COMMUNITY HOSPITALS AND WELLNESS CENTERS: Form 990, tax year 2022
View the entire original 990 at ProPublica ↗
- Organization
- COMMUNITY HOSPITALS AND WELLNESS CENTERS (EIN 34-1048666)
- Tax period
- 2022-10-01 to 2023-09-30
- Filed
- 2024-08-15
- IRS object ID
- 202402289349301990
- Schema version
- 2022v5.0
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
- Return header
- Form 990
- Schedule A
- Schedule B
- Schedule C
- Schedule D
- Schedule H
- Schedule J
- Schedule K
- Schedule L
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2024-08-15T12:27:22-05:00 | ReturnTs |
| Tax Period End | 2023-09-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 381357951 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | PLANTE & MORAN PLLC | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 250 S HIGH ST SUITE 100 | AddressLine1Txt |
| City | COLUMBUS | CityNm |
| State Abbreviation | OH | StateAbbreviationCd |
| ZIP | 43215 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2022-10-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 341048666 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | COMMUNITY HOSPITALS & WELLNESS CENTERS | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | COMM | BusinessNameControlTxt |
| Phone | 4196361131 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 433 W HIGH STREET | AddressLine1Txt |
| City | BRYAN | CityNm |
| State Abbreviation | OH | StateAbbreviationCd |
| ZIP | 43506 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | CHRISTA POMEROY | PersonNm |
| Person Title | CFO | PersonTitleTxt |
| Phone | 4196361131 | PhoneNum |
| Signature | 2024-08-14 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| IRS Responsible Prty Info Curr | 0 | IRSResponsiblePrtyInfoCurrInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | AMY CIMINELLO | PreparerPersonNm |
| PTIN | P00796388 | PTIN |
| Phone | 6148493000 | PhoneNum |
| Preparation | 2024-08-14 | PreparationDt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2022 | TaxYr |
| Build TS | 2024-08-08 14:25:15Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | CHAD D TINKEL | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 433 W HIGH STREET | AddressLine1Txt |
| City | BRYAN | CityNm |
| State Abbreviation | OH | StateAbbreviationCd |
| ZIP | 43506 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $118,114,175 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.CHWCHOSPITALS.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1969 | FormationYr |
| Legal Domicile State | OH | LegalDomicileStateCd |
| Activity Or Mission | WE WILL PROVIDE COMPREHENSIVE, PATIENT CENTERED HEALTHCARE. WE WILL RESPECT THE DIGNITY AND UNIQUENESS OF ALL. WE WILL ENHANCE THE HEALTH, SAFETY, AND WELL BEING OF OUR COMMUNITY. | ActivityOrMissionDesc |
| Voting Members Governing Body | 10 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 9 | VotingMembersIndependentCnt |
| Total Employee | 895 | TotalEmployeeCnt |
| Total Volunteers | 9 | TotalVolunteersCnt |
| Total Gross UBI | -$4,181 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $3,496,834 | PYContributionsGrantsAmt |
| CY Contributions Grants | $2,495,258 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $101,277,699 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $111,982,510 | CYProgramServiceRevenueAmt |
| PY Investment Income | $1,157,990 | PYInvestmentIncomeAmt |
| CY Investment Income | $1,225,556 | CYInvestmentIncomeAmt |
| PY Other Revenue | $2,037,901 | PYOtherRevenueAmt |
| CY Other Revenue | $2,122,535 | CYOtherRevenueAmt |
| PY Total Revenue | $107,970,424 | PYTotalRevenueAmt |
| CY Total Revenue | $117,825,859 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $57,944,522 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $65,719,401 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $55,089,779 | PYOtherExpensesAmt |
| CY Other Expenses | $56,657,412 | CYOtherExpensesAmt |
| PY Total Expenses | $113,034,301 | PYTotalExpensesAmt |
| CY Total Expenses | $122,376,813 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$5,063,877 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$4,550,954 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $144,492,449 | TotalAssetsBOYAmt |
| Total Assets EOY | $137,389,135 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $52,418,625 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $44,756,074 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $92,073,824 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $92,633,061 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | WE WILL PROVIDE COMPREHENSIVE, PATIENT CENTERED HEALTHCARE. WE WILL RESPECT THE DIGNITY AND UNIQUENESS OF ALL. WE WILL ENHANCE THE HEALTH, SAFETY, AND WELL BEING OF OUR COMMUNITY. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $12,487,564 | ExpenseAmt |
| Grant | $0 | GrantAmt |
| Revenue | $16,793,844 | RevenueAmt |
| Desc | INPATIENT CARE: BRYAN HOSPITAL MEDICAL & SURGICAL UNIT HAS 54 BEDS AND PROVIDE CARE FOR 662 PATIENTS AND 312 OBSERVATION PATIENTS; BRYAN HOSPITAL INTENSIVE CARE UNIT AND TELEMETRY UNIT HAS 16 BEDS AND PROVIDE CARE FOR 1,083 INPATIENTS AND 480 OBSERVATION PATIENTS; BRYAN HOSPITAL OBSTETRICS HAS 9 BEDS AND PROVIDED CARE FOR 462 INPATIENTS AND 547 OBSERVATION PATIENTS. MONTPELIER HOSPITAL HAS 25 BEDS AND PROVIDED CARE TO 211 INPATIENTS. | Desc |
Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $13,025,320 | ExpenseAmt |
| Grant | $0 | GrantAmt |
| Revenue | $41,862,002 | RevenueAmt |
| Desc | SURGERY CARE: BRYAN SURGERY HAS 6 OPERATING ROOMS THAT DID 687 GENERAL SURGERY CASES, 1,785 PAIN MANAGEMENT CASES, 729 ORTHOPEDIC CASES, 528 OPHTHALMOLOGY CASES, 389 ENT CASES, 97 GYNECOLOGY CASES, 146 UROLOGY CASES, 870 GASTROENTEROLOGY CASES AND 195 PODIATRY CASES, 82 COLORECTAL CASES. ARCHBOLD SURGERY HAS 4 OPERATING ROOMS THAT DID 17 GENERAL SURGERY CASES, 811 GASTROENTEROLOGY CASES AND 222 COLORECTAL CASES. | Desc |
Prog Srvc Accom Acty3 ProgSrvcAccomActy3Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $5,918,362 | ExpenseAmt |
| Grant | $0 | GrantAmt |
| Revenue | $24,841,004 | RevenueAmt |
| Desc | EMERGENCY ROOM CARE: BRYAN ED CARED FOR 16,283 PATIENTS WITH 1,406 BEING ADMITTED; MONTPELIER ED CARED FOR 4,121 PATIENTS WITH 0 BEING ADMITTED. | Desc |
Prog Srvc Accom Acty Other ProgSrvcAccomActyOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $63,498,855 | ExpenseAmt |
| Grant | $0 | GrantAmt |
| Revenue | $28,521,378 | RevenueAmt |
| Desc | COMMUNITY HOSPITALS AND WELLNESS CENTERS PROVIDED SERVICES TO APPROXIMATELY 2,418 INPATIENTS, APPROXIMATELY 1,350 OBSERVATION PATIENTS, AND APPROXIMATELY 20,404 EMERGENCY DEPARTMENT PATIENTS DURING THIS FISCAL YEAR. THE HOSPITAL UTILIZES A BOARD APPROVED CHARITABLE CARE PROGRAM THAT MEASURES INDIVIDUAL AND FAMILY NEEDS BASED ON FEDERAL POVERTY GUIDELINES. THE PROGRAM IS APPLIED UNIFORMLY ACROSS ALL LEVELS OF HOSPITAL SERVICES. THE PROGRAM EXTENDS BEYOND THE FEDERAL POVERTY DEFINITIONS TO ALLOW THE HOSPITAL TO PROVIDE FREE AND/OR SUBSIDIZED CARE FOR PERSONS FALLING WITHIN AND BEYOND THE FEDERAL GUIDELINES. THIS PROGRAM PROVIDED ASSISTANCE TO APPROXIMATELY 4,575 ACCOUNTS DURING THIS FISCAL YEAR. | Desc |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Prog Srvc Expense | $63,498,855 | TotalOtherProgSrvcExpenseAmt |
| Total Other Prog Srvc Grant | $0 | TotalOtherProgSrvcGrantAmt |
| Total Other Prog Srvc Revenue | $28,521,378 | TotalOtherProgSrvcRevenueAmt |
| Total Program Service Expenses | $94,930,101 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | Yes (1) | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Donor Rstr Or Quasi Endowments | 0 | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | Yes (1) | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (1) | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | Yes (1) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (1) | AuditedFinancialStmtAttInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | Yes (1) | TaxExemptBondsInd |
| Invest Tax Exempt Bonds | Yes (1) | InvestTaxExemptBondsInd |
| Escrow Account | Yes (1) | EscrowAccountInd |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuerInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With35 Ctrl Ent | Yes (1) | BusinessRlnWith35CtrlEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | Yes (1) | RelatedOrganizationCtrlEntInd |
| Transaction With Control Ent | Yes (1) | TransactionWithControlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 58 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 895 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | Yes (1) | UnrelatedBusIncmOverLimitInd |
| Form990 T Filed | Yes (1) | Form990TFiledInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | 0 | SubjToTaxRmnrtnExPrchtPymtInd |
| Subject To Excs Tax Net Invst Inc | 0 | SubjectToExcsTaxNetInvstIncInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 10 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 9 | IndependentVotingMemberCnt |
| Family Or Business Rln | Yes (1) | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | Yes (1) | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | 0 | MembersOrStockholdersInd |
| Election Of Board Members | 0 | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | 0 | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (1) | CompensationProcessOtherInd |
| Investment In Joint Venture | Yes (1) | InvestmentInJointVentureInd |
| Written Policy Or Procedure | 0 | WrittenPolicyOrProcedureInd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CHRISTA POMEROY | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 4196333594 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 433 W HIGH STREET | AddressLine1Txt |
| City | BRYAN | CityNm |
| State Abbreviation | OH | StateAbbreviationCd |
| ZIP | 43506 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (20 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | OfficerOfficerInd | Key EmployeeKeyEmployeeInd | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|---|
| STEVE BUMB MD | |||||||||
| DIRECTOR: CHIEF OF STAFF | 49.50 | 0.50 | Yes (X) | $306,264 | $0 | $23,674 | |||
| CHRISTOPHER KANNEL | |||||||||
| CHAIR OF BOARD | 0.10 | 0.10 | Yes (X) | $0 | $0 | $0 | Yes (X) | ||
| ELENA WEST | |||||||||
| VICE-CHAIR | 0.10 | 0.10 | Yes (X) | $0 | $0 | $0 | Yes (X) | ||
| DR CAROLYN DORSTEN | |||||||||
| VICE CHIEF OF STAFF | 0.10 | 0.10 | Yes (X) | $0 | $0 | $0 | |||
| KATRINA P HESTER | |||||||||
| DIRECTOR | 0.10 | 0.10 | Yes (X) | $0 | $0 | $0 | |||
| CINDY REED | |||||||||
| DIRECTOR | 0.10 | 0.10 | Yes (X) | $0 | $0 | $0 | |||
| RUSS DAVIES | |||||||||
| DIRECTOR | 0.10 | 0.10 | Yes (X) | $0 | $0 | $0 | |||
