HOLZER SENIOR CARE CENTER: Form 990, tax year 2019
View the entire original 990 at ProPublica ↗
- Organization
- HOLZER SENIOR CARE CENTER (EIN 31-1534051)
- Tax period
- 2019-07-01 to 2020-06-30
- Filed
- 2021-05-17
- IRS object ID
- 202131379349301698
- Schema version
- 2019v5.2
- 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 | 2021-05-17T09:49:48-05:00 | ReturnTs |
| Tax Period End | 2020-06-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 381357951 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | PLANTE & MORAN PLLC | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 250 S HIGH STREET SUITE 100 | AddressLine1Txt |
| City | COLUMBUS | CityNm |
| State Abbreviation | OH | StateAbbreviationCd |
| ZIP | 43215 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2019-07-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 311534051 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | HOLZER SENIOR CARE CENTER | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | HOLZ | BusinessNameControlTxt |
| Phone | 7404465195 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 380 COLONIAL DRIVE | AddressLine1Txt |
| City | BIDWELL | CityNm |
| State Abbreviation | OH | StateAbbreviationCd |
| ZIP | 45614 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | MICHAEL HAYNES | PersonNm |
| Person Title | CFO | PersonTitleTxt |
| Phone | 7404465195 | PhoneNum |
| Signature | 2021-05-12 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | AMY CIMINELLO | PreparerPersonNm |
| PTIN | P00796388 | PTIN |
| Phone | 6148493000 | PhoneNum |
| Preparation | 2021-05-07 | PreparationDt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2019 | 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 | SEE SCHEDULE O | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | MICHAEL CANADY | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 100 JACKSON PIKE | AddressLine1Txt |
| City | GALLIPOLIS | CityNm |
| State Abbreviation | OH | StateAbbreviationCd |
| ZIP | 45631 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $10,746,831 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.HOLZER.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1996 | FormationYr |
| Legal Domicile State | OH | LegalDomicileStateCd |
| Activity Or Mission | HOLZER SENIOR CARE CENTER IS A SKILLED NURSING FACILITY FOR THE CARE AND TREATMENT OF THE SICK, DISABLED, AND INJURED, PROVIDING CARING AND QUALITY SERVICES TOWARD THE ENHANCEMENT OF PHYSICAL AND MENTAL WELL-BEING WITHOUT REGARD TO THE PERSON'S FINANCIAL RESOURCES. | ActivityOrMissionDesc |
| Voting Members Governing Body | 16 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 0 | VotingMembersIndependentCnt |
| Total Employee | 262 | TotalEmployeeCnt |
| Total Volunteers | 0 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $0 | PYContributionsGrantsAmt |
| CY Contributions Grants | $0 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $9,058,517 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $10,347,408 | CYProgramServiceRevenueAmt |
| PY Investment Income | $885 | PYInvestmentIncomeAmt |
| CY Investment Income | $719 | CYInvestmentIncomeAmt |
| PY Other Revenue | $117,434 | PYOtherRevenueAmt |
| CY Other Revenue | $398,704 | CYOtherRevenueAmt |
| PY Total Revenue | $9,176,836 | PYTotalRevenueAmt |
| CY Total Revenue | $10,746,831 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $5,794,463 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $5,748,945 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $4,549,383 | PYOtherExpensesAmt |
| CY Other Expenses | $4,692,606 | CYOtherExpensesAmt |
| PY Total Expenses | $10,343,846 | PYTotalExpensesAmt |
| CY Total Expenses | $10,441,551 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$1,167,010 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $305,280 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $15,076,953 | TotalAssetsBOYAmt |
