2021-05-17T09:55:18-05:00 2020-06-30 381357951 PLANTE & MORAN PLLC 250 S HIGH ST SUITE 100 COLUMBUS OH 43215 990 2019-07-01 311156690 HOLZER HEALTH SYSTEM HOLZ 7404465060 100 JACKSON PIKE GALLIPOLIS OH 45631 MICHAEL HAYNES CFO 7404465060 2021-05-12 1 AMY CIMINELLO P00796388 6148493000 2021-05-07 2019 2022-09-23 18:48:47Z MICHAEL CANADY 100 JACKSON PIKE GALLIPOLIS OH 45631 120650027 0 X WWW.HOLZER.ORG X 1985 OH THE PRIMARY EXEMPT PURPOSE OF HOLZER HEALTH SYSTEM IS TO ACT AS THE MANAGING PARENT, SOLE VOTING MEMBER OF THE FOLLOWING 501(C)(3) ENTITIES, WHOSE PRIMARY PURPOSES ARE TO MEET THE HEALTHCARE NEEDS OF THEIR COMMUNITIES: HOLZER HOSPITAL FOUNDATION, HOLZER MEDICAL CENTER-JACKSON, HOLZER SENIOR CARE CENTER, HOLZER ASSISTED LIVING-GALLIPOLIS, HOLZER ASSISTED LIVING-JACKSON, HOLZER FOUNDATION AND HOLZER VANGUARD, A FOR-PROFIT SUBSIDIARY (COLLECTIVELY REFERRED TO AS CONSOLIDATED). 22 0 795 101 0 0 0 25 126670705 120029090 -16331 190141 17325 26167 126671699 120245423 0 0 0 0 90054684 89059468 0 0 1160 72531326 70606405 162586010 159665873 -35914311 -39420450 170186750 165436816 159131290 158053155 11055460 7383661 FRIENDLY VISITS, EXCELLENT CARE; EVERY PATIENT, EVERY TIME. 0 0 7292927 0 3510597 HOLZER HEALTH SYSTEM PROVIDED MANAGEMENT SERVICES/REAL ESTATE TO ITS SUBSIDIARIES WHOSE EXEMPT PURPOSES ARE TO MEET THE HEALTHCARE NEEDS OF THEIR COMMUNITIES. 833920 0 724578 HOLZER DENTAL CLINIC-JACKSON STRIVES TO IMPROVE THE DENTAL HEALTH STATUS OF THE PEOPLE AND COMMUNITIES WE SERVE. 90667592 0 115793915 HOLZER CLINIC, LLC IS A MULTIPLE DISCIPLINE HEALTH CARE SYSTEM OF OVER 160 PROVIDERS PROVIDING CARE IN MORE THAN THIRTY-FOUR AREAS OF EXPERTISE. 98794439 1 0 0 1 0 0 0 0 0 0 1 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 0 0 1 78 0 1 795 1 0 0 0 0 0 0 0 0 0 0 0 0 X 22 0 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X MICHAEL HAYNES CFO 7404465060 100 JACKSON PIKE GALLIPOLIS OH 45631 DR STEVEN CONLEY PHYSICIAN 50.00 0.00 X 1225063 0 0 DEAN SICILIANO PHYSICIAN 50.00 0.00 X 1070025 0 0 NIRAV PAREKH PHYSICIAN 50.00 0.00 X 978688 0 0 DR ROBERT BRADLEY PHYSICIAN 50.00 0.00 X 883433 0 0 SANTPAL MAVI PHYSICIAN 50.00 0.00 X 832032 0 0 DR PHIL LONG TRUSTEE 49.00 1.00 X 734673 0 0 DR MICHAEL CANADY CEO 46.00 4.00 X X 648610 0 0 DR RODNEY STOUT TRUSTEE - CMO 49.00 1.00 X 454546 0 0 BRENT SAUNDERS CHAIRMAN 46.00 4.00 X X 446228 0 1719 DR LOUIS WICKAS TRUSTEE 50.00 0.00 X 423852 0 0 LISA HALLEY TRUSTEE - CAO 50.00 0.00 X 374001 0 1517 ELLEN GARLING TRUSTEE 50.00 0.00 X 374000 0 0 TROY MILLER TRUSTEE 50.00 0.00 X 374000 0 0 MICHAEL HAYNES CFO 46.00 4.00 X X 374000 0 0 TODD FOWLER TRUSTEE - EVP AMBULARTORY 50.00 0.00 X 374000 0 0 DR DANIELLE CAPPELLETTI TRUSTEE 49.00 1.00 X 354778 0 0 DR LANCE BROY TRUSTEE 49.00 1.00 X 341356 0 0 DR JARED SHEETS TRUSTEE 49.00 1.00 X 304622 0 0 DR SCOTT DAVIS TRUSTEE 50.00 0.00 X 295209 0 0 DR RENUKA KANDULA TRUSTEE 49.00 1.00 X 265971 0 0 JOHN