| ALLYN LUCE | |||||||||
| DIRECTOR | 0.10 | 0.10 | Yes (X) | $0 | $0 | $0 | |||
| LARS ELLAR | |||||||||
| DIRECTOR | 0.10 | 0.10 | Yes (X) | $0 | $0 | $0 | |||
| JAMES WATKINS | |||||||||
| DIRECTOR | 0.10 | 0.10 | Yes (X) | $0 | $0 | $0 | |||
| CHAD D TINKEL | |||||||||
| EX-OFFICIO DIR: PRESIDENT/CEO/SECRETARY | 49.50 | 0.50 | $367,685 | $0 | $43,175 | Yes (X) | |||
| WADE PATRICK | |||||||||
| VP/CIO | 50.00 | 0.00 | $228,288 | $0 | $41,222 | Yes (X) | |||
| CHRISTA POMEROY | |||||||||
| TREASURER: VP/CFO | 49.50 | 0.50 | $187,092 | $0 | $15,373 | Yes (X) | |||
| JANICE DAVID | |||||||||
| VP PATIENT CARE: THRU 01.23 | 50.00 | 0.00 | $461,149 | $0 | $27,887 | Yes (X) | |||
| ELIZABETH GRIMES | |||||||||
| VP PATIENT CARE | 50.00 | 0.00 | $175,483 | $0 | $22,674 | Yes (X) | |||
| DR KHALID MINHAS | |||||||||
| PHYSICIAN | 50.00 | 0.00 | $785,902 | $0 | $22,674 | Yes (X) | |||
| DR DAVID COOLEY | |||||||||
| PHYSICIAN | 50.00 | 0.00 | $700,996 | $0 | $22,079 | Yes (X) | |||
| DR JODI TINKEL | |||||||||
| PHYSICIAN | 50.00 | 0.00 | $617,880 | $0 | $0 | Yes (X) | |||
| DR WAINWRIGHT JAGGERNAUTH | |||||||||
| PHYSICIAN | 50.00 | 0.00 | $570,608 | $0 | $0 | Yes (X) | |||
| DR MICHAEL NOSANOV | |||||||||
| PHYSICIAN | 50.00 | 0.00 | $555,688 | $0 | $10,294 | Yes (X) | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $4,957,035 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $229,052 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 61 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| PARVIEW HEALTH | |||||
| BOX 5600 | FT WAYNE | IN | 46895 | PHYSICIAN SERVICES | $1,686,397 |
| FORT WAYNE RADIOLOGY | |||||
| 3707 NEW VISION DR | FT WAYNE | IN | 46845 | RADIOLOGOY | $1,630,756 |
| WILLIAMS EMERGENCY GROUP LLP | |||||
| PO BOX 677979 | DALLAS | TX | 752677979 | PHYSICIAN SERVICES | $1,434,939 |
| UT PHYSICIANS | |||||
| MAIL STOP 840 4510 DORR ST | TOLEDO | OH | 43615 | PHYSICIAN SERVICES | $404,198 |
| VAN WERT HEALTH | |||||
| 1250 SOUTH WASHINGTON | VAN WERT | OH | 45891 | PHYSICIAN SERVICES | $371,300 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 5 | CntrctRcvdGreaterThan100KCnt |
| Government Grants | $2,487,717 | GovernmentGrantsAmt |
| All Other Contributions | $7,541 | AllOtherContributionsAmt |
| Total Contributions | $2,495,258 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | PATIENT REVENUE | Desc |
| Business | 621400 | BusinessCd |
| Total Revenue Column | $111,982,510 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $111,982,510 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $111,982,510 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $1,137,145 | TotalRevenueColumnAmt |
| Exclusion | $1,137,145 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $452,632 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $222,948 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $229,684 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $229,684 | TotalRevenueColumnAmt |
| Exclusion | $229,684 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $153,779 | OtherAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $34,243 | SecuritiesAmt |
| Other | $31,125 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | -$34,243 | SecuritiesAmt |
| Other | $122,654 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $88,411 | TotalRevenueColumnAmt |
| Exclusion | $88,411 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | ExclusionExclusionAmt | Unrelated Business RevenueUnrelatedBusinessRevenueAmt |
|---|---|---|---|---|
| INSURANCE FUNDS | 621400 | $1,857,133 | $1,857,133 | |
| CAFETERIA/VENDING | 621400 | $4,181 | $4,181 | |
| LOSS FROM VANTAGE HEALTHCARE | 621400 | -$4,181 | -$4,181 |
Miscellaneous Revenue MiscellaneousRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $35,718 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $35,718 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $1,892,851 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $117,825,859 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $112,018,228 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | -$4,181 | UnrelatedBusinessRevenueAmt |
| Exclusion | $3,316,554 | ExclusionAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,563,331 | TotalAmt |
| Program Services | $1,293,177 | ProgramServicesAmt |
| Management And General | $2,270,154 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $44,158,311 | TotalAmt |
| Program Services | $37,324,633 | ProgramServicesAmt |
| Management And General | $6,833,678 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,929,889 | TotalAmt |
| Program Services | $1,666,849 | ProgramServicesAmt |
| Management And General | $263,040 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $12,711,517 | TotalAmt |
| Program Services | $8,859,367 | ProgramServicesAmt |
| Management And General | $3,852,150 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,356,353 | TotalAmt |
| Program Services | $2,625,915 | ProgramServicesAmt |
| Management And General | $730,438 | ManagementAndGeneralAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $15,053,925 | TotalAmt |
| Program Services | $11,880,913 | ProgramServicesAmt |
| Management And General | $3,173,012 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $500,256 | TotalAmt |
| Management And General | $500,256 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $370,736 | TotalAmt |
| Management And General | $370,736 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $154,323 | TotalAmt |
| Program Services | $59,011 | ProgramServicesAmt |
| Management And General | $95,312 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $761,322 | TotalAmt |
| Program Services | $545,717 | ProgramServicesAmt |
| Management And General | $215,605 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,792,141 | TotalAmt |
| Program Services | $92,190 | ProgramServicesAmt |
| Management And General | $1,699,951 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $68,482 | TotalAmt |
| Program Services | $48,163 | ProgramServicesAmt |
| Management And General | $20,319 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $145,062 | TotalAmt |
| Program Services | $58,938 | ProgramServicesAmt |
| Management And General | $86,124 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,891,859 | TotalAmt |
| Management And General | $1,891,859 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,917,487 | TotalAmt |
| Program Services | $5,221,695 | ProgramServicesAmt |
| Management And General | $695,792 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $833,444 | TotalAmt |
| Program Services | $249,179 | ProgramServicesAmt |
| Management And General | $584,265 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| BILLABLE/NONBILLABLE SU | $19,508,933 | $19,166,574 | $342,359 |
| BAD DEBT EXPENSE | $4,739,312 | $4,739,312 | |
| FRANCHISE FEES & TAXES | $2,448,518 | $96,097 | $2,352,421 |
| REPAIRS & MAINTENANCE | $1,910,085 | $945,724 | $964,361 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $561,527 | TotalAmt |
| Program Services | $56,647 | ProgramServicesAmt |
| Management And General | $504,880 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $122,376,813 | TotalAmt |
| Program Services | $94,930,101 | ProgramServicesAmt |
| Management And General | $27,446,712 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,990,425 | BOYAmt |
| EOY | $6,078,501 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,481,315 | BOYAmt |
| EOY | $0 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $18,142,004 | BOYAmt |
| EOY | $17,936,683 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,932,812 | BOYAmt |
| EOY | $1,928,686 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $444,928 | BOYAmt |
| EOY | $1,092,619 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $150,437,300 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $83,066,264 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $71,563,785 | BOYAmt |
| EOY | $67,371,036 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $30,582,233 | BOYAmt |
| EOY | $31,767,191 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,315,426 | BOYAmt |
| EOY | $587,358 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $13,039,521 | BOYAmt |
| EOY | $10,627,061 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $144,492,449 | BOYAmt |
| EOY | $137,389,135 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $14,378,692 | BOYAmt |
| EOY | $8,147,919 | EOYAmt |
Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $25,305,979 | BOYAmt |
| EOY | $24,171,619 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $12,141,128 | BOYAmt |
| EOY | $11,243,690 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $592,826 | BOYAmt |
| EOY | $1,192,846 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $52,418,625 | BOYAmt |
| EOY | $44,756,074 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows FASB117 | Yes (X) | OrganizationFollowsFASB117Ind |
No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $92,073,824 | BOYAmt |
| EOY | $92,633,061 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $92,073,824 | BOYAmt |
| EOY | $92,633,061 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $144,492,449 | BOYAmt |
| EOY | $137,389,135 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | -$4,550,954 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | $1,610,191 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | $3,500,000 | OtherChangesInNetAssetsAmt |
| Info In Schedule O Part XII | Yes (X) | InfoInScheduleOPartXIIInd |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | Yes (1) | FederalGrantAuditRequiredInd |
| Federal Grant Audit Performed | Yes (1) | FederalGrantAuditPerformedInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | 0 | VolunteersInd |
| Paid Staff Or Management | 0 | PaidStaffOrManagementInd |
| Media Advertisements | 0 | MediaAdvertisementsInd |
| Mailings Members | 0 | MailingsMembersInd |
| Publications Or Broadcast | 0 | PublicationsOrBroadcastInd |
| Grants Other Organizations | 0 | GrantsOtherOrganizationsInd |
| Direct Contact Legislators | 0 | DirectContactLegislatorsInd |
| Rallies Demonstrations | 0 | RalliesDemonstrationsInd |
| Other Activities | Yes (1) | OtherActivitiesInd |
| Other Activities | $2,267 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $2,267 | TotalLobbyingExpendituresAmt |
| Not Described Section501c3 | 0 | NotDescribedSection501c3Ind |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART II-B, LINE 1: | FormAndLineReferenceDesc |
| Explanation | PART OF OHA DUES ARE ATTRIBUTED TO LOBBYING, TOTAL DUES WERE $41,210 OF WHICH 5.5% WERE CONTRIBUTED TO LOBBYING. | ExplanationTxt |