| Total Assets EOY | $14,674,145 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $8,460,298 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $7,752,210 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $6,616,655 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $6,921,935 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | FRIENDLY VISITS, EXCELLENT CARE; EVERY PATIENT, EVERY TIME. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $8,450,153 | ExpenseAmt |
| Grant | $0 | GrantAmt |
| Revenue | $10,628,645 | RevenueAmt |
| Desc | HOLZER SENIOR CARE CENTER IS A SEVENTY (70) BED FACILITY, GUIDED BY THE VISION OF QUALITY CARE AND OPTIMUM OUTCOME. IT IS COMMITTED TO IDENTIFY, UNDERSTAND AND RESPOND TO THE NEEDS OF THE RESIDENTS. HOLZER SENIOR CARE CENTER OFFERS:* A MEDICAL DIRECTOR* SKILLED NURSING CARE 24 HOURS PER DAY* REHABILITATION THERAPIES INCLUDING: PHYSICAL THERAPIES, OCCUPATIONAL THERAPIES, SPEECH THERAPY* SHORT AND LONG TERM PLACEMENT OF RESIDENTS* SOCIAL AND THERAPEUTIC ACTIVITIES* PROGRAM FOR HOSPICE PATIENTS* CHAPLAINCY SERVICES* DIETARY SERVICES WITH A QUALIFIED DIETITIAN* PERSONAL CARE (BEAUTICIAN & BARBER SERVICES)* ALL INCLUSIVE ROOM RATE* CABLE TVMEDICAL SUPPORT: HOLZER SENIOR CARE CENTER IS UNDER THE DIRECT SUPERVISION OF A MEDICAL DIRECTOR, WHO HELPS PROVIDE THE LATEST IN HIGH ACUITY CARE. RESIDENTS OF HOLZER SENIOR CARE CENTER MAY USE THE SERVICES OF THE CENTER'S MEDICAL DIRECTOR, OR CONTINUE UNDER THE DIRECT CARE OF THEIR OWN PHYSICIAN. A TRAINED STAFF, COMMITTED TO THE HIGHEST STANDARD IN CARING FOR THE RESIDENTS OF HOLZER SENIOR CARE CENTER IS ON DUTY TWENTY FOUR HOURS A DAY, EVERY DAY.REHABILITATION SERVICES: A COMPLETE RANGE OF REHABILITATION SERVICES IS OFFERED AT HOLZER SENIOR CARE CENTER, CONDUCTED BY REGISTERED THERAPISTS. PHYSICAL, OCCUPATIONAL, AND SPEECH THERAPIES ARE AVAILABLE TO PROVIDE THE MOST THOROUGH REHABILITATION CARE TO RESIDENTS. A RESTORATIVE NURSING CARE PROGRAM IS AN ONGOING SERVICE TO THE CENTER RESIDENTS. THE WIDE RANGE OF SPECIALIZED THERAPY PROGRAMS ENABLES MANY RESIDENTS TO RESUME THEIR FORMER LIFESTYLES AS THEY BECOME MORE INDEPENDENT.NUTRITIONAL SERVICES: RESIDENTS AT HOLZER SENIOR CARE CENTER ENJOY NUTRITIONAL AND APPETIZING MEALS IN A COMFORTABLE AND ATTRACTIVE DINING SETTING. A REGISTERED DIETITIAN WHO SPECIALIZES IN MEETING EACH RESIDENT'S NEEDS PLANS THE MENUS. BED SIDE SERVICE IS AVAILABLE FOR THOSE RESIDENTS WHO ARE UNABLE TO GO TO THE DINING ROOM FOR THEIR MEALS. FAMILY AND FRIENDS WHO WISH TO DINE WITH THEIR LOVED ONES MAY ALSO PURCHASE A MEAL FOR A NOMINAL FEE.SOCIAL AND RECREATIONAL ACTIVITIES: THE OVERALL ACTIVITY PROGRAM AT HOLZER SENIOR CARE CENTER IS THERAPEUTICALLY DESIGNED BY A QUALIFIED AND EXPERIENCED ACTIVITIES COORDINATOR, WHO GIVES SPECIAL ATTENTION TO THE PHYSICAL, MENTAL, SPIRITUAL, AND SOCIAL NEEDS OF EACH RESIDENT. THERE IS SOMETHING FOR EVERYONE. AMONG THE MOST POPULAR EVENTS ARE THE GAMES, CRAFTS, SING-ALONGS, RELIGIOUS SERVICES, PICNICS, AND COMMUNITY OUTINGS. EACH RESIDENT IS ENCOURAGED TO PARTICIPATE IN WHATEVER ACTIVITIES PROVIDE THE MOST FULFILLMENT AND BEST SERVES HIS OR HER PERSONAL NEEDS.ACCOMMODATIONS: A COMFORTABLE HOME-LIKE SETTING CAN PLAY A MAJOR ROLE IN RESTORING HEALTH AND WELL-BEING. THE ROOMS AT HOLZER SENIOR CARE CENTER ARE SPACIOUS AND SUNNY WITH WINDOWS THAT BRING IN AN ABUNDANCE OF NATURAL LIGHT. RESIDENTS ARE ENCOURAGED TO DECORATE THEIR ROOMS WITH FAVORITE PERSONAL BELONGINGS, SUCH AS QUILTS, PILLOWS, AND PICTURES. THE ROOM RATE AT HOLZER SENIOR CARE CENTER IS AN ALL-INCLUSIVE RATE. NO ADDITIONAL CHARGES ARE MADE FOR PERSONAL GROOMING ITEMS OR LAUNDRY SERVICES. THE ATTRACTIVE SOLARIUM AREAS ARE ALWAYS AVAILABLE FOR THE ENJOYMENT OF THE RESIDENTS, THEIR FAMILIES AND FRIENDS. QUALITY OF LIFE: EVERY MEMBER OF THE STAFF AT HOLZER SENIOR CARE CENTER IS COMMITTED TO ADDRESSING AND MEETING THE NEEDS OF EACH RESIDENT ON A PERSONAL BASIS. THEY RESPECT EVERY RESIDENT'S RIGHT TO PRIVACY, DIGNITY AND TREATMENT AS AN INDIVIDUAL.DURING THE YEAR, HOLZER SENIOR CARE SERVED 146 PATIENTS FOR 23,041 RESIDENT DAYS AND ASSISTED LIVING SERVED 112 PATIENTS FOR 32,120 RESIDENT DAYS. | Desc |
