEM: FOR THE 16TH CONSECUTIVE YEAR, SUMMA HEALTH WAS NAMED AS ONE OF THE 99 BEST WORKPLACES IN NORTHEAST OHIO, AS DETERMINED IN THE ANNUAL NORTHCOAST 99 AWARDS, SPONSORED BY THE EMPLOYERS RESOURCE COUNCILSUMMA HEALTH WAS RANKED AMONG THE TOP FIVE PERCENT OF U.S. HOSPITALS IN THE HEALTHGRADES 2019 250 BEST HOSPITALS AWARD FOR CLINICAL PERFORMANCE. HEALTHGRADES ALSO NAMED SUMMA HEALTH ONE OF HEALTHGRADES AMERICA'S 100 BEST HOSPITALS IN SIX DIFFERENT SPECIALTIES FOR 2020 INCLUDING CARDIAC CARE, STROKE CARE, PULMONARY CARE, GASTROINTESTINAL CARE, GENERAL SURGERY AND CRITICAL CARE.SUMMA HEALTH SYSTEM BARBERTON AND AKRON CAMPUSES ACHIEVED RESPECTIVE GRADES OF "A AND "B" IN THE FALL 2019 LEAPFROG HOSPITAL SAFETY GRADE.

	(Code: ) (Expenses $ including grants of $ ) (Revenue $ )
	SUMMARYALTHOUGH REIMBURSEMENT FOR SERVICES RENDERED IS CRITICAL TO THE OPERATIONS AND STABILITY OF SUMMA HEALTH, NOT ALL INDIVIDUALS POSSESS THE ABILITY TO PURCHASE ESSENTIAL MEDICAL SERVICES. SUMMA HEALTH PROVIDED SERVICES TO ALL PATIENTS ON A NON-DISCRIMINATORY BASIS AND WITHOUT REGARD TO ANY PATIENT'S ABILITY TO PAY FOR SUCH SERVICES OR THE INDIVIDUAL'S PARTICIPATION IN A GOVERNMENT-SPONSORED OR SUBSIDIZED HEALTHCARE SYSTEM.PATIENTS WERE ENCOURAGED TO APPLY FOR UNCOMPENSATED CARE AND, DEPENDING ON THEIR LEVEL OF INCOME AND NUMBER OF DEPENDENTS, ALL (OR A PORTION) OF THEIR BILL WAS REDUCED. GROSS ANNUAL FAMILY INCOME WAS COMPARED USING A SLIDING SCALE BASED ON THE FEDERAL POVERTY INCOME GUIDELINES TO DETERMINE THE CHARITY DISCOUNT FOR WHICH THE PATIENT MAY BE ELIGIBLE. IN 2019, SUMMA HEALTH PROVIDED CHARITY CARE TO THE INDIGENT (INCLUDING UNREIMBURSED MEDICAID) AT THE COST OF MORE THAN $55.5 MILLION. THIS AMOUNT DOES NOT INCLUDE SERVICES PROVIDED WRITTEN OFF AS BAD DEBT.IN ADDITION TO UNCOMPENSATED MEDICAL CARE, SUMMA HEALTH PROVIDED WELLNESS PROGRAMS, COMMUNITY EDUCATION PROGRAMS AND SPECIAL PROGRAMS FOR THE ELDERLY, PERSONS WITH DISABILITIES AND THE MEDICALLY UNDERSERVED. SUMMA HEALTH ALSO OPERATED A VARIETY OF BROAD COMMUNITY SUPPORT ACTIVITIES. THESE PROGRAMS WERE OFFERED AT A REDUCED PRICE OR PROVIDED TO THE COMMUNITY FREE OF CHARGE. SUMMA HEALTH OPERATES ITS FACILITIES IN A MANNER CONSISTENT WITH THE COMMUNITY BENEFIT REQUIREMENTS OF REV. RULE 69-545 AND SUBSEQUENT CASE LAW AND IRS GUIDELINES. SUMMA HEALTH'S HOSPITALS PROVIDE EMERGENCY SERVICES WHICH ARE OPEN AND AVAILABLE TO ALL PERSONS OF THE COMMUNITY, REGARDLESS OF THEIR ABILITY TO PAY. THE BOARD OF DIRECTORS CONSISTS OF PERSONS WHO ARE BROADLY REPRESENTATIVE OF THE COMMUNITY AND MEDICAL STAFF.SUMMA HEALTH MEDICAL GROUP- PROGRAM SERVICE ACCOMPLISHMENTS:SUMMA HEALTH MEDICAL GROUP, A SUMMA HEALTH ENTITY, IS A MULTI-SPECIALTY GROUP OF PHYSICIANS, ADVANCED PRACTICE PROVIDERS AND CARE TEAMS IN MEDICAL PRACTICES LOCATED IN THE COMMUNITIES WE SERVE. IN TOTAL, SUMMA HEALTH MEDICAL GROUP EMPLOYS NEARLY 300 PHYSICIANS, 150 ADVANCED PRACTICE PROVIDERS AND 700 SUPPORT STAFF IN MORE