2021-10-29T07:20:30-05:00 2020-12-31 341310124 REA & ASSOCIATES INC 941 STEUBENVILLE AVE PO BOX 820 CAMBRIDGE OH 437250820 990 2020-01-01 341785051 WOOSTER COMMUNITY HOSPITAL FOUNDATION WOOS 3302638148 1761 BEALL AVENUE WOOSTER OH 446912342 KEVIN TRENT SECRETARY/TREASURER 3302629370 2021-10-28 1 KEVIN TRENT 999009999 LANE A MCCARTNEY CPA P02044349 7404325658 2021-10-22 2 AAL1 IAL1 2020 2022-09-23 18:48:47Z WILLIAM SHERON 1761 BEALL AVENUE WOOSTER OH 446912342 29064397 0 X N/A X 1994 OH TO PROVIDE PROGRAMS AND SERVICES IN SUPPORT OF THE OPERATIONS OF WOOSTER COMMUNITY HOSPITAL IN A MANNER THAT PROMOTES THE PUBLIC PURPOSES OF IMPROVING THE DELIVERY OF HEALTHCARE AND WELLNESS SERVICES TO ALL PEOPLE WITHIN THE CITY OF WOOSTER AND SURROUNDING COMMUNITIES. 6 6 161 6 0 0 12676813 14809004 15331269 14075394 200059 162616 7500 17383 28215641 29064397 15313 106431 0 0 18546573 18934721 0 0 0 8022201 8948269 26584087 27989421 1631554 1074976 8832861 10011786 4086424 4188833 4746437 5822953 TO PROVIDE PROGRAMS AND SERVICES IN SUPPORT OF THE OPERATIONS OF WOOSTER COMMUNITY HOSPITAL IN A MANNER THAT PROMOTES THE PUBLIC PURPOSES OF IMPROVING THE DELIVERY OF HEALTHCARE AND WELLNESS SERVICES TO ALL PEOPLE WITHIN THE CITY OF WOOSTER AND SURROUNDING COMMUNITIES. 0 0 106431 106431 12400000 THE RECRUITMENT AND RETENTION OF PHYSICIANS, PHYSICIAN ASSISTANTS AND CERTIFIED NURSE PRACTITIONERS. 26454588 16069084 THE PROVISION OF MEDICAL SERVICES TO THE PUBLIC THROUGH THE OPERATION OF BLOOMINGTON MEDICAL SERVICES, LLC. 210000 THE PROVISION OF COMMUNITY HEALTH SUPPORT. 26771019 1 1 0 0 0 0 0 0 0 1 1 0 1 1 0 1 0 1 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 0 1 45 0 1 161 1 0 0 0 0 0 0 0 0 0 0 0 0 X 6 6 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 OH X KEVIN TRENT 3302638148 1761 BEALL AVENUE WOOSTER OH 44691 THOMAS CAPEK VICE PRESIDENT 1.00 X X 0 0 0 JERRY PACKARD PRESIDENT 1.00 X X 0 0 0 JOAN KIPER CHAIRMAN 1.00 X 0 0 0 DAN WAKEFIELD TRUSTEE 1.00 X 0 0 0 KEVIN TRENT SECRETARY/TREASURER 1.00 X X 0 0 0 DON NOBLE TRUSTEE 1.00 X 0 0 0 WILLIAM SHERON CEO 40.00 X 0 480953 149092 SCOTT BOYES CFO 40.00 X 0 376215 59543 CYRIL OFORI ASSOCIATE 40.00 X 1048208 0 29988 ROBERT D CEBUL ASSOCIATE 40.00 X 728433 0 13470 PAUL MOODISPAW ASSOCIATE 40.00 X 668802 0 35410 JOSEPH S BORRUSO ASSOCIATE 40.00 X 591020 0 27669 NAGAPRADEEP NAGAJOTHI ASSOCIATE 40.00 X 619009 0 26074 SHARON E MARCANTHONY ASSOCIATE 40.00 X 863277 0 24636 4518749 857168 365882 6 0 1 0 OSU SPECIALTY CARE NETWORK 660 ACKERMAN RD COLUMBUS OH 432183104 MEDICAL SERVICES 2928554 HEALTHSCOPE