GREATER DAYTON AREA HEALTH INFORMATION NETWORK: Form 990, tax year 2020
View the entire original 990 at ProPublica ↗
- Organization
- GREATER DAYTON AREA HEALTH INFORMATION NETWORK (EIN 31-1438763)
- Tax period
- 2020-01-01 to 2020-12-31
- Filed
- 2021-11-12
- IRS object ID
- 202113169349304331
- Schema version
- 2020v4.1
- 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 ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2021-11-12T10:53:34-06:00 | ReturnTs |
| Tax Period End | 2020-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 310800053 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CLARK SCHAEFER HACKETT & CO | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 10100 INNOVATION DRIVE | AddressLine1Txt |
| City | DAYTON | CityNm |
| State Abbreviation | OH | StateAbbreviationCd |
| ZIP | 45342 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2020-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 311438763 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | GREATER DAYTON AREA HEALTH INFORMATION | BusinessNameLine1Txt |
| Business Name Line2 | NETWORK | BusinessNameLine2Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | GREA | BusinessNameControlTxt |
| Phone | 9372712343 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 124 E THIRD ST NO 400 | AddressLine1Txt |
| City | DAYTON | CityNm |
| State Abbreviation | OH | StateAbbreviationCd |
| ZIP | 45402 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | MARTIN LARSON | PersonNm |
| Person Title | CFO | PersonTitleTxt |
| Phone | 9372281000 | PhoneNum |
| Signature | 2021-11-11 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Signing Officer SigningOfficerGrp
Person Full Name PersonFullName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person First | MARTIN | PersonFirstNm |
| Person Last | LARSON | PersonLastNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| SSN | 999009999 | SSN |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | HERBERT L LEMASTER CPA | PreparerPersonNm |
| PTIN | P00039882 | PTIN |
| Phone | 9372260070 | PhoneNum |
| Preparation | 2021-11-11 | PreparationDt |
Additional Filer Information AdditionalFilerInformation
Trusted Customer TrustedCustomerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Trusted Customer | 2 | TrustedCustomerCd |
| Authentication Assurance Level | AAL1 | AuthenticationAssuranceLevelCd |
| Identity Assurance Level | IAL1 | IdentityAssuranceLevelCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2020 | TaxYr |
| Build TS | 2022-09-23 18:48:47Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | SARAH HACKENBRACHT | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 124 E THIRD ST NO 400 | AddressLine1Txt |
| City | DAYTON | CityNm |
| State Abbreviation | OH | StateAbbreviationCd |
| ZIP | 45402 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $2,190,881 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.GDAHA.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1995 | FormationYr |
| Legal Domicile State | OH | LegalDomicileStateCd |
| Activity Or Mission | IMPROVE ACCESS TO HEALTHCARE SERVICES INFORMATION & SUPPORT DISASTER MEDICAL PLANNING | ActivityOrMissionDesc |
| Voting Members Governing Body | 30 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 30 | VotingMembersIndependentCnt |
| Total Employee | 0 | TotalEmployeeCnt |
| Total Volunteers | 0 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $838,030 | PYContributionsGrantsAmt |
| CY Contributions Grants | $976,290 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $1,206,933 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $1,212,955 | CYProgramServiceRevenueAmt |
| PY Investment Income | $3,521 | PYInvestmentIncomeAmt |
| CY Investment Income | $447 | CYInvestmentIncomeAmt |
| PY Other Revenue | -$1 | PYOtherRevenueAmt |
| CY Other Revenue | $1,189 | CYOtherRevenueAmt |
| PY Total Revenue | $2,048,483 | PYTotalRevenueAmt |
