COMMUNITY HOSPITALS AND WELLNESS CENTERS: Form 990, tax year 2019
View the entire original 990 at ProPublica ↗
- Organization
- COMMUNITY HOSPITALS AND WELLNESS CENTERS (EIN 34-1048666)
- Tax period
- 2019-10-01 to 2020-09-30
- Filed
- 2021-08-16
- IRS object ID
- 202132289349302258
- 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
- Form 990
- Schedule A
- Schedule B
- Schedule C
- Schedule D
- Schedule H
- Schedule J
- Schedule K
- Schedule L
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2021-08-16T10:32:33-05:00 | ReturnTs |
| Tax Period End | 2020-09-30 | 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 ST 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 | 2019-10-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 341048666 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | COMMUNITY HOSPITALS & WELLNESS CENTERS | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | COMM | BusinessNameControlTxt |
| Phone | 4196361131 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 433 W HIGH STREET | AddressLine1Txt |
| City | BRYAN | CityNm |
| State Abbreviation | OH | StateAbbreviationCd |
| ZIP | 43506 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | ROBERT L GOSHIA | PersonNm |
| Person Title | VP/CFO | PersonTitleTxt |
| Phone | 4196361131 | PhoneNum |
| Signature | 2021-08-12 | 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 | 2021-08-12 | PreparationDt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2019 | TaxYr |
| Build TS | 2022-09-23 18:48:47Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | CHAD D TINKEL | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 433 W HIGH STREET | AddressLine1Txt |
| City | BRYAN | CityNm |
| State Abbreviation | OH | StateAbbreviationCd |
| ZIP | 43506 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $91,192,659 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.CHWCHOSPITALS.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1969 | FormationYr |
| Legal Domicile State | OH | LegalDomicileStateCd |
| Activity Or Mission | TO PROVIDE QUALITY PATIENT CARE AT EVERY POINT OF SERVICE; TO RESPECT THE DIGNITY AND UNIQUENESS OF ALL PATIENTS; TO PROMOTE SAFE MEDICAL PRACTICES; TO ENCOURAGE MEDICAL RESEARCH; TO PERMIT ACCESS TO ALL SEEKING HEALTHCARE; AND TO MAINTAIN FISCAL SOUNDNESS. | ActivityOrMissionDesc |
| Voting Members Governing Body | 10 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 7 | VotingMembersIndependentCnt |
| Total Employee | 916 | TotalEmployeeCnt |
| Total Volunteers | 88 | TotalVolunteersCnt |
| Total Gross UBI | -$14,492 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | -$14,492 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $37,725 | PYContributionsGrantsAmt |
| CY Contributions Grants | $10,225,968 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $88,490,404 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $78,805,493 | CYProgramServiceRevenueAmt |
| PY Investment Income | $1,527,372 | PYInvestmentIncomeAmt |
| CY Investment Income | $1,199,579 | CYInvestmentIncomeAmt |
| PY Other Revenue | $787,206 | PYOtherRevenueAmt |
| CY Other Revenue | $739,573 | CYOtherRevenueAmt |
| PY Total Revenue | $90,842,707 | PYTotalRevenueAmt |
| CY Total Revenue | $90,970,613 | 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 | $47,220,611 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $47,502,499 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $39,332,173 | PYOtherExpensesAmt |
| CY Other Expenses | $38,363,668 | CYOtherExpensesAmt |
| PY Total Expenses | $86,552,784 | PYTotalExpensesAmt |
| CY Total Expenses | $85,866,167 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $4,289,923 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $5,104,446 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $158,158,601 | TotalAssetsBOYAmt |
| Total Assets EOY | $163,144,973 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $65,927,504 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $64,743,788 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $92,231,097 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $98,401,185 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | TO PROVIDE QUALITY PATIENT CARE AT EVERY POINT OF SERVICE; TO RESPECT THE DIGNITY AND UNIQUENESS OF ALL PATIENTS; TO PROMOTE SAFE MEDICAL PRACTICES; TO ENCOURAGE MEDICAL RESEARCH; TO PERMIT ACCESS TO ALL SEEKING HEALTHCARE; AND TO MAINTAIN FISCAL SOUNDNESS. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $8,410,577 | ExpenseAmt |
| Grant | $0 | GrantAmt |
| Revenue | $7,780,028 | RevenueAmt |
| Desc | INPATIENT CARE: BRYAN HOSPITAL MEDICAL & SURGICAL UNIT HAS 54 BEDS AND PROVIDE CARE FOR 575 PATIENTS AND 198 OBSERVATION PATIENTS; BRYAN HOSPITAL INTENSIVE CARE UNIT AND TELEMETRY UNIT HAS 16 BEDS AND PROVIDE CARE FOR 776 INPATIENTS AND 323 OBSERVATION PATIENTS; BRYAN HOSPITAL OBSTETRICS HAS 9 BEDS AND PROVIDED CARE FOR 336 INPATIENTS. MONTPELIER HOSPITAL HAS 25 BEDS AND PROVIDED CARE TO 194 INPATIENTS. | Desc |
Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $10,112,957 | ExpenseAmt |
| Grant | $0 | GrantAmt |
| Revenue | $15,875,933 | RevenueAmt |
| Desc | SURGERY CARE: BRYAN SURGERY HAS 6 OPERATING ROOMS THAT DID 1,742 GENERAL SURGERY CASES, 1,432 PAIN MANAGEMENT CASES, 787 ORTHOPEDIC CASES, 584 OPHTHALMOLOGY CASES, 222 ENT CASES, 263 GYNECOLOGY CASES, 222 ENT CASES, AND 228 UROLOGY CASES. ARCHBOLD SURGERY HAS 4 OPERATING ROOMS THAT DID 11 ORTHOPEDIC CASES, 683 GENERAL SURGERY CASES, 20 UROLOGY CASES AND 23 ENT CASES. | Desc |
Prog Srvc Accom Acty3 ProgSrvcAccomActy3Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $5,044,418 | ExpenseAmt |
| Grant | $0 | GrantAmt |
| Revenue | $8,051,587 | RevenueAmt |
| Desc | EMERGENCY ROOM CARE: BRYAN ED CARED FOR 12,034 PATIENTS WITH 966 BEING ADMITTED; MONTPELIER ED CARED FOR 3,050 PATIENTS WITH 2 BEING ADMITTED. | Desc |
Prog Srvc Accom Acty Other ProgSrvcAccomActyOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $50,772,824 | ExpenseAmt |
| Grant | $0 | GrantAmt |
| Revenue | $47,097,945 | RevenueAmt |
| Desc | COMMUNITY HOSPITALS AND WELLNESS CENTERS PROVIDED SERVICES TO APPROXIMATELY 2,214 INPATIENTS, APPROXIMATELY 815 OBSERVATION PATIENTS, AND APPROXIMATELY 15,084 EMERGENCY DEPARTMENT PATIENTS DURING THIS FISCAL YEAR. THE HOSPITAL UTILIZES A BOARD APPROVED CHARITABLE CARE PROGRAM THAT MEASURES INDIVIDUAL AND FAMILY NEEDS BASED ON FEDERAL POVERTY GUIDELINES. THE PROGRAM IS APPLIED UNIFORMLY ACROSS ALL LEVELS OF HOSPITAL SERVICES. THE PROGRAM EXTENDS BEYOND THE FEDERAL POVERTY DEFINITIONS TO ALLOW THE HOSPITAL TO PROVIDE FREE AND/OR SUBSIDIZED CARE FOR PERSONS FALLING WITHIN AND BEYOND THE FEDERAL GUIDELINES. THIS PROGRAM PROVIDED ASSISTANCE TO APPROXIMATELY 7,826 ACCOUNTS DURING THIS FISCAL YEAR. | Desc |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Prog Srvc Expense | $50,772,824 | TotalOtherProgSrvcExpenseAmt |