Schedule D IRS990ScheduleD
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | $830,800 | InvestmentCostOrOtherBasisAmt |
| Other Cost Or Other Basis | $2,572,072 | OtherCostOrOtherBasisAmt |
| Book Value | $3,402,872 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $95,094,863 | OtherCostOrOtherBasisAmt |
| Depreciation | $42,891,707 | DepreciationAmt |
| Book Value | $52,203,156 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | $10,928,109 | InvestmentCostOrOtherBasisAmt |
| Depreciation | $7,521,544 | DepreciationAmt |
| Book Value | $3,406,565 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $40,617,225 | OtherCostOrOtherBasisAmt |
| Depreciation | $32,445,473 | DepreciationAmt |
| Book Value | $8,171,752 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $394,231 | OtherCostOrOtherBasisAmt |
| Depreciation | $207,540 | DepreciationAmt |
| Book Value | $186,691 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $67,371,036 | TotalBookValueLandBuildingsAmt |
Other Assets Org OtherAssetsOrgGrp (3 entries)
| DescDesc | Book ValueBookValueAmt |
|---|---|
| OTHER RECEIVABLES | $536,535 |
| ASSETS LIMITED TO USE | $8,594,549 |
| COST REPORT SETTLEMENT | $1,495,977 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $10,627,061 | TotalBookValueOtherAssetsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | SETTLEMENTS PAYABLE UNDER THIRD PARTY REIMBURSEMENT CONTRACTS | Desc |
| Amt | $1,192,846 | Amt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $1,192,846 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART X, LINE 2: | FormAndLineReferenceDesc |
| Explanation | ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA REQUIRE MANAGEMENT TO EVALUATE TAX POSITIONS TAKEN BY THE HOSPITAL AND TO RECOGNIZE A TAX LIABILITY IF THE HOSPITAL HAS TAKEN AN UNCERTAIN POSITION THAT MORE LIKELY THAN NOT WOULD NOT BE SUSTAINED UPON EXAMINATION BY THE INTERNAL REVENUE SERVICE OR OTHER APPLICABLE TAXING AUTHORITIES. MANAGEMENT HAS ANALYZED THE TAX POSITIONS TAKEN BY THE HOSPITAL AND HAS CONCLUDED THAT, AS OF SEPTEMBER 30, 2023 AND 2022, THERE ARE NO UNCERTAIN POSITIONS TAKEN OR EXPECTED TO BE TAKEN THAT WOULD REQUIRE RECOGNITION OF A LIABILITY OR DISCLOSURE IN THE CONSOLIDATED FINANCIAL STATEMENTS. | ExplanationTxt |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (1) | FinancialAssistancePolicyInd |
| Written Policy | Yes (1) | WrittenPolicyInd |
| All Hospitals Policy | Yes (X) | AllHospitalsPolicyInd |
| FPG Reference Free Care | Yes (1) | FPGReferenceFreeCareInd |
| Percent200 | Yes (X) | Percent200Ind |
| FPG Reference Discounted Care | Yes (1) | FPGReferenceDiscountedCareInd |
| Percent300 | Yes (X) | Percent300Ind |
| Free Care Medically Indigent | Yes (1) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (1) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | 0 | ExpensesExceedBudgetInd |
| Annual Community Bnft Report | Yes (1) | AnnualCommunityBnftReportInd |
| Report Publically Available | Yes (1) | ReportPublicallyAvailableInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $2,388,717 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $299,195 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $2,089,522 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01770 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $15,618,192 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $9,055,590 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $6,562,602 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.05570 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $18,006,909 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $9,354,785 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $8,652,124 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.07340 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $176,533 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $176,533 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00150 | TotalExpensePct |
Cash And In Kind Contributions CashAndInKindContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $56,078 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $56,078 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00050 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $232,611 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $232,611 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00200 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $18,239,520 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $9,354,785 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $8,884,735 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.07540 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (1) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $4,739,312 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $473,931 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $18,259,521 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $22,699,413 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$4,439,892 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | Yes (X) | CostToChargeRatioInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | Yes (1) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (1) | FinancialAssistancePrvsnInd |
| Hospital Facilities | 2 | HospitalFacilitiesCnt |
Hospital Facilities HospitalFacilitiesGrp (2 entries)
| FacilityFacilityNum | Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | Licensed HospitalLicensedHospitalInd | General Medical And SurgicalGeneralMedicalAndSurgicalInd | Emergency Room24 HrsEmergencyRoom24HrsInd | Critical Access HospitalCriticalAccessHospitalInd | OtherOtherDesc |
|---|---|---|---|---|---|---|---|---|---|
| BRYAN HOSPITAL | |||||||||
| 1 | 433 WEST HIGH STREET | BRYAN | OH | 43506 | Yes (X) | Yes (X) | Yes (X) | ||
| MONTPELIER HOSPITAL | |||||||||
| 2 | 909 EAST SNYDER AVENUE | MONTPELIER | OH | 43543 | Yes (X) | Yes (X) | Yes (X) | SWING BEDS | |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp (2 entries)
| FacilityFacilityNum | First Licensed CY Or PYFirstLicensedCYOrPYInd | Tax Exempt Hospital CY Or PYTaxExemptHospitalCYOrPYInd | CHNA ConductedCHNAConductedInd | Community DefinitionCommunityDefinitionInd | Community DemographicsCommunityDemographicsInd | Existing ResourcesExistingResourcesInd | How Data ObtainedHowDataObtainedInd | Community Health NeedsCommunityHealthNeedsInd | Other Health IssuesOtherHealthIssuesInd | Community Hlth Needs Id ProcessCommunityHlthNeedsIdProcessInd | Consulting ProcessConsultingProcessInd | Prior CHNA ImpactPriorCHNAImpactInd | OtherOtherInd | CHNA ConductedCHNAConductedYr | Take Into Account Others InputTakeIntoAccountOthersInputInd | CHNA Conducted With Other FcltsCHNAConductedWithOtherFcltsInd | CHNA Conducted With Non FcltsCHNAConductedWithNonFcltsInd | CHNA Report Widely AvailableCHNAReportWidelyAvailableInd | Rpt Available On Own WebsiteRptAvailableOnOwnWebsiteInd | Own Website URLOwnWebsiteURLTxt | Other Website URLOtherWebsiteURLTxt | Paper Copy Public InspectionPaperCopyPublicInspectionInd | Rpt Available Thru Other MethodRptAvailableThruOtherMethodInd | Implementation Strategy AdoptImplementationStrategyAdoptInd | Implementation Strategy AdptImplementationStrategyAdptYr | Strategy Posted WebsiteStrategyPostedWebsiteInd | Strategy Website URLStrategyWebsiteURLTxt | Organization Incur Excise TaxOrganizationIncurExciseTaxInd | Elig Criteria ExplainedEligCriteriaExplainedInd | FPG Family Incm Lmt Free DscntFPGFamilyIncmLmtFreeDscntInd | FPG Family Incm Lmt Free CareFPGFamilyIncmLmtFreeCarePct | FPG Family Incm Lmt Dscnt CareFPGFamilyIncmLmtDscntCarePct | Income Level CriteriaIncomeLevelCriteriaInd | Asset Level CriteriaAssetLevelCriteriaInd | Medical Indigency CriteriaMedicalIndigencyCriteriaInd | Explained BasisExplainedBasisInd | App Financial Asst ExplnAppFinancialAsstExplnInd | Described InfoDescribedInfoInd | Described Suprt DocDescribedSuprtDocInd | Provided Hospital ContactProvidedHospitalContactInd | Includes Publicity MeasuresIncludesPublicityMeasuresInd | FAP Available On WebsiteFAPAvailableOnWebsiteInd | FAP Available On Website URLFAPAvailableOnWebsiteURLTxt | FAP App Available On WebsiteFAPAppAvailableOnWebsiteInd | FAP App Available On Website URLFAPAppAvailableOnWebsiteURLTxt | FAP Summary On WebsiteFAPSummaryOnWebsiteInd | FAP Summary On Website URLFAPSummaryOnWebsiteURLTxt | FAP Avlbl On Request No ChargeFAPAvlblOnRequestNoChargeInd | FAP App Avlbl On Request No ChrgFAPAppAvlblOnRequestNoChrgInd | FAP Sum Avlbl On Request No ChrgFAPSumAvlblOnRequestNoChrgInd | Notified FAP Copy Bill DisplayNotifiedFAPCopyBillDisplayInd | Communtity Notified FAPCommuntityNotifiedFAPInd | FAP TranslatedFAPTranslatedInd | FAP Actions On NonpaymentFAPActionsOnNonpaymentInd | Permit No ActionsPermitNoActionsInd | Collection ActivitiesCollectionActivitiesInd | Provided Written NoticeProvidedWrittenNoticeInd | Made Effort Orally NotifyMadeEffortOrallyNotifyInd | Processed FAP ApplicationProcessedFAPApplicationInd | Made Presumptive Elig DetermMadePresumptiveEligDetermInd | Other Actions TakenOtherActionsTakenInd | Nondis Emergency Care PolicyNondisEmergencyCarePolicyInd | Look Back Medicare PrivateLookBackMedicarePrivateInd | Amounts Generally BilledAmountsGenerallyBilledInd | Gross ChargesGrossChargesInd | Other WebsiteOtherWebsiteInd | Insurance Status CriteriaInsuranceStatusCriteriaInd | Underinsurance Stat CriteriaUnderinsuranceStatCriteriaInd | Residency CriteriaResidencyCriteriaInd | Other CriteriaOtherCriteriaInd |
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| BRYAN HOSPITAL | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| 1 | 0 | 0 | Yes (1) | Yes (X) | Yes (X) | Yes (X) | Yes (X) | Yes (X) | Yes (X) | Yes (X) | Yes (X) | Yes (X) | Yes (X) | 22 | Yes (1) | Yes (1) | Yes (1) | Yes (1) | Yes (X) | HTTPS://WWW.CHWCHOSPITAL.ORG/COMMUNITY-HEALTH-ASSESSMENT/ | HTTPS://WW.CHWCHOSPITAL.ORG/WP-CONTENT/UPLOADS/2022/09/2022-WILLIAMS-COUNTY | Yes (X) | Yes (X) | Yes (1) | 23 | Yes (1) | HTTPS://WWW.CHWCHOSPITAL.ORG/COMMUNITY-HEALTH-ASSESSMENT/ | 0 | Yes (1) | Yes (X) | 200.000000000000 | 300.000000000000 | Yes (X) | Yes (X) | Yes (X) | Yes (1) | Yes (1) | Yes (X) | Yes (X) | Yes (X) | Yes (1) | Yes (X) | HTTPS://WWW.CHWCHOSPITAL.ORG/CHWC-FINANCIAL-ASSISTANCE/ | Yes (X) | HTTPS://WWW.CHWCHOSPITAL.ORG/CHWC-FINANCIAL-ASSISTANCE/ | Yes (X) | HTTPS://WWW.CHWCHOSPITAL.ORG/CHWC-FINANCIAL-ASSISTANCE/ | Yes (X) | Yes (X) | Yes (X) | Yes (X) | Yes (X) | Yes (X) | Yes (1) | Yes (X) | 0 | Yes (X) | Yes (X) | Yes (X) | Yes (X) | Yes (X) | Yes (1) | Yes (X) | 0 | 0 | |||||
