THE CITY HOSPITAL ASSOCIATION: Form 990, tax year 2020
View the entire original 990 at ProPublica ↗
- Organization
- THE CITY HOSPITAL ASSOCIATION (EIN 34-0714583)
- Tax period
- 2020-01-01 to 2020-12-31
- Filed
- 2021-11-12
- IRS object ID
- 202123169349303847
- 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
- Form 990
- Schedule A
- Schedule B
- Schedule C
- Schedule D
- Schedule H
- Schedule J
- Schedule L
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2021-11-12T10:24:27-06:00 | ReturnTs |
| Tax Period End | 2020-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 910189318 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MOSS ADAMS LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 21700 OXNARD ST STE 300 | AddressLine1Txt |
| City | LOS ANGELES | CityNm |
| State Abbreviation | CA | StateAbbreviationCd |
| ZIP | 91367 | 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 | 340714583 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CITY HOSPITAL ASSOCIATION | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | CITY | BusinessNameControlTxt |
| Phone | 3303857200 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 425 WEST FIFTH STREET | AddressLine1Txt |
| City | EAST LIVERPOOL | CityNm |
| State Abbreviation | OH | StateAbbreviationCd |
| ZIP | 43920 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | STEVE ALEMAN | PersonNm |
| Person Title | CFO | PersonTitleTxt |
| Phone | 3303857200 | PhoneNum |
| Signature | 2021-11-10 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Signing Officer SigningOfficerGrp
Person Full Name PersonFullName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person First | STEVE | PersonFirstNm |
| Person Last | ALEMAN | PersonLastNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| SSN | 999009999 | SSN |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | LAUREN A HAVERLOCK | PreparerPersonNm |
| PTIN | P00545829 | PTIN |
| Phone | 8185771900 | PhoneNum |
| Preparation | 2021-11-10 | 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
Doing Business As Name DoingBusinessAsName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | EAST LIVERPOOL CITY HOSPITAL | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | KEITH RICHARDSON | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 425 WEST FIFTH STREET | AddressLine1Txt |
| City | EAST LIVERPOOL | CityNm |
| State Abbreviation | OH | StateAbbreviationCd |
| ZIP | 43920 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $95,325,103 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.ELCH.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1905 | FormationYr |
| Legal Domicile State | OH | LegalDomicileStateCd |
| Activity Or Mission | TO CHAMPION THE QUALITY OF LIFE AND PROVIDE EXCELLENT CARE FOR ALL THAT WE SERVE; BASED SOLELY ON OUR BELIEF IN THE SACRED VALUE OF HUMAN LIFE. | ActivityOrMissionDesc |
| Voting Members Governing Body | 8 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 6 | VotingMembersIndependentCnt |
| Total Employee | 675 | TotalEmployeeCnt |
| Total Volunteers | 46 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $0 | PYContributionsGrantsAmt |
| CY Contributions Grants | $18,886,828 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $80,715,070 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $76,348,617 | CYProgramServiceRevenueAmt |
| PY Investment Income | $37,690 | PYInvestmentIncomeAmt |
| CY Investment Income | $8,229 | CYInvestmentIncomeAmt |
| PY Other Revenue | $324,259 | PYOtherRevenueAmt |
| CY Other Revenue | $81,429 | CYOtherRevenueAmt |
| PY Total Revenue | $81,077,019 | PYTotalRevenueAmt |
| CY Total Revenue | $95,325,103 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $28,440 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $23,954 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $33,689,701 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $32,139,512 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $38,440,407 | PYOtherExpensesAmt |
| CY Other Expenses | $43,973,613 | CYOtherExpensesAmt |
| PY Total Expenses | $72,158,548 | PYTotalExpensesAmt |
| CY Total Expenses | $76,137,079 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $8,918,471 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $19,188,024 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $93,354,449 | TotalAssetsBOYAmt |
| Total Assets EOY | $117,538,212 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $16,640,117 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $21,897,307 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $76,714,332 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $95,640,905 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | THE ORGANIZATION PROVIDES HIGH QUALITY, COMPASSIONATE HEALTH CARE SERVICES WITHIN THE AVAILABLE RESOURCES. HEALTHCARE SERVICES WILL BE PROVIDED TO PREVENT ILLNESS, RELIEVE SUFFERING, AID IN HEALTH RESTORATION AND TO PROMOTE WELLNESS. THE ORGANIZATION PROVIDES SERVICES TO ANY PERSON, WITHOUT DISCRIMINATION. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $56,688,963 | ExpenseAmt |
| Grant | $23,954 | GrantAmt |
| Revenue | $95,316,874 | RevenueAmt |
| Desc | THE ORGANIZATION PROVIDES QUALITY MEDICAL HEALTHCARE REGARDLESS OF RACE, CREED, SEX, NATIONAL ORIGIN, HANDICAP, AGE, OR ABILITY TO PAY. ALTHOUGH REIMBURSEMENT FOR SERVICES RENDERED IS CRITICAL TO THE OPERATION AND STABILITY OF THE ORGANIZATION, IT IS RECOGNIZED THAT NOT ALL INDIVIDUALS POSSESS THE ABILITY TO AFFORD ESSENTIAL MEDICAL SERVICES AND HEALTHCARE EDUCATION. THEREFORE, IN KEEPING WITH THE ORGANIZATION'S COMMITMENT TO SERVE ALL MEMBERS OF THE ORGANIZATIONS COMMUNITY WITH FREE CARE AND/OR SUBSIDIZED CARE, CARE PROVIDED TO PERSONS COVERED BY GOVERNMENTAL PROGRAMS BELOW COSTS, AND HEALTH ACTIVITIES AND PROGRAMS TO SUPPORT THE COMMUNITY HAVE BEEN CONSIDERED WHERE THE NEED AND AN INDIVIDUAL'S INABILITY TO PAY EXIST. THESE ACTIVITIES INCLUDE WELLNESS PROGRAMS, COMMUNITY EDUCATION PROGRAMS, AND A VARIETY OF BROAD COMMUNITY SUPPORT ACTIVITIES. THE ORGANIZATION PROVIDES CARE TO PERSONS COVERED BY GOVERNMENTAL PROGRAMS BELOW COST. RECOGNIZING ITS MISSION