| Total Other Prog Srvc Grant | $0 | TotalOtherProgSrvcGrantAmt |
| Total Other Prog Srvc Revenue | $47,097,945 | TotalOtherProgSrvcRevenueAmt |
| Total Program Service Expenses | $74,340,776 | 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 | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (1) | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | 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 | Yes (1) | TaxExemptBondsInd |
| Invest Tax Exempt Bonds | Yes (1) | InvestTaxExemptBondsInd |
| Escrow Account | Yes (1) | EscrowAccountInd |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuerInd |
| 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 | Yes (1) | RelatedOrganizationCtrlEntInd |
| Transaction With Control Ent | Yes (1) | TransactionWithControlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 51 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 916 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | Yes (1) | UnrelatedBusIncmOverLimitInd |
| Form990 T Filed | Yes (1) | Form990TFiledInd |
| 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 | 10 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 7 | IndependentVotingMemberCnt |
| Family Or Business Rln | Yes (1) | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | Yes (1) | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | 0 | MembersOrStockholdersInd |
| Election Of Board Members | 0 | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | 0 | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | 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 |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ROBERT L GOSHIA | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 4196333594 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 433 W HIGH STREET | AddressLine1Txt |
| City | BRYAN | CityNm |
| State Abbreviation | OH | StateAbbreviationCd |
| ZIP | 43506 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (22 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Highest Compensated EmployeeHighestCompensatedEmployeeInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Key EmployeeKeyEmployeeInd |
|---|---|---|---|---|---|---|---|---|---|
| DAVID COOLEY MD | |||||||||
| PHYSICIAN | 50.00 | 0.00 | Yes (X) | $656,858 | $0 | $11,148 | |||
| JODI TINKEL MD | |||||||||
| PHYSICIAN | 50.00 | 0.00 | Yes (X) | $616,205 | $0 | $0 | |||
| MICHAEL NOSANOV | |||||||||
| PHYSICIAN | 50.00 | 0.00 | Yes (X) | $605,750 | $0 | $10,104 | |||
| HANAN BAZZI MD | |||||||||
| PHYSICIAN | 50.00 | 0.00 | Yes (X) | $426,358 | $0 | $22,128 | |||
| CHAD D TINKEL | |||||||||
| PRESIDENT/SECRETARY, CEO | 49.50 | 0.50 | $335,674 | $0 | $40,420 | Yes (X) | Yes (X) | ||
| SCOTT FREDERICK MD | |||||||||
| PHYSICIAN | 50.00 | 0.00 | Yes (X) | $339,343 | $0 | $23,942 | |||
| WADE PATRICK | |||||||||
| VP/CIO | 50.00 | 0.00 | $248,357 | $0 | $16,158 | Yes (X) | |||
| JANICE DAVID | |||||||||
| VP PATIENT CARE | 50.00 | 0.00 | $222,081 | $0 | $28,960 | Yes (X) | |||
| ROBERT L GOSHIA | |||||||||
| VP/CFO | 49.50 | 0.50 | $80,796 | $0 | $5,574 | Yes (X) | |||
| BRUCE SPANGLER | |||||||||
| CHAIRMAN | 0.10 | 0.10 | $0 | $0 | $0 | Yes (X) | Yes (X) | ||
| JIM WYSE | |||||||||
| DIRECTOR | 0.10 | 0.10 | $0 | $0 | $0 | Yes (X) | |||
| NIKI MOSIER | |||||||||
| DIRECTOR | 0.10 | 0.10 | $0 | $0 | $0 | Yes (X) | |||
| STEVE BUMB MD | |||||||||
| DIRECTOR | 0.10 | 0.10 | $0 | $0 | $0 | Yes (X) | |||
| PEGGY WATSON MD | |||||||||
| DIRECTOR | 0.10 | 0.10 | $0 | $0 | $0 | Yes (X) | |||
| KATRINA P HESTER | |||||||||
| VICE PRESIDENT/FINANCE COMMITTEE CHAIR | 0.10 | 0.10 | $0 | $0 | $0 | Yes (X) | |||
| CHRISTOPHER KANNEL | |||||||||
| DIRECTOR | 0.10 | 0.10 | $0 | $0 | $0 | Yes (X) | |||
| ELENA WEST | |||||||||
| DIRECTOR | 50.00 | 0.00 | $0 | $0 | $0 | Yes (X) | |||
| ROBERT GOLDING | |||||||||
| DIRECTOR | 0.10 | 0.10 | $0 | $0 | $0 | Yes (X) | |||
| CHRISTOPHER CULLIS | |||||||||
| CHAIRMAN (PART YEAR) | 0.10 | 0.10 | $0 | $0 | $0 | Yes (X) | |||
| JAMES RUPP | |||||||||
| DIRECTOR (PART YEAR) | 0.10 | 0.10 | $0 | $0 | $0 | Yes (X) | |||
| DAVID SWANSON | |||||||||
| DIRECTOR (PART YEAR) | 0.10 | 0.10 | $0 | $0 | $0 | Yes (X) | |||
| ANGELIA FOSTER | |||||||||
| VP/CHRO (PART YEAR) | 50.00 | 0.00 | $0 | $0 | $0 | Yes (X) | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $3,531,422 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $158,434 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 30 | 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 |
|---|---|---|---|---|---|
| WILLIAMS EMERGENCY GROUP LLP | |||||
| PO BOX 677979 | DALLAS | TX | 752677979 | PHYSICIAN SERVICES | $1,948,144 |
| PARVIEW HEALTH | |||||
| BOX 5600 | FT WAYNE | IN | 46895 | PHYSICIAN SERVICES | $1,320,998 |
| TOLEDO RADIATION ONCOLOGY | |||||
| 3000 RECENCY COURT | TOLEDO | OH | 43623 | PHYSICIAN SERVICES | $598,800 |
| ASSOCIATED ANESTHESIOLOGIST | |||||
| 10315 DAWSON CREEK | FT WAYNE | IN | 46825 | ANESTHESIOLOGY SERVICES | $565,371 |
| ALLSCRIPTS HEALTHCARE LLC | |||||
| 24630 NETWORK PLACE | CHICAGO | IL | 60673 | COMPUTER | $560,530 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 18 | CntrctRcvdGreaterThan100KCnt |
| Government Grants | $10,220,154 | GovernmentGrantsAmt |
| All Other Contributions | $5,814 | AllOtherContributionsAmt |
| Total Contributions | $10,225,968 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | PATIENT REVENUE | Desc |
| Business | 621400 | BusinessCd |
| Total Revenue Column | $78,805,493 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $78,805,493 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $78,805,493 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $1,198,087 | TotalRevenueColumnAmt |
| Exclusion | $1,198,087 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $453,886 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $214,713 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $239,173 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $239,173 | TotalRevenueColumnAmt |
| Exclusion | $239,173 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $8,825 | OtherAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $7,333 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $1,492 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $1,492 | TotalRevenueColumnAmt |
| Exclusion | $1,492 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | ExclusionExclusionAmt | Unrelated Business RevenueUnrelatedBusinessRevenueAmt |
|---|---|---|---|---|
| CAFETERIA/VENDING | 621400 | $470,493 | $470,493 | |
| CASH SURRENDER VALUE INCREASE | 900099 | $44,399 | $44,399 | |