| CY Total Revenue | $2,190,881 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $637,583 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $613,407 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $0 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $0 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $1,408,941 | PYOtherExpensesAmt |
| CY Other Expenses | $1,577,398 | CYOtherExpensesAmt |
| PY Total Expenses | $2,046,524 | PYTotalExpensesAmt |
| CY Total Expenses | $2,190,805 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $1,959 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $76 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $635,291 | TotalAssetsBOYAmt |
| Total Assets EOY | $878,897 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $826,176 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $1,069,706 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | -$190,885 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | -$190,809 | NetAssetsOrFundBalancesEOYAmt |
| Mission | TO PROMOTE A HEALTHIER COMMUNITY BY IMPROVING ACCESS TO CLINICAL, FINANCIAL AND ADMINISTRATIVE INFORMATION TO FACILITATE DELIVERY OF HEALTHCARE SERVICES IN A TIMELY AND COST-EFFECTIVE MANNER; TO PROVIDE SUPPORT SERVICES FOR DISASTER MEDICAL PLANNING. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $613,407 | ExpenseAmt |
| Grant | $613,407 | GrantAmt |
| Desc | GRANTS AND CONTRACTS THROUGH THE ASPR/ODH TO PROVIDE MULTIPLE HOSPITALS WITH FUNDING FOR DOMESTIC PREPAREDNESS PROGRAMS. | Desc |
Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $1,419,658 | ExpenseAmt |
| Revenue | $1,214,144 | RevenueAmt |
| Desc | TO PROVIDE A COMMUNITY-WIDE MEDICAL INFORMATION NETWORK, SUPPORT THE ACTIVITIES OF THE DISASTER MEDICAL ASSISTANCE TEAM. | Desc |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Expenses | $2,033,065 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | 0 | 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 | 0 | 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 | 0 | OperateHospitalInd |
| Grants To Organizations | Yes (1) | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| 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 | 0 | 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 | 0 | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 3 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Employee | 0 | EmployeeCnt |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| 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 | 30 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 30 | IndependentVotingMemberCnt |
| Family Or Business Rln | Yes (1) | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | 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 | 0 | 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 | 0 | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | 0 | CompensationProcessOtherInd |
| Investment In Joint Venture | Yes (1) | InvestmentInJointVentureInd |
| Written Policy Or Procedure | 0 | WrittenPolicyOrProcedureInd |
| States Where Copy Of Return Is Fld | OH | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MARTIN LARSON | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 9372712343 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 124 E THIRD ST NO 400 | AddressLine1Txt |
| City | DAYTON | CityNm |
| State Abbreviation | OH | StateAbbreviationCd |
| ZIP | 45402 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (40 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt |
|---|---|---|---|---|---|---|---|
| MICHAEL UHL | |||||||
| CHAIR | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| TERRY BURNS | |||||||
| VICE CHAIR | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| KEVIN HARLAN | |||||||
| TREASURER (JAN-JUL) / TRUSTEE (JUL-DEC) | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| DEBORAH FELDMAN | |||||||
| IMMEDIATE PAST CHAIR | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| LYNNE BLINCO | |||||||
| TRUSTEE | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| MARY BOOSALIS | |||||||
| TRUSTEE | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| WILLIAM BRYANT | |||||||