TO THE COMMUNITY, SERVICES ARE PROVIDED TO BOTH MEDICARE AND MEDICAID PATIENTS. TO THE EXTENT REIMBURSEMENT IS BELOW COST, THE ORGANIZATION CONSIDERS THESE AMOUNTS AS UNCOMPENSATED CARE IN MEETING ITS MISSION IN THE ENTIRE COMMUNITY. THE ORGANIZATION IS LOCATED IN EAST LIVERPOOL, OHIO AND SERVICES THE SURROUNDING COMMUNITIES; STAFFING 120 BEDS FOR ACUTE CARE, INTENSIVE CARE AND SKILLED NURSING IN THE MEDICALLY UNDESERVED AREA. DURING 2019, THE ORGANIZATION PROVIDED NUMEROUS BENEFITS TO THE SURROUNDING COMMUNITY, INCLUDING FINANCIAL SUPPORT THROUGH THE COMMUNITY BENEFIT INITIATIVE PROGRAM. COMMUNITY EDUCATION AND WELLNESS PROGRAMS - THE ORGANIZATION OFFERED THE FOLLOWING TO THE COMMUNITY FREE OR AT A NOMINAL CHARGE: HEALTH FAIRS, CPR CLASSES, CHILDBIRTH CLASSES, GARFIELD ELEMENTARY WELLNESS PROGRAM, COVER THE UNINSURED, PROGRAM HEARTSAVER FIRST AID CLASSES, ADVANCE CARDIAC LIFE SUPPORT, HEALTHCARE PROVIDER RECERTIFICATION, BREAST FEEDING SUPPORT, PASTORAL OUTREACH PROGRAMS, DIABETES EDUCATION, SMOKING CESSATION CLASSES, BASICS IN BABYSITTING CLASSES, AUTISM SUPPORT GROUP, CONDUCTED HOSPITAL TOURS FOR AREA SCHOOLS AND COMMUNITY GROUPS, SERVED AS AN OBSERVATION SITE FOR THE HIGH SCHOOL FOR HEALTH PROFESSIONS DEVELOPED BY THE PUBLIC SCHOOLS, HOSTED SEVERAL SHADOW STUDENTS FROM AREA SCHOOLS, SERVED AS HOST SITE FOR OHIO HIGHER EDUCATION TELECOMMUNICATION SYSTEM, OPERATED A PHYSICIAN REFERRAL LINE FREE TO THE COMMUNITY, HOSTED PROGRAMS FOR STUDENT NURSES AND RADIOLOGY TECHNICIANS IN TRAINING, PROVIDED FOOD TO NEEDY FAMILIES FOR THANKSGIVING, AND GIFTS TO NEEDY CHILDREN FOR CHRISTMAS TO THE SALVATION ARMY DAY OF CARING, DAY OF GIVING PROGRAM - MONEY AND FOOD DRIVE | Desc |
Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $795,491 | ExpenseAmt |
| Desc | THE PODIATRY PROGRAM STARTED JULY 2018 WITH 12 D.P.M.'S. THERE ARE FOUR IN THEIR FIRST YEAR, FOUR IN THEIR SECOND YEAR AND FOUR IN THEIR FOURTH YEAR FOR THE 2020-2021 YEAR. | Desc |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Expenses | $57,484,454 | 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 | 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 | 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 | 0 | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 140 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 675 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| 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 | 8 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 6 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | Yes (1) | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (1) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (1) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | Yes (1) | 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 | 0 | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | OH | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | DONALD BEVERS | PersonNm |
| Phone | 3303863096 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 425 WEST FIFTH STREET | AddressLine1Txt |
| City | EAST LIVERPOOL | CityNm |
| State Abbreviation | OH | StateAbbreviationCd |
| ZIP | 43920 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part VII | Yes (X) | InfoInScheduleOPartVIIInd |
Form990 Part VII Section A Form990PartVIISectionAGrp (19 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|
| DAVID HAMILTON | ||||||||
| CHAIRMAN | 1.00 | 0.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| GREGORY BRICKER | ||||||||
| DIRECTOR | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| GRETCHEN NICKELL DO | ||||||||
| DIRECTOR | 1.00 | 40.00 | Yes (X) | $0 | $563,581 | $30,236 | ||
| KEITH RICHARDSON | ||||||||
| CEO (REGIONAL) AND SECRETARY | 40.00 | 1.00 | Yes (X) | Yes (X) | $389,388 | $0 | $29,491 | |
| KENNETH PAYNE | ||||||||
| CFO (REGIONAL) - (THRU MAY 2020) | 40.00 | 1.00 | Yes (X) | Yes (X) | $80,000 | $0 | $0 | |
| MARK MANGANO | ||||||||
| DIRECTOR | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| ROBERT O'HARA | ||||||||
| DIRECTOR | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| TAMMIE MCINTOSH | ||||||||
| PAST CHAIRMAN | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| DONALD BEVERS | ||||||||
| CFO (REGIONAL) | 40.00 | 1.00 | Yes (X) | $42,939 | $0 | $2,055 | ||
| KAVITHA BHATIA | ||||||||
| PRESIDENT | 1.00 | 12.00 | Yes (X) | $0 | $0 | $0 | ||
| MARC GOLDSTONE | ||||||||
| SECRETARY (THRU 11/2020) | 1.00 | 7.00 | Yes (X) | $0 | $0 | $0 | ||
| MIKE HEATHER | ||||||||
| CFO (THRU 04/2020) | 1.00 | 17.00 | Yes (X) | $0 | $0 | $0 | ||
| RAMONA THOMAS | ||||||||
| SECRETARY (BEGIN 11/2020) | 1.00 | 7.00 | Yes (X) | $0 | $0 | $0 | ||
| STEVE ALEMAN | ||||||||
| CFO (BEGIN 04/2020) | 1.00 | 17.00 | Yes (X) | $0 | $0 | $0 | ||
| JAYNE ROSE | ||||||||
| C.N.O. | 40.00 | 0.00 | $171,060 | $0 | $20,838 | Yes (X) | ||
| JESSE SHILOT | ||||||||
| PHARMACIST | 40.00 | 0.00 | $129,278 | $0 | $15,646 | Yes (X) | ||
| MICHAEL DALEY | ||||||||
| PHARMACIST | 40.00 | 0.00 | $126,051 | $0 | $26,037 | Yes (X) | ||
| NICHOLAS PETRUSKA | ||||||||
| PHARMACIST | 40.00 | 0.00 | $133,086 | $0 | $17,448 | Yes (X) | ||
| WILLIAM SMITH | ||||||||
| DIRECTOR OF PHARMACY | 40.00 | 0.00 | $148,548 | $0 | $26,215 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $1,220,350 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $563,581 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $167,966 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 15 | 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 |
|---|---|---|---|---|---|
| PRIME HEALTHCARE MANAGEMENT INC | |||||
| 3480 E GUASTI ROAD | ONTARIO | CA | 91761 | MANAGEMENT | $4,926,928 |
| MORRISON HEALTHCARE | |||||
| PO BOX 102289 | ATLANTA | GA | 30368 | DIETARY SERVICES | $1,308,379 |
| CROTHALL HEALTHCARE | |||||
| 13028 COLLECTION CENTER DR | CHICAGO | IL | 60693 | HOUSEKEEPING | $1,181,623 |
| OHIO VALLEY ANESTHETISTS LLC | |||||
| 425 WEST 5TH STREET | EAST LIVERPOOL | OH | 43920 | ANESTHESIA | $1,038,440 |
| BIO MED SERVICES INC | |||||
| 3300 E GUASTI ROAD 1ST FLOOR | ONTARIO | CA | 91761 | MATERIALS MANAGEMENT | $940,860 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 45 | CntrctRcvdGreaterThan100KCnt |