| LOSS FROM VANTAGE HEALTHCARE | 621400 | -$14,492 | -$14,492 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $500,400 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $90,970,613 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $78,805,493 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | -$14,492 | UnrelatedBusinessRevenueAmt |
| Exclusion | $1,953,644 | ExclusionAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,310,624 | TotalAmt |
| Program Services | $454,599 | ProgramServicesAmt |
| Management And General | $856,025 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $35,827,686 | TotalAmt |
| Program Services | $35,628,276 | ProgramServicesAmt |
| Management And General | $199,410 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,208,309 | TotalAmt |
| Program Services | $1,208,309 | ProgramServicesAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $6,673,870 | TotalAmt |
| Program Services | $4,856,238 | ProgramServicesAmt |
| Management And General | $1,817,632 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,482,010 | TotalAmt |
| Program Services | $1,220,369 | ProgramServicesAmt |
| Management And General | $1,261,641 | ManagementAndGeneralAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $7,672,989 | TotalAmt |
| Program Services | $5,124,352 | ProgramServicesAmt |
| Management And General | $2,548,637 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $172,488 | TotalAmt |
| Management And General | $172,488 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $171,705 | TotalAmt |
| Management And General | $171,705 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $230,284 | TotalAmt |
| Program Services | $230,284 | ProgramServicesAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $229,950 | TotalAmt |
| Program Services | $229,950 | ProgramServicesAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,840,215 | TotalAmt |
| Program Services | $1,840,215 | ProgramServicesAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $88,377 | TotalAmt |
| Program Services | $88,377 | ProgramServicesAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $128,946 | TotalAmt |
| Program Services | $128,946 | ProgramServicesAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,211,127 | TotalAmt |
| Program Services | $1,065,792 | ProgramServicesAmt |
| Management And General | $145,335 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,610,574 | TotalAmt |
| Program Services | $3,622,456 | ProgramServicesAmt |
| Management And General | $1,988,118 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $581,253 | TotalAmt |
| Management And General | $581,253 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| BILLABLE/NONBILLABLE SU | $11,324,000 | $9,891,842 | $1,432,158 |
| REPAIRS & MAINTENANCE | $3,529,270 | $3,389,695 | $139,575 |
| BAD DEBT EXPENSE | $3,260,676 | $3,260,676 | |
| FRANCHISE FEES & TAXES | $1,845,967 | $1,824,085 | $21,882 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $465,847 | TotalAmt |
| Program Services | $276,315 | ProgramServicesAmt |
| Management And General | $189,532 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $85,866,167 | TotalAmt |
| Program Services | $74,340,776 | ProgramServicesAmt |
| Management And General | $11,525,391 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $20,583,811 | BOYAmt |
| EOY | $11,182,445 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $17,217,291 | BOYAmt |
| EOY | $31,419,146 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $8,428,280 | BOYAmt |
| EOY | $9,679,443 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,497,870 | BOYAmt |
| EOY | $1,599,161 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,162,567 | BOYAmt |
| EOY | $2,766,123 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $164,743,394 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $91,491,663 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $74,929,762 | BOYAmt |
| EOY | $73,251,731 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $32,188,326 | BOYAmt |
| EOY | $33,092,355 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $97,656 | BOYAmt |
| EOY | $131,838 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $53,038 | BOYAmt |
| EOY | $22,731 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $158,158,601 | BOYAmt |
| EOY | $163,144,973 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $10,107,395 | BOYAmt |
| EOY | $20,619,314 | EOYAmt |
Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $37,490,001 | BOYAmt |
| EOY | $27,515,980 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $15,025,707 | BOYAmt |
| EOY | $13,832,318 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,304,401 | BOYAmt |
| EOY | $2,776,176 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $65,927,504 | BOYAmt |
| EOY | $64,743,788 | 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 | $92,231,097 | BOYAmt |
| EOY | $98,401,185 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $92,231,097 | BOYAmt |
| EOY | $98,401,185 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $158,158,601 | BOYAmt |
| EOY | $163,144,973 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $5,104,446 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | $1,065,642 | NetUnrlzdGainsLossesInvstAmt |
| 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) |
|---|---|---|
| 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 | 0 | GrantsOtherOrganizationsInd |
| Direct Contact Legislators | 0 | DirectContactLegislatorsInd |
| Rallies Demonstrations | 0 | RalliesDemonstrationsInd |
| Other Activities | Yes (1) | OtherActivitiesInd |
| Other Activities | $2,300 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $2,300 | 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 | PART OF OHA DUES ARE ATTRIBUTED TO LOBBYING, TOTAL DUES WERE $39,323 OF WHICH 5.85% WERE CONTRIBUTED TO LOBBYING. | ExplanationTxt |
Schedule D IRS990ScheduleD
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | $830,800 | InvestmentCostOrOtherBasisAmt |
| Other Cost Or Other Basis | $2,124,658 | OtherCostOrOtherBasisAmt |
| Book Value | $2,955,458 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $96,208,407 | OtherCostOrOtherBasisAmt |
| Depreciation | $37,364,655 | DepreciationAmt |
| Book Value | $58,843,752 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | $9,816,515 | InvestmentCostOrOtherBasisAmt |
| Depreciation | $6,263,998 | DepreciationAmt |
| Book Value | $3,552,517 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $54,484,406 | OtherCostOrOtherBasisAmt |
| Depreciation | $47,666,353 | DepreciationAmt |
| Book Value | $6,818,053 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $1,278,608 | OtherCostOrOtherBasisAmt |
| Depreciation | $196,657 | DepreciationAmt |