| TRUSTEE (JAN-MAR) | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| WAYNE DESCHAMBEAU | |||||||
| TRUSTEE | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| RICK DODDS | |||||||
| TRUSTEE | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| JONATHAN DUCKETT | |||||||
| TRUSTEE | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| MARGARET DUNN MD | |||||||
| TRUSTEE (JAN-JUN) | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| MICHEAL D FOUTCH | |||||||
| TRUSTEE (JAN-JUL) | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| ADAM GROSHANS | |||||||
| SECRETARY | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| JOHN JOHNSON MD | |||||||
| TRUSTEE (JAN-NOV) | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| FRED MANCHUR | |||||||
| TRUSTEE | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| RICHARD MANCHUR | |||||||
| TRUSTEE | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| TOM PARKER | |||||||
| TRUSTEE (JAN-JUL) | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| WALTER SACKETT | |||||||
| TRUSTEE | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| DAVID SMITH MD | |||||||
| TRUSTEE | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| PHILLIP UNDERWOOD | |||||||
| TRUSTEE | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| KENT ANDERSON | |||||||
| TRUSTEE | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| ANITA ADAMS-JENKINS | |||||||
| TRUSTEE (JAN-FEB) | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| KEITH D BRICKING MD | |||||||
| TRUSTEE | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| RON CONNOVICH | |||||||
| TRUSTEE | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| MARK KLOSTERMAN | |||||||
| TRUSTEE (JAN-JUL) / TREAS (JULY-DEC) | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| JOANN RINGER | |||||||
| TRUSTEE | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| MARK MURDOCK | |||||||
| TRUSTEE | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| ANDREW PACYNA | |||||||
| TRUSTEE (DEC) | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| CINDY BERNING | |||||||
| TRUSTEE (JULY-DEC) | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| LUIS CHANAGA | |||||||
| TRUSTEE (FEB-DEC) | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| CHRISTIAN LYONS | |||||||
| TRUSTEE (JUL-DEC) | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| ANGELA NICKELL | |||||||
| TRUSTEE (NOV-DEC) | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| SHAWN TODD | |||||||
| TRUSTEE (NOV-DEC) | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| JONATHAN COHEE | |||||||
| TRUSTEE (SEPT-NOV) | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| JIM COHICK | |||||||
| TRUSTEE (MAR-SEPT) | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| DANIEL TRYON | |||||||
| TRUSTEE (JAN-DEC) | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| VALERIE WEBER MD | |||||||
| TRUSTEE (NOV-DEC) | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| DR BRUCE BINDER | |||||||
| TRUSTEE (JUN-NOV) | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| SARAH HACKENBRACHT | |||||||
| PRESIDENT & CEO | 10.00 | Yes (X) | $0 | $280,849 | $21,938 | 30.00 | |
| MARTIN LARSON | |||||||
| EXECUTIVE VICE PRESIDENT | 12.00 | Yes (X) | $0 | $217,593 | $39,746 | 28.00 | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $0 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $498,442 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $61,684 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 0 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp
Contractor Name ContractorName
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | HEALTH COLLABORATIVE | BusinessNameLine1Txt |
Contractor Address ContractorAddress
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 615 ELSINORE PL SUITE 500 | AddressLine1Txt |
| City | CINCINNATI | CityNm |
| State Abbreviation | OH | StateAbbreviationCd |
| ZIP | 45202 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Services | HEALTH INFORMATION EXCHANGE SERVICES | ServicesDesc |
