2022-11-14T15:00:18-06:00 2021-12-31 381357951 PLANTE & MORAN PLLC 250 SOUTH HIGH ST SUITE 100 COLUMBUS OH 43215 990 2021-01-01 341893452 UHHSCSAHS - CUYAHOGA INC UHHS 2168616200 2351 EAST 22ND STREET CLEVELAND OH 44115 JOHN RUSNACZYK PRESIDENT 2168616200 2022-11-11 1 JOHN RUSNACZYK 999009999 AMY CIMINELLO P00796388 6148493000 2022-11-09 3 AAL1 IAL1 2021 2022-09-23 18:48:47Z JOHN RUSNACZYK 2351 EAST 22ND STREET CLEVELAND OH 44115 2666157 0 X N/A X 1999 OH UHHS/CSAHS-CUYAHOGA, INC (CUYAHOGA) IS AN ORGANIZATION JOINTLY OWNED BY THE SISTERS OF CHARITY OF ST. AUGUSTINE HEALTH SYSTEM, INC. AND UNIVERSITY HOSPITALS HEALTH SYSTEM, INC. (THE MEMBERS), OPERATED FOR THE EXCLUSIVE BENEFIT OF THE MEMBERS AND THEIR RELATED SUBSIDIARIES. BOTH MEMBERS ARE TAX-EXEMPT 501(C)3 CHARITABLE ORGANIZATIONS. CUYAHOGA PROVIDES ADMINISTRATIVE SUPPORT SERVICES FOR ORGANIZATIONS OPERATED BY THE MEMBERS. X 4 4 0 4 0 0 0 0 5261956 2664388 2338 4 24 1765 5264318 2666157 0 0 0 0 1959837 56819 0 0 0 3406049 2700341 5365886 2757160 -101568 -91003 1755012 1136833 575652 48476 1179360 1088357 X SEE SCHEDULE OUHHS/CSAHS-CUYAHOGA, INC (CUYAHOGA) IS AN ORGANIZATION JOINTLY OWNED BY THE SISTERS OF CHARITY OF ST. AUGUSTINE HEALTH SYSTEM, INC. AND UNIVERSITY HOSPITALS HEALTH SYSTEM, INC. (THE MEMBERS), OPERATED FOR THE EXCLUSIVE BENEFIT OF THE MEMBERS AND THEIR RELATED SUBSIDIARIES. BOTH MEMBERS ARE TAX-EXEMPT 501(C)3 CHARITABLE ORGANIZATIONS. CUYAHOGA PROVIDES ADMINISTRATIVE SUPPORT SERVICES FOR ORGANIZATIONS OPERATED BY THE MEMBERS. 0 1 2555010 2664388 SEE PART III, LINE 1 MISSION STATEMENT. 2555010 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 1 1 0 0 0 1 5 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 X 4 4 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 0 X WILLIAM BOTCH 2168616200 2351 EAST 22ND STREET CLEVELAND OH 44115 X MICHAEL SZUBSKI VICE CHAIR 2.00 0.00 X X 0 0 0 MELISSA ROGERS CHAIRPERSON 2.00 0.00 X X 0 0 0 PAUL TAIT SECRETARY 2.00 0.00 X X 0 0 0 JOHN RUSNACZYK PRESIDENT & TREASURER 2.00 0.00 X X 0 0 0 0 0 0 0 0 0 0 MEDICAL INFORMATION TECHNOLOGY PO BOX 74569 CHICAGO IL 60696 IT SUPPORT 980527 1 MEMBERSHIP REVENUES 561000 2664388 2664388 2664388 4 4 SHARED SERVICES REVENU 900099 1765 1765 1765 2666157 2664388 0 1769 47763 47763 3109 3109 5947 5947 5250 5250 162766 162766 150885 150885 1680591 1680591 337379 337379 696 696 1150 1150 164724 164724 179616 179616 BANK FEES 12284 12284 SHARED ADMINISTRATIVE 5000 5000 2757160 2555010 202150 0 353604 467053 466194 669780 618195 0 0 0 288737 0 28282 0 1755012 1136833 500992 48476 74660 0 575652 48476 