| Book Value | $1,081,951 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $73,251,731 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (2 entries)
| DescDesc | AmtAmt |
|---|---|
| DEFERRED COMPENSATION | $483,867 |
| SETTLEMENTS PAYABLE UNDER THIRD PARTY REIMBURSEMENT CONTRACTS | $2,292,309 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $2,776,176 | 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 | ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA REQUIRE MANAGEMENT TO EVALUATE TAX POSITIONS TAKEN BY THE HOSPITAL AND TO RECOGNIZE A TAX LIABILITY IF THE HOSPITAL HAS TAKEN AN UNCERTAIN POSITION THAT MORE LIKELY THAN NOT WOULD NOT BE SUSTAINED UPON EXAMINATION BY THE INTERNAL REVENUE SERVICE OR OTHER APPLICABLE TAXING AUTHORITIES. MANAGEMENT HAS ANALYZED THE TAX POSITIONS TAKEN BY THE HOSPITAL AND HAS CONCLUDED THAT, AS OF SEPTEMBER 30, 2020 AND 2019, THERE ARE NO UNCERTAIN POSITIONS TAKEN OR EXPECTED TO BE TAKEN THAT WOULD REQUIRE RECOGNITION OF A LIABILITY OR DISCLOSURE IN THE CONSOLIDATED FINANCIAL STATEMENTS. | ExplanationTxt |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (1) | FinancialAssistancePolicyInd |
| Written Policy | Yes (1) | WrittenPolicyInd |
| All Hospitals Policy | Yes (X) | AllHospitalsPolicyInd |
| FPG Reference Free Care | Yes (1) | FPGReferenceFreeCareInd |
| Percent200 | Yes (X) | Percent200Ind |
| FPG Reference Discounted Care | Yes (1) | FPGReferenceDiscountedCareInd |
| Percent300 | Yes (X) | Percent300Ind |
| Free Care Medically Indigent | Yes (1) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (1) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | 0 | ExpensesExceedBudgetInd |
| Annual Community Bnft Report | Yes (1) | AnnualCommunityBnftReportInd |
| Report Publically Available | Yes (1) | ReportPublicallyAvailableInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $3,889,094 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $266,808 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $3,622,286 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.04390 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $11,789,410 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $7,521,943 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $4,267,467 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.05170 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $15,678,504 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $7,788,751 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $7,889,753 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.09560 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $146,577 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $0 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $146,577 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00180 | TotalExpensePct |
Cash And In Kind Contributions CashAndInKindContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $58,104 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $0 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $58,104 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00070 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $204,681 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $204,681 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00250 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $15,883,185 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $7,788,751 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $8,094,434 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.09810 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (1) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $3,260,676 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $326,068 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $15,873,385 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $19,940,282 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$4,066,897 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | Yes (X) | CostToChargeRatioInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | Yes (1) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (1) | FinancialAssistancePrvsnInd |
| Hospital Facilities | 2 | HospitalFacilitiesCnt |
Hospital Facilities HospitalFacilitiesGrp (2 entries)
| FacilityFacilityNum | Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | Licensed HospitalLicensedHospitalInd | General Medical And SurgicalGeneralMedicalAndSurgicalInd | Emergency Room24 HrsEmergencyRoom24HrsInd | Critical Access HospitalCriticalAccessHospitalInd | OtherOtherDesc |
|---|---|---|---|---|---|---|---|---|---|
| BRYAN HOSPITAL | |||||||||
| 1 | 433 WEST HIGH STREET | BRYAN | OH | 43506 | Yes (X) | Yes (X) | Yes (X) | ||
| MONTPELIER HOSPITAL | |||||||||
| 2 | 909 EAST SNYDER AVENUE | MONTPELIER | OH | 43543 | Yes (X) | Yes (X) | Yes (X) | SWING BEDS | |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp (2 entries)
| FacilityFacilityNum | First Licensed CY Or PYFirstLicensedCYOrPYInd | Tax Exempt Hospital CY Or PYTaxExemptHospitalCYOrPYInd | CHNA ConductedCHNAConductedInd | Community DefinitionCommunityDefinitionInd | Community DemographicsCommunityDemographicsInd | Existing ResourcesExistingResourcesInd | How Data ObtainedHowDataObtainedInd | Community Health NeedsCommunityHealthNeedsInd | Other Health IssuesOtherHealthIssuesInd | Community Hlth Needs Id ProcessCommunityHlthNeedsIdProcessInd | Consulting ProcessConsultingProcessInd | Prior CHNA ImpactPriorCHNAImpactInd | OtherOtherInd | CHNA ConductedCHNAConductedYr | Take Into Account Others InputTakeIntoAccountOthersInputInd | CHNA Conducted With Other FcltsCHNAConductedWithOtherFcltsInd | CHNA Conducted With Non FcltsCHNAConductedWithNonFcltsInd | CHNA Report Widely AvailableCHNAReportWidelyAvailableInd | Rpt Available On Own WebsiteRptAvailableOnOwnWebsiteInd | Own Website URLOwnWebsiteURLTxt | Other WebsiteOtherWebsiteInd | Other Website URLOtherWebsiteURLTxt | Paper Copy Public InspectionPaperCopyPublicInspectionInd | Rpt Available Thru Other MethodRptAvailableThruOtherMethodInd | Implementation Strategy AdoptImplementationStrategyAdoptInd | Implementation Strategy AdptImplementationStrategyAdptYr | Strategy Posted WebsiteStrategyPostedWebsiteInd | Strategy Website URLStrategyWebsiteURLTxt | Organization Incur Excise TaxOrganizationIncurExciseTaxInd | Elig Criteria ExplainedEligCriteriaExplainedInd | FPG Family Incm Lmt Free DscntFPGFamilyIncmLmtFreeDscntInd | FPG Family Incm Lmt Free CareFPGFamilyIncmLmtFreeCarePct | FPG Family Incm Lmt Dscnt CareFPGFamilyIncmLmtDscntCarePct | Income Level CriteriaIncomeLevelCriteriaInd | Asset Level CriteriaAssetLevelCriteriaInd | Medical Indigency CriteriaMedicalIndigencyCriteriaInd | Explained BasisExplainedBasisInd | App