THAN 30 SPECIALTIES AND SUB-SPECIALTIES. SUMMA HEALTH MEDICAL GROUP PROMOTES STRONG AFFILIATION AND EMPLOYMENT OF PHYSICIANS TO ENSURE COMMUNITY AND HOSPITAL NEEDS FOR PHYSICIAN SERVICES ARE MET. IN 2019, SUMMA HEALTH MEDICAL GROUP CONTINUED ITS DEVELOPMENT OF PRIMARY CARE PODS, MEDICAL SPECIALTY PODS, MULTIDISCIPLINARY CARE TEAMS AND THE MEDICAL HOME MODEL OF CARE, TO FURTHER ENHANCE THE FOCUSED PATIENT AND FAMILY CENTERED CARE MODEL, BETTER COMMUNICATE QUALITY INITIATIVES AND ENHANCE PHYSICIAN RECRUITMENT.SUMMA FOUNDATION - PROGRAM SERVICE ACCOMPLISHMENTS:THROUGH PHILANTHROPY, SUMMA FOUNDATION SUPPORTS PATIENT CARE, MEDICAL EDUCATION AND RESEARCH. SUMMA FOUNDATION OFFERS A SPECTRUM OF PHILANTHROPIC OPTIONS FOR DONORS DESIGNED TO CREATE A POSITIVE IMPACT ON SUMMA HEALTH'S OPERATIONS, PROGRAMS, PROJECTS AND PERCEPTIONS AND TO AFFECT POSITIVE CHANGE IN THE COMMUNITIES SUMMA HEALTH SERVES. PHILANTHROPIC COMMITMENTS TO THE SUMMA HEALTH FOUNDATION IN 2019 TOTALED $9.5 MILLION.COMMUNITY BENEFIT AND DIVERSITY:THIS DEPARTMENT LEADS EFFORTS TO ADDRESS HEALTH DISPARITIES AND OTHER IMPORTANT COMMUNITY NEEDS AND RAISE AWARENESS OF HEALTH AND HEALTHCARE ISSUES AFFECTING THE COMMUNITIES SERVED BY SUMMA HEALTH. COMMUNITY BENEFIT AND DIVERSITY PROVIDE WELLNESS AND EDUCATIONAL TOOLS, FACILITATE ECONOMIC DEVELOPMENT PROGRAMS, DEVELOP COMMUNITY PARTNERSHIPS, COMMUNICATE SUMMA HEALTH'S BENEFIT TO THE COMMUNITY AND ENGAGE THE COMMUNITY AND ITS WORKFORCE WITHIN THE SYSTEM AND THROUGHOUT THE REGION.GOVERNMENT RELATIONS: THIS DEPARTMENT IS DEDICATED TO ELEVATING SUMMA HEALTH AS A CREDIBLE LEADER AND PARTNER IN THE HEALTH POLICY PLANNING PROCESS. THIS DEPARTMENT COLLABORATES WITH NUMEROUS DEPARTMENTS TO BEST POSITION SUMMA EDUCATION, RESEARCH AND CLINICAL INNOVATION PRIORITIES WITH PUBLIC SECTOR FUNDING OPPORTUNITIES.

4d	Other program services (Describe in Schedule O.)
	(Expenses $ 66,720,283 including grants of $ 390,500 ) (Revenue $ 83,104,701 )
4e	Total program service expenses898,764,144

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)...........	9,988,102	4,005,020	473,106

(A) Name and business address	(B) Description of services	(C) Compensation





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 0

1a	Federated campaigns..		1a
b	Membership dues..		1b
c	Fundraising events..		1c
d	Related organizations		1d
e	Government grants (contributions)		1e	2,059,556

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

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

h Total. Add lines 1a-1f.......		2,059,556

		Business Code
2a	NET PATIENT REVENUE le	621110	993,125,954	993,034,470	91,484
b	SHMG Practice support	621110	44,547,001	44,547,001
c	Program related invest	900099	10,947,615	10,246,958	700,657
d	Reference Lab	621500	8,505,688		8,505,688
e	Rental Income From Aff	900099	2,576,486	2,576,486
f	All other program service revenue.		18,915,376	18,915,376
g	Total. Add lines 2a–2f .....		1,078,618,120