BENEFITS INC 12448 COLLECTION CENTER DRIVE CHICAGO IL 60693 3RD PART ADMIN FOR BMS HEALTH PLAN 657522 BARTON ASSOCIATES PO BOX 417844 BOSTON MA 022417844 MEDICAL SERVICES 423925 DAVID AKWAINHA KITTOE DBA DAVEN MED 3487 EAST GALLOWAY DRIVE RICHFIELD OH 44286 MEDICAL SERVICES 363179 CHG COMPANIES INC DBA COMPHEALTH PO BOX 972651 DALLAS TX 75397 MEDICAL SERVICES 127441 5 12400000 1976307 432697 14809004 PATIENT REVENUE 621110 13603851 13603851 MISCELLANEOUS REVENUE 900099 471543 471543 14075394 162616 162616 REPAYMENT 900099 17383 17383 17383 29064397 14092777 0 162616 X 106431 106431 1078196 1078196 15191411 15191411 2665114 2665114 2508 2508 773 773 5562941 5562941 582484 582484 191077 191077 528417 528417 PHYSICIAN ADVANCES AND 1067529 1067529 SUPPLIES 615055 615055 COMMUNITY SUPPORT 210000 210000 REPAIRS AND MAINTENANCE 17582 17582 169903 169903 27989421 26771019 1218402 0 2420441 2973897 2259656 3091648 2115678 1452340 145724 302653 2065234 1310247 716087 754987 9233 10674 413686 533762 752356 891825 8832861 10011786 4086424 4188833 4086424 4188833 X 4692796 5807937 53641 15016 4746437 5822953 8832861 10011786 X 1074976 1540 X X 0 1 X 1 0 X 7519198 9482663 12812140 12676813 14809004 57299818 7519198 9482663 12812140 12676813 14809004 57299818 417296 56882522 1005 794 94317 200059 162616 458791 117730 137945 124419 7500 17383 404977 58163586 61676768 0.97800 0.97360 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 13476 1540 15016 11445 2031 13476 10048 1397 11445 10048 10048 10048 10048 1.00000 1 0 2065234 1310247 754987 754987 INVESTMENT IN WAYNE NETWORK 533762 C 533762 457 (F) CONTRIBUTIONS 786380 OTHER RECEIVABLES 105445 891825 X PART V, LINE 4: THE ENDOWMENT FUNDS WERE ESTABLISHED TO GROW FOR THE PURPOSE OF PROVIDING FINANCIAL RESOURCES FOR THE FOUNDATION IN THE FUTURE. PART X, LINE 2: FEDERAL INCOME TAX: THE ORGANIZATION IS TAX EXEMPT UNDER SECTION 501 (C)(3) OF THE INTERNAL REVENUE CODE. WITH FEW EXCEPTIONS THE ORGANIZATION IS NO LONGER SUBJECT TO INCOME TAX EXAMINATIONS BY THE U.S. FEDERAL, STATE, OR LOCAL AUTHORITIES FOR THE YEARS BEFORE 2015. 0 WOOSTER COMMUNITY HOSPITAL 1761 BEALL AVE WOOSTER OH 44691 346003129 501C3 106431 ACTUAL SUPPORT OF NURSING SCHOLARSHIP AND MEDICAL PROFESSIONAL EDUCATION 1 X X 0 1 0 1 0 0 0 0 0 CYRIL OFORI ASSOCIATE 1048208 0 0 0 0 0 11400 0 18588 0 1078196 0 0 0 SHARON E MARCANTHONY ASSOCIATE 863277 0 0 0 0 0 11400 0 13236 0 887913 0 0 0 ROBERT D CEBUL ASSOCIATE 728433 0 0 0 0 0 11400 0 2070 0 741903 0 0 0 PAUL MOODISPAW ASSOCIATE 668802 0 0 0 0 0 11400 0 24010 0 704212 0 0 0 