Financial Asst ExplnAppFinancialAsstExplnInd | Described InfoDescribedInfoInd | Described Suprt DocDescribedSuprtDocInd | Provided Hospital ContactProvidedHospitalContactInd | Includes Publicity MeasuresIncludesPublicityMeasuresInd | FAP Available On WebsiteFAPAvailableOnWebsiteInd | FAP Available On Website URLFAPAvailableOnWebsiteURLTxt | FAP App Available On WebsiteFAPAppAvailableOnWebsiteInd | FAP App Available On Website URLFAPAppAvailableOnWebsiteURLTxt | FAP Summary On WebsiteFAPSummaryOnWebsiteInd | FAP Summary On Website URLFAPSummaryOnWebsiteURLTxt | FAP Avlbl On Request No ChargeFAPAvlblOnRequestNoChargeInd | FAP App Avlbl On Request No ChrgFAPAppAvlblOnRequestNoChrgInd | FAP Sum Avlbl On Request No ChrgFAPSumAvlblOnRequestNoChrgInd | Notified FAP Copy Bill DisplayNotifiedFAPCopyBillDisplayInd | Communtity Notified FAPCommuntityNotifiedFAPInd | FAP TranslatedFAPTranslatedInd | FAP Actions On NonpaymentFAPActionsOnNonpaymentInd | Permit No ActionsPermitNoActionsInd | Collection ActivitiesCollectionActivitiesInd | Provided Written NoticeProvidedWrittenNoticeInd | Made Effort Orally NotifyMadeEffortOrallyNotifyInd | Processed FAP ApplicationProcessedFAPApplicationInd | Made Presumptive Elig DetermMadePresumptiveEligDetermInd | Other Actions TakenOtherActionsTakenInd | Nondis Emergency Care PolicyNondisEmergencyCarePolicyInd | Look Back Medicare PrivateLookBackMedicarePrivateInd | Amounts Generally BilledAmountsGenerallyBilledInd | Gross ChargesGrossChargesInd | Insurance Status CriteriaInsuranceStatusCriteriaInd | Underinsurance Stat CriteriaUnderinsuranceStatCriteriaInd | Residency CriteriaResidencyCriteriaInd | Other CriteriaOtherCriteriaInd |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| BRYAN HOSPITAL | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| 1 | 0 | 0 | Yes (1) | Yes (X) | Yes (X) | Yes (X) | Yes (X) | Yes (X) | Yes (X) | Yes (X) | Yes (X) | Yes (X) | Yes (X) | 18 | Yes (1) | Yes (1) | Yes (1) | Yes (1) | Yes (X) | HTTPS://WWW.CHWCHOSPITAL.ORG/COMMUNITY-HEALTH-ASSESSMENT/ | Yes (X) | HTTP://WWW.WILLIAMSCOUNTYHEALTH.ORG/WP-CONTENT/UPLOADS/2014/08/2019-WILLIAM | Yes (X) | Yes (X) | Yes (1) | 18 | Yes (1) | HTTPS://WWW.CHWCHOSPITAL.ORG/COMMUNITY-HEALTH-ASSESSMENT/ | 0 | Yes (1) | Yes (X) | 200.000000000000 | 300.000000000000 | Yes (X) | Yes (X) | Yes (X) | Yes (1) | Yes (1) | Yes (X) | Yes (X) | Yes (X) | Yes (1) | Yes (X) | HTTPS://WWW.CHWCHOSPITAL.ORG/CHWC-FINANCIAL-ASSISTANCE/ | Yes (X) | HTTPS://WWW.CHWCHOSPITAL.ORG/CHWC-FINANCIAL-ASSISTANCE/ | Yes (X) | HTTPS://WWW.CHWCHOSPITAL.ORG/CHWC-FINANCIAL-ASSISTANCE/ | Yes (X) | Yes (X) | Yes (X) | Yes (X) | Yes (X) | Yes (X) | Yes (1) | Yes (X) | 0 | Yes (X) | Yes (X) | Yes (X) | Yes (X) | Yes (X) | Yes (1) | Yes (X) | 0 | 0 | ||||
| MONTPELIER HOSPITAL | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| 2 | 0 | 0 | Yes (1) | Yes (X) | Yes (X) | Yes (X) | Yes (X) | Yes (X) | Yes (X) | Yes (X) | Yes (X) | Yes (X) | Yes (X) | 18 | Yes (1) | Yes (1) | Yes (1) | Yes (1) | Yes (X) | HTTPS://WWW.CHWCHOSPITAL.ORG/COMMUNITY-HEALTH-ASSESSMENT/ | Yes (X) | HTTP://WWW.WILLIAMSCOUNTYHEALTH.ORG/WP-CONTENT/UPLOADS/2014/08/2019-WILLIAM | Yes (X) | Yes (X) | Yes (1) | 18 | Yes (1) | HTTPS://WWW.CHWCHOSPITAL.ORG/COMMUNITY-HEALTH-ASSESSMENT/ | 0 | Yes (1) | Yes (X) | 200.000000000000 | 300.000000000000 | Yes (X) | Yes (X) | Yes (X) | Yes (1) | Yes (1) | Yes (X) | Yes (X) | Yes (X) | Yes (1) | Yes (X) | HTTPS://WWW.CHWCHOSPITAL.ORG/CHWC-FINANCIAL-ASSISTANCE/ | Yes (X) | HTTPS://WWW.CHWCHOSPITAL.ORG/CHWC-FINANCIAL-ASSISTANCE/ | Yes (X) | HTTPS://WWW.CHWCHOSPITAL.ORG/CHWC-FINANCIAL-ASSISTANCE/ | Yes (X) | Yes (X) | Yes (X) | Yes (X) | Yes (X) | Yes (X) | Yes (1) | Yes (X) | 0 | Yes (X) | Yes (X) | Yes (X) | Yes (X) | Yes (X) | Yes (1) | Yes (X) | 0 | 0 | Yes (X) | Yes (X) | Yes (X) | Yes (X) |
Supplemental Information SupplementalInformationGrp (14 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| BRYAN HOSPITAL | PART V, SECTION B, LINE 3J: THE OVERALL GOAL OF THE NEEDS ASSESSMENT WAS TO PERFORM A COMMUNITY HEALTH ASSESSMENT THAT WILL LEAD TO IMPROVED QUALITY OF PUBLIC AND PRIVATE HEALTH SERVICES. IN ADDITION, THE HEALTH ASSESSMENT CAN BE USED FOR A VARIETY OF PURPOSES SUCH AS THE FOLLOWING:- TO ASSESS THE DISTRIBUTION OF DISEASE AND BEHAVIORAL RISK FACTORS.- TO ASSESS BROAD COMMUNITY HEALTH ISSUES AND TO SHAPE A BROADER DEFINITION OF COMMUNITY HEALTH.- TO MONITOR THE IMPACT OF COMMUNITY HEALTH ACTION PLANS AND TRENDS IN BEHAVIORAL RISK MODIFICATIONS. - TO PROVIDE A VEHICLE TO DISCUSS WAYS TO IMPROVE COMMUNITY HEALTH. THE STUDY CAN ASSIST STAKEHOLDERS WORKING COLLABORATIVELY IN THE COMMUNITY TO ADDRESS ISSUES THAT AFFECT HEALTH.THE COMMUNITY HEALTH ASSESSMENT WILL CONTINUE TO BE REPEATED EVERY THREE YEARS TO DETERMINE IF ACTIONS TAKEN BY COMMUNITIES ARE IMPACTING THE BEHAVIORS THAT LEAD TO POOR HEALTH. |
| MONTPELIER HOSPITAL | PART V, SECTION B, LINE 3J: THE OVERALL GOAL OF THE NEEDS ASSESSMENT WAS TO PERFORM A COMMUNITY HEALTH ASSESSMENT THAT WILL LEAD TO IMPROVED QUALITY OF PUBLIC AND PRIVATE HEALTH SERVICES. IN ADDITION, THE HEALTH ASSESSMENT CAN BE USED FOR A VARIETY OF PURPOSES SUCH AS THE FOLLOWING:- TO ASSESS THE DISTRIBUTION OF DISEASE AND BEHAVIORAL RISK FACTORS.- TO ASSESS BROAD COMMUNITY HEALTH ISSUES AND TO SHAPE A BROADER DEFINITION OF COMMUNITY HEALTH.- TO MONITOR THE IMPACT OF COMMUNITY HEALTH ACTION PLANS AND TRENDS IN BEHAVIORAL RISK MODIFICATIONS. - TO PROVIDE A VEHICLE TO DISCUSS WAYS TO IMPROVE COMMUNITY HEALTH. THE STUDY CAN ASSIST STAKEHOLDERS WORKING COLLABORATIVELY IN THE COMMUNITY TO ADDRESS ISSUES THAT AFFECT HEALTH.THE COMMUNITY HEALTH ASSESSMENT WILL CONTINUE TO BE REPEATED EVERY THREE YEARS TO DETERMINE IF ACTIONS TAKEN BY COMMUNITIES ARE IMPACTING THE BEHAVIORS THAT LEAD TO POOR HEALTH. |