| MONTPELIER HOSPITAL | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| 2 | 0 | 0 | Yes (1) | Yes (X) | Yes (X) | Yes (X) | Yes (X) | Yes (X) | Yes (X) | Yes (X) | Yes (X) | Yes (X) | Yes (X) | 22 | Yes (1) | Yes (1) | Yes (1) | Yes (1) | Yes (X) | HTTPS://WWW.CHWCHOSPITAL.ORG/COMMUNITY-HEALTH-ASSESSMENT/ | HTTPS://WW.CHWCHOSPITAL.ORG/WP-CONTENT/UPLOADS/2022/09/2022-WILLIAMS-COUNTY | Yes (X) | Yes (X) | Yes (1) | 23 | Yes (1) | HTTPS://WWW.CHWCHOSPITAL.ORG/COMMUNITY-HEALTH-ASSESSMENT/ | 0 | Yes (1) | Yes (X) | 200.000000000000 | 300.000000000000 | Yes (X) | Yes (X) | Yes (X) | Yes (1) | Yes (1) | Yes (X) | Yes (X) | Yes (X) | Yes (1) | Yes (X) | HTTPS://WWW.CHWCHOSPITAL.ORG/CHWC-FINANCIAL-ASSISTANCE/ | Yes (X) | HTTPS://WWW.CHWCHOSPITAL.ORG/CHWC-FINANCIAL-ASSISTANCE/ | Yes (X) | HTTPS://WWW.CHWCHOSPITAL.ORG/CHWC-FINANCIAL-ASSISTANCE/ | Yes (X) | Yes (X) | Yes (X) | Yes (X) | Yes (X) | Yes (X) | Yes (1) | Yes (X) | 0 | Yes (X) | Yes (X) | Yes (X) | Yes (X) | Yes (X) | Yes (1) | Yes (X) | 0 | 0 | Yes (X) | Yes (X) | Yes (X) | Yes (X) | Yes (X) |
Supplemental Information SupplementalInformationGrp (16 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| BRYAN HOSPITAL | PART V, SECTION B, LINE 3J: THE OVERALL GOAL OF THE NEEDS ASSESSMENT WAS TO PERFORM A COMMUNITY HEALTH ASSESSMENT THAT WILL LEAD TO IMPROVED QUALITY OF PUBLIC AND PRIVATE HEALTH SERVICES. IN ADDITION, THE HEALTH ASSESSMENT CAN BE USED FOR A VARIETY OF PURPOSES SUCH AS THE FOLLOWING:- TO ASSESS THE DISTRIBUTION OF DISEASE AND BEHAVIORAL RISK FACTORS.- TO ASSESS BROAD COMMUNITY HEALTH ISSUES AND TO SHAPE A BROADER DEFINITION OF COMMUNITY HEALTH.- TO MONITOR THE IMPACT OF COMMUNITY HEALTH ACTION PLANS AND TRENDS IN BEHAVIORAL RISK MODIFICATIONS. - TO PROVIDE A VEHICLE TO DISCUSS WAYS TO IMPROVE COMMUNITY HEALTH. THE STUDY CAN ASSIST STAKEHOLDERS WORKING COLLABORATIVELY IN THE COMMUNITY TO ADDRESS ISSUES THAT AFFECT HEALTH.THE COMMUNITY HEALTH ASSESSMENT WILL CONTINUE TO BE REPEATED EVERY THREE YEARS TO DETERMINE IF ACTIONS TAKEN BY COMMUNITIES ARE IMPACTING THE BEHAVIORS THAT LEAD TO POOR HEALTH. |
| MONTPELIER HOSPITAL | PART V, SECTION B, LINE 3J: THE OVERALL GOAL OF THE NEEDS ASSESSMENT WAS TO PERFORM A COMMUNITY HEALTH ASSESSMENT THAT WILL LEAD TO IMPROVED QUALITY OF PUBLIC AND PRIVATE HEALTH SERVICES. IN ADDITION, THE HEALTH ASSESSMENT CAN BE USED FOR A VARIETY OF PURPOSES SUCH AS THE FOLLOWING:- TO ASSESS THE DISTRIBUTION OF DISEASE AND BEHAVIORAL RISK FACTORS.- TO ASSESS BROAD COMMUNITY HEALTH ISSUES AND TO SHAPE A BROADER DEFINITION OF COMMUNITY HEALTH.- TO MONITOR THE IMPACT OF COMMUNITY HEALTH ACTION PLANS AND TRENDS IN BEHAVIORAL RISK MODIFICATIONS. - TO PROVIDE A VEHICLE TO DISCUSS WAYS TO IMPROVE COMMUNITY HEALTH. THE STUDY CAN ASSIST STAKEHOLDERS WORKING COLLABORATIVELY IN THE COMMUNITY TO ADDRESS ISSUES THAT AFFECT HEALTH.THE COMMUNITY HEALTH ASSESSMENT WILL CONTINUE TO BE REPEATED EVERY THREE YEARS TO DETERMINE IF ACTIONS TAKEN BY COMMUNITIES ARE IMPACTING THE BEHAVIORS THAT LEAD TO POOR HEALTH. |
| BRYAN HOSPITAL | PART V, SECTION B, LINE 5: THE WILLIAMS COUNTY HEALTH PARTNERS HAS BEEN CONDUCTING CHAS SINCE 2006 FOR THE PURPOSE OF MEASURING COMMUNITY HEALTH STATUS. THE MOST RECENT WILLIAMS COUNTY CHA WAS CROSS-SECTIONAL IN NATURE AND INCLUDED A WRITTEN SURVEY OF ADULTS AND AN ELECTRONIC SURVEY OF ADOLESCENTS WITHIN WILLIAMS COUNTY. THE QUESTIONS WERE MODELED AFTER THE SURVEY INSTRUMENTS USED BY THE CENTERS FOR DISEASE CONTROL AND PREVENTION (CDC) FOR THEIR NATIONAL AND STATE BEHAVIORAL RISK FACTOR SURVEILLANCE SYSTEM (BRFSS) AND YOUTH RISK BEHAVIOR SURVEILLANCE SYSTEM (YRBSS). THIS HAS ALLOWED WILLIAMS COUNTY TO COMPARE THEIR CHA DATA TO NATIONAL, STATE, AND LOCAL HEALTH TRENDS. COMMUNITY STAKEHOLDERS WERE ACTIVELY ENGAGED IN THE EARLY PHASES OF CHA PLANNING AND HELPED DEFINE THE CONTENT, SCOPE, AND SEQUENCE OF THE PROJECT. THE WILLIAMS COUNTY COMBINED HEALTH DISTRICT CONTRACTED WITH THE HOSPITAL COUNCIL OF NORTHWEST OHIO (HCNO), A NEUTRAL, REGIONAL, NONPROFIT HOSPITAL ASSOCIATION, TO FACILITATE THE CHA AND CHIP. THE WILLIAMS COUNTY COMBINED HEALTH DISTRICT, ALONG WITH COMMUNITY HOSPITALS AND WELLNESS CENTERS (CHWC), THEN INVITED VARIOUS COMMUNITY STAKEHOLDERS TO PARTICIPATE IN THE COMMUNITY HEALTH IMPROVEMENT PROCESS. DATA FROM THE MOST RECENT CHA WERE CAREFULLY CONSIDERED AND CATEGORIZED INTO COMMUNITY PRIORITIES WITH ACCOMPANYING STRATEGIES. THIS WAS DONE USING THE NATIONAL ASSOCIATION OF COUNTY AND CITY HEALTH OFFICIALS' (NACCHO) NATIONAL FRAMEWORK: MOBILIZING FOR ACTION THROUGH PLANNING AND PARTNERSHIPS (MAPP). OVER THE NEXT THREE YEARS, THESE PRIORITIES AND STRATEGIES WILL BE IMPLEMENTED AT THE COUNTY-LEVEL WITH THE HOPE TO IMPROVE POPULATION HEALTH AND CREATE LASTING, SUSTAINABLE CHANGE. IT IS THE HOPE OF THE WILLIAMS COUNTY PARTNERS HEALTH PARTNERS THAT EACH AGENCY IN THE COUNTY WILL TIE THEIR INTERNAL STRATEGIC PLAN TO AT LEAST ONE STRATEGY IN THE CHIP.THE CHIP WAS PLANNED BY VARIOUS AGENCIES AND SERVICE-PROVIDERS WITHIN WILLIAMS COUNTY. FROM OCTOBER 2022 TO JANUARY 2023, THE WILLIAMS COUNTY HEALTH PARTNERS REVIEWED MANY DATA SOURCES CONCERNING THE HEALTH AND SOCIAL CHALLENGES THAT WILLIAMS COUNTY RESIDENTS ARE FACING. THEY DETERMINED PRIORITY ISSUES WHICH, IF ADDRESSED, COULD IMPROVE FUTURE OUTCOMES; DETERMINED GAPS IN CURRENT PROGRAMMING AND POLICIES; EXAMINED BEST PRACTICES AND SOLUTIONS; AND DETERMINED SPECIFIC STRATEGIES TO ADDRESS IDENTIFIED PRIORITY ISSUES. WE WOULD LIKE TO RECOGNIZE THESE INDIVIDUALS AND THANK THEM FOR THEIR DEDICATION TO THIS PROCESS: WILLIAMS COUNTY HEALTH PARTNERS; ALICIA GRAHAM, SHALOM COUNSELING & MEDIATION CENTER; ALLYN LUCE, ALTENLOH, BRINCK & CO.; AMY KIRBY, UNITED WAY OF WILLIAMS COUNTY; ASHLEY EPLING, WILLIAMS COUNTY ECONOMIC; DEVELOPMENT CORPORATION (WEDCO); BECKY KIMBLE, THE ABILITY CENTER; BECKY MCGUIRE, OHIO STATE UNIVERSITY EXTENSION OFFICE; BETHANY COUTZ, EDUCATING COMMUNITIES ON HEALTHY OPPORTUNITIES (ECHO) COALITION; BETHANY SHIRKEY, FOUR COUNTY ALCOHOL, DRUG ADDICTION AND MENTAL HEALTH SERVICES (ADAMHS) BOARD; BOBBI CASE, COMMUNITY HOSPITALS AND WELLNESS CENTERS (CHWC); CHASITY YODER, UNITED WAY OF WILLIAMS COUNTY; CHRIS KANNEL, VILLAGE OF MONTPELIER; DEANNA CUSTAR, WILLIAMS COUNTY BOARD OF HEALTH; DONNA SPROW, WILLIAMS COUNTY DEPARTMENT OF AGING; GENE MCBRIDE, PIONEER AREA MINISTERIAL ASSOCIATION; JENNI MCKARNS, WILLIAMS COUNTY COMMUNITY GARDENING ASSOCIATION (WCCGA); JIM WATKINS, WILLIAMS COUNTY HEALTH DEPARTMENT (WCHD); JIM WYSE, MILLCREEK-WEST UNITY LOCAL SCHOOLS; KAREN VONDEYLEN, MAUMEE VALLEY GUIDANCE CENTER; KATIE BROWN, WCHD; KEIRA CHRISTMAN, WEDCO; KERMIT RIEHLE, EDGERTON SCHOOLS; KIM LAMMERS, MAUMEE VALLEY PLANNING ORGANIZATION; MELISSA EWERS, VILLAGE OF MONTPELIER; MICHELLE KANNEL, MONTPELIER SCHOOLS; NATHAN HOFFER, WCHD; RACHEL AESCHLIMAN, WCHD; RACHEL BLANTON, SARAH'S FRIENDS; RUTH PECK, RECOVERY SERVICES OF NORTHWEST OHIO; SALLY TAYLOR, PARKVIEW PHYSICIANS GROUP; SARAH VASHAW, BRYAN CITY SCHOOLS; SHEANA BEHRINGER, NOCAC; SUSAN SHEETS, WILLIAMS COUNTY JUVENILE COURTS; TAMMY RIEGSECKER, WCHD; TODD ROTH, WILLIAMS COUNTY ENGINEER'S OFFICE; AND VICTORIA SMITH, WCHDPROGRESS WILL BE MONITORED WITH MEASURABLE INDICATORS IDENTIFIED FOR EACH STRATEGY. MOST INDICATORS ALIGN DIRECTLY WITH THE SHIP. THE INDIVIDUALS OR AGENCIES THAT ARE WORKING ON STRATEGIES WILL MEET ON AN AS NEEDED BASIS. THE FULL COMMITTEE WILL MEET QUARTERLY OR AS NEEDED TO REPORT OUT PROGRESS. THE COMMITTEE WILL CREATE A PLAN TO DISSEMINATE THE CHIP TO THE COMMUNITY. STRATEGIES, RESPONSIBLE AGENCIES, AND TIMELINES WILL BE REVIEWED AT THE END OF EACH YEAR BY THE COMMITTEE. AS THIS CHIP IS A LIVING DOCUMENT, EDITS AND REVISIONS WILL BE MADE ACCORDINGLY.WILLIAMS COUNTY WILL CONTINUE FACILITATING CHA EVERY THREE YEARS TO COLLECT DATA AND DETERMINE TRENDS. PRIMARY DATA WILL BE COLLECTED FOR ADULTS AND YOUTH USING NATIONAL SETS OF QUESTIONS TO NOT ONLY COMPARE TRENDS IN WILLIAMS COUNTY, BUT ALSO BE ABLE TO COMPARE TO THE STATE AND NATION. THIS DATA WILL SERVE AS MEASURABLE OUTCOMES FOR EACH PRIORITY AREA. IN ADDITION TO OUTCOME EVALUATION, PROCESS EVALUATION WILL ALSO BE USED ON A CONTINUOUS BASIS TO FOCUS ON THE SUCCESS OF THE STRATEGIES. AREAS OF PROCESS EVALUATION THAT THE CHIP COMMITTEE WILL MONITOR INCLUDE THE FOLLOWING: NUMBER OF PARTICIPANTS, LOCATION(S) WHERE SERVICES ARE PROVIDED, NUMBER OF POLICIES IMPLEMENTED, ECONOMIC STATUS AND RACIAL/ETHNIC BACKGROUND OF THOSE RECEIVING SERVICES (WHEN APPLICABLE), AND INTERVENTION DELIVERY (QUANTITY AND FIDELITY).FURTHERMORE, ALL STRATEGIES HAVE BEEN INCORPORATED INTO A "PROGRESS REPORT" TEMPLATE THAT CAN BE COMPLETED AT ALL FUTURE MEETINGS, KEEPING THE COMMITTEE ON TASK AND ACCOUNTABLE. THIS PROGRESS REPORT MAY ALSO SERVE AS MEETING MINUTES. |
| MONTPELIER HOSPITAL | PART V, SECTION B, LINE 5: THE WILLIAMS COUNTY HEALTH PARTNERS HAS BEEN CONDUCTING CHAS SINCE 2006 FOR THE PURPOSE OF MEASURING COMMUNITY HEALTH STATUS. THE MOST RECENT WILLIAMS COUNTY CHA WAS CROSS-SECTIONAL IN NATURE AND INCLUDED A WRITTEN SURVEY OF ADULTS AND AN ELECTRONIC SURVEY OF ADOLESCENTS WITHIN WILLIAMS COUNTY. THE QUESTIONS WERE MODELED AFTER THE SURVEY INSTRUMENTS USED BY THE CENTERS FOR DISEASE CONTROL AND PREVENTION (CDC) FOR THEIR NATIONAL AND STATE BEHAVIORAL RISK FACTOR SURVEILLANCE SYSTEM (BRFSS) AND YOUTH RISK BEHAVIOR SURVEILLANCE SYSTEM (YRBSS). THIS HAS ALLOWED WILLIAMS COUNTY TO COMPARE THEIR CHA DATA TO NATIONAL, STATE, AND LOCAL HEALTH TRENDS. COMMUNITY STAKEHOLDERS WERE ACTIVELY ENGAGED IN THE EARLY PHASES OF CHA PLANNING AND HELPED DEFINE THE CONTENT, SCOPE, AND SEQUENCE OF THE PROJECT. THE WILLIAMS COUNTY COMBINED HEALTH DISTRICT CONTRACTED WITH THE HOSPITAL COUNCIL OF NORTHWEST OHIO (HCNO), A NEUTRAL, REGIONAL, NONPROFIT HOSPITAL ASSOCIATION, TO FACILITATE THE CHA AND CHIP. THE WILLIAMS COUNTY COMBINED HEALTH DISTRICT, ALONG WITH COMMUNITY HOSPITALS AND WELLNESS CENTERS (CHWC), THEN INVITED VARIOUS COMMUNITY STAKEHOLDERS TO PARTICIPATE IN THE COMMUNITY HEALTH IMPROVEMENT PROCESS. DATA FROM THE MOST RECENT CHA WERE CAREFULLY CONSIDERED AND CATEGORIZED INTO COMMUNITY PRIORITIES WITH ACCOMPANYING STRATEGIES. THIS WAS DONE USING THE NATIONAL ASSOCIATION OF COUNTY AND CITY HEALTH OFFICIALS' (NACCHO) NATIONAL FRAMEWORK: MOBILIZING FOR ACTION THROUGH PLANNING AND PARTNERSHIPS (MAPP). OVER THE NEXT THREE YEARS, THESE PRIORITIES AND STRATEGIES WILL BE IMPLEMENTED AT THE COUNTY-LEVEL WITH THE HOPE TO IMPROVE POPULATION HEALTH AND CREATE LASTING, SUSTAINABLE CHANGE. IT IS THE HOPE OF THE WILLIAMS COUNTY PARTNERS HEALTH PARTNERS THAT EACH AGENCY IN THE COUNTY WILL TIE THEIR INTERNAL STRATEGIC PLAN TO AT LEAST ONE STRATEGY IN THE CHIP.THE CHIP WAS PLANNED BY VARIOUS AGENCIES AND SERVICE-PROVIDERS WITHIN WILLIAMS COUNTY. FROM OCTOBER 2022 TO JANUARY 2023, THE WILLIAMS COUNTY HEALTH PARTNERS REVIEWED MANY DATA SOURCES CONCERNING THE HEALTH