| Compensation | $633,040 | CompensationAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 1 | CntrctRcvdGreaterThan100KCnt |
| Government Grants | $976,290 | GovernmentGrantsAmt |
| Total Contributions | $976,290 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | PROGRAM SERVICES | Desc |
| Business | 624100 | BusinessCd |
| Total Revenue Column | $1,212,955 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $1,212,955 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $1,212,955 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $447 | TotalRevenueColumnAmt |
| Exclusion | $447 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | MISC. | Desc |
| Business | 900099 | BusinessCd |
| Total Revenue Column | $1,189 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $1,189 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $1,189 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $2,190,881 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $1,214,144 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $447 | ExclusionAmt |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $613,407 | TotalAmt |
| Program Services | $613,407 | ProgramServicesAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $29,157 | TotalAmt |
| Program Services | $26,241 | ProgramServicesAmt |
| Management And General | $2,916 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $63,948 | TotalAmt |
| Program Services | $57,553 | ProgramServicesAmt |
| Management And General | $6,395 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,404 | TotalAmt |
| Program Services | $3,064 | ProgramServicesAmt |
| Management And General | $340 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,041 | TotalAmt |
| Program Services | $1,837 | ProgramServicesAmt |
| Management And General | $204 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $70 | TotalAmt |
| Program Services | $63 | ProgramServicesAmt |
| Management And General | $7 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $6,736 | TotalAmt |
| Program Services | $6,062 | ProgramServicesAmt |
| Management And General | $674 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| CONSULTING SERVICES | $1,069,052 | $962,147 | $106,905 |
| ALLOCATED WAGES & EXP F | $389,917 | $350,926 | $38,991 |
| DUES & SUBSCRIPTIONS | $6,160 | $5,543 | $617 |
| EQUIPMENT MAINTENANCE A | $3,713 | $3,342 | $371 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,200 | TotalAmt |
| Program Services | $2,880 | ProgramServicesAmt |
| Management And General | $320 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,190,805 | TotalAmt |
| Program Services | $2,033,065 | ProgramServicesAmt |
| Management And General | $157,740 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $410,486 | BOYAmt |
| EOY | $491,339 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $226,021 | BOYAmt |
| EOY | $387,558 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | -$1,287 | BOYAmt |
| EOY | $0 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $5,198 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $5,198 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $71 | BOYAmt |
| EOY | $0 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $635,291 | BOYAmt |
| EOY | $878,897 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $180,004 | BOYAmt |
| EOY | $174,651 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $354,189 | BOYAmt |
| EOY | $441,159 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $291,983 | BOYAmt |
| EOY | $453,896 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $826,176 | BOYAmt |
| EOY | $1,069,706 | 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 | -$190,885 | BOYAmt |
| EOY | -$190,809 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | -$190,885 | BOYAmt |
| EOY | -$190,809 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $635,291 | BOYAmt |