| Government Grants | $18,886,828 | GovernmentGrantsAmt |
| Total Contributions | $18,886,828 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | NET PATIENT REVENUE | Desc |
| Business | 621500 | BusinessCd |
| Total Revenue Column | $76,348,617 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $76,348,617 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $76,348,617 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $8,229 | TotalRevenueColumnAmt |
| Exclusion | $8,229 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp (2 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| CAFETERIA/VENDING | 900099 | $72,978 | $72,978 |
| HEALTH EDUCATION | 900099 | $8,451 | $8,451 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $81,429 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $95,325,103 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $76,430,046 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $8,229 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $23,954 | TotalAmt |
| Program Services | $23,954 | ProgramServicesAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $456,574 | TotalAmt |
| Program Services | $257,431 | ProgramServicesAmt |
| Management And General | $199,143 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $24,548,432 | TotalAmt |
| Program Services | $14,729,059 | ProgramServicesAmt |
| Management And General | $9,819,373 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $359,814 | TotalAmt |
| Program Services | $359,814 | ProgramServicesAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,799,048 | TotalAmt |
| Program Services | $4,799,048 | ProgramServicesAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,975,644 | TotalAmt |
| Program Services | $1,442,219 | ProgramServicesAmt |
| Management And General | $533,425 | ManagementAndGeneralAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,016,591 | TotalAmt |
| Management And General | $5,016,591 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $358,664 | TotalAmt |
| Management And General | $358,664 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $57,617 | TotalAmt |
| Management And General | $57,617 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $10,986,037 | TotalAmt |
| Program Services | $10,279,676 | ProgramServicesAmt |
| Management And General | $706,361 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $192,783 | TotalAmt |
| Program Services | $165,793 | ProgramServicesAmt |
| Management And General | $26,990 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $231,490 | TotalAmt |
| Program Services | $156,845 | ProgramServicesAmt |
| Management And General | $74,645 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $92,234 | TotalAmt |
| Program Services | $79,321 | ProgramServicesAmt |
| Management And General | $12,913 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $412,373 | TotalAmt |
| Program Services | $412,373 | ProgramServicesAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,773,199 | TotalAmt |
| Program Services | $1,773,199 | ProgramServicesAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $704,536 | TotalAmt |
| Program Services | $704,536 | ProgramServicesAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| BAD DEBT EXPENSE | $11,496,242 | $11,496,242 | |
| MEDICAL SUPPLIES | $6,230,688 | $5,607,619 | $623,069 |
| REPAIRS AND MAINTENANCE | $1,985,115 | $1,191,069 | $794,046 |
| TAXES AND LICENSES | $1,705,886 | $1,705,886 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,730,158 | TotalAmt |
| Program Services | $2,300,370 | ProgramServicesAmt |
| Management And General | $429,788 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $76,137,079 | TotalAmt |
| Program Services | $57,484,454 | ProgramServicesAmt |
| Management And General | $18,652,625 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $11,341,442 | BOYAmt |
| EOY | $9,750,715 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $9,186,372 | BOYAmt |
| EOY | $7,704,130 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $874,913 | BOYAmt |
| EOY | $959,499 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $332,378 | BOYAmt |
| EOY | $266,211 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $18,304,723 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $10,383,407 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,930,183 | BOYAmt |
| EOY | $7,921,316 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,074,203 | BOYAmt |
| EOY | $2,079,641 | EOYAmt |
Intangible Assets IntangibleAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,137,889 | BOYAmt |
| EOY | $1,035,222 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $61,477,069 | BOYAmt |
| EOY | $87,821,478 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $93,354,449 | BOYAmt |
| EOY | $117,538,212 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,528,133 | BOYAmt |
| EOY | $8,426,696 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $11,111,984 | BOYAmt |
| EOY | $13,470,611 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $16,640,117 | BOYAmt |
| EOY | $21,897,307 | 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 | $76,714,332 | BOYAmt |
| EOY | $95,640,905 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $76,714,332 | BOYAmt |
| EOY | $95,640,905 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $93,354,449 | BOYAmt |
| EOY | $117,538,212 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $19,188,024 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | -$678,524 | NetUnrlzdGainsLossesInvstAmt |
| Prior Period Adjustments | $417,073 | PriorPeriodAdjustmentsAmt |
| Other Changes In Net Assets | $0 | OtherChangesInNetAssetsAmt |
| 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 | 0 | FederalGrantAuditRequiredInd |
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 | Yes (1) | GrantsOtherOrganizationsInd |
| Grants Other Organizations | $1,697 | GrantsOtherOrganizationsAmt |
| Direct Contact Legislators | 0 | DirectContactLegislatorsInd |
| Rallies Demonstrations | 0 | RalliesDemonstrationsInd |
| Other Activities | 0 | OtherActivitiesInd |