| BRYAN HOSPITAL | PART V, SECTION B, LINE 5: WILLIAMS COUNTY PARTNERS FOR HEALTH (WCPH) BEGAN CONDUCTING COMMUNITY HEALTH ASSESSMENTS (CHA) FOR THE PURPOSE OF MEASURING AND ADDRESSING HEALTH STATUS. THE MOST RECENT WILLIAMS COUNTY COMMUNITY HEALTH ASSESSMENT WAS CROSS-SECTIONAL IN NATURE AND INCLUDED A WRITTEN SURVEY OF ADULTS AND ADOLESCENTS WITHIN WILLIAMS COUNTY. THE QUESTIONS WERE MODELED AFTER THE SURVEY INSTRUMENTS USED BY THE CENTERS FOR DISEASE CONTROL AND PREVENTION FOR THEIR NATIONAL AND STATE BEHAVIORAL RISK FACTOR SURVEILLANCE SYSTEM (BRFSS) AND THE YOUTH RISK BEHAVIOR SURVEILLANCE SYSTEM (YRBSS). THIS HAS ALLOWED WILLIAMS COUNTY TO COMPARE THE DATA COLLECTED IN THEIR CHA TO NATIONAL, STATE AND LOCAL HEALTH TRENDS. WILLIAMS COUNTY CHA ALSO FULFILLS NATIONAL MANDATED REQUIREMENTS FOR THE HOSPITALS IN OUR COUNTY. H.R. 3590 PATIENT PROTECTION AND AFFORDABLE CARE ACT STATES THAT IN ORDER TO MAINTAIN TAX-EXEMPT STATUS, NOT-FOR-PROFIT HOSPITALS ARE REQUIRED TO CONDUCT A COMMUNITY HEALTH NEEDS ASSESSMENT AT LEAST ONCE EVERY THREE YEARS, AND ADOPT AN IMPLEMENTATION STRATEGY TO MEET THE NEEDS IDENTIFIED THROUGH THE ASSESSMENT. FROM THE BEGINNING PHASES OF THE CHA, COMMUNITY LEADERS WERE ACTIVELY ENGAGED IN THE PLANNING PROCESS AND HELPED DEFINE THE CONTENT, SCOPE, AND SEQUENCE OF THE PROJECT. ACTIVE ENGAGEMENT OF COMMUNITY MEMBERS THROUGHOUT THE PLANNING PROCESS IS REGARDED AS AN IMPORTANT STEP IN COMPLETING A VALID NEEDS ASSESSMENT. THE WILLIAMS COUNTY CHA HAS BEEN UTILIZED AS A VITAL TOOL FOR CREATING THE WILLIAMS COUNTY COMMUNITY HEALTH IMPROVEMENT PLAN (CHIP). THE PUBLIC HEALTH ACCREDITATION BOARD (PHAB) DEFINES A CHIP AS A LONG-TERM, SYSTEMATIC EFFORT TO ADDRESS HEALTH PROBLEMS ON THE BASIS OF THE RESULTS OF ASSESSMENT ACTIVITIES AND THE COMMUNITY HEALTH IMPROVEMENT PROCESS. THIS PLAN IS USED BY HEALTH AND OTHER GOVERNMENTAL EDUCATION AND HUMAN SERVICE AGENCIES, IN COLLABORATION WITH COMMUNITY PARTNERS, TO SET PRIORITIES AND COORDINATE AND TARGET RESOURCES. A CHIP IS CRITICAL FOR DEVELOPING POLICIES AND DEFINING ACTIONS TO TARGET EFFORTS THAT PROMOTE HEALTH. IT SHOULD DEFINE THE VISION FOR THE HEALTH OF THE COMMUNITY INCLUSIVELY AND SHOULD BE DONE IN A TIMELY WAY. TO FACILITATE THE COMMUNITY HEALTH IMPROVEMENT PROCESS, THE WILLIAMS COUNTY HEALTH DEPARTMENT (WCHD) AND COMMUNITY HOSPITALS AND WELLNESS CENTERS (CHWC) INVITED KEY COMMUNITY LEADERS TO PARTICIPATE IN AN ORGANIZED PROCESS OF STRATEGIC PLANNING TO IMPROVE THE HEALTH OF RESIDENTS OF THE COUNTY. THE NATIONAL ASSOCIATION OF CITY COUNTY HEALTH OFFICER'S (NACCHO) STRATEGIC PLANNING TOOL, MOBILIZING FOR ACTION THROUGH PLANNING AND PARTNERSHIPS (MAPP), WAS USED THROUGHOUT THIS PROCESS.THE 2017-2019 COMMUNITY HEALTH IMPROVEMENT PLAN WAS DRAFTED BY AGENCIES AND SERVICE PROVIDERS WITHIN WILLIAMS COUNTY. DURING JUNE-JULY, 2016, THE COMMITTEE REVIEWED MANY SOURCES OF INFORMATION CONCERNING THE HEALTH AND SOCIAL CHALLENGES WILLIAMS COUNTY ADULTS AND YOUTH MAY BE FACING. THEY DETERMINED PRIORITY ISSUES WHICH IF ADDRESSED, COULD IMPROVE FUTURE OUTCOMES, DETERMINED GAPS IN CURRENT PROGRAMMING AND POLICIES AND EXAMINED BEST PRACTICES AND SOLUTIONS. THE COMMITTEE HAS RECOMMENDED SPECIFIC ACTIONS STEPS THEY HOPE MANY AGENCIES AND ORGANIZATIONS WILL EMBRACE TO ADDRESS THE PRIORITY ISSUES IN THE COMING MONTHS AND YEARS. WE WOULD LIKE TO RECOGNIZE THESE INDIVIDUALS AND THANK THEM FOR THEIR DEVOTION TO THIS PROCESS AND THIS BODY OF WORK: WILLIAMS COUNTY PARTNERS FOR HEALTH ABBY CALVIN, COMMUNITY HOSPITALS AND WELLNESS CENTERS AMY BOEHM, AMERICAN CANCER SOCIETY ANNA MEYERS, JOB & FAMILY SERVICES BILL PEPPLE, UNITED WAY OF WILLIAMS COUNTY DAVID TILLY, MONTPELIER MINISTERIAL ASSOCIATION DIANA SAVAGE, BRYAN CITY SCHOOLS DOTTIE VOLLMAR, BUCKEYE COMMUNITY HOPE FOUNDATION JAMIE MARSHALL, PARKVIEW PHYSICIANS GROUP JAN DAVID, COMMUNITY HOSPITALS AND WELLNESS CENTERS JEANETTE ROBERTS, COMMUNITY HOSPITALS AND WELLNESS CENTERS JERRY STOLLINGS, JUVENILE COURT ADMINISTRATION JESSICA REITZEL, COMMUNITY HOSPITALS AND WELLNESS CENTERS JILL OSTREM, PARKVIEW PHYSICIANS GROUP JIM WATKINS, WILLIAMS COUNTY HEALTH DEPARTMENT KIM OWEN, COMMUNITY HOSPITALS AND WELLNESS CENTERS KIRSTEN FRISSORA, WILLIAMS COUNTY HEALTH DEPARTMENT LARRY LONG, MILLCREEK-WEST UNITY SCHOOLS LES MCCASLIN, FOUR COUNTY ALCOHOL, DRUG AND MENTAL HEALTH BOARD LINDA TRAUSCH, COMMUNITY HOSPITALS AND WELLNESS CENTERS LORI PHILLIPS, PARKVIEW PHYSICIANS GROUP MAGGIE FISHER, WILLIAMS COUNTY DEPARTMENT OF AGING MEGAN RILEY, WILLIAMS COUNTY HEALTH DEPARTMENT MICHELLE PRICE, STEP TOWARD HEALTH NATE JOHNSON, STRYKER LOCAL SCHOOLS PAM PFLUM, FOUR COUNTY ALCOHOL, DRUG AND MENTAL HEALTH BOARD PHIL ENNEN, COMMUNITY HOSPITALS AND WELLNESS CENTERS RACHEL AESCHLIMAN, WILLIAMS COUNTY HEALTH DEPARTMENT ROB IMBER, YMCA RON RITTICHIER, SAFE SCHOOLS/HEALTHY STUDENTS RONDA MUEHLFELD, BRYAN COMMUNITY HEALTH CENTER SALLY TAYLOR, PARKVIEW PHYSICIANS GROUP STEVE TOWNS, WILLIAMS COUNTY SHERIFF. |
| MONTPELIER HOSPITAL | PART V, SECTION B, LINE 5: WILLIAMS COUNTY PARTNERS FOR HEALTH (WCPH) BEGAN CONDUCTING COMMUNITY HEALTH ASSESSMENTS (CHA) FOR THE PURPOSE OF MEASURING AND ADDRESSING HEALTH STATUS. THE MOST RECENT WILLIAMS COUNTY COMMUNITY HEALTH ASSESSMENT WAS CROSS-SECTIONAL IN NATURE AND INCLUDED A WRITTEN SURVEY OF ADULTS AND ADOLESCENTS WITHIN WILLIAMS COUNTY. THE QUESTIONS WERE MODELED AFTER THE SURVEY INSTRUMENTS USED BY THE CENTERS FOR DISEASE CONTROL AND PREVENTION FOR THEIR NATIONAL AND STATE BEHAVIORAL RISK FACTOR SURVEILLANCE SYSTEM (BRFSS) AND THE YOUTH RISK BEHAVIOR SURVEILLANCE SYSTEM (YRBSS). THIS HAS ALLOWED WILLIAMS COUNTY TO COMPARE THE DATA COLLECTED IN THEIR CHA TO NATIONAL, STATE AND LOCAL HEALTH TRENDS. WILLIAMS COUNTY CHA ALSO FULFILLS NATIONAL MANDATED REQUIREMENTS FOR THE HOSPITALS IN OUR COUNTY. H.R. 3590 PATIENT PROTECTION AND AFFORDABLE CARE ACT STATES THAT IN ORDER TO MAINTAIN TAX-EXEMPT STATUS, NOT-FOR-PROFIT HOSPITALS ARE REQUIRED TO CONDUCT A COMMUNITY HEALTH NEEDS ASSESSMENT AT LEAST ONCE EVERY THREE YEARS, AND ADOPT AN IMPLEMENTATION STRATEGY TO MEET THE NEEDS IDENTIFIED THROUGH THE ASSESSMENT. FROM THE BEGINNING PHASES OF THE CHA, COMMUNITY LEADERS WERE ACTIVELY ENGAGED IN THE PLANNING PROCESS AND HELPED DEFINE THE CONTENT, SCOPE, AND SEQUENCE OF THE PROJECT. ACTIVE ENGAGEMENT OF COMMUNITY MEMBERS THROUGHOUT THE PLANNING PROCESS IS REGARDED AS AN IMPORTANT STEP IN COMPLETING A VALID NEEDS ASSESSMENT. THE WILLIAMS COUNTY CHA HAS BEEN UTILIZED AS A VITAL TOOL FOR CREATING THE WILLIAMS COUNTY COMMUNITY HEALTH IMPROVEMENT PLAN (CHIP). THE PUBLIC HEALTH ACCREDITATION BOARD (PHAB) DEFINES A CHIP AS A LONG-TERM, SYSTEMATIC EFFORT TO ADDRESS HEALTH PROBLEMS ON THE BASIS OF THE RESULTS OF ASSESSMENT ACTIVITIES AND THE COMMUNITY HEALTH IMPROVEMENT PROCESS. THIS PLAN IS USED BY HEALTH AND OTHER GOVERNMENTAL EDUCATION AND HUMAN SERVICE AGENCIES, IN COLLABORATION WITH COMMUNITY PARTNERS, TO SET PRIORITIES AND COORDINATE AND TARGET RESOURCES. A CHIP IS CRITICAL FOR DEVELOPING POLICIES AND DEFINING ACTIONS TO TARGET EFFORTS THAT PROMOTE HEALTH. IT SHOULD DEFINE THE VISION FOR THE HEALTH OF THE COMMUNITY INCLUSIVELY AND SHOULD BE DONE IN A TIMELY WAY. TO FACILITATE THE COMMUNITY HEALTH IMPROVEMENT PROCESS, THE WILLIAMS COUNTY HEALTH DEPARTMENT (WCHD) AND COMMUNITY HOSPITALS AND WELLNESS CENTERS (CHWC) INVITED KEY COMMUNITY LEADERS TO PARTICIPATE IN AN ORGANIZED PROCESS OF STRATEGIC PLANNING TO IMPROVE THE HEALTH OF RESIDENTS OF THE COUNTY. THE NATIONAL ASSOCIATION OF CITY COUNTY HEALTH OFFICER'S (NACCHO) STRATEGIC PLANNING TOOL, MOBILIZING FOR ACTION THROUGH PLANNING AND PARTNERSHIPS (MAPP), WAS USED THROUGHOUT THIS PROCESS.THE 2017-2019 COMMUNITY HEALTH IMPROVEMENT PLAN WAS DRAFTED BY AGENCIES AND SERVICE