NAGAPRADEEP NAGAJOTHI ASSOCIATE 619009 0 0 0 0 0 11400 0 14674 0 645083 0 0 0 WILLIAM SHERON CEO 0 480953 0 0 0 0 0 0 0 149092 0 630045 0 0 JOSEPH S BORRUSO ASSOCIATE 591020 0 0 0 0 0 11400 0 16269 0 618689 0 0 0 SCOTT BOYES CFO 0 376215 0 0 0 0 0 39900 0 19643 0 435758 0 0 PART I, LINE 4B THE FOLLOWING EMPLOYEES WERE COVERED UNDER A 457(F) PLAN: CYRIL OFORI $ 58,488 PAUL MOODISPAW $ 39,326 ROBERT CEBUL $ 39,699 DANIEL PEABODY $ 26,764 JAMES SLABY $21,971 PART I, LINE 5 BASED ON PHYSICIAN RVU'S ABOVE A PREDETERMINED LEVEL. FORM 990, PART VI, SECTION B, LINE 11B THE COMPLETED RETURN IS PRESENTED TO THE BOARD. THE BOARD REVIEWS THE RETURN, ADDRESSES ANY QUESTIONS, AND PROPOSES NECESSARY REVISIONS PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C ALL BOARD MEMBERS OF WOOSTER COMMUNITY HOSPITAL FOUNDATION AND THE BLOOMINGTON MEDICAL SERVICES INC. EMPLOYED DOCTORS MUST SIGN ANNUAL DISCLOSURE STATEMENTS, DISCLOSING ANY POTENTIAL CONFLICTS OF INTEREST. DUE TO THE SMALL SIZE OF THE COMMUNITY, THE FOUNDATION'S MANAGEMENT WOULD LIKELY BECOME AWARE OF ANY CONFLICTS OF INTEREST UPON THEIR CREATION. FORM 990, PART VI, SECTION B, LINE 15 COMPENSATION FOR SENIOR MANAGEMENT IS BASED ON OHA COMPARABILITY DATA. COMPENSATION FOR THE ORGANIZATION'S CEO IS DETERMINED BY THE HOSPITAL BOARD. FORM 990, PART VI, SECTION C, LINE 19 THE FOUNDATION MAINTAINS PERTINENT PUBLIC RECORDS AND RELEASES THEM TO THE PUBLIC UPON REQUEST. FORM 990, PART IX, LINE 11G MEDICAL SERVICE PROVIDERS: PROGRAM SERVICE EXPENSES 5,562,941. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 5,562,941. FORM 990, PART XI, LINE 9: NET CHANGE IN ENDOWMENT FUND AT WAYNE COMMUNITY FOUNDATION 1,540. 990, PART XI LINE 2C A COMMITTEE ASSUMES RESPONSIBILITY OF THE OVERSIGHT OF THE AUDIT AND THE INDEPENDENT ACCOUNTANT. THIS PROCESS HAS NOT CHANGED FROM PRIOR YEARS BLOOMINGTON MEDICAL SERVICES LLC 1761 BEALL AVENUE WOOSTER OH 44691 261803679 PROVIDING MEDICAL SERVICES OH 16051701 6375205 N/A WOOSTER COMMUNITY HOSPITAL 1761 BEALL AVENUE WOOSTER OH 44691 346003129 TO OPERATE A HOSPITAL IN ORDER TO PROVIDE MEDICAL SERVICES TO THE COMMUNITY OH GOVERMENTAL ENTITY N/A 0 WAYNE NETWORK 1761 BEALL AVENUE WOOSTER OH 44691 270014500 PROVIDE HEALTHCARE UTILIZATION AND CARE COORDINATION SERVICES TO EMPLOYERS OH N/A C 195263 533762 1.00000 0 0 0 1 0 0 0 0 0 0 0 1 1 1 0 1 1 0 0 0 WOOSTER COMMUNITY HOSPITAL C 12400000 ACTUAL WOOSTER COMMUNITY HOSPITAL K 559648 ACTUAL WOOSTER COMMUNITY HOSPITAL O 5443472 ACTUAL WOOSTER COMMUNITY HOSPITAL P 513524 ACTUAL WOOSTER COMMUNITY HOSPITAL M 600000 ACTUAL