3 Investment income (including dividends, interest, and othersimilar amounts) ......			199,608			199,608
4 Income from investment of tax-exempt bond proceeds			877,359			877,359
5 Royalties...........
		(ii) Personal	(i) Real
6a	Gross rents		5,624,534	6a
b	Less: rental expenses		7,139,657	6b
c	Rental income or (loss)		-1,515,123	6c
d	Net rental income or (loss).......			-1,515,123			-1,515,123
		(ii) Other	(i) Securities
7a	Gross amount from sales of assets other than inventory	4,751,679		7a
b	Less: cost or other basis and sales expenses	941,651		7b
c	Gain or (loss)	3,810,028		7c
d	Net gain or (loss).........			3,810,028			3,810,028
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	CAFETERIA SALES		722210	5,640,325		405,998	5,234,327
b	Wellness Institute		621990	2,660,136		382,734	2,277,402
c	REBATES		900099	2,010,291			2,010,291
d	All other revenue ....			9,583,668		316,274	9,267,394
e	Total. Add lines 11a–11d ......			19,894,420
12	Total revenue. See instructions.....			1,103,943,968	1,069,320,291	10,402,835	22,161,286

1	Grants and other assistance to domestic organizations and domestic governments. See Part IV, line 21 ....	390,500	390,500
2	Grants and other assistance to domestic individuals. See Part IV, line 22 ...........
3	Grants and other assistance to foreign organizations, foreign governments, and foreign individuals. See Part IV, lines 15 and 16. .............
4	Benefits paid to or for members .......
5	Compensation of current officers, directors, trustees, and key employees ...........	4,289,949	3,494,163	795,786
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........	405,658,728	329,092,411	74,949,837	1,616,480
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	7,724,242	6,257,624	1,425,156	41,462
9	Other employee benefits .......	47,900,142	38,851,182	8,848,243	200,717
10	Payroll taxes ...........	25,418,899	20,619,101	4,695,940	103,858
11	Fees for services (non-employees):
a	Management ......	2,620,664	2,134,531	486,133
b	Legal .........
c	Accounting ...........	226,848		226,848
d	Lobbying ...........	7,488		7,488
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)	88,224,483	61,982,232	26,217,749	24,502
12	Advertising and promotion ....	54,049	44,023	10,026
13	Office expenses .......	9,588,752	7,781,978	1,772,323	34,451
14	Information technology ......	823,933	614,609	139,975	69,349
15	Royalties ..
16	Occupancy ...........	13,760,178	11,207,665	2,552,513
17	Travel ............	370,714	295,302	67,254	8,158
18	Payments of travel or entertainment expenses for any federal, state, or local public officials .
19	Conferences, conventions, and meetings ....	1,432,725	1,166,596	265,689	440
20	Interest ...........	21,575,048	17,572,877	4,002,171
21	Payments to affiliates .......
22	Depreciation, depletion, and amortization ..	46,544,087	37,910,159	8,633,928
23	Insurance ...	3,247,235	2,644,873	602,362
24	Other expenses. Itemize expenses not covered above (List miscellaneous expenses in line 24e. If line 24e amount exceeds 10% of line 25, column (A) amount, list line 24e expenses on Schedule O.)
a	Medical Supplies	179,551,374	179,532,658		18,716
b	Management fees	143,314,584	116,640,883	26,564,621	109,080
c	SHMG PRACTICE SUPPORT	44,547,001	36,283,532	8,263,469
d	Taxes and Franchise fee	14,491,589	11,803,399	2,688,190
e	All other expenses	15,429,053	12,443,846	2,834,050	151,157
25	Total functional expenses. Add lines 1 through 24e	1,077,192,265	898,764,144	176,049,751	2,378,370
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 ........			100,200	1	114,795
2	Savings and temporary cash investments .........			5,092,750	2	6,910,286
3	Pledges and grants receivable, net ......				3
4	Accounts receivable, net .............			126,197,284	4	132,131,882
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 ...........			3,343,435	7	2,493,094
8	Inventories for sale or use ............			14,570,264	8	16,652,748
9	Prepaid expenses and deferred charges ......			3,213,183	9	3,939,589
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	1,515,883,240
b	Less: accumulated depreciation	10b	901,265,058	539,251,760	10c	614,618,182
11	Investments—publicly traded securities .			78,373,119	11	20,380,714
12	Investments—other securities. See Part IV, line 11 .....				12
13	Investments—program-related. See Part IV, line 11 ..			9,001,289	13	10,094,452
14	Intangible assets ...............			2,228,740	14	2,228,740
15	Other assets. See Part IV, line 11 ...........			597,461,000	15	630,817,965
16	Total assets. Add lines 1 through 15 (must equal line 33)...			1,378,833,024	16	1,440,382,447