AND SOCIAL CHALLENGES THAT WILLIAMS COUNTY RESIDENTS ARE FACING. THEY DETERMINED PRIORITY ISSUES WHICH, IF ADDRESSED, COULD IMPROVE FUTURE OUTCOMES; DETERMINED GAPS IN CURRENT PROGRAMMING AND POLICIES; EXAMINED BEST PRACTICES AND SOLUTIONS; AND DETERMINED SPECIFIC STRATEGIES TO ADDRESS IDENTIFIED PRIORITY ISSUES. WE WOULD LIKE TO RECOGNIZE THESE INDIVIDUALS AND THANK THEM FOR THEIR DEDICATION TO THIS PROCESS: WILLIAMS COUNTY HEALTH PARTNERS; ALICIA GRAHAM, SHALOM COUNSELING & MEDIATION CENTER; ALLYN LUCE, ALTENLOH, BRINCK & CO.; AMY KIRBY, UNITED WAY OF WILLIAMS COUNTY; ASHLEY EPLING, WILLIAMS COUNTY ECONOMIC; DEVELOPMENT CORPORATION (WEDCO); BECKY KIMBLE, THE ABILITY CENTER; BECKY MCGUIRE, OHIO STATE UNIVERSITY EXTENSION OFFICE; BETHANY COUTZ, EDUCATING COMMUNITIES ON HEALTHY OPPORTUNITIES (ECHO) COALITION; BETHANY SHIRKEY, FOUR COUNTY ALCOHOL, DRUG ADDICTION AND MENTAL HEALTH SERVICES (ADAMHS) BOARD; BOBBI CASE, COMMUNITY HOSPITALS AND WELLNESS CENTERS (CHWC); CHASITY YODER, UNITED WAY OF WILLIAMS COUNTY; CHRIS KANNEL, VILLAGE OF MONTPELIER; DEANNA CUSTAR, WILLIAMS COUNTY BOARD OF HEALTH; DONNA SPROW, WILLIAMS COUNTY DEPARTMENT OF AGING; GENE MCBRIDE, PIONEER AREA MINISTERIAL ASSOCIATION; JENNI MCKARNS, WILLIAMS COUNTY COMMUNITY GARDENING ASSOCIATION (WCCGA); JIM WATKINS, WILLIAMS COUNTY HEALTH DEPARTMENT (WCHD); JIM WYSE, MILLCREEK-WEST UNITY LOCAL SCHOOLS; KAREN VONDEYLEN, MAUMEE VALLEY GUIDANCE CENTER; KATIE BROWN, WCHD; KEIRA CHRISTMAN, WEDCO; KERMIT RIEHLE, EDGERTON SCHOOLS; KIM LAMMERS, MAUMEE VALLEY PLANNING ORGANIZATION; MELISSA EWERS, VILLAGE OF MONTPELIER; MICHELLE KANNEL, MONTPELIER SCHOOLS; NATHAN HOFFER, WCHD; RACHEL AESCHLIMAN, WCHD; RACHEL BLANTON, SARAH'S FRIENDS; RUTH PECK, RECOVERY SERVICES OF NORTHWEST OHIO; SALLY TAYLOR, PARKVIEW PHYSICIANS GROUP; SARAH VASHAW, BRYAN CITY SCHOOLS; SHEANA BEHRINGER, NOCAC; SUSAN SHEETS, WILLIAMS COUNTY JUVENILE COURTS; TAMMY RIEGSECKER, WCHD; TODD ROTH, WILLIAMS COUNTY ENGINEER'S OFFICE; AND VICTORIA SMITH, WCHDPROGRESS WILL BE MONITORED WITH MEASURABLE INDICATORS IDENTIFIED FOR EACH STRATEGY. MOST INDICATORS ALIGN DIRECTLY WITH THE SHIP. THE INDIVIDUALS OR AGENCIES THAT ARE WORKING ON STRATEGIES WILL MEET ON AN AS NEEDED BASIS. THE FULL COMMITTEE WILL MEET QUARTERLY OR AS NEEDED TO REPORT OUT PROGRESS. THE COMMITTEE WILL CREATE A PLAN TO DISSEMINATE THE CHIP TO THE COMMUNITY. STRATEGIES, RESPONSIBLE AGENCIES, AND TIMELINES WILL BE REVIEWED AT THE END OF EACH YEAR BY THE COMMITTEE. AS THIS CHIP IS A LIVING DOCUMENT, EDITS AND REVISIONS WILL BE MADE ACCORDINGLY.WILLIAMS COUNTY WILL CONTINUE FACILITATING CHA EVERY THREE YEARS TO COLLECT DATA AND DETERMINE TRENDS. PRIMARY DATA WILL BE COLLECTED FOR ADULTS AND YOUTH USING NATIONAL SETS OF QUESTIONS TO NOT ONLY COMPARE TRENDS IN WILLIAMS COUNTY, BUT ALSO BE ABLE TO COMPARE TO THE STATE AND NATION. THIS DATA WILL SERVE AS MEASURABLE OUTCOMES FOR EACH PRIORITY AREA. IN ADDITION TO OUTCOME EVALUATION, PROCESS EVALUATION WILL ALSO BE USED ON A CONTINUOUS BASIS TO FOCUS ON THE SUCCESS OF THE STRATEGIES. AREAS OF PROCESS EVALUATION THAT THE CHIP COMMITTEE WILL MONITOR INCLUDE THE FOLLOWING: NUMBER OF PARTICIPANTS, LOCATION(S) WHERE SERVICES ARE PROVIDED, NUMBER OF POLICIES IMPLEMENTED, ECONOMIC STATUS AND RACIAL/ETHNIC BACKGROUND OF THOSE RECEIVING SERVICES (WHEN APPLICABLE), AND INTERVENTION DELIVERY (QUANTITY AND FIDELITY).FURTHERMORE, ALL STRATEGIES HAVE BEEN INCORPORATED INTO A "PROGRESS REPORT" TEMPLATE THAT CAN BE COMPLETED AT ALL FUTURE MEETINGS, KEEPING THE COMMITTEE ON TASK AND ACCOUNTABLE. THIS PROGRESS REPORT MAY ALSO SERVE AS MEETING MINUTES. |
| BRYAN HOSPITAL | PART V, SECTION B, LINE 6A: MONTPELIER HOSPITAL |
| MONTPELIER HOSPITAL | PART V, SECTION B, LINE 6A: BRYAN HOSPITAL |
| BRYAN HOSPITAL | PART V, SECTION B, LINE 6B: WILLIAMS COUNTY HEALTH DEPARTMENT |
| MONTPELIER HOSPITAL | PART V, SECTION B, LINE 6B: WILLIAMS COUNTY HEALTH DEPARTMENT |
| BRYAN HOSPITAL | PART V, SECTION B, LINE 7D: THE 2022 WILLIAMS COUNTY HEALTH ASSESSMENT IS AVAILABLE ON THE FOLLOWING WEBSITES:COMMUNITY HOSPITALS AND WELLNESS CENTERSHTTPS://WWW.CHWCHOSPITAL.ORG/COMMUNITY-HEALTH-ASSESMENT/WILLIAMS COUNTY COMBINED HEALTH DISTRICTHTTP://WWW.WILLIAMSCOUNTYHEALTH.ORG/HOSPITAL COUNCIL OF NORTHWEST OHIOHTTP://WWW.HCNO.ORG/COMMUNITY/REPORTS.HTML |
| MONTPELIER HOSPITAL | PART V, SECTION B, LINE 7D: THE 2019 WILLIAMS COUNTY HEALTH ASSESSMENT IS AVAILABLE ON THE FOLLOWING WEBSITES:COMMUNITY HOSPITALS AND WELLNESS CENTERSHTTPS://WWW.CHWCHOSPITAL.ORG/COMMUNITY-HEALTH-ASSESMENT/WILLIAMS COUNTY COMBINED HEALTH DISTRICTHTTP://WWW.WILLIAMSCOUNTYHEALTH.ORG/HOSPITAL COUNCIL OF NORTHWEST OHIOHTTP://WWW.HCNO.ORG/COMMUNITY/REPORTS.HTML |
| BRYAN HOSPITAL | PART V, SECTION B, LINE 11: THE STRATEGIC PLAN OF ACTION IS TO ADDRESS THREE PRIORITIES 1) ACCESS TO CARE, 2) HEALTH BEHAVIORS, 3) MENTAL HEALTH AND ADDICTION. ALL PRIORITIES HAVE SPECIFIC STRATEGIES AND ACTION STEPS OUTLINED ON PAGES 38-50 IN TEH WILLIAMS COUNTY CHIP PLAN.PROGRESS WILL BE MONITORED WITH MEASURABLE INDICATORS IDENTIFIED FOR EACH STRATEGY. MOST INDICATORS ALIGN DIRECTLY WITH THE SHIP. THE INDIVIDUALS OR AGENCIES THAT ARE WORKING ON STRATEGIES WILL MEET ON AN AS NEEDED BASIS. THE FULL COMMITTEE WILL MEET QUARTERLY OR AS NEEDED TO REPORT OUT PROGRESS. THE COMMITTEEWILL CREATE A PLAN TO DISSEMINATE THE CHIP TO THE COMMUNITY. STRATEGIES, RESPONSIBLE AGENCIES, AND TIMELINES WILL BE REVIEWED AT THE END OF EACH YEAR BY THE COMMITTEE. AS THIS CHIP IS A LIVING DOCUMENT, EDITS AND REVISIONS WILL BE MADE ACCORDINGLY.WILLIAMS COUNTY WILL CONTINUE FACILITATING CHA EVERY THREE YEARS TO COLLECT DATA AND DETERMINE TRENDS. PRIMARY DATA WILL BE COLLECTED FOR ADULTS AND YOUTH USING NATIONAL SETS OF QUESTIONS TO NOT ONLY COMPARE TRENDS IN WILLIAMS COUNTY, BUT ALSO BE ABLE TO COMPARE TO THE STATE AND NATION. THIS DATA WILL SERVE AS MEASURABLE OUTCOMES FOR EACH PRIORITY AREA. INDICATORS HAVE ALREADY BEEN DEFINED THROUGHOUT THIS REPORT AND ARE IDENTIFIED WITH THE ICON.IN ADDITION TO OUTCOME EVALUATION, PROCESS EVALUATION WILL ALSO BE USED ON A CONTINUOUS BASIS TO FOCUS ON THE SUCCESS OF THE STRATEGIES. AREAS OF PROCESS EVALUATION THAT THE CHIP COMMITTEE WILL MONITOR INCLUDE THE FOLLOWING: NUMBER OF PARTICIPANTS, LOCATION(S) WHERE SERVICES ARE PROVIDED, NUMBER OF POLICIES IMPLEMENTED, ECONOMIC STATUS AND RACIAL/ETHNIC BACKGROUND OF THOSE RECEIVING SERVICES (WHEN APPLICABLE), AND INTERVENTION DELIVERY (QUANTITY AND FIDELITY).FURTHERMORE, ALL STRATEGIES HAVE BEEN INCORPORATED INTO A "PROGRESS REPORT" TEMPLATE THAT CAN BE COMPLETED AT ALL FUTURE MEETINGS, KEEPING THE COMMITTEE ON TASK AND ACCOUNTABLE. THIS PROGRESS REPORT MAY ALSO SERVE AS MEETING MINUTES. |
| MONTPELIER HOSPITAL | PART V, SECTION B, LINE 11: THE STRATEGIC PLAN OF ACTION IS TO ADDRESS THREE PRIORITIES 1) ACCESS TO CARE, 2) HEALTH BEHAVIORS, 3) MENTAL HEALTH AND ADDICTION. ALL PRIORITIES HAVE SPECIFIC STRATEGIES AND ACTION STEPS OUTLINED ON PAGES 38-50 IN TEH WILLIAMS COUNTY CHIP PLAN.PROGRESS WILL BE MONITORED WITH MEASURABLE INDICATORS IDENTIFIED FOR EACH STRATEGY. MOST INDICATORS ALIGN DIRECTLY WITH THE SHIP. THE INDIVIDUALS OR AGENCIES THAT ARE WORKING ON STRATEGIES WILL MEET ON AN AS NEEDED BASIS. THE FULL COMMITTEE WILL MEET QUARTERLY OR AS NEEDED TO REPORT OUT PROGRESS. THE COMMITTEEWILL CREATE A PLAN TO DISSEMINATE THE CHIP TO THE COMMUNITY. STRATEGIES, RESPONSIBLE AGENCIES, AND TIMELINES WILL BE REVIEWED AT THE END OF EACH YEAR BY THE COMMITTEE. AS THIS CHIP IS A LIVING DOCUMENT, EDITS AND REVISIONS WILL BE MADE ACCORDINGLY.WILLIAMS COUNTY WILL CONTINUE FACILITATING CHA EVERY THREE YEARS TO COLLECT DATA AND DETERMINE TRENDS. PRIMARY DATA WILL BE COLLECTED FOR ADULTS AND YOUTH USING NATIONAL SETS OF QUESTIONS TO NOT ONLY COMPARE TRENDS IN WILLIAMS COUNTY, BUT ALSO BE ABLE TO COMPARE TO THE STATE AND NATION. THIS DATA WILL SERVE AS MEASURABLE OUTCOMES FOR EACH PRIORITY AREA. INDICATORS HAVE ALREADY BEEN DEFINED THROUGHOUT THIS REPORT AND ARE IDENTIFIED WITH THE ICON.IN ADDITION TO OUTCOME EVALUATION, PROCESS EVALUATION WILL ALSO BE USED ON A CONTINUOUS BASIS TO FOCUS ON THE SUCCESS OF THE STRATEGIES. AREAS OF PROCESS EVALUATION THAT THE CHIP COMMITTEE WILL MONITOR INCLUDE THE FOLLOWING: NUMBER OF PARTICIPANTS, LOCATION(S) WHERE SERVICES ARE PROVIDED, NUMBER OF POLICIES IMPLEMENTED, ECONOMIC STATUS AND RACIAL/ETHNIC BACKGROUND OF THOSE RECEIVING SERVICES (WHEN APPLICABLE), AND INTERVENTION DELIVERY (QUANTITY AND FIDELITY).FURTHERMORE, ALL STRATEGIES HAVE BEEN INCORPORATED INTO A "PROGRESS REPORT" TEMPLATE THAT CAN BE COMPLETED AT ALL FUTURE MEETINGS, KEEPING THE COMMITTEE ON TASK AND ACCOUNTABLE. THIS PROGRESS REPORT MAY ALSO SERVE AS MEETING MINUTES. |
| BRYAN HOSPITAL | PART V, SECTION B, LINE 13B: ALL PATIENTS REGISTERING FOR EMERGENCY OR MEDICALLY NECESSARY CARE WILL BE OFFERED A FINANCIAL APPLICATION AND "PLAIN LANGUAGE SUMMARY" AT THE TIME OF REGISTRATION. CHWC WILL ALSO FOLLOW UP WITH UNINSURED PATIENTS WITHIN 3 TO 4 WEEKS OF SERVICE, IF A FINANCIAL APPLICATION IS NOT RECEIVED OR MEDICAID APPLICATION IS NOT COMPLETED BY THAT DATE. FOLLOW UP CONSISTS OF A PHONE CALL TO OFFER THE PATIENT ASSISTANCE WITH THE MEDICAID APPLICATION AND DISCUSS FINANCIAL ASSISTANCE OPTIONS. PATIENT BILLING STATEMENTS INCLUDE ON THE BACK SIDE, INFORMATION ON THE HCAP AND HOSPITAL FINANCIAL ASSISTANCE PROGRAMS, INCLUDING CURRENT POVERTY LEVELS, AS REQUIRED BY HCAP POLICY. THE OPTIONS FOR REQUESTING A FINANCIAL APPLICATION ARE ALSO LISTED ON THE STATEMENT. REFERENCE TO THE FINANCIAL ASSISTANCE INFORMATION WILL BE CLEARLY NOTED ON THE FRONT SIDE OF THE STATEMENT. THE PLAIN LANGUAGE SUMMARY, FINANCIAL APPLICATION, BILLING AND COLLECTIONS POLICY, AND THIS FINANCIAL ASSISTANCE POLICY ARE DISPLAYED ON THE HOSPITAL WEBSITE. IN COMPLIANCE WITH THE 5-PERCENT/1000 PERSON THRESHOLD UNDER THE HHS GUIDANCE SAFE HARBOR AND 501R REGULATIONS, THE SPANISH VERSION OF THE FAP, FINANCIAL APPLICATION AND PLAIN LANGUAGE SUMMARY IS ALSO AVAILABLE AT ALL HOSPITAL LOCATIONS AND ON THE HOSPITAL WEBSITE. SIGNAGE IS POSTED AT ALL 3 HOSPITAL BUILDINGS IN CUSTOMER AREAS INCLUDING ADMISSIONS OFFICE, BILLING OFFICE, CASHIER AREA AND EMERGENCY DEPARTMENT. THE SIGNAGE WILL PROVIDE INFORMATION ON THE HOSPITAL FINANCIAL PROGRAM AND THE APPLICATION PROCESS.COPIES OF THE FINANCIAL APPLICATION AND PLAIN LANGUAGE SUMMARY ARE DISTRIBUTED TO THE COMPASSION CLINIC IN WILLIAMS COUNTY. THIS IS A 'FREE CLINIC AND PATIENTS ARE ENCOURAGED TO COMPLETE THE APPLICATION IF THEY NEED FOLLOW UP SERVICES AT THE HOSPITAL. CHWC WILL PERIODICALLY INCLUDE INFORMATION ON THE HOSPITAL FINANCIAL ASSISTANCE POLICIES, IN THE QUARTERLY NEWSLETTER THAT IS MAILED TO RESIDENTS IN THE 4 COUNTY AREA. |