X 1179360 1088357 1179360 1088357 1755012 1136833 -91003 0 X X 0 0 0 X X X 2 SISTERS OF CHARITY OF ST AUGUSTINE HEALTH SYSTEM INC 340714763 1 1 0 0 UNIVERSITY HOSPITAL HEALTH SYSTEM INC 341576805 3 1 0 0 2 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 SCHEDULE A - PART 1 LINE 12B SUPPORT THAT IS PROVIDED BY UHHS/CSAHS-CUYAHOGA INC. IS IN THE FORM OF SERVICES (I.E. INFORMATION SERVICES) TO THE MEMBER ORGANIZATIONS. SCHEDULE A - SECTION C LINE 1 THREE MEMBERS OF THE BOARD ARE OFFICERS OF THE SUPPORTED ORGANIZATIONS OF SISTERS OF CHARITY OF ST. AUGUSTINE HEALTH SYSTEM, INC (SCHS) (ONE BOARD MEMBER) AND UNIVERSITY HOSPITAL HEALTH SYSTEM, INC (UHHS) (TWO BOARD MEMBERS). THE OTHER BOARD MEMBER IS AN OFFICER FOR ORGANIZATIONS RELATED TO SCHS. SINCE THE SUPERVISION OF THE LATTER BOARD MEMBER IS IN LINE WITH THE CONTROL OF THE SUPPORTED ORGANIZATIONS, UHHS/SCHS ARE DEEMED TO HAVE SUPERVISION AND CONTROL OF THE UHHS/CSAHS-CUYAHOGA, INC AND ARE PROPERLY CLASSIFIED AS TYPE II SUPPORTING ORGANIZATION. PREPAID EXPENSES 2021-11-30 313265 BOOK VALUE 340714763 SISTERS OF CHARITY OF ST AUGUSTINE HEALTH SYSTEM 2475 EAST 22ND ST CLEVELAND OH 44115 170(B)(1)(A)(I) PREPAID EXPENSES 2021-11-30 12386 BOOK VALUE 341576805 UNIVERSITY HOSPITAL HEALTH SYSTEM INC 11100 EUCLID AVE CLEVELAND OH 44106 170(B)(1)(A)(III) I.T. EQUIPMENT 2021-11-30 123860 BOOK VALUE 340714763 SISTERS OF CHARITY OF ST AUGUSTINE HEALTH SYSTEM 2475 EAST 22ND ST CLEVELAND OH 44115 170(B)(1)(A)(I) 0 0 0 0 FORM 990, PART III, LINE 3 THE ENTITY CEASED CONDUCTING SERVICES PRIOR TO THE END OF 2021. THE ORGANIZATION WAS SUBSEQUENTLY DISSOLVED DURING 2022. FORM 990, PART VI, SECTION A, LINE 6 THE ORGANIZATION HAS TWO CORPORATE MEMBERS: SISTERS OF CHARITY OF ST. AUGUSTINE HEALTH SYSTEM, INC. AND UNIVERSITY HOSPITALS HEALTH SYSTEM, INC. FORM 990, PART VI, SECTION A, LINE 7A THE ORGANIZATION'S MEMBERS MAY APPOINT THEIR RESPECTIVE MEMBERS TO THE GOVERNING BODY. FORM 990, PART VI, SECTION A, LINE 7B CERTAIN DECISIONS OF THE GOVERNING BODY, SUCH AS APPROVAL OF BUDGETS, CAPITAL EXPENDITURES, AND ACQUISITION OF LAND, MUST BE APPROVED BY THE BOARD OF THE MEMBER ORGANIZATION. FORM 990, PART VI, SECTION B, LINE 11B THE DATA AND INFORMATION FOR THE 990 IS PREPARED INTERNALLY, AND IT IS SUBMITTED TO THE TAX ADVISORS. THE TAX ADVISORS INPUT ALL DATA AND INFORMATION INTO THE TAX SOFTWARE TO GENERATE THE RETURN, AND THEY REVIEW THE RETURN. THEY REVIEW FOR COMPLETENESS AND COMMUNICATE ANY CONCERNS THAT THEY IDENTIFY WITHIN THE DOCUMENTS AND WORKSHEETS OF THE TAX RETURN. A DRAFT COPY IS PROVIDED TO THE ACCOUNTING