| EOY | $878,897 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $76 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | $0 | 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) |
|---|---|---|
| Public Organization170 | Yes (X) | PublicOrganization170Ind |
Gifts Grants Contri Rcvd170 GiftsGrantsContriRcvd170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $953,415 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $865,687 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $998,826 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $838,030 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $976,290 | CurrentTaxYearAmt |
| Total | $4,632,248 | TotalAmt |
Total Calendar Year170 TotalCalendarYear170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $953,415 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $865,687 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $998,826 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $838,030 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $976,290 | CurrentTaxYearAmt |
| Total | $4,632,248 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support Total170 | $4,632,248 | PublicSupportTotal170Amt |
Gross Investment Income170 GrossInvestmentIncome170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $224 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $1,036 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $3,065 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $3,525 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $447 | CurrentTaxYearAmt |
| Total | $8,297 | TotalAmt |
Other Income170 OtherIncome170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $16,446 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $410 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus1 Year | -$1 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $1,189 | CurrentTaxYearAmt |
| Total | $18,044 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Support | $4,658,589 | TotalSupportAmt |
| Gross Receipts Rltd Activities | $6,208,521 | GrossReceiptsRltdActivitiesAmt |
| Public Support CY170 | 0.99430 | PublicSupportCY170Pct |
| Public Support PY170 | 0.99460 | PublicSupportPY170Pct |
| Thirty Thr Pct Suprt Tests CY170 | Yes (X) | ThirtyThrPctSuprtTestsCY170Ind |
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 D IRS990ScheduleD
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $5,198 | OtherCostOrOtherBasisAmt |
| Depreciation | $5,198 | DepreciationAmt |
| Book Value | $0 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $0 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (2 entries)
| DescDesc | AmtAmt |
|---|---|
| PAYABLE TO THE GREATER DAYTON AREA HOSPITAL ASSOCIATION | $386,743 |
| PAYABLE TO THE GMVEMS | $67,153 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $453,896 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $2,190,881 | TotalRevEtcAuditedFinclStmtAmt |
| Revenue Not Reported | $0 | RevenueNotReportedAmt |
| Revenue Subtotal | $2,190,881 | RevenueSubtotalAmt |
| Revenue Not Reported Fincl Stmt | $0 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $2,190,881 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $2,190,805 | TotExpnsEtcAuditedFinclStmtAmt |
| Expenses Not Reported | $0 | ExpensesNotReportedAmt |
| Expenses Subtotal | $2,190,805 | ExpensesSubtotalAmt |
| Expenses Not Rpt Fincl Stmt | $0 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $2,190,805 | TotalExpensesPerForm990Amt |
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 ASSOCIATION AND RECOGNIZE A TAX LIABILITY IF THE ASSOCIATION HAS TAKEN AN UNCERTAIN POSITION THAT MORE LIKELY THAN NOT WOULD NOT BE SUSTAINED UPON EXAMINATION BY THE INTERNAL REVENUE SERVICE. AS DISCUSSED ABOVE, GDAHA AND GDAHIN ARE EXEMPT FROM INCOME TAXES AND MANAGEMENT BELIEVES THESE ENTITIES HAVE NOT ENGAGED IN ANY ACTIVITIES THAT WOULD DISQUALIFY THEM FROM TAX-EXEMPT STATUS. THE ASSOCIATION'S POLICY IS TO RECOGNIZE INTEREST RELATED TO UNRECOGNIZED TAX BENEFITS IN INTEREST EXPENSE AND PENALTIES IN OTHER EXPENSES. | ExplanationTxt |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Records Maintained | Yes (1) | GrantRecordsMaintainedInd |