| Total Lobbying Expenditures | $1,697 | 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 | AMOUNT REPORTED IN PART II-B, LINE 1F REPRESENTS PORTION OF DUES PAID TO TRADE ASSOCATIONS THAT IS ATTRIBUTABLE TO LOBBYING ACTIVITIES. | ExplanationTxt |
Schedule D IRS990ScheduleD
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $975,065 | OtherCostOrOtherBasisAmt |
| Book Value | $975,065 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $5,323,411 | OtherCostOrOtherBasisAmt |
| Depreciation | $5,267,338 | DepreciationAmt |
| Book Value | $56,073 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $4,951,312 | OtherCostOrOtherBasisAmt |
| Depreciation | $962,392 | DepreciationAmt |
| Book Value | $3,988,920 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $4,979,702 | OtherCostOrOtherBasisAmt |
| Depreciation | $3,991,964 | DepreciationAmt |
| Book Value | $987,738 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $2,075,233 | OtherCostOrOtherBasisAmt |
| Depreciation | $161,713 | DepreciationAmt |
| Book Value | $1,913,520 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $7,921,316 | TotalBookValueLandBuildingsAmt |
Other Assets Org OtherAssetsOrgGrp (8 entries)
| DescDesc | Book ValueBookValueAmt |
|---|---|
| RIGHT OF USE ASSETS, NET | $2,975,918 |
| DUE FROM SAINT MARY'S KC | $5,145 |
| DUE FROM PRIME HEALTHCARE MANAGEMENT | -$1,814,398 |
| DUE FROM OHIO VALLEY HOME HEALTH | $1,665,374 |
| DUE FROM KEENAN | $4,948,197 |
| DUE FROM FOUNDATION | $43,363,031 |
| DUE FROM EAST LIVERPOOL MEDICAL GROUP | $36,452,117 |
| DUE FROM COSHOCTON REGIONAL | $226,094 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $87,821,478 | TotalBookValueOtherAssetsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (6 entries)
| DescDesc | AmtAmt |
|---|---|
| CAPITAL LEASES | $1,559,528 |
| DUE TO AFFILIATES | $523,161 |
| IBNR | $790,753 |
| OTHER CURRENT LIABILITIES | -$250,000 |
| INTEREST RATE SWAP | $10,827,763 |
| OTHER DEFERRED ITEMS | $19,406 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $13,470,611 | 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 | THE LITERATURE RELATED TO UNCERTAIN TAX POSITIONS PRESCRIBES A RECOGNITION THRESHOLD AND MEASUREMENT PROCESS FOR ACCOUNTING FOR UNCERTAIN TAX POSITIONS AND ALSO PROVIDES GUIDANCE ON VARIOUS RELATED MATTERS SUCH AS DE-RECOGNITION, INTEREST, PENALTIES AND DISCLOSURES REQUIRED. THE COMPANY DOES NOT HAVE ANY ENTITY-LEVEL UNCERTAIN TAX POSITIONS. | ExplanationTxt |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (1) | FinancialAssistancePolicyInd |
| Written Policy | Yes (1) | WrittenPolicyInd |
| FPG Reference Free Care | Yes (1) | FPGReferenceFreeCareInd |
Free Care Oth Percentage FreeCareOthPercentageGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | Yes (X) | OtherInd |
| Free Care Other | 350.000000000000 | FreeCareOtherPct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| FPG Reference Discounted Care | Yes (1) | FPGReferenceDiscountedCareInd |
Discounted Care Oth Percentage DiscountedCareOthPercentageGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | Yes (X) | OtherInd |
| Discounted Care Other | 450.000000000000 | DiscountedCareOtherPct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Free Care Medically Indigent | Yes (1) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (1) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | 0 | ExpensesExceedBudgetInd |
| Annual Community Bnft Report | 0 | AnnualCommunityBnftReportInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,696,184 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,384,494 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $311,690 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00410 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $17,289,253 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $31,758,868 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00000 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $18,985,437 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $33,143,362 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $311,690 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00410 | TotalExpensePct |
Health Professions Education HealthProfessionsEducationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $3,081,951 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,539,662 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,542,289 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.02030 | TotalExpensePct |
Cash And In Kind Contributions CashAndInKindContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $23,604 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $0 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $23,604 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00030 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $3,105,555 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,539,662 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,565,893 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.02060 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $22,090,992 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $34,683,024 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,877,583 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.02470 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (1) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $11,496,242 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $4,943,384 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $13,860,007 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $14,746,297 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$886,290 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | Yes (X) | OtherInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | Yes (1) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (1) | FinancialAssistancePrvsnInd |
| Hospital Facilities | 1 | HospitalFacilitiesCnt |
Hospital Facilities HospitalFacilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | EAST LIVERPOOL CITY HOSPITAL | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 425 WEST FIFTH STREET | AddressLine1Txt |