17	Accounts payable and accrued expenses .....	84,737,027	17	67,089,161
18	Grants payable ...		18
19	Deferred revenue .........	806,200	19	751,936
20	Tax-exempt bond liabilities .........	597,152,806	20	588,617,185
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 ..		23
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	294,784,257	25	322,265,508
26	Total liabilities. Add lines 17 through 25..	977,480,290	26	978,723,790

	Organizations that follow FASB ASC 958, check here and complete lines 27, 28, 32, and 33.
27	Net assets without donor restrictions ..........	400,989,497	27	461,334,340
28	Net assets with donor restrictions ...........	363,237	28	324,317
	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 ...........	401,352,734	32	461,658,657
33	Total liabilities and net assets/fund balances ........	1,378,833,024	33	1,440,382,447

1	Was the organization a U.S. transferor of property to a foreign corporation during the tax year? If "Yes," the organization may be required to file Form 926, Return by a U.S. Transferor of Property to a Foreign Corporation (see Instructions for Form 926). . . . . . . . . . . . . . . . . . . . . . . . . . . . . .	Yes	No
2	Did the organization have an interest in a foreign trust during the tax year? If "Yes," the organization may be required to separately file Form 3520, Annual Return to Report Transactions with Foreign Trusts and Receipt of Certain Foreign Gifts, and/or Form 3520-A, Annual Information Return of Foreign Trust With a U.S. Owner (see Instructions for Forms 3520 and 3520-A; don't file with Form 990). . . . . . . . . . . . . . . . . . . . . . . .	Yes	No
3	Did the organization have an ownership interest in a foreign corporation during the tax year? If "Yes," the organization may be required to file Form 5471, Information Return of U.S. Persons with Respect to Certain Foreign Corporations. (see Instructions for Form 5471). . . . . . . . . . . . . . . . . . . . . . . . . . . .	Yes	No
4	Was the organization a direct or indirect shareholder of a passive foreign investment company or a qualified electing fund during the tax year? If “Yes,” the organization may be required to file Form 8621, Information Return by a Shareholder of a Passive Foreign Investment Company or Qualified Electing Fund. (see Instructions for Form 8621) .	Yes	No
5	Did the organization have an ownership interest in a foreign partnership during the tax year? If "Yes," the organization may be required to file Form 8865, Return of U.S. Persons with Respect to Certain Foreign Partnerships (see Instructions for Form 8865). . . . . . . . . . . . . . . . . . . . . . . . . . . . . .	Yes	No
6	Did the organization have any operations in or related to any boycotting countries during the tax year? If "Yes," the organization may be required to separately file Form 5713, International Boycott Report (see Instructions for Form 5713; don't file with Form 990).. . . . . . . . . . . . . . . . . . . . . . . . . . . .	Yes	No

(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)St Thomas Medical Center Women's Board 444 North Main Street Akron,OH44310 34-6576575	Support Organization	OH	501(c)(3)	Line 12a, I	Summa Health System		No
(2)Summa Health System Community 1077 Gorge Blvd PO Box 2090 Akron,OH443092090 46-3018310	Support Organization	OH	501(c)(3)	Line 12b, II	N/A	Yes

(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) Summa Rehab Hospital LLC 29 North Adams Street Akron,OH44304 27-1952573	Rehab Hospital	OH	summa Health System	Related	14,020,760	3,163,680		No			No	52.000 %
(2) SUMMA HHAH HOLDINGS LLC C/O 1077 GORGE BLVD Akron,OH44310 82-3600079	HOME HEALTH AND HOSPICE	OH	Summa Health System	RELATED	25,467,000	6,185,400		No			No	60.000 %

(a) Name of related organization	(b) Transaction type (a-s)	(c) Amount involved	(d) Method of determining amount involved
(1) Summa Rehab Hospital LLC	A	2,576,486	FMV
(2) SUMMACARE INC	L	47,971,929	FMV
(3) SUMMACARE INC	L	9,002,586	FMV
(4) SUMMA INSURANCE COMPANY INC	L	16,570,324	FMV
(5) SUMMA INSURANCE COMPANY INC	L	1,585,827	FMV
(6) SUMMACARE INC	L	523,754	FMV
(7) Summa Rehab Hospital LLC	L	523,898	FMV
(8) Middlebury Assurance Company	M	7,016,116	FMV
(9) Middlebury Assurance Company	M	2,946,710	FMV
(10) Summa Integrated Services Organization	M	1,911,259	FMV

(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