Recipient Table RecipientTable (12 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | Recipient EINRecipientEIN | IRC SectionIRCSectionDesc | Cash GrantCashGrantAmt | Purpose Of GrantPurposeOfGrantTxt |
|---|---|---|---|---|---|---|---|
| MIAMI VALLEY HOSPITAL | |||||||
| ONE WYOMING STREET | DAYTON | OH | 45409 | 310537504 | 501(C)(3) | $349,847 | FOR HEALTH CARE PREPAREDNESS |
| DAYTON CHILDREN'S HOSPITAL | |||||||
| ONE CHILDRENS PLAZA | DAYTON | OH | 45404 | 310672132 | 501(C)(3) | $11,176 | FOR HEALTH CARE PREPAREDNESS |
| WILSON HEALTH | |||||||
| 915 W MICHIGAN RD | SIDNEY | OH | 45365 | 344427944 | 501(C)(3) | $9,000 | FOR HEALTH CARE PREPAREDNESS |
| WAYNE HEALTHCARE | |||||||
| 835 SWEITZER STREET | GREENVILLE | OH | 45331 | 344428598 | 501(C)(3) | $9,706 | FOR HEALTH CARE PREPAREDNESS |
| WRIGHT STATE RESEARCH INSTITUTE | |||||||
| 4035 COLONEL GLENN HIGHWAY | DAYTON | OH | 45431 | 161704454 | 501(C)(3) | $5,600 | FOR HEALTH CARE PREPAREDNESS |
| UPPER VALLEY MEDICAL CENTER | |||||||
| 3130 N DIXIE DRIVE | TROY | OH | 45373 | 310537095 | 501(C)(3) | $7,970 | FOR HEALTH CARE PREPAREDNESS |
| CITY OF DAYTON | |||||||
| 300 NORTH MAIN STREET | DAYTON | OH | 45402 | 170(C)(1) | $65,000 | FOR HEALTH CARE PREPAREDNESS | |
| GREG LOCKER | |||||||
| 28770 GEORGIA ROAD | PERRYSBURG | OH | 43551 | $10,000 | FOR HEALTH CARE PREPAREDNESS | ||
| PUBLIC HEALTH DAYTON & MONTGOMERY COUNTY | |||||||
| 117 S MAIN STREET | DAYTON | OH | 45422 | 316000172 | 170(C)(1) | $30,000 | FOR HEALTH CARE PREPAREDNESS |
| COMMUNITY MERCY HEALTH PARTNERS | |||||||
| 100 MEDICAL CENTER DRIVE | SPRINGFIELD | OH | 45504 | 310785684 | 501(C)(3) | $18,000 | FOR HEALTH CARE PREPAREDNESS |
| DIXIE KIRKLAND | |||||||
| 2358 STATE RT 68 SOUTH | XENIA | OH | 45385 | 287509188 | $33,000 | FOR HEALTH CARE PREPAREDNESS | |
| CARE COORDINATION SYSTEMS | |||||||
| 75 E MARKET ST | AKRON | OH | 44308 | 461234542 | $55,000 | FOR HEALTH CARE PREPAREDNESS | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total501c3 Org | 9 | Total501c3OrgCnt |
| Total Other Org | 3 | TotalOtherOrgCnt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART I, LINE 2: | FormAndLineReferenceDesc |
| Explanation | THE USE OF GRANT FUNDS IS MONITORED BY THE GRANTING ORGANIZATIONS: THE OHIO DEPARTMENT OF HEALTH & THE OHIO HEALTH INFORMATION PARTNERSHIP. | ExplanationTxt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | 0 | 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 (2 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| SARAH HACKENBRACHT | ||||||||||||||
| PRESIDENT & CEO | $0 | $280,849 | $0 | $0 | $0 | $0 | $0 | $15,476 | $0 | $6,462 | $0 | $302,787 | $0 | $0 |
| MARTIN LARSON | ||||||||||||||
| EXECUTIVE VICE PRESIDENT | $0 | $217,593 | $0 | $0 | $0 | $0 | $0 | $26,169 | $0 | $13,577 | $0 | $257,339 | $0 | $0 |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (7 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 2 | MARY BOOSALIS IS THE PRESIDENT AND CEO OF PREMIER HEALTH; DURING 2020 TOM PARKER AND KEVIN HARLAN SERVED AS THE PRESIDENT OF UPPER VALLEY MEDICAL CENTER, A MEDICAL PROVIDER IN PREMIER HEALTH'S NETWORK. MICHAEL UHL IS THE PRESIDENT AND CEO OF MIAMI VALLEY HOSPITAL, A MEDICAL PROVIDER IN PREMIER HEALTH'S NETWORK. KEITH D. BRICKING, MD IS THE PRESIDENT AND CEO OF ATRIUM MEDICAL CENTER, A MEDICAL PROVIDER IN PREMIER HEALTH'S NETWORK. JOANN RINGER IS THE PRESIDENT AND CEO OF MIAMI VALLEY SOUTH, A MEDICAL PROVIDER IN PREMIER HEALTH'S NETWORK. TERRY BURNS, WALTER SACKETT, RICHARD MANCHUR, AND RICK DODDS ARE EMPLOYED BY KETTERING ADVENTIST HEALTHCARE; FRED MANCHUR IS AN EMPLOYEE, OFFICER, AND VOTING TRUSTEE OF THE SAME ORGANIZATION. ANITA ADAMS-JENKINS WAS THE PRESIDENT OF SYCAMORE MEDICAL CENTER, A MEDICAL PROVIDER IN THE KETTERING HEALTH NETWORK UNITL FEBRUARY 2020. LUIS CHANAGA WAS THE PRESIDENT OF SYCAMORE MEDICAL CENTER FROM MARCH 2020 THROUGH THE END OF THE YEAR. RON CONNOVICH IS PRESIDENT OF FORT HAMILTON HOSPITAL, A MEDICAL