| Total Program Service Expenses | $8,450,153 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | 0 | 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 | Yes (1) | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | 0 | 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 | 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 | 0 | BusinessRlnWith35CtrlEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | Yes (1) | 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 | 2 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 262 | 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 | 16 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 0 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (1) | MembersOrStockholdersInd |
| Election Of Board Members | 0 | 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 | 0 | CompensationProcessCEOInd |
| Compensation Process Other | 0 | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | WILLIAM CRABTREE | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 7402880192 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 190 WATER ST SUITE 4 | AddressLine1Txt |
| City | JACKSON | CityNm |
| State Abbreviation | OH | StateAbbreviationCd |
| ZIP | 45640 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (18 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | OfficerOfficerInd |
|---|---|---|---|---|---|---|---|
| DR PHIL LONG | |||||||
| TRUSTEE | 1.00 | 49.00 | Yes (X) | $0 | $734,673 | $0 | |
| DR MICHAEL CANADY | |||||||
| CEO - HHS | 1.00 | 49.00 | $0 | $648,610 | $0 | Yes (X) | |
| DR RODNEY STOUT | |||||||
| TRUSTEE | 1.00 | 49.00 | Yes (X) | $0 | $454,546 | $0 | |
| BRENT SAUNDERS | |||||||
| CHAIRMAN HHS | 1.00 | 49.00 | Yes (X) | $0 | $446,228 | $1,719 | Yes (X) |
| MICHAEL HAYNES | |||||||
| CFO - HHS | 1.00 | 49.00 | $0 | $374,000 | $0 | Yes (X) | |
| DR DANIELLE CAPPELLETTI | |||||||
| TRUSTEE | 1.00 | 49.00 | Yes (X) | $0 | $354,778 | $0 | |
| DR LANCE BROY | |||||||
| TRUSTEE | 1.00 | 49.00 | Yes (X) | $0 | $341,356 | $0 | |
| DR JARED SHEETS | |||||||
| TRUSTEE | 1.00 | 49.00 | Yes (X) | $0 | $304,622 | $0 | |
| DR RENUKA KANDULA | |||||||
| TRUSTEE | 1.00 | 49.00 | Yes (X) | $0 | $265,971 | $0 | |
| STEVE CHAPMAN | |||||||
| TRUSTEE | 1.00 | 3.00 | Yes (X) | $0 | $24,000 | $0 | |
| LARRY KIDD | |||||||
| TREASURER | 1.00 | 3.00 | Yes (X) | $0 | $24,000 | $0 | Yes (X) |
| DANNY HOLSCHUH | |||||||
| TRUSTEE | 1.00 | 3.00 | Yes (X) | $0 | $24,000 | $0 | |
| GARY ROACH | |||||||
| TRUSTEE | 1.00 | 3.00 | Yes (X) | $0 | $24,000 | $0 | |
| PAUL REED | |||||||
| TRUSTEE | 1.00 | 3.00 | Yes (X) | $0 | $24,000 | $0 | |
| BOB GRILLO | |||||||
| TRUSTEE | 1.00 | 3.00 | Yes (X) | $0 | $24,000 | $0 | |
| BRAD MUNN | |||||||
| TRUSTEE | 1.00 | 3.00 | Yes (X) | $0 | $24,000 | $0 | |
| ROBBIE PUGH | |||||||
| TRUSTEE | 1.00 | 1.00 | Yes (X) | $0 | $24,000 | $0 | |
| TOM WISEMAN | |||||||
| TRUSTEE | 1.00 | 3.00 | Yes (X) | $0 | $24,000 | $0 | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $0 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $4,140,784 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $1,719 | 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 (3 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| RELIANT REHABILITATION | |||||
| PO BOX 207773 | DALLAS | TX | 75320 | CONTRACT THERAPY | $845,499 |
| SKILLED CARE PHARMACY | |||||
| 6175 HI-TEK COURT | MASON | OH | 45040 | PHARMACY SERVICES | $225,062 |
| SHIFTWISE INC | |||||
| 200 SW MARKET ST SUITE 700 | PORTLAND | OR | 97201 | MEDICAL STAFFING | $121,004 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 3 | CntrctRcvdGreaterThan100KCnt |