STAFF FOR REVIEW. THE TAX ADVISORS AND THE ACCOUNTING STAFF ADDRESS ALL THE CONCERNS FROM THE REVIEW PROCESS. THE RETURN IS THEN SUBMITTED TO THE BOARD FOR REVIEW ONCE CONCERNS ARE ADDRESSED. FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION HAS IN PLACE A CONFLICT OF INTEREST POLICY AS WELL AS A NON-RETALIATION POLICY (WHISTLE-BLOWER) MANAGED THROUGH THE COMPLIANCE OFFICER. THE CONFLICT OF INTEREST FORMS ARE SENT OUT ANNUALLY TO ADMINISTRATION AND OTHER LEADERSHIP EMPLOYEES, AS WELL AS BOARD MEMBERS. THE FORMS ARE THEN RETURNED TO ADMINISTRATION. ONCE RETURNED, THEY ARE REVIEWED BY THE COMPLIANCE OFFICER AND THE PRESIDENT TO DETERMINE IF ANYTHING WOULD BE DEEMED A POTENTIAL CONFLICT OF INTEREST. IF THERE IS A CONFLICT, THE PRESIDENT, COMPLIANCE OFFICER, AND EMPLOYEE/INDIVIDUAL MEET TO DISCUSS. THE RESULTS OF THOSE MEETINGS ARE AN AGENDA ITEM AT THE ORGANIZATION'S ADMINISTRATIVE COMPLIANCE MEETING AND IT IS FURTHER DISCUSSED THERE. ONCE A DECISION IS MADE REGARDING THE CONFLICT, FOLLOW-UP IS MADE BY THE COMPLIANCE OFFICER/PRESIDENT WITH THE EMPLOYEE, IF APPROPRIATE. THE ORGANIZATION ALSO DISCUSSES THE RESULTS OF THE CONFLICT OF INTEREST WITH THE BOARD OF TRUSTEES. FORM 990, PART VI, SECTION C, LINE 18 FORMS 990 AND 1023 ARE AVAILABLE TO PUBLIC UPON REQUEST AT THE ORGANIZATION'S OFFICE INDICATED ON PAGE ONE OF THE RETURN. FORM 990, PART VI, SECTION C, LINE 19 GOVERNING DOCUMENTS, THE FINANCIAL STATEMENTS, AND THE CONFLICT OF INTEREST POLICY ARE AVAILABLE TO THE PUBLIC UPON REQUEST AT THE ORGANIZATION'S OFFICE INDICATED ON PAGE ONE OF THE RETURN. SCHEDULE R, PART II UHHS/CSAHS - CUYAHOGA, INC. HAS TWO CORPORATE MEMBERS, UNIVERSITY HOSPITALS HEALTH SYSTEM, INC. AND THE SISTERS OF CHARITY OF ST. AUGUSTINE HEALTH SYSTEM, INC. THE ENTIRE BOARD OF UHHS/CSAHS-CUYAHOGA, INC. ARE EMPLOYEES OF ONE OF THE CORPORATE MEMBERS OR A RELATED ORGANIZATION OF ONE OF THE CORPORATE MEMBERS AND THEREFORE RECEIVE COMPENSATION FROM ONE OF THE CORPORATE MEMBERS. NEITHER CORPORATE MEMBER MEETS THE NECESSARY ELEMENT OF CONTROL TO BE CONSIDERED A RELATED ORGANIZATION AND ARE THEREFORE NOT REPORTED ON SCHEDULE R. ACCORDINGLY, THERE IS NO COMPENSATION REPORTED FOR THE BOARD MEMBERS SINCE THEY ARE NOT COMPENSATED BY THE ORGANIZATION OR A RELATED ORGANIZATION. AS A RESULT, ALL FOUR BOARD MEMBERS HAVE BEEN LISTED ON FORM 990, PART VI, AND LINE B AS NOT LACKING INDEPENDENCE. UHHSCSAHS - CUYAHOGA HOLDING COMPANY INC 2351 EAST 22ND ST CLEVELAND OH 44115 341895400 HOLDING CO OH UHHSCSAHS CUYAHOGA INC C 1.00000 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0