CUNNINGHAM TRUSTEE - EVP POPULATION (PART YEAR) 50.00 0.00 X 257006 0 0 LISA DETTY TRUSTEE - CNO 50.00 0.00 X 250773 0 0 LARRY KIDD TREASURER 1.00 3.00 X X 24000 0 0 BOB GRILLO TRUSTEE 1.00 3.00 X 24000 0 0 STEVE CHAPMAN TRUSTEE 1.00 3.00 X X 24000 0 0 TOM WISEMAN TRUSTEE 1.00 3.00 X 24000 0 0 DANNY HOLSCHUH TRUSTEE 1.00 3.00 X 24000 0 0 GARY ROACH TRUSTEE 1.00 3.00 X 24000 0 0 PAUL REED TRUSTEE 1.00 3.00 X 24000 0 0 BRAD MUNN TRUSTEE 1.00 3.00 X 24000 0 0 ROBBIE PUGH TRUSTEE 1.00 3.00 X 24000 0 0 11852866 0 3236 179 0 1 0 OHIO VALLEY PHYSICIANS INC PO BOX 390 HUNTINGTON WV 25708 EMERGENCY DEPT. STAFFING 16808527 NTHRIVE PO BOX 733492 DALLAS TX 753733492 MEDICAL CODING & MANAGEMENT SERVICES 1863538 JACKSON & COKER LOCUMTENENS LLC PO BOX 277638 ATLANTA GA 303847638 PHYSICIAN STAFFING 586034 MARSHALL HEALTH PO BOX 1896 HUNTINGTON WV 257191896 ORTHOPEDICS CONSULTING 245000 KIDNEY & HYPERTENSION CENTER OF DELAWARE 36 TROY ROAD DELAWARE OH 43015 NEPHROLOGIST 217063 11 25 25 NET PATIENT SERVICE REVENUE 621110 114124990 114124990 RENTAL INCOME 531120 3431749 3431749 MANAGEMENT FEES 561000 2527913 2527913 INVESTMENTS IN JVS 523930 -55562 -55562 120029090 221434 221434 21528 4203 17325 17325 17325 269108 100000 295425 104976 -26317 -4976 -31293 -31293 VENDOR REBATE 900099 8842 8842 8842 120245423 120029090 0 216308 X 6270643 6270643 69110112 50837475 18272637 9878579 2740761 7137818 3800134 1407498 2392636 5361200 1222070 4139130 282609 213093 69516 498569 200204 298365 27265873 18463195 8802678 1160 1160 5327496 3447745 1879751 5048037 84601 4963436 595293 423444 171849 683973 286453 397520 9866449 7596098 2270351 2997063 106973 2890090 1520682 1339639 181043 BAD DEBT EXPENSE 9295170 9295170 MEDICAL SUPPLIES 1054107 1049607 4500 DUES AND MEMBERSHIPS 345999 69159 276840 PROPERTY TAX 193496 772 192724 269229 10482 258747 159665873 98794439 60870274 1160 11509146 13533137 20717575 18325066 1397260 1634422 100475076 27793027 74765036 72682049 4577378 4636219 569112 513570 3904000 3904000 18812055 18812055 33935188 31396298 170186750 165436816 28768856 28965174 1263631 115115712 112839470 4183105 4709287 11063617 10275593 159131290 158053155 X 11055460 7383661 11055460 7383661 170186750 165436816 X -39420450 10863 35737788 X X 0 1 X 1 0 X X 4 HOLZER HOSPITAL FOUNDATION 314379491 3 1 0 32605036 HOLZER MEDICAL CENTER-JACKSON 311724085 3 1 0 3737000 HOLZER SENIOR CARE CENTER 311534051 10 1 0 0 HOLZER HERITAGE FOUNDATION 310927482 7 1 0 0 4 0 36342036 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 X 1 1 SCHEDULE A, PART IV, SECTION D, LINE 3: HOLZER HEALTH SYSTEMS' BOARD OVERLAPS WITH THE BOARD OF THE SUPPORTING ORGANIZATION. THIS OVERLAP CAUSES THE SUPPORTED ORGANIZATION TO HAVE A SIGNIFICANT VOICE OVER THE HOLZER HEALTH SYSTEMS. SCHEDULE A, PART IV, SECTION E, LINE 3A: HOLZER HEALTH SYSTEM IS THE SOLE MEMBER OF EACH OF ITS SUPPORTED ORGANIZATIONS. SCHEDULE A, PART IV, SECTION E, LINE 3B: DECISIONS MADE BY THE BOARD OF DIRECTORS OF EACH SUPPORTED ORGANIZATION CAN BE OVERRULED BY THE BOARD OF DIRECTORS OF HOLZER HEALTH SYSTEM. 