| City | EAST LIVERPOOL | CityNm |
| State Abbreviation | OH | StateAbbreviationCd |
| ZIP | 43920 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | WWW.ELCH.ORG | WebsiteAddressTxt |
| State License | 11418 | StateLicenseNum |
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | EAST LIVERPOOL CITY HOSPITAL | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| First Licensed CY Or PY | 0 | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | 0 | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | Yes (1) | CHNAConductedInd |
| Community Definition | Yes (X) | CommunityDefinitionInd |
| Community Demographics | Yes (X) | CommunityDemographicsInd |
| Existing Resources | Yes (X) | ExistingResourcesInd |
| How Data Obtained | Yes (X) | HowDataObtainedInd |
| Community Health Needs | Yes (X) | CommunityHealthNeedsInd |
| Other Health Issues | Yes (X) | OtherHealthIssuesInd |
| Community Hlth Needs Id Process | Yes (X) | CommunityHlthNeedsIdProcessInd |
| Consulting Process | Yes (X) | ConsultingProcessInd |
| Prior CHNA Impact | Yes (X) | PriorCHNAImpactInd |
| CHNA Conducted | 19 | CHNAConductedYr |
| Take Into Account Others Input | Yes (1) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | Yes (1) | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | Yes (1) | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (1) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | HTTP://WWW.ELCH.ORG/ABOUT-US/COMMUNITY-HEALTH/ | OwnWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Implementation Strategy Adopt | Yes (1) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 19 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (1) | StrategyPostedWebsiteInd |
| Strategy Website URL | HTTP://WWW.ELCH.ORG/ABOUT-US/COMMUNITY-HEALTH/ | StrategyWebsiteURLTxt |
| Organization Incur Excise Tax | 0 | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (1) | EligCriteriaExplainedInd |
| FPG Family Incm Lmt Free Dscnt | Yes (X) | FPGFamilyIncmLmtFreeDscntInd |
| FPG Family Incm Lmt Free Care | 350.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 450.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Asset Level Criteria | Yes (X) | AssetLevelCriteriaInd |
| Medical Indigency Criteria | Yes (X) | MedicalIndigencyCriteriaInd |
| Insurance Status Criteria | Yes (X) | InsuranceStatusCriteriaInd |
| Underinsurance Stat Criteria | Yes (X) | UnderinsuranceStatCriteriaInd |
| Residency Criteria | Yes (X) | ResidencyCriteriaInd |
| Explained Basis | Yes (1) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (1) | AppFinancialAsstExplnInd |
| Described Info | Yes (X) | DescribedInfoInd |
| Described Suprt Doc | Yes (X) | DescribedSuprtDocInd |
| Provided Hospital Contact | Yes (X) | ProvidedHospitalContactInd |
| Includes Publicity Measures | Yes (1) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | HTTP://ELCH.ORG/PATIENTS-VISITORS/INSURANCE-FINANCIAL-INFO/ | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | HTTP://ELCH.ORG/PATIENTS-VISITORS/INSURANCE-FINANCIAL-INFO/ | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | HTTP://ELCH.ORG/PATIENTS-VISITORS/INSURANCE-FINANCIAL-INFO/ | FAPSummaryOnWebsiteURLTxt |
| FAP Avlbl On Request No Charge | Yes (X) | FAPAvlblOnRequestNoChargeInd |
| FAP App Avlbl On Request No Chrg | Yes (X) | FAPAppAvlblOnRequestNoChrgInd |
| FAP Sum Avlbl On Request No Chrg | Yes (X) | FAPSumAvlblOnRequestNoChrgInd |
| Notified FAP Copy Bill Display | Yes (X) | NotifiedFAPCopyBillDisplayInd |
| Communtity Notified FAP | Yes (X) | CommuntityNotifiedFAPInd |
| FAP Translated | Yes (X) | FAPTranslatedInd |
| FAP Actions On Nonpayment | Yes (1) | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | 0 | CollectionActivitiesInd |
| Provided Written Notice | Yes (X) | ProvidedWrittenNoticeInd |
| Made Effort Orally Notify | Yes (X) | MadeEffortOrallyNotifyInd |
| Processed FAP Application | Yes (X) | ProcessedFAPApplicationInd |
| Made Presumptive Elig Determ | Yes (X) | MadePresumptiveEligDetermInd |
| Nondis Emergency Care Policy | Yes (1) | NondisEmergencyCarePolicyInd |
| Prospective Medicare Medicaid | Yes (X) | ProspectiveMedicareMedicaidInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | 0 | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (4 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| EAST LIVERPOOL CITY HOSPITAL | PART V, SECTION B, LINE 5: PRIMARY QUALITATIVE DATA TO REFLECT INPUT FROM THE BROAD COMMUNITY AND VULNERABLE POPULATIONS WAS COLLECTED THROUGH 377 WRITTEN COMMUNITY SURVEYS COMPLETED BY INDIVIDUALS REPRESENTING DIVERSE CONSTITUENT GROUPS WITH THIS DATA GATHERED AND ANALYZED BY HCNO; AND 34 STAKEHOLDER AND FOCUS GROUP INTERVIEWS, REFLECTING INPUT FROM 115 PARTICIPANTS WITH THIS DATA GATHERED AND ANALYZED BY THE PARTNERS' WORKGROUP.COMMUNITY LEADERS AND KEY STAKEHOLDERS WERE IDENTIFIED BY THE PARTNERS AS EXPERTS IN A PARTICULAR FIELD RELATED TO THEIR BACKGROUND EXPERIENCE OR PROFESSIONAL POSITION; AND/OR THOSE WHO UNDERSTAND THE NEEDS OF A PARTICULAR COMMUNITY/GEOGRAPHIC REGION OR UNDER-REPRESENTED GROUP, INCLUDING THE MEDICALLY UNDERSERVED AND VULNERABLE POPULATIONS DEFINED IN THE CHNA.COMMUNITY PARTICIPANTS REPRESENTED IN THE FOCUS GROUP AND STAKEHOLDER INTERVIEWS INCLUDED: - SCHOOL DISTRICTS AND YOUTH SERVICES - HOSPITAL CASE MANAGERS - JUVENILE JUSTICE SYSTEM - LOCAL GOVERNMENT OFFICIALS/ COUNTY COMMISSIONERS - COMMUNITY RESOURCE CENTERS - HEALTH AND HUMAN SERVICE PROVIDERS - FOOD PANTRIES - MENTAL HEALTH AND RECOVERY SERVICE PROVIDERS - SENIOR SERVICES & HOME HEALTH PROVIDERS - FAITH-BASED ORGANIZATIONS PROVIDING ASSISTANCE - HISPANIC COMMUNITY MEMBERS & SERVICE PROVIDERS |
| EAST LIVERPOOL CITY HOSPITAL | PART V, SECTION B, LINE 6A: THE 2019 COLUMBIANA COUNTY HEALTH PARTNERS' COLLABORATIVE WORKGROUP IS COMPOSED OF THE FOLLOWING HOSPITALS: AKRON CHILDREN'S HOSPITAL, SALEM REGIONAL MEDICAL CENTER AND EAST LIVERPOOL CITY HOSPITAL. |