Program Service Revenue ProgramServiceRevenueGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| PROGRAM SERVICES | 623000 | $9,545,768 | $9,545,768 |
| RESIDENT MEALS | 623000 | $763,140 | $763,140 |
| ADMISSION FEES | 623000 | $38,500 | $38,500 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $10,347,408 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $719 | TotalRevenueColumnAmt |
| Exclusion | $719 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt | ExclusionExclusionAmt |
|---|---|---|---|---|
| COVID RELIEF FUNDS | 623000 | $281,237 | $281,237 | |
| PHONE INCOME | 623000 | $57,478 | $57,478 | |
| CABLE TV INCOME | 623000 | $51,851 | $51,851 |
Miscellaneous Revenue MiscellaneousRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $8,138 | TotalRevenueColumnAmt |
| Exclusion | $8,138 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $398,704 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $10,746,831 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $10,628,645 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $118,186 | ExclusionAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,038,062 | TotalAmt |
| Program Services | $3,607,420 | ProgramServicesAmt |
| Management And General | $430,642 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,529,681 | TotalAmt |
| Program Services | $1,383,704 | ProgramServicesAmt |
| Management And General | $145,977 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $181,202 | TotalAmt |
| Program Services | $170,269 | ProgramServicesAmt |
| Management And General | $10,933 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,016,104 | TotalAmt |
| Program Services | $399,676 | ProgramServicesAmt |
| Management And General | $616,428 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $199,651 | TotalAmt |
| Program Services | $183,191 | ProgramServicesAmt |
| Management And General | $16,460 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $316,083 | TotalAmt |
| Program Services | $296,665 | ProgramServicesAmt |
| Management And General | $19,418 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $198,665 | TotalAmt |
| Program Services | $188,732 | ProgramServicesAmt |
| Management And General | $9,933 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $461,691 | TotalAmt |
| Program Services | $438,606 | ProgramServicesAmt |
| Management And General | $23,085 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| THERAPY | $834,120 | $834,120 | |
| FOOD | $381,492 | $358,669 | $22,823 |
| MEDICAL SUPPLIES | $361,518 | $361,518 | $0 |
| FRANCHISE TAX/PROPERTY | $360,319 | $4,367 | $355,952 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $562,963 | TotalAmt |
| Program Services | $223,216 | ProgramServicesAmt |
| Management And General | $339,747 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $10,441,551 | TotalAmt |
| Program Services | $8,450,153 | ProgramServicesAmt |
| Management And General | $1,991,398 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,950 | BOYAmt |
| EOY | $2,089 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $678,173 | BOYAmt |
| EOY | $1,230,489 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,131,204 | BOYAmt |
| EOY | $983,043 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $10,000 | BOYAmt |
| EOY | $10,000 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $366,836 | BOYAmt |
| EOY | $109,495 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $15,705,245 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $9,086,265 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,025,559 | BOYAmt |
| EOY | $6,618,980 | EOYAmt |
Investments Program Related InvestmentsProgramRelatedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $246,973 | BOYAmt |
| EOY | $167,567 | EOYAmt |
Intangible Assets IntangibleAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,432,080 | BOYAmt |