0 0 0 0 0 0 0 0 1 3321 3321 0 PART II-B, LINE 1: A PORTION OF DUES PAID TO THE OHIO HOSPITAL ASSOCIATION ARE CONSIDERED LOBBYING ACTIVITIES. IN TOTAL $56,286 WERE PAID TO OHA OF WHICH $3,321 ARE CONSIDERED LOBBYING ACTIVITIES. 6672087 6672087 85223824 25052799 60171025 8099781 2729235 5370546 479384 10993 468391 72682049 RELATED PARTY RECEIVABLES 13478749 FUNDS HELD BY TRUSTEES UNDER BOND INDENTURE 17917549 31396298 RELATED PARTY PAYABLES 10275593 10275593 X X 0 0 0 0 0 0 0 1 0 DR STEVEN CONLEY PHYSICIAN 1225063 0 0 0 0 0 0 0 0 0 1225063 0 0 0 DEAN SICILIANO PHYSICIAN 1070025 0 0 0 0 0 0 0 0 0 1070025 0 0 0 NIRAV PAREKH PHYSICIAN 978688 0 0 0 0 0 0 0 0 0 978688 0 0 0 DR ROBERT BRADLEY PHYSICIAN 883433 0 0 0 0 0 0 0 0 0 883433 0 0 0 SANTPAL MAVI PHYSICIAN 832032 0 0 0 0 0 0 0 0 0 832032 0 0 0 DR PHIL LONG TRUSTEE 734673 0 0 0 0 0 0 0 0 0 734673 0 0 0 DR MICHAEL CANADY CEO 590145 0 58465 0 0 0 0 0 0 0 648610 0 0 0 DR RODNEY STOUT TRUSTEE - CMO 420246 0 34300 0 0 0 0 0 0 0 454546 0 0 0 BRENT SAUNDERS CHAIRMAN 405662 0 40566 0 0 0 0 0 1719 0 447947 0 0 0 DR LOUIS WICKAS TRUSTEE 423852 0 0 0 0 0 0 0 0 0 423852 0 0 0 LISA HALLEY TRUSTEE - CAO 340001 0 34000 0 0 0 0 0 1517 0 375518 0 0 0 ELLEN GARLING TRUSTEE 340000 0 34000 0 0 0 0 0 0 0 374000 0 0 0 TROY MILLER TRUSTEE 340000 0 34000 0 0 0 0 0 0 0 374000 0 0 0 MICHAEL HAYNES CFO 340000 0 34000 0 0 0 0 0 0 0 374000 0 0 0 TODD FOWLER TRUSTEE - EVP AMBULARTORY 340000 0 34000 0 0 0 0 0 0 0 374000 0 0 0 DR DANIELLE CAPPELLETTI TRUSTEE 354778 0 0 0 0 0 0 0 0 0 354778 0 0 0 DR LANCE BROY TRUSTEE 341356 0 0 0 0 0 0 0 0 0 341356 0 0 0 DR JARED SHEETS TRUSTEE 304622 0 0 0 0 0 0 0 0 0 304622 0 0 0 DR SCOTT DAVIS TRUSTEE 295209 0 0 0 0 0 0 0 0 0 295209 0 0 0 DR RENUKA KANDULA TRUSTEE 265971 0 0 0 0 0 0 0 0 0 265971 0 0 0 JOHN CUNNINGHAM TRUSTEE - EVP POPULATION (PART YEAR) 257006 0 0 0 0 0 0 0 0 0 257006 0 0 0 LISA DETTY TRUSTEE - CNO 230773 0 20000 0 0 0 0 0 0 0 250773 0 0 0 PART I, LINE 7 BONUS AMOUNTS ARE BASED ON MEETING THRESHOLDS INCLUDED IN CONTRACTS AND ARE ULTIMATELY AT THE BOARD'S DISCRETION. A COUNTY OF GALLIA OHIO- BONDS SERIES 2012 A2012 SERIES B 316400068 36381PAP2 2012-03-27 155315000 SEE SCHEDULE O 0 0 0 A 155315478 11135117 3087477 106281906 3817000 2012 1 0 0 1 A 0 0 0 0 0.00000 0.00000 0.00000 0 0 0 A 0 0 1 0 0 0 0 0 0 A 1 SCHEDULE K, PART I DESCRIPTION OF PURPOSE: (A) CURRENTLY REFUNDED THE ENTITY'S (I) SERIES 1998 BONDS ISSUED ON OCTOBER 1, 1998; (II) SERIES 2009 BONDS, ISSUED ON NOVEMBER 3, 2009, WHICH WERE A REISSUANCE OF THE SERIES 2005 BONDS ISSUES ON MARCH 10, 2005; AND (III) VARIOUS TAXABLE OBLIGATIONS; AND (B) ACQUISITION OF HOSPITAL FACILITIES INCLUDING A CLINIC AND FUTURE CAPITAL EQUIPMENT ACQUISITIONS AND FACILITY RENOVATIONS; AND CANCER CENTER PROJECT. FORM 