| EAST LIVERPOOL CITY HOSPITAL | PART V, SECTION B, LINE 6B: THE 2019 COLUMBIANA COUNTY HEALTH PARTNERS' COLLABORATIVE WORKGROUP IS COMPOSED OF THE FOLLOWING NON-HOSPITAL ORGANIZATIONS: EAST LIVERPOOL CITY HEALTH DEPARTMENT, COLUMBIANA COUNTY EDUCATION SERVICE CENTER, COLUMBIANA COUNTY GENERAL HEALTH DISTRICT, FAMILY AND CHILDREN FIRST COUNCIL, COLUMBIANA COUNTY MENTAL HEALTH AND RECOVERY SERVICES BOARD, SALEM CITY HEALTH DEPARTMENT, COMMUNITY ACTION AGENCY OF COLUMBIANA COUNTY, COORDINATED ACTION FOR SCHOOL HEALTH (CASH) COALITION AND THE OHIO STATE UNIVERSITY- EXTENSION. |
| EAST LIVERPOOL CITY HOSPITAL | PART V, SECTION B, LINE 11: PROGRESS IN MEETING THE PRIORITIES IDENTIFIED IN ELCH'S 2019-2022 IMPLEMENTATION PLAN WILL BE MONITORED VIA MEASURABLE INDICATORS THAT ARE EVALUATED ON A MINIMUM OF AN ANNUAL BASIS BY ELCH'S SENIOR LEADERSHIP TEAM, INCLUDING QUARTERLY COMMUNITY HEALTH MEETINGS WITH THE INVOLVEMENT OF SENIOR LEADERSHIP. IN ADDITION, ELCH WILL BE COLLABORATING ON THE IMPLEMENTATION OF THE COLUMBIANA COUNTY HEALTH IMPROVEMENT PLAN (CHIP), SO THAT POPULATION HEALTH IMPROVEMENT INITIATIVES AND RESOURCES CAN BE COORDINATED AND INTEGRATED THROUGHOUT THE COUNTY. THE CHIP STEERING COMMITTEE, OF WHICH ELCH IS A KEY MEMBER, WILL MEET AT LEAST SEMI-ANNUALLY FOR THE FIRST YEAR OF THE CHIP'S IMPLEMENTATION AND DEPENDING ON THE PROGRESS, MAY MEET ANNUALLY AFTER THAT TO EVALUATE AND REPORT OUTCOMES. ACTION STEPS, ACCOUNTABLE PERSON/ORGANIZATION, AND TIMELINES WILL BE REVIEWED AT THE END OF EACH YEAR BY THE STEERING COMMITTEE; WITH REVISIONS MADE TO THE CHIP ACCORDINGLY. BEYOND OUTCOME EVALUATION, PROCESS EVALUATION WILL ALSO BE USED ON AN ONGOING BASIS TO FOCUS ON HOW WELL ACTION STEPS ARE BEING IMPLEMENTED. |
Supplemental Information Detail SupplementalInformationDetail (10 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART III, LINE 2: | THE AMOUNT REPORTED ON LINE 2 IS BASED ON BAD DEBTS PER THE AUDITED FINANCIAL STATEMENTS. |
| PART III, LINE 3: | THE ESTIMATED AMOUNT OF THE ORGANIZATION'S BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S FINANCIAL ASSISTANCE POLICY WAS ESTIMATED TO BE 43% OF THE AMOUNT OF THE ORGANIZATION'S BAD DEBT EXPENSE. |
| PART III, LINE 4: | THE COMPANY'S PATIENT ACCOUNTS RECEIVABLE IS REDUCED BY ALLOWANCES FOR CONTRACTUAL ADJUSTMENTS AND DOUBTFUL ACCOUNTS. IN EVALUATING THE COLLECTABILITY OF PATIENT ACCOUNTS RECEIVABLE, THE COMPANY ANALYZES ITS PAST HISTORY AND IDENTIFIES TRENDS FOR EACH MAJOR PAYER SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCES FOR BOTH CONTRACTUAL ADJUSTMENTS AND DOUBTFUL ACCOUNTS AND PROVISION FOR BAD DEBTS. MANAGEMENT REGULARLY REVIEWS DATA ABOUT THESE MAJOR PAYER SOURCES OF REVENUE IN EVALUATING THE SUFFICIENCY OF THESE ALLOWANCES. FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS (WHICH INCLUDES BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND CO-PAYMENT BALANCES DUE FOR WHICH THIRD-PARTY COVERAGE EXISTS FOR PART OF THE BILL), THE COMPANY RECORDS A PROVISION FOR DOUBTFUL ACCOUNTS 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 EXPECTED RATES (OR 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: | THE HOSPITAL CONTENDS THAT THE ENTIRE AMOUNT OF THE MEDICARE SURPLUS SHOULD ALSO BE CONSIDERED AS A COMMUNITY BENEFIT. THE REASON FOR THIS IS THAT THE MEDICARE RATES ARE SET UNILATERALLY BY THE FEDERAL GOVERNMENT AND THE HOSPITAL AGREES TO SERVICE THESE PATIENTS AT THESE RATES AS PART OF OUR MISSION AND SERVICE TO THE COMMUNITY.THE COST INCLUDED ON LINE 6 COMES FROM THE MEDICARE COST REPORT WHICH THE FEDERAL GOVERNMENT HAS SET UP AS THEIR WAY TO CAPTURE AND SEGREGATE THE COSTS OF SERVICES PROVIDED TO MEDICARE PATIENTS. |
| PART III, LINE 9B: | THE HOSPITAL PRACTICE IS THAT UPON VERIFICATION THAT A PATIENT QUALIFIES FOR CHARITY OR FINANCIAL ASSISTANCE, THE HOSPITAL DISCONTINUES COLLECTION EFFORTS AND MAKES THE APPROPRIATE ADJUSTMENT TO THE PATIENT'S ACCOUNT BASED UPON THE PATIENT'S INDIVIDUAL CIRCUMSTANCES. |
| PART VI, LINE 2: | ONGOING EFFORTS AND EVALUATION OF MANAGEMENT, STAFF, PHYSICIANS WITH FEEDBACK FROM PATIENTS AND COMMUNITY. DEMOGRAPHIC RESEARCH AND STUDIES ALSO UTILIZED TO DETERMINE TYPE AND QUANTITY OF SERVICES NEEDED BY SPECIALTY TO BEST SERVE OUR COMMUNITY. |
| PART VI, LINE 3: | INFORMATION REGARDING FINANCIAL ASSISTANCE AND CHARITY CARE IS MADE AVAILABLE AT TIME OF REGISTRATION, ON THE HOSPITAL'S WEBSITE, AND ON PATIENT STATEMENTS. APPLICATIONS ARE ALSO MADE AVAILABLE TO PATIENTS AT TIME OF REGISTRATION IF APPROPRIATE.IN ORDER TO ENSURE THAT PATIENTS ARE AWARE OF THE EXISTENCE OF THE FINANCIAL ASSISTANCE POLICY, THE HOSPITAL WIDELY DISSEMINATES THE EXISTENCE AND TERMS OF THIS POLICY THROUGHOUT ITS SERVICE AREA. IN ADDITION TO OTHER APPROPRIATE EFFORTS TO INFORM THE COMMUNITY ABOUT THE POLICY IN A WAY TARGETED TO REACH COMMUNITY MEMBERS MOST LIKELY TO NEED FINANCIAL ASSISTANCE, THE FOLLOWING ACTIONS ARE TAKEN:A. WRITTEN NOTICE TO ALL PATIENTSEACH PATIENT WHO IS SEEN, WHETHER ADMITTED OR NOT, SHALL RECEIVE THE PLAIN LANGUAGE SUMMARY. THE NOTICE SHALL BE PROVIDED IN NON-ENGLISH LANGUAGES SPOKEN BY A SUBSTANTIAL NUMBER OF THE PATIENTS SERVED BY THE HOSPITAL.B. POSTING OF NOTICESTHE FINANCIAL ASSISTANCE POLICY SHALL BE CLEARLY AND CONSPICUOUSLY POSTED IN LOCATIONS THAT ARE VISIBLE TO THE PATIENTS IN THE FOLLOWING AREAS: (1) EMERGENCY DEPARTMENT; (2) BILLING OFFICE; (3) ADMISSIONS OFFICE; AND (4) OTHER OUTPATIENT SETTINGS. THE NOTICE SHALL BE PROVIDED IN NON-ENGLISH LANGUAGES SPOKEN BY A SUBSTANTIAL NUMBER OF THE PATIENTS SERVED BY THE HOSPITAL.C. NOTICE TO ACCOMPANY BILLING STATEMENTSEVERY POST DISCHARGE STATEMENT SHALL INCLUDE A COPY OF THE NOTICE. EACH BILL THAT IS SENT TO A PATIENT WHO HAS NOT PROVIDED PROOF OF COVERAGE BY A THIRD PARTY AT THE TIME CARE IS PROVIDED OR UPON DISCHARGE MUST INCLUDE A STATEMENT OF CHARGES FOR SERVICES RENDERED BY THE HOSPITAL. THESE NOTICES SHALL BE PROVIDED IN NON-ENGLISH LANGUAGES SPOKEN BY A SUBSTANTIAL NUMBER OF THE PATIENTS SERVED BY THE HOSPITAL.D. AVAILABILITY OF FINANCIAL ASSISTANCE DOCUMENTSTHE HOSPITAL SHALL POST A COPY OF THIS POLICY, THE PLAIN LANGUAGE SUMMARY AND THE FINANCIAL ASSISTANCE APPLICATION ON ITS WEBSITE AND MAKE ALL SUCH DOCUMENTS AVAILABLE FOR FREE DOWNLOAD. SUCH DOCUMENTS SHALL BE AVAILABLE IN THE EMERGENCY ROOM AND ADMISSIONS OFFICE AND BY MAIL UPON REQUEST. THE DOCUMENTS SHALL BE PROVIDED IN NON-ENGLISH LANGUAGES SPOKEN BY A SUBSTANTIAL NUMBER OF THE PATIENTS SERVED BY THE HOSPITAL.E. ACCESSIBILITY TO LIMITED ENGLISH PROFICIENT INDIVIDUALSTHE HOSPITAL SHALL MAKE TRANSLATIONS OF THIS POLICY, THE PLAIN LANGUAGE SUMMARY, AND THE FINANCIAL ASSISTANCE APPLICATION AVAILABLE IN ANY LANGUAGE THAT IS THE PRIMARY LANGUAGE OF THE LESSER OF ONE THOUSAND (1,000) INDIVIDUALS OR FIVE PERCENT (5%) OF THE POPULATION OF THE COMMUNITIES SERVED BY THE HOSPITAL. |