PROVIDERS WITHIN WILLIAMS COUNTY. DURING JUNE-JULY, 2016, THE COMMITTEE REVIEWED MANY SOURCES OF INFORMATION CONCERNING THE HEALTH AND SOCIAL CHALLENGES WILLIAMS COUNTY ADULTS AND YOUTH MAY BE FACING. THEY DETERMINED PRIORITY ISSUES WHICH IF ADDRESSED, COULD IMPROVE FUTURE OUTCOMES, DETERMINED GAPS IN CURRENT PROGRAMMING AND POLICIES AND EXAMINED BEST PRACTICES AND SOLUTIONS. THE COMMITTEE HAS RECOMMENDED SPECIFIC ACTIONS STEPS THEY HOPE MANY AGENCIES AND ORGANIZATIONS WILL EMBRACE TO ADDRESS THE PRIORITY ISSUES IN THE COMING MONTHS AND YEARS. WE WOULD LIKE TO RECOGNIZE THESE INDIVIDUALS AND THANK THEM FOR THEIR DEVOTION TO THIS PROCESS AND THIS BODY OF WORK: WILLIAMS COUNTY PARTNERS FOR HEALTH ABBY CALVIN, COMMUNITY HOSPITALS AND WELLNESS CENTERS AMY BOEHM, AMERICAN CANCER SOCIETY ANNA MEYERS, JOB & FAMILY SERVICES BILL PEPPLE, UNITED WAY OF WILLIAMS COUNTY DAVID TILLY, MONTPELIER MINISTERIAL ASSOCIATION DIANA SAVAGE, BRYAN CITY SCHOOLS DOTTIE VOLLMAR, BUCKEYE COMMUNITY HOPE FOUNDATION JAMIE MARSHALL, PARKVIEW PHYSICIANS GROUP JAN DAVID, COMMUNITY HOSPITALS AND WELLNESS CENTERS JEANETTE ROBERTS, COMMUNITY HOSPITALS AND WELLNESS CENTERS JERRY STOLLINGS, JUVENILE COURT ADMINISTRATION JESSICA REITZEL, COMMUNITY HOSPITALS AND WELLNESS CENTERS JILL OSTREM, PARKVIEW PHYSICIANS GROUP JIM WATKINS, WILLIAMS COUNTY HEALTH DEPARTMENT KIM OWEN, COMMUNITY HOSPITALS AND WELLNESS CENTERS KIRSTEN FRISSORA, WILLIAMS COUNTY HEALTH DEPARTMENT LARRY LONG, MILLCREEK-WEST UNITY SCHOOLS LES MCCASLIN, FOUR COUNTY ALCOHOL, DRUG AND MENTAL HEALTH BOARD LINDA TRAUSCH, COMMUNITY HOSPITALS AND WELLNESS CENTERS LORI PHILLIPS, PARKVIEW PHYSICIANS GROUP MAGGIE FISHER, WILLIAMS COUNTY DEPARTMENT OF AGING MEGAN RILEY, WILLIAMS COUNTY HEALTH DEPARTMENT MICHELLE PRICE, STEP TOWARD HEALTH NATE JOHNSON, STRYKER LOCAL SCHOOLS PAM PFLUM, FOUR COUNTY ALCOHOL, DRUG AND MENTAL HEALTH BOARD PHIL ENNEN, COMMUNITY HOSPITALS AND WELLNESS CENTERS RACHEL AESCHLIMAN, WILLIAMS COUNTY HEALTH DEPARTMENT ROB IMBER, YMCA RON RITTICHIER, SAFE SCHOOLS/HEALTHY STUDENTS RONDA MUEHLFELD, BRYAN COMMUNITY HEALTH CENTER SALLY TAYLOR, PARKVIEW PHYSICIANS GROUP STEVE TOWNS, WILLIAMS COUNTY SHERIFF. |
| BRYAN HOSPITAL | PART V, SECTION B, LINE 6A: MONTPELIER HOSPITAL |
| MONTPELIER HOSPITAL | PART V, SECTION B, LINE 6A: BRYAN HOSPITAL |
| BRYAN HOSPITAL | PART V, SECTION B, LINE 6B: WILLIAMS COUNTY HEALTH DEPARTMENT |
| MONTPELIER HOSPITAL | PART V, SECTION B, LINE 6B: WILLIAMS COUNTY HEALTH DEPARTMENT |
| BRYAN HOSPITAL | PART V, SECTION B, LINE 7D: THE 2019 WILLIAMS COUNTY HEALTH ASSESSMENT IS AVAILABLE ON THE FOLLOWING WEBSITES:COMMUNITY HOSPITALS AND WELLNESS CENTERSHTTPS://WWW.CHWCHOSPITAL.ORG/COMMUNITY-HEALTH-ASSESMENT/WILLIAMS COUNTY COMBINED HEALTH DISTRICTHTTP://WWW.WILLIAMSCOUNTYHEALTH.ORG/HOSPITAL COUNCIL OF NORTHWEST OHIOHTTP://WWW.HCNO.ORG/COMMUNITY/REPORTS.HTML |
| MONTPELIER HOSPITAL | PART V, SECTION B, LINE 7D: THE 2019 WILLIAMS COUNTY HEALTH ASSESSMENT IS AVAILABLE ON THE FOLLOWING WEBSITES:COMMUNITY HOSPITALS AND WELLNESS CENTERSHTTPS://WWW.CHWCHOSPITAL.ORG/COMMUNITY-HEALTH-ASSESMENT/WILLIAMS COUNTY COMBINED HEALTH DISTRICTHTTP://WWW.WILLIAMSCOUNTYHEALTH.ORG/HOSPITAL COUNCIL OF NORTHWEST OHIOHTTP://WWW.HCNO.ORG/COMMUNITY/REPORTS.HTML |
| BRYAN HOSPITAL | PART V, SECTION B, LINE 11: TO WORK TOWARD DECREASING ADULT AND YOUTH OBESITY, THE FOLLOWING ACTION STEPS ARE RECOMMENDED: 1. INCREASE EDUCATION OF HEALTHY EATING FOR ADULTS 2. IMPLEMENT FOOD PHARMACY PROGRAM 3. INCREASE EDUCATION OF HEALTHY EATING FOR YOUTH 4. IMPLEMENT COMPLETE STREETS POLICIES 5. IMPLEMENT OHA HEALTHY HOSPITALS INITIATIVETO WORK TOWARD IMPROVING ADULT CARDIOVASCULAR HEALTH, THE FOLLOWING ACTIONS STEPS ARE RECOMMENDED: 1. IMPLEMENT GO RED FOR WOMEN INITIATIVE 2. INCREASE NUTRITION/PHYSICAL EDUCATION MATERIALS BEING OFFERED TO PATIENTS BY PRIMARY CARE OFFICES TO WORK TOWARD IMPROVING YOUTH MENTAL HEALTH, THE FOLLOWING ACTIONS STEPS ARE RECOMMENDED: 1. INCREASE AWARENESS OF TRAUMA INFORMED CARE 2. INCREASE THE NUMBER PRIMARY CARE PHYSICIANS SCREENING FOR DEPRESSION DURING OFFICE VISITS 3. EXPAND EVIDENCE-BASED PROGRAMS TARGETING YOUTH 4. PROVIDE MENTAL HEALTH FIRST AID TRAINING 5. IMPLEMENT EVIDENCE-BASED PROGRAMS AND COUNSELING SERVICES TARGETING YOUTH 6. INCREASE EVIDENCE-BASED SERVICES THROUGH PROVIDERSTO WORK TOWARD DECREASING YOUTH SUBSTANCE ABUSE, THE FOLLOWING ACTIONS STEPS ARE RECOMMENDED: 1. EXPAND EVIDENCE-BASED PROGRAMS AND COUNSELING SERVICES TARGETING YOUTH AND FAMILIES 2. INCREASE THE NUMBER OF SCHOOLS SCREENING FOR ALCOHOL 3. IMPLEMENT A COMMUNITY BASED COMPREHENSIVE PROGRAM TO REDUCE ALCOHOL ABUSE 4. INCREASE COMMUNITY AWARENESS & EDUCATION OF SUBSTANCE ABUSE ISSUES AND TRENDS 5. IMPLEMENT PARENT PROJECTTO WORK TOWARD INCREASING WOMEN'S HEALTH SCREENINGS, THE FOLLOWING ACTIONS STEPS ARE RECOMMENDED: 1. CREATE CONSISTENT WOMEN'S HEALTH SCREENING RECOMMENDATIONS 2. INCREASE EDUCATION MATERIALS BEING OFFERED TO PATIENTS BY PRIMARY CARE OFFICES 3. DECREASE BARRIERS TO TREATMENT |
| MONTPELIER HOSPITAL | PART V, SECTION B, LINE 11: TO WORK TOWARD DECREASING ADULT AND YOUTH OBESITY, THE FOLLOWING ACTION STEPS ARE RECOMMENDED: 1. INCREASE EDUCATION OF HEALTHY EATING FOR ADULTS 2. IMPLEMENT FOOD PHARMACY PROGRAM 3. INCREASE EDUCATION OF HEALTHY EATING FOR YOUTH 4. IMPLEMENT COMPLETE STREETS POLICIES 5. IMPLEMENT OHA HEALTHY HOSPITALS INITIATIVETO WORK TOWARD IMPROVING ADULT CARDIOVASCULAR HEALTH, THE FOLLOWING ACTIONS STEPS ARE RECOMMENDED: 1. IMPLEMENT GO RED FOR WOMEN INITIATIVE 2. INCREASE NUTRITION/PHYSICAL EDUCATION MATERIALS BEING OFFERED TO PATIENTS BY PRIMARY CARE OFFICESTO WORK TOWARD IMPROVING YOUTH MENTAL HEALTH, THE FOLLOWING ACTIONS STEPS ARE RECOMMENDED: 1. INCREASE AWARENESS OF TRAUMA INFORMED CARE 2. INCREASE THE NUMBER PRIMARY CARE PHYSICIANS SCREENING FOR DEPRESSION DURING OFFICE VISITS 3. EXPAND EVIDENCE-BASED PROGRAMS TARGETING YOUTH 4. PROVIDE MENTAL HEALTH FIRST AID TRAINING 5. IMPLEMENT EVIDENCE-BASED PROGRAMS AND COUNSELING SERVICES TARGETING YOUTH 6. INCREASE EVIDENCE-BASED SERVICES THROUGH PROVIDERSTO WORK TOWARD DECREASING YOUTH SUBSTANCE ABUSE, THE FOLLOWING ACTIONS STEPS ARE RECOMMENDED: 1. EXPAND EVIDENCE-BASED PROGRAMS AND COUNSELING SERVICES TARGETING YOUTH AND FAMILIES 2. INCREASE THE NUMBER OF SCHOOLS SCREENING FOR ALCOHOL 3. IMPLEMENT A COMMUNITY BASED COMPREHENSIVE PROGRAM TO REDUCE ALCOHOL ABUSE 4. INCREASE COMMUNITY AWARENESS & EDUCATION OF SUBSTANCE ABUSE ISSUES AND TRENDS 5. IMPLEMENT PARENT PROJECTTO WORK TOWARD INCREASING WOMEN'S HEALTH SCREENINGS, THE FOLLOWING ACTIONS STEPS ARE RECOMMENDED: 1. CREATE CONSISTENT WOMEN'S HEALTH SCREENING RECOMMENDATIONS 2. INCREASE EDUCATION MATERIALS BEING OFFERED TO PATIENTS BY PRIMARY CARE OFFICES 3. DECREASE BARRIERS TO TREATMENT |