| MONTPELIER HOSPITAL | PART V, SECTION B, LINE 13B: ALL PATIENTS REGISTERING FOR EMERGENCY OR MEDICALLY NECESSARY CARE WILL BE OFFERED A FINANCIAL APPLICATION AND "PLAIN LANGUAGE SUMMARY" AT THE TIME OF REGISTRATION. CHWC WILL ALSO FOLLOW UP WITH UNINSURED PATIENTS WITHIN 3 TO 4 WEEKS OF SERVICE, IF A FINANCIAL APPLICATION IS NOT RECEIVED OR MEDICAID APPLICATION IS NOT COMPLETED BY THAT DATE. FOLLOW UP CONSISTS OF A PHONE CALL TO OFFER THE PATIENT ASSISTANCE WITH THE MEDICAID APPLICATION AND DISCUSS FINANCIAL ASSISTANCE OPTIONS. PATIENT BILLING STATEMENTS INCLUDE ON THE BACK SIDE, INFORMATION ON THE HCAP AND HOSPITAL FINANCIAL ASSISTANCE PROGRAMS, INCLUDING CURRENT POVERTY LEVELS, AS REQUIRED BY HCAP POLICY. THE OPTIONS FOR REQUESTING A FINANCIAL APPLICATION ARE ALSO LISTED ON THE STATEMENT. REFERENCE TO THE FINANCIAL ASSISTANCE INFORMATION WILL BE CLEARLY NOTED ON THE FRONT SIDE OF THE STATEMENT. THE PLAIN LANGUAGE SUMMARY, FINANCIAL APPLICATION, BILLING AND COLLECTIONS POLICY, AND THIS FINANCIAL ASSISTANCE POLICY ARE DISPLAYED ON THE HOSPITAL WEBSITE. IN COMPLIANCE WITH THE 5-PERCENT/1000 PERSON THRESHOLD UNDER THE HHS GUIDANCE SAFE HARBOR AND 501R REGULATIONS, THE SPANISH VERSION OF THE FAP, FINANCIAL APPLICATION AND PLAIN LANGUAGE SUMMARY IS ALSO AVAILABLE AT ALL HOSPITAL LOCATIONS AND ON THE HOSPITAL WEBSITE. SIGNAGE IS POSTED AT ALL 3 HOSPITAL BUILDINGS IN CUSTOMER AREAS INCLUDING ADMISSIONS OFFICE, BILLING OFFICE, CASHIER AREA AND EMERGENCY DEPARTMENT. THE SIGNAGE WILL PROVIDE INFORMATION ON THE HOSPITAL FINANCIAL PROGRAM AND THE APPLICATION PROCESS.COPIES OF THE FINANCIAL APPLICATION AND PLAIN LANGUAGE SUMMARY ARE DISTRIBUTED TO THE COMPASSION CLINIC IN WILLIAMS COUNTY. THIS IS A 'FREE CLINIC AND PATIENTS ARE ENCOURAGED TO COMPLETE THE APPLICATION IF THEY NEED FOLLOW UP SERVICES AT THE HOSPITAL. CHWC WILL PERIODICALLY INCLUDE INFORMATION ON THE HOSPITAL FINANCIAL ASSISTANCE POLICIES, IN THE QUARTERLY NEWSLETTER THAT IS MAILED TO RESIDENTS IN THE 4 COUNTY AREA. |
| BRYAN HOSPITAL | PART V, SECTION B, LINE 20E: VISITS DETERMINED TO BE CHARITY ELIGIBLE THROUGH THE I-SOLUTIONS PROGRAM, WILL RECEIVE CHARITY DISCOUNTS ACCORDING TO THE 'SELF PAY/COLLECTION POLICY'. I-SOLUTIONS IS AN ELECTRONIC SCREENING PROCESS THAT PROVIDES A SCORE RELATING TO THE PATIENT'S ABILITY TO PAY.PRESUMPTIVE ELIGIBILITY IS DETERMINED IMMEDIATELY PRIOR TO SENDING AN ACCOUNT TO COLLECTIONS. PATIENTS RECEIVING A FINANCIAL DISCOUNT FROM THE I-SOLUTIONS PROCESS MAY ALSO COMPLETE A FINANCIAL APPLICATION TO DETERMINE ELIGIBILITY FOR A HIGHER DISCOUNT, AS LONG AS THE APPLICATION IS COMPLETED WITHIN 240 DAYS OF THE 1ST STATEMENT DATE. THE PATIENT DOES NOT RECEIVE NOTIFICATION OF THE CHARITY DISCOUNT APPLIED BASED ON PRESUMPTIVE ELIGIBILITY AS THE ACCOUNT HAS ALREADY MET THE HOSPITAL GUIDELINES FOR PLACEMENT WITH A COLLECTION AGENCY AND IS IMMEDIATELY FORWARDED TO THE AGENCY FOR COLLECTION OF THE REMAINING BALANCE. THE COLLECTION AGENCY WILL ENCOURAGE COMPLETION OF A FINANCIAL APPLICATION, IF THEY DETERMINE THE PATIENT IS LIKELY ELIGIBLE FOR FINANCIAL ASSISTANCE, REGARDLESS IF THE ACCOUNT HAS ALREADY RECEIVED A DISCOUNT BASED ON PRESUMPTIVE ELIGIBILITY. |
| MONTPELIER HOSPITAL | PART V, SECTION B, LINE 20E: VISITS DETERMINED TO BE CHARITY ELIGIBLE THROUGH THE I-SOLUTIONS PROGRAM, WILL RECEIVE CHARITY DISCOUNTS ACCORDING TO THE 'SELF PAY/COLLECTION POLICY'. I-SOLUTIONS IS AN ELECTRONIC SCREENING PROCESS THAT PROVIDES A SCORE RELATING TO THE PATIENT'S ABILITY TO PAY.PRESUMPTIVE ELIGIBILITY IS DETERMINED IMMEDIATELY PRIOR TO SENDING AN ACCOUNT TO COLLECTIONS. PATIENTS RECEIVING A FINANCIAL DISCOUNT FROM THE I-SOLUTIONS PROCESS MAY ALSO COMPLETE A FINANCIAL APPLICATION TO DETERMINE ELIGIBILITY FOR A HIGHER DISCOUNT, AS LONG AS THE APPLICATION IS COMPLETED WITHIN 240 DAYS OF THE 1ST STATEMENT DATE. THE PATIENT DOES NOT RECEIVE NOTIFICATION OF THE CHARITY DISCOUNT APPLIED BASED ON PRESUMPTIVE ELIGIBILITY AS THE ACCOUNT HAS ALREADY MET THE HOSPITAL GUIDELINES FOR PLACEMENT WITH A COLLECTION AGENCY AND IS IMMEDIATELY FORWARDED TO THE AGENCY FOR COLLECTION OF THE REMAINING BALANCE. THE COLLECTION AGENCY WILL ENCOURAGE COMPLETION OF A FINANCIAL APPLICATION, IF THEY DETERMINE THE PATIENT IS LIKELY ELIGIBLE FOR FINANCIAL ASSISTANCE, REGARDLESS IF THE ACCOUNT HAS ALREADY RECEIVED A DISCOUNT BASED ON PRESUMPTIVE ELIGIBILITY. |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 2 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp (2 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | FacilityFacilityTxt |
|---|---|---|---|---|
| 1 - ARCHBOLD MEDICAL CENTER | ||||
| 121 WESTFIELD DR | ARCHBOLD | OH | 43502 | OP SURGERY CENTER, OP RADIOLOGY, OP LAB, OP THERAPIES, AND MOB |
| 2 - RADIATION ONCOLOGY CENTER | ||||
| 524 WEST HIGH ST | BRYAN | OH | 43506 | RADIATION ONCOLOGY |
Supplemental Information Detail SupplementalInformationDetail (18 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 3C: | NOT APPLICABLE |
| PART I, LINE 6A: | NOT APPLICABLE |
| PART I, LINE 7: | CHARITY CARE AND MEDICAID COSTS WERE CALCULATED USING A COST TO CHARGE RATIO (51%) WHICH WAS DERIVED FROM WORKSHEET 2. |
| PART I, LINE 7G: | NOT APPLICABLE |
| PART I, LN 7 COL(F): | THE PERCENTAGE CALCULATED ON LINE 7F IS BASED ON TOTAL EXPENSES FROM FORM 990, PART IX, LESS BAD DEBTS IN THE AMOUNT OF $4,739,312. |
| PART I, LINE 7E: | AMOUNTS PRESENTED ARE BASED ON ACTUAL SPEND FOR THOSE SERVICES AND BENEFITS PROVIDED DEEMED TO IMPROVE THE HEALTH OF THE COMMUNITIES IN WHICH WE SERVE AND CONFORM WITH THE MISSION OF OUR EXEMPT PURPOSE. |
| PART I, LINE 7I: | IN KEEPING WITH OUR MISSION AND COMMITMENT TO THE COMMUNITIES IN WHICH WE SERVE, COMMUNITY HOSPITALS AND WELLNESS CENTERS CONTINUES ITS TRADITION OF CONTRIBUTING TO NUMEROUS ORGANIZATIONS ON BOTH AN AS-NEEDED BASIS AND NEGOTIATED BASIS. AMOUNTS PRESENTED REPRESENT ACTUAL SPEND TO ORGANIZATIONS THROUGHOUT OUR COMMUNITIES. |
| PART II, COMMUNITY BUILDING ACTIVITIES: | NOT APPLICABLE |
| PART III, LINE 2: | BAD DEBT WAS CALCULATED USING AUDITED FINANCIAL, IT IS NOT AN ESTIMATED AMOUNT. |
| PART III, LINE 3: | ESTIMATE OF 10% OF TOTAL BAD DEBT EXPENSE IN ORDER TO CALCULATE THE AMOUNT RECORDED AS BAD DEBT THAT WOULD BE ATTRIBUTABLE TO PATIENTS WHO WOULD QUALIFY UNDER THE HOSPITAL'S CHARITY CARE POLICY. NONE OF THE BAD DEBT EXPENSE IS TREATED AS A COMMUNITY BENEFIT. |
| PART III, LINE 4: | ACCOUNTS RECEIVABLE ARE REDUCED BY AN ALLOWANCE FOR DOUBTFUL ACCOUNTS. IN EVALUATING THE COLLECTIBILITY OF ACCOUNTS RECEIVABLE, THE HOSPITAL ANALYZES ITS PAST HISTORY AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYOR SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND PROVISION FOR BAD DEBTS. MANAGEMENT REGULARLY REVIEWS DATA ABOUT THESE MAJOR PAYOR SOURCES OF REVENUE IN EVALUATING THE SUFFICIENCY OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY COVERAGE, THE HOSPITAL ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS AND A PROVISION FOR BAD DEBTS IF NECESSARY (FOR EXAMPLE, FOR EXPECTED UNCOLLECTIBLE DEDUCTIBLES AND COPAYMENTS ON ACCOUNTS FOR WHICH THE THIRD-PARTY PAYOR HAS NOT YET PAID OR FOR PAYORS WHO ARE KNOWN TO BE HAVING FINANCIAL DIFFICULTIES THAT MAKE THE REALIZATION OF AMOUNTS DUE UNLIKELY).FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS (WHICH INCLUDE BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND COPAYMENT BALANCES DUE FOR WHICH THIRD-PARTY COVERAGE EXISTS FOR PART OF THE BILL), THE HOSPITAL RECORDS A SIGNIFICANT PROVISION FOR BAD DEBTS IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST EXPERIENCE, WHICH INDICATES THAT MANY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. THE DIFFERENCE BETWEEN THE STANDARD RATES (OR THE DISCOUNTED RATES, IF NEGOTIATED) AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. |
| PART III, LINE 8: | MEDICARE COSTS WERE CALCULATED USING A COST TO CHARGE RATIO BASED ON METHODOLOGY REQUIRED FOR COMPLETING THE MEDICARE COST REPORT. THE SHORTFALL IS CONSIDERED COMMUNITY BENEFIT DUE TO THE ELDERLY POPULATION IN THE HOSPITAL'S SERVICE AREA. |
| PART III, LINE 9B: | THE FOLLOWING COLLECTION PRACTICES ARE CONSISTENANT WITH ALL PATIENTS:STATEMENT CYCLE:THE FIRST STATEMENT MAILED TO THE PATIENT/GUARANTOR IS A STATEMENT SUMMARIZING THE CHARGES AND INSURANCE PAYMENTS, IF APPLICABLE. THIS STATEMENT IS MAILED TO THE GUARANTOR THE DAY AFTER THE ACCOUNT IS FINAL BILLED IN THE HOSPITAL SYSTEM, OR THE DAY FOLLOWING RECEIPT AND SETTLEMENT OF INSURANCE PAYMENT, IF APPLICABLE. IF INSURANCE HAS PENDED PROCESSING OF A CLAIM, HOLDING FOR REQUESTED INFORMATION FROM THE POLICY HOLDER, THE BILLER CALLS THE GUARANTOR OF THE ACCOUNT, IF UNABLE TO REACH THEM A LETTER IS SENT TO THE PATIENT/GUARANTOR ASKING THEM TO PROVIDE THE INSURANCE WITH THE REQUESTED INFORMATION AND NOTIFY THE PATIENT ACCOUNTS OFFICE WHEN IT IS COMPLETED. IF THE PATIENT DOES NOT RESPOND TO THE LETTER BY THE DUE DATE, THE ACCOUNT WILL BE CHANGED TO SELF-PAY PRIOR TO INSURANCE PAYMENT, AND THE PATIENT WILL BEGIN RECEIVING STATEMENTS. FOLLOWING THE INITIAL SUMMARY STATEMENT, A GUARANTOR STATEMENT IS MAILED TO THE GUARANTOR THE FIRST WEEK OF EACH MONTH, UNTIL THE ACCOUNT IS SETTLED IN FULL, OR REFERRED TO AN OUTSIDE AGENCY FOR COLLECTIONS. THE GUARANTOR STATEMENT LISTS ALL ACCOUNTS WITH AN OUTSTANDING PATIENT BALANCE, EXCLUDING BAD DEBT ACCOUNTS THAT ARE PROCESSING WITH A COLLECTION AGENCY. ACCOUNTS PROCESSING WITH INSURANCE WILL NOT BE INCLUDED ON PATIENT/GUARANTOR STATEMENTS, UNTIL THERE IS A PATIENT BALANCE DUE ON THE ACCOUNT. PHONE CALLS:CHWC WILL ATTEMPT TO MAKE A PHONE CALL TO ALL PATIENTS WITH NO INSURANCE APPROXIMATELY 2 WEEKS AFTER THE DATE OF SERVICE, AT THAT TIME WE OFFER ASSISTANCE WITH MEDICAID ENROLLMENT, FINANCIAL ASSISTANCE INCLUDING HOSPITAL PROGRAM AND HCAP OR SETTING UP PAYMENT ARRANGEMENTS. THIS PHONE CALL WILL BE DOCUMENTED ON THE ACCOUNT NOTES. PAYMENT ARRANGEMENT GUIDELINES:THE PATIENT STATEMENT INCLUDES CONTACT INFORMATION FOR THE PATIENT ACCOUNTS BILLING OFFICE. PATIENT REPRESENTATIVES ARE AVAILABLE TO SET UP PAYMENT ARRANGEMENTS WITH THE GUARANTOR. WHEN A GUARANTOR CALLS TO SET UP PAYMENT ARRANGEMENTS, THE GUARANTOR IS ASKED TO PAY IN FULL, AND OFFERED THE OPTION OF A 15% PROMPT PAY DISCOUNT IF PAID IN FULL WITHIN 30 DAYS OF THE FIRST STATEMENT DATE. REQUESTS FOR DISCOUNTS EXCEEDING 15% ARE TO BE APPROVED BY THE PRESIDENT/CEO OR CFO. IF PAYMENT IN FULL IS NOT POSSIBLE, THE GUARANTOR IS ASKED TO MAKE MONTHLY PAYMENTS TO PAY THE ACCOUNT IN FULL WITHIN 18 MONTHS, AND WITH A MINIMUM PAYMENT OF $50.00 PER MONTH. EXCEPTIONS CAN BE MADE TO THESE PAYMENT GUIDELINES TO ALLOW A SMALLER PAYMENT OR EXTENDED TIME TO PAY OFF THE BILL, IF DETERMINATION IS MADE THAT THE GUARANTOR IS MAKING EVERY EFFORT TO PAY AND AGREES TO INCREASE PAYMENTS