| PART VI, LINE 4: | COLUMBIANA COUNTY, OHIO COLUMBIANA COUNTY IS LOCATED IN NORTHEASTERN OHIO AND IS ONE OF OHIO'S 32 APPALACHIAN COUNTIES. IT IS BORDERED ON THE NORTH BY MAHONING COUNTY; ON THE EAST BY PENNSYLVANIA; ON THE SOUTH BY THE OHIO RIVER AND WEST VIRGINIA; AND ON THE WEST BY JEFFERSON, CARROLL AND STARK COUNTIES. OVER HALF OF THE COUNTY'S TOTAL POPULATION OF 105,686 LIVES IN UNINCORPORATED RURAL AREAS, WITH VILLAGES AND TOWNS SOME DISTANCE APART.THE COUNTY HAS TWO MAJOR GEOGRAPHIC CONCENTRATIONS OF DEVELOPMENT AND POPULATION. THE NORTHERN CORRIDOR BETWEEN THE CITIES OF SALEM AND EAST PALESTINE, (INCLUDING THE VILLAGES OF WASHINGTONVILLE, LEETONIA, COLUMBIANA AND NEW WATERFORD AND THE FOUR TOWNSHIPS OF PERRY, SALEM, FAIRFIELD AND UNITY); EXTEND ALONG A 20-MILE DISTANCE BORDERING MAHONING COUNTY TO THE NORTH, AND CONTAIN ALMOST 48% OF THE COUNTY'S POPULATION. THE SOUTHERN CORRIDOR EXTENDS FOR ABOUT 10 MILES FROM THE VILLAGE OF WELLSVILLE TO EAST LIVERPOOL, (INCLUDING ST. CLAIR TOWNSHIP) AND CONTAINS 11% OF THE COUNTY'S TOTAL POPULATION.EAST LIVERPOOL CITY HOSPITAL IS THE ONLY HOSPITAL WITHIN 20 MILES OF THE CITY. THE HOSPITAL SERVES PATIENTS WITHIN A 10 TO 15-MILE RADIUS INCLUDING PATIENTS FROM NEIGHBORING PENNSYLVANIA AND WEST VIRGINIA. MOST RESIDENTS HAVE LIVED HERE ALL THEIR LIVES AND THE COMMUNITY IS COMPRISED OF A SIGNIFICANT BIAS OF SENIOR CITIZENS. |
| PART VI, LINE 5: | EAST LIVERPOOL CITY HOSPITAL HAS AN OPEN MEDICAL STAFF, A COMMUNITY BOARD OF TRUSTEES AND IS EXTREMELY GENEROUS WITH FUNDING COMMUNITY CHARITIES AND DONATING EMPLOYEE TIME TO SERVE THE GENERAL POPULATION OF THE AREA SERVED. THIS INCLUDES PARTICIPATING IN COMMUNITY HEALTH FAIRS, SCHOOL PROGRAMS, AND FREE PUBLIC SPEAKING REGARDING TOPICS RECOGNIZED AS IMPLEMENTATION PRIORITIES IN THE 2019 CHNA. ELCH OFFERS FREE SMOKING CESSATION, DIABETES EDUCATION, AND HEALTH NUTRITION TO ALL COMMUNITY MEMBERS. |
| PART VI, LINE 6: | AFFILIATED HEALTH CARE SYSTEMCITY HOSPITAL ASSOCIATION IS A SUBSIDIARY OF PRIME HEALTHCARE FOUNDATION, INC. (PHF). PHF AND ITS SUBSIDIARIES ARE THEIR OWN HEALTH SYSTEM MANAGED BY PRIME HEALTHCARE MANAGEMENT, INC.PART VI, LINE 7STATE FILING OF COMMUNITY BENEFIT REPORTTHIS IS NOT APPLICABLE TO CITY HOSPITAL ASSOCIATION. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Travel For Companions | Yes (X) | TravelForCompanionsInd |
| Club Dues Or Fees | Yes (X) | ClubDuesOrFeesInd |
| Written Policy Ref T And E Expnss | Yes (1) | WrittenPolicyRefTAndEExpnssInd |
| Substantiation Required | Yes (1) | SubstantiationRequiredInd |
| 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 | Yes (1) | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (6 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| GRETCHEN NICKELL DO | ||||||||||||||
| DIRECTOR | $0 | $270,485 | $0 | $25,096 | $0 | $268,000 | $0 | $0 | $0 | $30,236 | $0 | $593,817 | $0 | $0 |
| KEITH RICHARDSON | ||||||||||||||
| CEO (REGIONAL) AND SECRETARY | $350,388 | $0 | $30,000 | $0 | $9,000 | $0 | $0 | $0 | $29,491 | $0 | $418,879 | $0 | $0 | $0 |
| JAYNE ROSE | ||||||||||||||
| C.N.O. | $166,060 | $0 | $5,000 | $0 | $0 | $0 | $0 | $0 | $20,838 | $0 | $191,898 | $0 | $0 | $0 |
| WILLIAM SMITH | ||||||||||||||
| DIRECTOR OF PHARMACY | $148,548 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $26,215 | $0 | $174,763 | $0 | $0 | $0 |
| MICHAEL DALEY | ||||||||||||||
| PHARMACIST | $126,051 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $26,037 | $0 | $152,088 | $0 | $0 | $0 |
| NICHOLAS PETRUSKA | ||||||||||||||
| PHARMACIST | $133,086 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $17,448 | $0 | $150,534 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 1A | CITY HOSPITAL ASSOCIATION ALLOWS COMPANION TRAVEL BY EXECUTIVES ONLY WHEN IT SERVCES A JUSTIFIED BUSINESS PURPOSE. IF IT IS LATER DETERMINED THAT THERE WAS NOT A JUSTIFIED BUSINESS PURPOSE, THIS WILL RESULT IN TAXABLE COMPENSATION TO THE EXECUTIVE IN QUESTION. CITY HOSPITAL ASSOCIATION PROVIDES A MEMBERSHIP TO AN AREA SOCIAL CLUB IN ORDER FOR EXECUTIVES TO CONDUCT HOSPITAL BUSINESS. ANY PERSONAL USE BY THE EXECUTIVES IS INCLUDED IN THAT EXECUTIVE'S TAXABLE WAGES. |
| PART I, LINE 3 | A RELATED ORGANIZATION USES THE FOLLOWING METHODS TO ESTABLISH COMPENSATION: WRITTEN EMPLOYMENT CONTRACT COMPENSATION SURVEY OR STUDY OFFICER COMPENSATION IS ESTABLISHED BY PRIME HEALTHCARE MANAGEMENT, INC. IN ACCORDANCE WITH A MANAGEMENT AGREEMENT. WRITTEN EMPLOYMENT CONTRACTS ARE FORWARDED TO THE FACILITY ONCE EXECUTED. COMPENSATION SURVEY OR STUDIES ARE UTILIZED. |
| FORM 990, PART III, SECTION J, LINE 7 | BONUS PAYMENTS ARE DISCRETIONARY IN NATURE |
Schedule L IRS990ScheduleL
Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp (3 entries)
| Relationship DescriptionRelationshipDescriptionTxt | TransactionTransactionAmt | TransactionTransactionDesc | Sharing Of RevenuesSharingOfRevenuesInd |
|---|---|---|---|
| PRIME HEALTHCARE MANAGEMENT INC | |||
| SEE PART V | $4,926,928 | MANAGEMENT FEE | Yes (1) |
| HOSPITAL BUSINESS SOLUTIONS INC | |||
| SEE PART V | $610,517 | BUSINESS OFFICE SERVICES | 0 |
| BIO-MED SERVICES INC | |||
| SEE PART V | $940,860 | BIO-MEDICAL SERVICES | 0 |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART IV, LINES (2) AND (3), COLUMN (B) | ENTITY IS OWNED BY DR. PREM REDDY, FOUNDER OF PRIME HEALTHCARE FOUNDATION AND A FORMER DIRECTOR AND OFFICER OF PRIME HEALTHCARE FOUNDATION WHO RESIGNED FROM SUCH POSITIONS ON JANUARY 29,2016, AND LATER RESIGNED FROM A NON-VOTING POSITION (CHAIR-EMERITUS) ON OCTOBER 27, 2016. ENTITY IS ALSO DIRECTLY OWNED BY DR. KAVITHA BHATIA, WHO HAS A FAMILY RELATIONSHIP WITH DR. PREM REDDY, SERVES AS PRESIDENT OF THE ORGANIZATION, AND SERVES AS PRESIDENT AND CHAIR OF THE BOARD OF PRIME HEALTHCARE FOUNDATION. |