PROVIDER IN THE KETTERING HEALTH NETWORK. DANIEL TRYON IS THE PRESIDENT OF SOUTHVIEW MEDICAL CENTER, A MEDICAL PROVIDER IN THE KETTERING HEALTH NETWORK. DURING 2020, WILIAM BRYANT, JIM COHICK, JONATHAN COHEE, AND SHAWN TODD ALL SERVED AS EXECUTIVES WITH PAM SPECIALTY HOSPITAL OF DAYTON. DURING 2020, MARGARET DUNN, BRUCE BINDER, AND VALERIE WEBER ALL SERVED AS EXECUTIVES WITH WSU BOONSHOFT SCHOOL OF MEDICINE. DURING 2020, KEVIN HARLAN AND CINDY BERNING EACH SERVED AS AN EXECUTIVE WITH THE GRAND LAKE HEALTH SYSTEM. DURING 2020, COL. MICHAEL FOUTCH AND COL. CHRISTIAN LYONS EACH SERVED AS THE COMMANDER OF THE WPAFB MEDICAL CENTER. DURING 2020, JOHN JOHNSON AND ANGELA NICKELL EACH SERVED AS EXECUTIVES WITH ACCESS HOSPITAL OF DAYTON. FRED MANCHUR AND RICHARD MANCHUR SHARE A FAMILY RELATIONSHIP. |
| FORM 990, PART VI, SECTION A, LINE 8B | THERE ARE NO COMMITTEES WITH THE AUTHORITY TO ACT ON BEHALF OF THE GOVERNING BODY. |
| FORM 990, PART VI, SECTION B, LINE 11B | THE FORM 990 IS REVIEWED BY THE PRESIDENT AND VICE PRESIDENT OF FINANCE PRIOR TO FILING. THEN THE DRAFT IS PROVIDED TO ALL BOARD MEMBERS PRIOR TO FILING. |
| FORM 990, PART VI, SECTION B, LINE 12C | THE BOARD OF DIRECTORS REVIEWS ANY ACTIVITY THAT COULD GIVE RISE TO POTENTIAL CONFLICTS OF INTEREST ON A "AS NEEDED" BASIS. A GENERAL REVIEW FOR CONFLICTS OF INTEREST OCCURS ANNUALLY BY THE PRESIDENT AND BOARD OF DIRECTORS. |
| FORM 990, PART VI, SECTION B, LINE 15A | THE BOARD UTILIZES NATIONAL MARKET KNOWLEDGE AND ANNUAL PERFORMANCE EVALUATION TO EVALUATE AND ADJUST COMPENSATION OF THE PRESIDENT AND OTHER KEY EMPLOYEES. |
| FORM 990, PART VI, SECTION C, LINE 19 | THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON WRITTEN REQUEST. |
| FORM 990, PART XII, LINE 2C: | THE BOARD OF TRUSTEES IS RESPONSIBLE FOR OVERSIGHT OF THE INDEPENDENT AUDIT. THIS PROCESS IS CONSISTENT WITH THE PRIOR YEAR. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (2 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Direct Controlling NADirectControllingNACd | Controlled OrganizationControlledOrganizationInd | Public Charity StatusPublicCharityStatusTxt |
|---|---|---|---|---|---|---|---|---|---|---|
| GREATER DAYTON AREA HOSPITAL ASSOCIATION | ||||||||||
| 124 E THIRD ST SUITE 400 | DAYTON | OH | 454021470 | 311221836 | HEALTHCARE | OH | 501(C)(6) | N/A | 0 | |
| GREATER MIAMI VALLEY EMERGENCY MEDICAL SERVICES COUNCIL | ||||||||||
| 124 E THIRD ST SUITE 400 | DAYTON | OH | 454021470 | 310909738 | HEALTHCARE | OH | 501(C)(3) | N/A | 0 | LINE 1 |
Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp
Related Organization Name RelatedOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | QBASE HOLDINGS LLC | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 3800 PENTAGON BLVD | AddressLine1Txt |
| City | BEAVERCREEK | CityNm |
| State Abbreviation | OH | StateAbbreviationCd |
| ZIP | 45431 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 271717852 | EIN |
| Primary Activities | DATA SERVICES | PrimaryActivitiesTxt |
| Legal Domicile State | OH | LegalDomicileStateCd |
| Direct Controlling NA | N/A | DirectControllingNACd |
| Predominant Income Type | EXCLUDED | PredominantIncomeTypeTxt |
| Disproportionate Allocations | 0 | DisproportionateAllocationsInd |
| General Or Managing Partner | 0 | GeneralOrManagingPartnerInd |
| Ownership | 0.00020 | 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 | Yes (1) | 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 | 0 | 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 | 0 | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |
Transactions Related Org TransactionsRelatedOrgGrp (3 entries)
| Transaction TypeTransactionTypeTxt | InvolvedInvolvedAmt | Method Of Amount DeterminationMethodOfAmountDeterminationTxt |
|---|---|---|
| GREATER DAYTON AREA HOSPITAL ASSOCIATION | ||
| E | $386,743 | FAIR MARKET VALUE |
| GREATER DAYTON AREA HOSPITAL ASSOCIATION | ||
| O | $389,917 | FAIR MARKET VALUE |
| GREATER DAYTON AREA HOSPITAL ASSOCIATION | ||
| P | $286,926 | FAIR MARKET VALUE |