| EOY | $4,432,080 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,184,178 | BOYAmt |
| EOY | $1,120,402 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $15,076,953 | BOYAmt |
| EOY | $14,674,145 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,756,363 | BOYAmt |
| EOY | $3,108,745 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $99,674 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,813,684 | BOYAmt |
| EOY | $3,304,678 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,890,251 | BOYAmt |
| EOY | $1,239,113 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $8,460,298 | BOYAmt |
| EOY | $7,752,210 | 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 | $6,616,655 | BOYAmt |
| EOY | $6,921,935 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,616,655 | BOYAmt |
| EOY | $6,921,935 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $15,076,953 | BOYAmt |
| EOY | $14,674,145 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $305,280 | 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 | 0 | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Publicly Supported Org509a2 | Yes (X) | PubliclySupportedOrg509a2Ind |
Gross Receipts Admissions GrossReceiptsAdmissionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $9,356,648 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $9,114,039 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $9,678,049 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $9,058,517 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $10,628,645 | CurrentTaxYearAmt |
| Total | $47,835,898 | TotalAmt |
Total509 Total509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $9,356,648 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $9,114,039 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $9,678,049 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $9,058,517 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $10,628,645 | CurrentTaxYearAmt |
| Total | $47,835,898 | TotalAmt |
Amounts Rcvd Dsqlfy Person AmountsRcvdDsqlfyPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Substantial Contributors Amt SubstantialContributorsAmtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Subst And Dsqlfy Prsns Tot SubstAndDsqlfyPrsnsTotGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support Total509 | $47,835,898 | PublicSupportTotal509Amt |
Gross Investment Income509 GrossInvestmentIncome509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $790 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $788 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $780 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $885 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $719 | CurrentTaxYearAmt |
| Total | $3,962 | TotalAmt |
Investment Income And UBTI InvestmentIncomeAndUBTIGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $790 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $788 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $780 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $885 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $719 | CurrentTaxYearAmt |
| Total | $3,962 | TotalAmt |
Other Income509 OtherIncome509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $125,836 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $124,969 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $131,851 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $117,434 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $117,467 | CurrentTaxYearAmt |
| Total | $617,557 | TotalAmt |
Total Support Calendar Year TotalSupportCalendarYearGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $9,483,274 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $9,239,796 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $9,810,680 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $9,176,836 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $10,746,831 | CurrentTaxYearAmt |