| PART IV, LINES (1), COLUMN (B) | ENTITY IS INDIRECTLY OWNED BY DR. PREM REDDY, FOUNDER OF PRIME HEALTHCARE FOUNDATION AND A FORMER DIRECTOR AND OFFICER OF PRIME HEALTHCARE FOUNDATION WHO RESIGNED FROM SUCH POSITIONS ON JANUARY 29,2016, AND LATER RESIGNED FROM A NON-VOTING POSITION (CHAIR-EMERITUS) ON OCTOBER 27, 2016. ENTITY IS ALSO INDIRECTLY OWNED BY DR. KAVITHA BHATIA, WHO HAS A FAMILY RELATIONSHIP WITH DR. PREM REDDY, SERVES AS PRESIDENT OF THE ORGANIZATION, AND SERVES AS PRESIDENT AND CHAIR OF THE BOARD OF PRIME HEALTHCARE FOUNDATION. |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (10 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 3 | THE ORGANIZATION IS BEING MANAGED BY PRIME HEALTHCARE MANAGEMENT, INC., AN AFFILIATE OF PRIME HEALTHCARE FOUNDATION, INC. |
| FORM 990, PART VI, SECTION A, LINE 6 | PRIME HEALTHCARE FOUNDATION, INC. (PHF) IS THE SOLE CORPORATE CONTROLLING MEMBER. |
| FORM 990, PART VI, SECTION A, LINE 7A | PRIME HEALTHCARE FOUNDATION, INC. (PHF) HAS THE POWER TO APPOINT THE BOARD MEMBERS. |
| FORM 990, PART VI, SECTION A, LINE 7B | PRIME HEALTHCARE FOUNDATION, INC. (PHF), THE SOLE CORPORATE MEMBER, HOLDS CERTAIN RESERVED POWERS AS SET FORTH IN THE ARTICLES OF INCORPORATION. PHF HAS THE POWER TO APPOINT THE BOARD MEMBERS AND APPROVE ANY AMENDMENTS OF THE ORGANIZATION'S ARTICLES OR BYLAWS. |
| FORM 990, PART VI, SECTION B, LINE 11B | THE ORGANIZATION ENGAGES AN OUTSIDE ACCOUNTING FIRM TO PREPARE FORM 990. ONCE PREPARED, THE FORMS ARE REVIEWED BY THE ORGANIZATION'S CFO AND OUTSIDE COUNSEL PRIOR TO FILING AND THEN THE RETURNS ARE PROVIDED TO THE BOARD FOR THEIR REVIEW CONTEMPORANEOUSLY WITH THEIR FILING. |
| FORM 990, PART VI, SECTION B, LINE 12C | THE CONFLICT OF INTEREST POLICY IS MONITORED BY THE REVIEW OF QUESTIONNAIRES THAT OFFICERS, DIRECTORS, AND KEY EMPLOYEES COMPLETE ANNUALLY. |
| FORM 990, PART VI, SECTION B, LINE 15 | A RELATED ORGANIZATOIN USES THE FOLLOWING METHODS TO ESTABLISH COMPENSATION: WRITTEN EMPLOYMENT CONTRACT COMPENSATION SURVEY OR STUDY OFFICER COMPENSATION IS ESTABLISHED BY PRIME HEALTHCARE MANAGEMENT, INC. IN ACCORDANCE WITH A MANAGEMENT AGREEMENT. WRITTEN EMPLOYMENT CONTRACTS ARE FORWARDED TO THE FACILITY ONCE EXECUTED. COMPENSATION SURVEY OR STUDIES ARE UTILIZED. |
| FORM 990, PART VI, SECTION C, LINE 19 | THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE MADE AVAILABLE TO THE PUBLIC UPON REQUEST. |
| FORM 990, PT VI LINE 3 & 15; PT VII, SEC B; SCH J, PART III; SCH L, PART IV | DURING 2020, THE ORGANIZATION'S MANAGEMENT COMPANY, PRIME HEALTHCARE MANAGEMENT II, INC., MERGED WITH PRIME HEALTHCARE MANAGEMENT, INC. THE ORGANIZATION'S DISCLOSURES AND REPORTING IN THE FORM 990 HAVE BEEN UPDATED TO REFLECT THE SUCCESSOR MANAGEMENT COMPANY'S NAME, WHERE APPLICABLE. |
| FORM 990, PART IX, LINE 11G | MEDICAL PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 1,184,227. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,184,227. OTHER PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 5,356,486. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 5,356,486. OTHER PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 3,192,352. MANAGEMENT AND GENERAL EXPENSES 706,361. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,898,713. COLLECTION FEES: PROGRAM SERVICE EXPENSES 258,278. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 258,278. MEDICAL DIRECTOR FEES: PROGRAM SERVICE EXPENSES 288,333. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 288,333. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (9 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Direct Controlling NADirectControllingNACd | Controlled OrganizationControlledOrganizationInd | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt |
|---|---|---|---|---|---|---|---|---|---|---|---|
| PRIME HEALTHCARE FOUNDATION INC | |||||||||||
| 3480 EAST GUASTI ROAD | ONTARIO | CA | 91761 | 208065139 | HOSPITAL/MGMT | DE | 501(C)(3) | LINE 3 | N/A | 0 | |
| OHIO VALLEY HOME HEALTH SERVICES | |||||||||||
| 425 WEST FIFTH STREET | EAST LIVERPOOL | OH | 43920 | 341014198 | HEALTHCARE | OH | 501(C)(3) | LINE 10 | 0 | PHF-EAST LIV | |
| KNAPP MEDICAL CENTER | |||||||||||
| 1401 E 8TH STREET-PO BOX 1110 | WESLACO | TX | 78596 | 741393060 | HOSPITAL | TX | 501(C)(3) | LINE 3 | 0 | PHF | |
| MID-VALLEY PHYSICIANS ASSOCIATION | |||||||||||
| 1401 E 8TH STREET | WESLACO | TX | 78596 | 742755150 | SUPPORT | TX | 501(C)(3) | LINE 12A, I | 0 | KMC | |
| KNAPP MEDICAL GROUP | |||||||||||
| 1401 E 8TH STREET | WESLACO | TX | 78596 | 271619835 | HEALTHCARE | TX | 501(C)(3) | LINE 3 | 0 | KMC | |
| CALIFORNIA UNIVERSITY OF SCIENCE AND MEDICINE | |||||||||||
| 3300 E GUASTI ROAD SUITE 300 | ONTARIO | CA | 91761 | 464141445 | EDUCATION | CA | 501(C)(3) | LINE 2 | 0 | PHF | |
| MISSION HOSPITAL INC | |||||||||||
| 900 SOUTH BRYAN ROAD | MISSION | TX | 78572 | 742206635 | HOSPITAL | TX | 501(C)(3) | LINE 3 | 0 | PHF-MISSION | |
| MISSION HOSPITAL FOUNDATION | |||||||||||
| 900 SOUTH BRYAN ROAD | MISSION | TX | 78572 | 542076455 | SUPPORT | TX | 501(C)(3) | LINE 12A, I | 0 | MISSION HOSP | |
| MISSION DOCTORS GROUP | |||||||||||
| 906 SOUTH BRYAN ROAD SUITE 209 | MISSION | TX | 78572 | 742798500 | HEALTHCARE | TX | 501(C)(3) | LINE 3 | 0 | MISSION HOSP | |
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (3 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Direct Controlling NADirectControllingNACd | Entity TypeEntityTypeTxt | Controlled OrganizationControlledOrganizationInd |
|---|---|---|---|---|---|---|---|---|---|
| SIGNATURE PAMPA MEDICAL GROUP | |||||||||
| ONE MEDICAL PLAZA | PAMPA | TX | 79065 | 800458752 | PHYSICIAN SERVICES | TX | N/A | C | 0 |
| LANDMARK PHYSICIAN SERVICES | |||||||||
| 115 CASS AVE | WOONSOCKET | RI | 02895 | 205025078 | PHYSICIAN SERVICES | DE | N/A | C | 0 |
| LANDMARK PHYSICIAN ASSOCIATES PC | |||||||||
| 115 CASS AVE | WOONSOCKET | RI | 02895 | 050473637 | INACTIVE | DE | N/A | C | 0 |
| 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 | 0 | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | Yes (1) | 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 |