IN THE FUTURE, IF THE FINANCIAL CIRCUMSTANCES CHANGE. THE GUARANTOR MAY BE ASKED TO COMPLETE A FINANCIAL APPLICATION TO DETERMINE ELIGIBILITY FOR FINANCIAL ASSISTANCE, IF HE/SHE IS NOT ABLE TO MAKE ACCEPTABLE PAYMENT ARRANGEMENTS. (SEE FINANCIAL ASSISTANCE POLICY). FINAL NOTICE:IF NO PAYMENT IS RECEIVED OR PAYMENT ARRANGEMENT ESTABLISHED BY DAY 63 FROM THE INITIAL STATEMENT DATE, A "PAST DUE LETTER" IS SENT TO THE GUARANTOR OF PARAGON ACCOUNTS WITH A REQUEST TO PAY IN FULL OR CONTACT PATIENT ACCOUNTS WITHIN 30 DAYS. THE PAST DUE LETTER WILL INCLUDE THE 'PLAIN LANGUAGE SUMMARY". THE PAST DUE LETTER WILL INFORM THE PATIENT THAT THE ACCOUNT WILL BE CONSIDERED FOR COLLECTIONS IF THERE IS NO RESPONSE WITHIN 30 DAYS AND WILL ALSO LIST THE ECA'S (SEE ECA BELOW) THAT MAY BE INITIATED IF THE GUARANTOR DOES NOT RESPOND. IF THERE IS NO RESPONSE BY THE 38TH DAY FOLLOWING THE DATE OF THE 'PAST DUE LETTER OR ACCEPTABLE PAYMENTS HAVE NOT BEEN ESTABLISHED, THE ACCOUNT IS REVIEWED BY THE PATIENT REPRESENTATIVE TO DETERMINE ELIGIBILITY FOR BAD DEBT AND COLLECTION AGENCY PROCESSING. IF THE PATIENT HAD PREVIOUSLY ESTABLISHED A PAYMENT ARRANGEMENT BUT DID NOT FOLLOW THROUGH WITH TIMELY PAYMENTS, A PHONE CALL TO THE PATIENT WILL BE MADE TO RE-ESTABLISH THE PAYMENT ARRANGEMENT. IF THE PATIENT IS NOT ABLE TO BE REACHED AFTER A MINIMUM OF 2 ATTEMPTS, OR IS NOT COOPERATIVE, THE ACCOUNT WILL BE CONSIDERED FOR BAD DEBT/COLLECTIONS DURING THE NEXT TRANSFER OF ACCOUNTS. INVALID ADDRESS OR CONTACT INFORMATION:IF A PATIENT STATEMENT IS RETURNED FOR AN INVALID ADDRESS, THE PATIENT WILL BE CONTACTED BY PHONE TO OBTAIN CORRECT BILLING INFORMATION. IF THERE IS NO VALID PHONE CONTACT, OR THE PATIENT DOESN'T RESPOND TO A PHONE CALL, THE ACCOUNT MAY BE SENT TO THE COLLECTION AGENCY PRIOR TO SENDING A FINAL "PAST DUE LETTER". THE AGENCY WILL ATTEMPT TO LOCATE A VALID ADDRESS FOR THE GUARANTOR. THE AGENCY WILL NOTIFY THE HOSPITAL IF A VALID ADDRESS IS OBTAINED. IF THE PATIENT DOES NOT COOPERATE WITH THE COLLECTION AGENCY REGARDING PAYMENT OR COMPLETION OF A FINANCIAL APPLICATION, THE AGENCY WILL CONTACT THE HOSPITAL SO THAT A FINAL 'PAST DUE LETTER' CAN BE SENT. IF THERE IS NO RESPONSE TO THE PAST DUE LETTER, THE COLLECTION AGENCY MAY CONTINUE WITH APPROPRIATE ECA'S 240 DAYS FROM THE ORIGINAL STATEMENT DATE. THE HOSPITAL AND AGENCY WILL WORK TOGETHER TO ASSURE THE AGENCY HAS THE APPROPRIATE 1ST STATEMENT DATE SINCE THE ACCOUNTS MAY BE INITIALLY SENT TO THE AGENCY PRIOR TO THE NORMAL MINIMUM OF DAY 100. PRESUMPTIVE ELIGIBILITY:AFTER THE SECONDARY COLLECTION AGENCY HAS DETERMINED AN ACCOUNT TO BE UNCOLLECTIBLE, THE ACCOUNT IS SENT TO "I-SOLUTIONS" TO REVIEW AND DETERMINE CHARITY ELIGIBILITY. ANY ACCOUNTS THAT LIST ON THE I-SOLUTIONS REPORT AS "YES" UNDER THE CHARITY COLUMN WILL RECEIVE A CHARITY DISCOUNT EQUAL TO THE "W/O AMOUNT" LISTED ON THE REPORT. ACCOUNTS THAT CONTAIN A POSITIVE "W/O AMOUNT AND FALL IN THE "BD OR "LOW" PROPENSITY TO PAY CATEGORY, AND ACCOUNTS WITH NO LISTED PROPENSITY TO PAY BUT A POSITIVE "W/O AMOUNT" WILL ALSO RECEIVE A CHARITY DISCOUNT EQUAL TO THE "W/O AMOUNT" LISTED ON THE REPORT. VISITS WITH A PROPENSITY TO PAY "NMD" (NEED MORE DATA) DO NOT RECEIVE A CHARITY ADJUSTMENT.THE ADMISSION AUTHORIZATION FORM INCLUDES A STATEMENT AUTHORIZING THE HOSPITAL TO REVIEW THE GUARANTOR'S CREDIT INFORMATION. IF THIS IS NOT SIGNED BY THE PATIENT OR HIS/HER REPRESENTATIVE, THE VISIT WILL NOT BE SENT TO I-SOLUTIONS FOR REVIEW. ACCOUNTS RECEIVING A DISCOUNT BASED ON PRESUMPTIVE ELIGIBILITY ARE ELIGIBLE TO APPLY FOR AN ADDITIONAL DISCOUNT IF A FINANCIAL APPLICATION IS COMPLETED WITHIN 240 DAYS FROM THE 1ST STATEMENT DATE. |
| PART VI, LINE 2: | THE WILLIAMS COUNTY PARTNERS FOR HEALTH COMMITTEE PRESENTS THE 2022 WILLIAMS COUNTY COMMUNITY HEALTH ASSESSMENT. THE DATA CONTAINED IN THIS REPORT IS A SCIENTIFICALLY VALID SAMPLING CONDUCTED EVERY THREE YEARS IN THE COMMUNITY TO BETTER IDENTIFY AND UNDERSTAND HEALTH ISSUES FACING WILLIAMS COUNTY RESIDENTS. THROUGH A COMBINED EFFORT BY THE WILLIAMS COUNTY HEALTH DEPARTMENT, COMMUNITY HOSPITALS AND WELLNESS CENTERS BRYAN AND MONTPELIER, AND THE MANY ORGANIZATIONS LISTED IN THIS PUBLICATION, WE ARE ABLE TO PROVIDE VALUABLE INFORMATION BOTH TO INDIVIDUAL RESIDENTS AND ORGANIZATIONS IN THE COMMUNITY. IN THE PAST, THIS INFORMATION HAS HELPED TO EDUCATE CITIZENS ABOUT THEIR COMMUNITY AND WE HOPE YOU FIND THE NEW REPORT HELPFUL IN THAT REGARD. IN THE 2022 REPORT YOU WILL FIND THAT IN MANY WAYS THE HEALTH OF OUR COMMUNITY IS VERY GOOD AND RANKS HIGHER THAN BOTH THE NATION AND STATE AVERAGES. IN OTHER AREAS, YOU WILL FIND WE STILL HAVE CHALLENGES THAT NEED TO BE ADDRESSED FOR THE BETTERMENT OF OUR COMMUNITY. WHETHER YOU USE THIS INFORMATION TO APPLY FOR GRANTS OR JUST BECOME MORE INFORMED WE HOPE THAT YOU FIND THIS REPORT USEFUL FOR YOUR PURPOSES. |
| PART VI, LINE 3: | ALL PATIENTS REGISTERING FOR EMERGENCY OR MEDICALLY NECESSARY CARE WILL BE OFFERED A FINANCIAL APPLICATION AND "PLAIN LANGUAGE SUMMARY" AT THE TIME OF REGISTRATION. CHWC WILL ALSO FOLLOW UP WITH UNINSURED PATIENTS WITHIN 3 TO 4 WEEKS OF SERVICE, IF A FINANCIAL APPLICATION IS NOT RECEIVED OR MEDICAID APPLICATION IS NOT COMPLETED BY THAT DATE. FOLLOW UP CONSISTS OF A PHONE CALL TO OFFER THE PATIENT ASSISTANCE WITH THE MEDICAID APPLICATION AND DISCUSS FINANCIAL ASSISTANCE OPTIONS. PATIENT BILLING STATEMENTS INCLUDE ON THE BACK SIDE, INFORMATION ON THE HCAP AND HOSPITAL FINANCIAL ASSISTANCE PROGRAMS, INCLUDING CURRENT POVERTY LEVELS, AS REQUIRED BY HCAP POLICY. THE OPTIONS FOR REQUESTING A FINANCIAL APPLICATION ARE ALSO LISTED ON THE STATEMENT. REFERENCE TO THE FINANCIAL ASSISTANCE INFORMATION WILL BE CLEARLY NOTED ON THE FRONT SIDE OF THE STATEMENT. THE PLAIN LANGUAGE SUMMARY, FINANCIAL APPLICATION, BILLING AND COLLECTIONS POLICY, AND THIS FINANCIAL ASSISTANCE POLICY ARE DISPLAYED ON THE HOSPITAL WEBSITE. IN COMPLIANCE WITH THE 5-PERCENT/1000 PERSON THRESHOLD UNDER THE HHS GUIDANCE SAFE HARBOR AND 501R REGULATIONS, THE SPANISH VERSION OF THE FAP, FINANCIAL APPLICATION AND PLAIN LANGUAGE SUMMARY IS ALSO AVAILABLE AT ALL HOSPITAL LOCATIONS AND ON THE HOSPITAL WEBSITE. SIGNAGE IS POSTED AT ALL 3 HOSPITAL BUILDINGS IN CUSTOMER AREAS INCLUDING ADMISSIONS OFFICE, BILLING OFFICE, CASHIER AREA AND EMERGENCY DEPARTMENT. THE SIGNAGE WILL PROVIDE INFORMATION ON THE HOSPITAL FINANCIAL PROGRAM AND THE APPLICATION PROCESS.COPIES OF THE FINANCIAL APPLICATION AND PLAIN LANGUAGE SUMMARY ARE DISTRIBUTED TO THE COMPASSION CLINIC IN WILLIAMS COUNTY. THIS IS A 'FREE CLINIC AND PATIENTS ARE ENCOURAGED TO COMPLETE THE APPLICATION IF THEY NEED FOLLOW UP SERVICES AT THE HOSPITAL. CHWC WILL PERIODICALLY INCLUDE INFORMATION ON THE HOSPITAL FINANCIAL ASSISTANCE POLICIES, IN THE QUARTERLY NEWSLETTER THAT IS MAILED TO RESIDENTS IN THE 4 COUNTY AREA. |
| PART VI, LINE 4: | HOSPITALS ARE LOCATED IN BRYAN AND MONTPELIER, OHIO, IN ADDITION TO A MEDICAL CENTER LOCATED IN ARCHBOLD. CHWC SERVICES THE FOLLOWING THREE COUNTIES: WILLIAMS, DEFIANCE AND FULTON. APPROXIMATELY 17.9% OF THE POPULATION IS 65 YEARS OR OLDER, 19.5% IS BELOW POVERTY LEVEL, AND 10.8% ARE WITHOUT HEALTH INSURANCE UNDER AGE 65. |
| PART VI, LINE 5: | THE ORGANIZATION'S TEN BOARD MEMBERS RESIDE IN THE ORGANIZATION'S PRIMARY SERVICE AREA, WITH ONLY ONE BEING AN EMPLOYEE. NINE OF THE TEN BOARD MEMBERS ARE VOLUNTEER POSITIONS WITH NO PAY. THE HOSPITAL PROVIDES THE HIGHEST QUALITY OF CARE IN THE MOST EFFICIENT MANNER POSSIBLE. WE TAKE INTO CONSIDERATION THE COMMUNITIES FEEDBACK ON SERVICES THEY WOULD LIKE PROVIDED LOCALLY AND ASSESS IF WE CAN PROVIDE THEM WITH THE UPMOST QUALITY AND EFFICIENCY. |
| PART VI, LINE 6: | NOT APPLICABLE |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Committee | Yes (X) | CompensationCommitteeInd |
| Form990 Of Other Organizations | Yes (X) | Form990OfOtherOrganizationsInd |
| Written Employment Contract | Yes (X) | WrittenEmploymentContractInd |
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | Yes (1) | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (11 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| DR KHALID MINHAS | ||||||||||||||
| PHYSICIAN | $785,902 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $22,674 | $0 | $808,576 | $0 | $0 | $0 |
| DR DAVID COOLEY | ||||||||||||||
| PHYSICIAN | $700,996 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $22,079 | $0 | $723,075 | $0 | $0 | $0 |
| DR JODI TINKEL | ||||||||||||||
| PHYSICIAN | $617,880 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $617,880 | $0 | $0 | $0 |
| DR WAINWRIGHT JAGGERNAUTH | ||||||||||||||
| PHYSICIAN | $570,608 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $570,608 | $0 | $0 | $0 |
| DR MICHAEL NOSANOV | ||||||||||||||
| PHYSICIAN | $555,688 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $10,294 | $0 | $565,982 | $0 | $0 | $0 |
| JANICE DAVID | ||||||||||||||
| VP PATIENT CARE: THRU 01.23 | $218,908 | $0 | $0 | $0 | $242,241 | $0 | $17,500 | $0 | $10,387 | $0 | $489,036 | $0 | $0 | $0 |
| CHAD D TINKEL | ||||||||||||||
| EX-OFFICIO DIR: PRESIDENT/CEO/SECRET | $367,685 | $0 | $0 | $0 | $0 | $0 | $20,500 | $0 | $22,675 | $0 | $410,860 | $0 | $0 | $0 |
| STEVE BUMB MD | ||||||||||||||
| DIRECTOR: CHIEF OF STAFF | $306,264 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $23,674 | $0 | $329,938 | $0 | $0 | $0 |
| WADE PATRICK | ||||||||||||||
| VP/CIO | $228,288 | $0 | $0 | $0 | $0 | $0 | $17,500 | $0 | $23,722 | $0 | $269,510 | $0 | $0 | $0 |
| CHRISTA POMEROY | ||||||||||||||
| TREASURER: VP/CFO | $187,092 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $15,373 | $0 | $202,465 | $0 | $0 | $0 |
| ELIZABETH GRIMES | ||||||||||||||
| VP PATIENT CARE | $175,483 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $22,674 | $0 | $198,157 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART I, LINE 3 | FormAndLineReferenceDesc |
| Explanation | THE FOLLOWING INDVIDUALS PARTICIPATED IN A 457(B) RETIREMENT PLAN: JANICE DAVID, WADE PATRICK AND CHAD D. TINKEL. A $20,500 CONTRIBUTION WAS MADE TO 457(B) PLAN TO TINKEL. A $17,500 CONTRIBUTION WAS MADE TO 457(B) TO PATRICK & DAVID. THESE AMOUNTS HAVE BEEN PROPERLY INCLUDED IN OFFICERS' COMPENSATION ON SCHEDULE J, PART II, COLUMN B(III). THE HOSPITAL HAS A SUPPLEMENTAL EXECUTIVE RETENTION PLAN FOR THESE EXECUTIVES UNDER IRC SECTION 457(B). THE AMOUNTS DEFERRED UNDER THIS PLAN WILL BE TAXABLE TO THE EXECUTIVE WHEN VESTED AND THERE IS NO LONGER A SUBSTANTIAL RISK OF FORFEITURE. IN ORDER TO HAVE THE RIGHT TO FUTURE PAYMENT OF ANY EMPLOYER DEFERRAL, THE EXECUTIVE WILL HAVE TO REMAIN IN SERVICE UNTIL THE ACCOUNT BECOMES VESTED AS PROVIDED IN THE PLAN DOCUMENT. | ExplanationTxt |
Schedule K IRS990ScheduleK
Tax Exempt Bonds Issues TaxExemptBondsIssuesGrp (4 entries)