| Total | $48,457,417 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support CY509 | 0.98720 | PublicSupportCY509Pct |
| Public Support PY509 | 0.98640 | PublicSupportPY509Pct |
| Investment Income CY | 0.00010 | InvestmentIncomeCYPct |
| Investment Income PY | 0.00010 | InvestmentIncomePYPct |
| Thirty Thr Pct Suprt Tests CY509 | Yes (X) | ThirtyThrPctSuprtTestsCY509Ind |
Schedule D IRS990ScheduleD
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $542,107 | OtherCostOrOtherBasisAmt |
| Book Value | $542,107 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $11,631,828 | OtherCostOrOtherBasisAmt |
| Depreciation | $7,163,352 | DepreciationAmt |
| Book Value | $4,468,476 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $2,687,369 | OtherCostOrOtherBasisAmt |
| Depreciation | $1,794,713 | DepreciationAmt |
| Book Value | $892,656 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $843,941 | OtherCostOrOtherBasisAmt |
| Depreciation | $128,200 | DepreciationAmt |
| Book Value | $715,741 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $6,618,980 | TotalBookValueLandBuildingsAmt |
Other Assets Org OtherAssetsOrgGrp (3 entries)
| DescDesc | Book ValueBookValueAmt |
|---|---|
| INTERCOMPANY RECEIVABLE | $797,136 |
| ASSETS LIMITED AS TO USE | $322,266 |
| DEPOSITS | $1,000 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $1,120,402 | TotalBookValueOtherAssetsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | INTERCOMPANY PAYABLE | Desc |
| Amt | $1,239,113 | Amt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $1,239,113 | TotalLiabilityAmt |
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 (9 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| DR PHIL LONG | ||||||||||||||
| TRUSTEE | $0 | $734,673 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $734,673 | $0 | $0 |
| DR MICHAEL CANADY | ||||||||||||||
| CEO - HHS | $0 | $590,145 | $0 | $58,465 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $648,610 | $0 | $0 |
| DR RODNEY STOUT | ||||||||||||||
| TRUSTEE | $0 | $420,246 | $0 | $34,300 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $454,546 | $0 | $0 |
| BRENT SAUNDERS | ||||||||||||||
| CHAIRMAN HHS | $0 | $405,662 | $0 | $40,566 | $0 | $0 | $0 | $0 | $0 | $1,719 | $0 | $447,947 | $0 | $0 |
| MICHAEL HAYNES | ||||||||||||||
| CFO - HHS | $0 | $340,000 | $0 | $34,000 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $374,000 | $0 | $0 |
| DR DANIELLE CAPPELLETTI | ||||||||||||||
| TRUSTEE | $0 | $354,778 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $354,778 | $0 | $0 |
| DR LANCE BROY | ||||||||||||||
| TRUSTEE | $0 | $341,356 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $341,356 | $0 | $0 |
| DR JARED SHEETS | ||||||||||||||
| TRUSTEE | $0 | $304,622 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $304,622 | $0 | $0 |
| DR RENUKA KANDULA | ||||||||||||||
| TRUSTEE | $0 | $265,971 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $265,971 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART I, LINE 3 | FormAndLineReferenceDesc |
| Explanation | COMPENSATION PAID TO THE ORGANIZATION'S CEO IS ESTABLISHED BY A RELATED ORGANIZATION, HOLZER HEALTH SYSTEM, AND INCLUDES USE OF AN INDEPENDENT COMPENSATION CONSULTANT AND APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE. | ExplanationTxt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (8 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 6 | HOLZER HEALTH SYSTEM IS THE SOLE MEMBER OF THE ORGANIZATION. |
| FORM 990, PART VI, SECTION A, LINE 7B | HOLZER SENIOR CARE CENTER'S DECISIONS THAT ARE MADE BY THEIR BOARD OF DIRECTORS CAN BE OVERRULED BY HOLZER HEALTH SYSTEM'S BOARD OF DIRECTORS. |
| FORM 990, PART VI, SECTION B, LINE 11B | THE CONTROLLER AND THE CFO OF HOLZER HEALTH SYSTEM REVIEW FORM 990. A COPY WILL BE PROVIDED TO ALL BOARD MEMBERS PRIOR TO FILING. |