990, PART VI, SECTION B, LINE 11B THE CONTROLLER AND THE CFO REVIEW FORM 990 AND A COPY WILL BE PROVIDED TO ALL BOARD MEMBERS PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION FOLLOWS THE ADOPTED POLICIES OF HOLZER MEDICAL CENTER- JACKSON AND HOLZER HOSPITAL FOUNDATION, RELATED TAX-EXEMPT ORGANIZATIONS. CONFLICT OF INTEREST STATEMENTS ARE COMPLETED ANNUALLY BY ALL BOARD MEMBERS AND OFFICERS, 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 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. THE ORGANIZATION DOES NOT HAVE ITS OWN CONFLICT OF INTEREST POLICY. FORM 990, PART IX, LINE 11G OUTSIDE SERVICES: PROGRAM SERVICE EXPENSES 17,810,175. MANAGEMENT AND GENERAL EXPENSES 6,299,277. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 24,109,452. FOOD: PROGRAM SERVICE EXPENSES 12,566. MANAGEMENT AND GENERAL EXPENSES 161,219. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 173,785. RECRUITMENT: PROGRAM SERVICE EXPENSES 501,182. MANAGEMENT AND GENERAL EXPENSES 109,683. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 610,865. LICENSURE FEES: PROGRAM SERVICE EXPENSES 70,159. MANAGEMENT AND GENERAL EXPENSES 273,071. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 343,230. CONTRACT LABOR: PROGRAM SERVICE EXPENSES 69,113. MANAGEMENT AND GENERAL EXPENSES 1,959,428. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,028,541. FORM 990, PART XI, LINE 9: TRANSFERS TO/FROM AFFILIATES 35,737,788. 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, PART VI, LINE 16 THE ORGANIZATION DOES NOT HAVE IN PLACE A WRITTEN POLICY TO EVALUATE ITS PARTICIPATION IN JOINT VENTURES, HOWEVER IT MAKES SURE TO TAKE THE NECESSARY PRECAUTIONS TO SAFEGUARD ITS TAX-EXEMPT STATUS. IN ADDITION, LEGAL COUNSEL IS CONSULTED BEFORE CONSIDERING A NEW JOINT VENTURE. HOLZER DENTAL CLINIC JACKSON 100 JACKSON PIKE GALLIPOLIS OH 45631 275346256 HEALTHCARE OH 724578 1204721 HOLZER HEALTH SYSTEM HOLZER CLINIC LLC 90 JACKSON PIKE GALLIPOLIS OH 45631 310917085 PHYSICIAN PRACTICES OH 115794310 26730195 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 HOLZER HEALTH SYSTEM 1 HOLZER MEDICAL CENTER - JACKSON 100 JACKSON PIKE GALLIPOLIS OH 45631 311724085 HEALTH CARE OH 501(C)(3) LINE 3 HOLZER HEALTH SYSTEM 1 HOLZER SENIOR CARE CENTER 380 COLONIAL DRIVE BIDWELL OH 45614 311534051 SKILLED NURSING FACILITY OH 501(C)(3) LINE 10 HOLZER HEALTH SYSTEM 1 HOLZER HOSPITAL FOUNDATION 100 JACKSON PIKE GALLIPOLIS OH 45631 314379491 HEALTH CARE OH 501(C)(3) LINE 3 HOLZER HEALTH SYSTEM 1 HOLZER VANGUARD INC 100 JACKSON PIKE GALLIPOLIS OH 45631 311192567 STOCK HOLDING COMPANY OH HOLZER HEALTH SYSTEM C 1.00000 1 1 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0 1 HOLZER HOSPITAL FOUNDATION L 32496860 ACCRUAL TRANSACTION HOLZER MEDICAL CENTER- JACKSON L 3737000 ACCRUAL TRANSACTION HOLZER HOSPITAL FOUNDATION J 557629 ACCRUAL TRANSACTION HOLZER HOSPITAL FOUNDATION K 108176 ACCRUAL TRANSACTION