| Bond ReferenceBondReferenceCd | Bond Issuer EINBondIssuerEIN | Bond IssuedBondIssuedDt | Issue PriceIssuePriceAmt | PurposePurposeDesc | DefeasedDefeasedInd | On Behalf Of IssuerOnBehalfOfIssuerInd | Pool FinancingPoolFinancingInd |
|---|---|---|---|---|---|---|---|
| CITY OF BRYAN OH | |||||||
| A | 346400228 | 2008-07-01 | $10,000,000 | SEE PART VI | 0 | 0 | 0 |
| VILLAGE OF ARCHBOLD OH | |||||||
| B | 346400063 | 2008-08-20 | $10,000,000 | SEE PART VI | 0 | 0 | 0 |
| CITY OF BRYAN OH | |||||||
| C | 346400228 | 2016-06-15 | $10,000,000 | SEE PART VI | 0 | 0 | 0 |
| COUNTY OF WILLIAMS OH | |||||||
| D | 346401595 | 2016-06-30 | $10,000,000 | SEE PART VI | 0 | 0 | 0 |
Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp (4 entries)
| Bond ReferenceBondReferenceCd | Total ProceedsTotalProceedsAmt | Capital ExpendituresCapitalExpendituresAmt | Substantial CompletionSubstantialCompletionYr | Refunding Tax Exempt BondsRefundingTaxExemptBondsInd | Refunding Taxable BondsRefundingTaxableBondsInd | Final Allocation MadeFinalAllocationMadeInd | Adequate Books And Rec MaintAdequateBooksAndRecMaintInd |
|---|---|---|---|---|---|---|---|
| A | $10,208,153 | $10,208,153 | 2011 | 0 | 0 | Yes (1) | Yes (1) |
| B | $10,208,153 | $10,208,153 | 2011 | 0 | 0 | Yes (1) | Yes (1) |
| C | $10,000,000 | $10,000,000 | Yes (1) | 0 | Yes (1) | Yes (1) | |
| D | $10,000,000 | $1,000,000 | 2011 | Yes (1) | 0 | Yes (1) | Yes (1) |
Tax Exempt Bonds Private Bus Use TaxExemptBondsPrivateBusUseGrp (4 entries)
| Bond ReferenceBondReferenceCd | Owning Bond Financed PropertyOwningBondFinancedPropertyInd | Any Lease ArrangementsAnyLeaseArrangementsInd | Mgmt Contract Bond Fincd PropMgmtContractBondFincdPropInd | Engage Bond Counsel ContractsEngageBondCounselContractsInd | Any Research AgreementsAnyResearchAgreementsInd | Private Bus Use By OthersPrivateBusUseByOthersPct | Total Private Business UseTotalPrivateBusinessUsePct | Bond Iss Meet Prvt Sec Pymt TestBondIssMeetPrvtSecPymtTestInd | Change In Use Bond Financed PropChangeInUseBondFinancedPropInd | Procs Nonqualified Bond RemdtdProcsNonqualifiedBondRemdtdInd |
|---|---|---|---|---|---|---|---|---|---|---|
| A | 0 | 0 | Yes (1) | Yes (1) | 0 | 0.01240 | 0.01240 | 0 | 0 | Yes (1) |
| B | 0 | 0 | Yes (1) | Yes (1) | 0 | 0 | 0 | Yes (1) | ||
| C | 0 | Yes (1) | Yes (1) | Yes (1) | 0 | 0.31000 | 0.31000 | 0 | 0 | Yes (1) |
| D | 0 | Yes (1) | Yes (1) | Yes (1) | 0 | 0.01240 | 0.01240 | 0 | 0 | Yes (1) |
Tax Exempt Bonds Arbitrage TaxExemptBondsArbitrageGrp (4 entries)
| Bond ReferenceBondReferenceCd | Form8038 T FiledForm8038TFiledInd | Rebate Not Due YetRebateNotDueYetInd | Exception To RebateExceptionToRebateInd | No Rebate DueNoRebateDueInd | Variable Rate IssueVariableRateIssueInd | Hedge Identified In Bks And RecHedgeIdentifiedInBksAndRecInd | Gross Proceeds Invested In GICGrossProceedsInvestedInGICInd | Gross Proceeds InvestedGrossProceedsInvestedInd | Written Proc To Monitor ReqsWrittenProcToMonitorReqsInd | Term Of HedgeTermOfHedgePct | Superintegrated HedgeSuperintegratedHedgeInd | Hedge TerminatedHedgeTerminatedInd |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| (no name) | ||||||||||||
| A | 0 | 0 | Yes (1) | Yes (1) | Yes (1) | 0 | 0 | 0 | Yes (1) | |||
| (no name) | ||||||||||||
| B | 0 | 0 | Yes (1) | Yes (1) | Yes (1) | 0 | 0 | 0 | Yes (1) | |||
| FIFTH THIRD BANK | ||||||||||||
| C | 0 | Yes (1) | Yes (1) | 0 | Yes (1) | Yes (1) | 0 | 0 | Yes (1) | 1.400000000000 | 0 | 0 |
| FIFTH THIRD BANK | ||||||||||||
| D | 0 | Yes (1) | Yes (1) | 0 | Yes (1) | Yes (1) | 0 | 0 | Yes (1) | 1.400000000000 | 0 | 0 |
Procedures Corrective Action ProceduresCorrectiveActionGrp (4 entries)
| Bond ReferenceBondReferenceCd | Procedures Corrective ActionProceduresCorrectiveActionInd |
|---|---|
| A | Yes (1) |
| B | Yes (1) |
| C | Yes (1) |
| D | Yes (1) |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | FORM 990, SCHEDULE K, PART II | FormAndLineReferenceDesc |
| Explanation | PART II, LINE 3, COLUMN A: TOTAL PROCEEDS OF ISSUE ARE $10,208,153, WHICH ARE SALE PROCEEDS OF $10,000,000 PLUS INVESTMENT EARNINGS OF $208,153. PART II, LINE 3, COLUMN B: TOTAL PROCEEDS OF ISSUE ARE $10,208,153 WHICH ARE SALE PROCEEDS OF $10,000,000 PLUS INVESTMENT EARNINGS OF $208,153. PART III, LINE 4, COLUMN D: PRIVATE BUSINESS USE OF 1.24% IS A RESULT OF A DISCRETE PAIN MANAGEMENT AREA WITHIN THE BOND-FINANCED PROJECT. PART IV, LINE 2C, COLUMN A: REBATE COMPUTATION WAS PERFORMED ON 02/04/2013. PART IV, LINE 2C, COLUMN B: REBATE COMPUTATION WAS PERFORMED ON 02/04/2013. | ExplanationTxt |
Schedule L IRS990ScheduleL
Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp
Name Of Interested NameOfInterested
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | JODI TINKEL | PersonNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Relationship Description | SEE SCH L, PART V | RelationshipDescriptionTxt |
| Transaction | $617,880 | TransactionAmt |
| Transaction | JODI TINKEL IS THE SPOUSE OF CHAD TINKEL, PRESIDENT/CEO. | TransactionDesc |
| Sharing Of Revenues | 0 | SharingOfRevenuesInd |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (9 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 2 | DR. DORSTEN HAS A BUSINESS RELATIONSHIP WITH THE PHYSICIAN GROUP MCHA/PPG-OH. |
| FORM 990, PART VI, SECTION A, LINE 3 | DR. DORSTEN PROVIDED SERVICES AS CHIEF OVER THE MEDICAL STAFF, THROUGH HER OUTSIDE EMPLOYER. THE AMOUNT WAS ($500X12/MO) $6,000. |
| FORM 990, PART VI, SECTION B, LINE 11B | PRIOR TO FILING, FORM 990 IS PROVIDED TO THE BOARD, AND A SUMMARY OF THE DISCLOSURES AND CHANGES TO THE FORM IS PRESENTED BY THE PREPARERS OF THE TAX RETURN (PLANTE & MORAN) AT A MONTHLY BOARD MEETING. ALL BOARD MEMBERS WILL RECEIVE A COPY OF FORM 990 PRIOR TO FILING. |
| FORM 990, PART VI, SECTION B, LINE 12C | OFFICERS AND VOTING MEMBERS OF THE BOARD ARE COVERED BY THE CONFLICT OF INTEREST POLICY, WHICH THEY SIGN ON AN ANNUAL BASIS. CONFLICTS OF INTEREST ARE REVIEWED ON A CASE BY CASE BASIS. IF A TRANSACTION ARISES THAT WOULD RESULT IN A CONFLICT, THE INTERESTED INDIVIDUAL SIGNS A CONFLICT OF INTEREST STATEMENT NOTING THAT THEY ARE NOT INDEPENDENT WITH RESPECT TO THE TRANSACTION, AND THEY ABSTAIN FROM VOTING ON THAT MATTER. THE POLICY IS MONITORED BY ALL BOARD MEMBERS AND OFFICERS. THE POLICY IS REVIEWED WITH ANY NEW BOARD MEMBERS OR OFFICERS. |
| FORM 990, PART VI, SECTION B, LINE 15 | THE CEO'S COMPENSATION IS REVIEWED ANNUALLY AND APPROVED BY THE COMPENSATION COMMITTEE. THE VICE AND ASSISTANT VICE PRESIDENTS' COMPENSATIONS ARE REVIEWED ANNUALLY AND APPROVED BY THE COMPENSATION COMMITTEE. THE DECISIONS REGARDING COMPENSATION ARE DOCUMENTED IN THE MINUTES FROM THE COMPENSATION COMMITTEE MEETINGS. OHA SURVEY DATA IS USED FOR COMPARABILITY PURPOSES. SIMILAR HOSPITALS' 990'S ARE REVIEWED FOR COMPARABILITY PURPOSES. THE PROCESS WAS LAST UNDERTAKEN FOR THE PRESIDENT, VICE AND ASSSISTANT PRESIDENTS IN DECEMBER 2023. |
| FORM 990, PART VI, SECTION C, LINE 19 | THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. |
| FORM 990, PART VII, LINE 16: | CHWC DID NOT ENTER INTO ANY NEW JOINT VENTURES DURING THE YEAR. WHEN THE PAIN MANAGEMENT JOINT VENTURE WAS ESTABLISHED CHWC HAD OUTSIDE LEGAL COUNCIL REVIEW AND APPROVE THE DOCUMENTS. |
| FORM 990, PART XI, LINE 9: | TRANSFER FROM SHARE FOUNDATION 3,500,000. |
| FORM 990, PART XII, LINE 2C: | THE ORGANIZATION HAS AN AUDIT COMMITTEE THAT OVERSEES THE AUDIT AND SELECTION OF AN INDEPENDENT ACCOUNTANT. THIS PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp
Disregarded Entity Name DisregardedEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SHARE FOUNDATION | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 433 WEST HIGH STREET | AddressLine1Txt |
| City | BRYAN | CityNm |
| State Abbreviation | OH | StateAbbreviationCd |
| ZIP | 43506 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 341596175 | EIN |
| Primary Activities | ASSIST COMMUNITY HOSPITALS AND WELLNESS CENTERS WITH FUNDRAISING | PrimaryActivitiesTxt |
| Legal Domicile State | OH | LegalDomicileStateCd |
| Exempt Code Section | 501(C)(3) | ExemptCodeSectionTxt |
| Public Charity Status | 11A | PublicCharityStatusTxt |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | COMMUNITY HOSPITALS AND WELLNESS CENTERS | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Controlled Organization | Yes (1) | ControlledOrganizationInd |
Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp
Related Organization Name RelatedOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | COMMUNITY HOSPITALS & WELLNESS CENTERS PAIN MANAGEMENT LLC | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 433 WEST HIGH STREET | AddressLine1Txt |
| City | BRYAN | CityNm |
| State Abbreviation | OH | StateAbbreviationCd |
| ZIP | 43506 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 461084537 | EIN |
| Primary Activities | MEDICAL SERVICES | PrimaryActivitiesTxt |
| Legal Domicile State | OH | LegalDomicileStateCd |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | COMMUNITY HOSPITALS & WELLNESS CENTERS | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Predominant Income Type | RELATED | PredominantIncomeTypeTxt |
| Share Of Total Income | $842,424 | ShareOfTotalIncomeAmt |
| Share Of EOY Assets | $1,222,518 | ShareOfEOYAssetsAmt |
| Disproportionate Allocations | 0 | DisproportionateAllocationsInd |
| General Or Managing Partner | Yes (1) | GeneralOrManagingPartnerInd |
| Ownership | 0.51000 | OwnershipPct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | 0 | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | 0 | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | 0 | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | 0 | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | Yes (1) | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | 0 | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | 0 | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | Yes (1) | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (1) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | Yes (1) | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | Yes (1) | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | Yes (1) | TransferFromOtherOrgInd |
Transactions Related Org TransactionsRelatedOrgGrp (4 entries)
| Transaction TypeTransactionTypeTxt | InvolvedInvolvedAmt | Method Of Amount DeterminationMethodOfAmountDeterminationTxt |
|---|---|---|
| CHWC PAIN MANAGEMENT LLC | ||
| Q | $2,084,958 | ACTUAL EXPENSES |
| CHWC PAIN MANAGEMENT LLC | ||
| O | $514,967 | ACTUAL EXPENSES |
| CHWC PAIN MANAGEMENT LLC | ||
| K | $73,811 | ACTUAL EXPENSES |
| SHARE FOUNDATION | ||
| S | $3,500,000 | CASH TRANSACTIONS |