| FORM 990, PART VI, SECTION B, LINE 12C | CONFLICT OF INTEREST STATEMENTS ARE COMPLETED ANNUALLY AND ARE REVIEWED BY THE CONFLICT OF INTEREST REVIEW COMMITTEE. MEMBERS OF THE BOARD ARE AWARE THAT THEY SHOULD DISCLOSE CONFLICTS WHEN THEY ARISE, AND MEMBERS ABSTAIN FROM PARTICIPATING IN DISCUSSIONS OR VOTING ON MATTERS WHERE A CONFLICT IS PRESENT. |
| FORM 990, PART VI, SECTION B, LINE 15 | THE HOLZER HEALTH SYSTEM BOARD APPROVES COMPENSATION OF THE CEO AND OTHER OFFICERS. THE BOARD UTILIZES WAGE RECOMMENDATIONS FROM AN UNRELATED CONSULTANT TO DETERMINE THE COMPENSATION. THE CEO MAY BE INVOLVED IN DETERMINING OTHER OFFICERS' COMPENSATION, HOWEVER THE ULTIMATE DECISION RESTS WITH THE BOARD. THE PROCESS WAS LAST UNDERTAKEN DURING 2019 AS THERE WERE NO EXECUTIVE COMPENSATION CHANGES NECESSARY IN 2020. |
| FORM 990, PART VI, SECTION C, LINE 19 | GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST. |
| FORM 990, PART XI, LINE 2C: | THE AUDIT OVERSIGHT PROCESS AND THE PROCESS OF SELECTION OF AN INDEPENDENT ACCOUNTANT HAVE NOT CHANGED FROM THE PRIOR YEAR. |
| FORM 990, PAGE 1, LINE C: | DOING BUSINESS AS: HOLZER ASSISTED LIVING - GALLIPOLIS HOLZER ASSISTED LIVING - JACKSON |
Schedule R IRS990ScheduleR
Id Disregarded Entities IdDisregardedEntitiesGrp (2 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Total IncomeTotalIncomeAmt | End Of Year AssetsEndOfYearAssetsAmt | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt |
|---|---|---|---|---|---|---|---|---|---|
| HOLZER ASSISTED LIVING - GALLIPOLIS | |||||||||
| 300 BRIARWOOD DR | GALLIPOLIS | OH | 45631 | 311534051 | ASSISTED LIVING | OH | $2,356,690 | $5,691,289 | HOLZER SENIOR CARE CENTER |
| HOLZER ASSISTED LIVING - JACKSON | |||||||||
| 101 MARKHAM DRIVE | JACKSON | OH | 45640 | 311534051 | ASSISTED LIVING | OH | $1,974,840 | $4,409,320 | HOLZER SENIOR CARE CENTER |
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (4 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|
| HOLZER HEALTH SYSTEM | |||||||||||
| 100 JACKSON PIKE | GALLIPOLIS | OH | 45631 | 311156690 | MANAGEMENT SERVICES | OH | 501(C)(3) | LINE 12A, I | N/A | 0 | |
| HOLZER HOSPITAL FOUNDATION | |||||||||||
| 100 JACKSON PIKE | GALLIPOLIS | OH | 45631 | 314379491 | HEALTH CARE | OH | 501(C)(3) | LINE 3 | Yes (1) | HOLZER HEALTH SYSTEM | |
| HOLZER MEDICAL CENTER - JACKSON | |||||||||||
| 100 JACKSON PIKE | GALLIPOLIS | OH | 45631 | 311724085 | HEALTH CARE | OH | 501(C)(3) | LINE 3 | Yes (1) | HOLZER HEALTH SYSTEM | |
| HOLZER HERITAGE FOUNDATION | |||||||||||
| 100 JACKSON PIKE | GALLIPOLIS | OH | 45631 | 310927482 | CONTINUING ADVANCEMENT OF HEALTH AND MEDICAL CARE | OH | 501(C)(3) | LINE 10 | Yes (1) | HOLZER HEALTH SYSTEM | |
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp
Related Organization Name RelatedOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | HOLZER VANGUARD INC | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 100 JACKSON PIKE | AddressLine1Txt |
| City | GALLIPOLIS | CityNm |
| State Abbreviation | OH | StateAbbreviationCd |
| ZIP | 45631 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 311192567 | EIN |
| Primary Activities | STOCK HOLDING COMPANY | PrimaryActivitiesTxt |
| Legal Domicile State | OH | LegalDomicileStateCd |
| Direct Controlling NA | N/A | DirectControllingNACd |
| Entity Type | C | EntityTypeTxt |
| Controlled Organization | Yes (1) | ControlledOrganizationInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | 0 | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | 0 | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | 0 | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | 0 | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | Yes (1) | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | 0 | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | 0 | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | 0 | 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 |