| BRYAN HOSPITAL | PART V, SECTION B, LINE 20E: VISITS DETERMINED TO BE CHARITY ELIGIBLE THROUGH THE I-SOLUTIONS PROGRAM, WILL RECEIVE CHARITY DISCOUNTS ACCORDING TO THE 'SELF PAY/COLLECTION POLICY'. I-SOLUTIONS IS AN ELECTRONIC SCREENING PROCESS THAT PROVIDES A SCORE RELATING TO THE PATIENT'S ABILITY TO PAY.PRESUMPTIVE ELIGIBILITY IS DETERMINED IMMEDIATELY PRIOR TO SENDING AN ACCOUNT TO COLLECTIONS. PATIENTS RECEIVING A FINANCIAL DISCOUNT FROM THE I-SOLUTIONS PROCESS MAY ALSO COMPLETE A FINANCIAL APPLICATION TO DETERMINE ELIGIBILITY FOR A HIGHER DISCOUNT, AS LONG AS THE APPLICATION IS COMPLETED WITHIN 240 DAYS OF THE 1ST STATEMENT DATE. THE PATIENT DOES NOT RECEIVE NOTIFICATION OF THE CHARITY DISCOUNT APPLIED BASED ON PRESUMPTIVE ELIGIBILITY AS THE ACCOUNT HAS ALREADY MET THE HOSPITAL GUIDELINES FOR PLACEMENT WITH A COLLECTION AGENCY AND IS IMMEDIATELY FORWARDED TO THE AGENCY FOR COLLECTION OF THE REMAINING BALANCE. THE COLLECTION AGENCY WILL ENCOURAGE COMPLETION OF A FINANCIAL APPLICATION, IF THEY DETERMINE THE PATIENT IS LIKELY ELIGIBLE FOR FINANCIAL ASSISTANCE, REGARDLESS IF THE ACCOUNT HAS ALREADY RECEIVED A DISCOUNT BASED ON PRESUMPTIVE ELIGIBILITY. |
| MONTPELIER HOSPITAL | PART V, SECTION B, LINE 20E: VISITS DETERMINED TO BE CHARITY ELIGIBLE THROUGH THE I-SOLUTIONS PROGRAM, WILL RECEIVE CHARITY DISCOUNTS ACCORDING TO THE 'SELF PAY/COLLECTION POLICY'. I-SOLUTIONS IS AN ELECTRONIC SCREENING PROCESS THAT PROVIDES A SCORE RELATING TO THE PATIENT'S ABILITY TO PAY.PRESUMPTIVE ELIGIBILITY IS DETERMINED IMMEDIATELY PRIOR TO SENDING AN ACCOUNT TO COLLECTIONS. PATIENTS RECEIVING A FINANCIAL DISCOUNT FROM THE I-SOLUTIONS PROCESS MAY ALSO COMPLETE A FINANCIAL APPLICATION TO DETERMINE ELIGIBILITY FOR A HIGHER DISCOUNT, AS LONG AS THE APPLICATION IS COMPLETED WITHIN 240 DAYS OF THE 1ST STATEMENT DATE. THE PATIENT DOES NOT RECEIVE NOTIFICATION OF THE CHARITY DISCOUNT APPLIED BASED ON PRESUMPTIVE ELIGIBILITY AS THE ACCOUNT HAS ALREADY MET THE HOSPITAL GUIDELINES FOR PLACEMENT WITH A COLLECTION AGENCY AND IS IMMEDIATELY FORWARDED TO THE AGENCY FOR COLLECTION OF THE REMAINING BALANCE. THE COLLECTION AGENCY WILL ENCOURAGE COMPLETION OF A FINANCIAL APPLICATION, IF THEY DETERMINE THE PATIENT IS LIKELY ELIGIBLE FOR FINANCIAL ASSISTANCE, REGARDLESS IF THE ACCOUNT HAS ALREADY RECEIVED A DISCOUNT BASED ON PRESUMPTIVE ELIGIBILITY. |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 2 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp (2 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | FacilityFacilityTxt |
|---|---|---|---|---|
| 1 - ARCHBOLD MEDICAL CENTER | ||||
| 121 WESTFIELD DR | ARCHBOLD | OH | 43502 | OP SURGERY CENTER, OP RADIOLOGY, OP LAB, OP THERAPIES, AND MOB |
| 2 - RADIATION ONCOLOGY CENTER | ||||
| 524 WEST HIGH ST | BRYAN | OH | 43506 | RADIATION ONCOLOGY |
Supplemental Information Detail SupplementalInformationDetail (17 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 3C: | NOT APPLICABLE |
| PART I, LINE 6A: | NOT APPLICABLE |
| PART I, LINE 7: | CHARITY CARE AND MEDICAID COSTS WERE CALCULATED USING A COST TO CHARGE RATIO (54%) WHICH WAS DERIVED FROM WORKSHEET 2. |
| PART I, LINE 7G: | NOT APPLICABLE |
| PART I, LN 7 COL(F): | THE PERCENTAGE CALCULATED ON LINE 7F IS BASED ON TOTAL EXPENSES FROM FORM 990, PART IX, LESS BAD DEBTS IN THE AMOUNT OF $3,260,676. |
| PART I, LINE 7E: | CHWC OFFERS ADVANCED CARDIAC LIFE SUPPORT (ACLS) AND PEDIATRIC ADVANCED LIFE SUPPORT (PALS) COURSES FOR PHYSICIANS, COUNTY EMS PROVIDERS, AND OTHER AREA HOSPITAL EMPLOYEES AT NO CHARGE.THE ORGANIZATION CONDUCTED FREE CPR CLASSES TO AREA LIFEGUARDS AND COACHES. IT ALSO PROVIDED CPR EQUIPMENT TO AREA SCHOOLS FOR STUDENT TRAINING AT NO CHARGE.CHWC OFFERS CHILDBIRTH EDUCATION CLASSES (INCLUDING PREPARED CHILDBIRTH, BABY CARE, SIBLING READINESS, AND BREASTFEEDING) AT NO CHARGE. LACTATION CONSULTING IS ALSO PROVIDED WITH FOLLOW UP HOME VISITS WHEN NECESSARY. REPRESENTATIVES OF CHWC GAVE COMMUNITY PRESENTATIONS ON A VARIETY OF HEALTHCARE- RELATED TOPICS.SMOKING CESSATION PROGRAMS AND SPEAKERS WERE ALSO OFFERED TO COMMUNITY AT NO COST.CHWC HAS HOSTED CAREER DAY FOR LOCAL SCHOOLS, WITH A FOCUS ON OPPORTUNITIES IN HEALTH CARE PROFESSIONS.MONTHLY DIABETIC SUPPORT GROUPS ARE AVAILABLE BY LICENSED DIETITIANS THAT PROVIDE RESOURCES TO APPROXIMATELY 11 COMMUNITY MEMBERS. THESE MEMBERS OF OUR STAFF ALSO PRESENT TO LOCAL BUSINESSES, SCHOOLS, AND CIVIC GROUPS.MINDFULNESS- BASED STRESS REDUCTION CLASSES WERE GIVEN AWAY TO 33 COMMUNITY PARTICIPANTS.THE ORGANIZATION PAID $100,214 FOR TWO SCHOOL- BASED MENTAL HEALTH COUNSELORS WERE PROVIDED TO SCHOOLS WITHIN THE COUNTY AT NO COST. |
| PART II, COMMUNITY BUILDING ACTIVITIES: | NOT APPLICABLE |
| PART III, LINE 2: | BAD DEBT WAS CALCULATED USING AUDITED FINANCIAL, IT IS NOT AN ESTIMATED AMOUNT. |
| PART III, LINE 3: | ESTIMATE OF 10% OF TOTAL BAD DEBT EXPENSE IN ORDER TO CALCULATE THE AMOUNT RECORDED AS BAD DEBT THAT WOULD BE ATTRIBUTABLE TO PATIENTS WHO WOULD QUALIFY UNDER THE HOSPITAL'S CHARITY CARE POLICY. NONE OF THE BAD DEBT EXPENSE IS TREATED AS A COMMUNITY BENEFIT. |
| PART III, LINE 4: | ACCOUNTS RECEIVABLE ARE REDUCED BY AN ALLOWANCE FOR DOUBTFUL ACCOUNTS. IN EVALUATING THE COLLECTIBILITY OF ACCOUNTS RECEIVABLE, THE HOSPITAL ANALYZES ITS PAST HISTORY AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYOR SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND PROVISION FOR BAD DEBTS. MANAGEMENT REGULARLY REVIEWS DATA ABOUT THESE MAJOR PAYOR SOURCES OF REVENUE IN EVALUATING THE SUFFICIENCY OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY COVERAGE, THE HOSPITAL ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS AND A PROVISION FOR BAD DEBTS IF NECESSARY (FOR EXAMPLE, FOR EXPECTEDUNCOLLECTIBLE DEDUCTIBLES AND COPAYMENTS ON ACCOUNTS FOR WHICH THE THIRD-PARTY PAYOR HAS NOT YET PAID OR FOR PAYORS WHO ARE KNOWN TO BE HAVING FINANCIAL DIFFICULTIES THAT MAKE THE REALIZATION OF AMOUNTS DUE UNLIKELY).FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS (WHICH INCLUDE BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND COPAYMENT BALANCES DUE FOR WHICH THIRD-PARTY COVERAGE EXISTS FOR PART OF THE BILL), THE HOSPITAL RECORDS A SIGNIFICANT PROVISION FOR BAD DEBTS 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 THE STANDARD RATES (OR THE 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: | MEDICARE COSTS WERE CALCULATED USING A COST TO CHARGE RATIO BASED ON METHODOLOGY REQUIRED FOR COMPLETING THE MEDICARE COST REPORT. THE SHORTFALL IS CONSIDERED COMMUNITY BENEFIT DUE TO THE ELDERLY POPULATION IN THE HOSPITAL'S SERVICE AREA. |
| PART III, LINE 9B: | THE FOLLOWING COLLECTION PRACTICES ARE CONSISTENANT WITH ALL PATIENTS:STATEMENT CYCLE:THE FIRST STATEMENT MAILED TO THE PATIENT/GUARANTOR IS A STATEMENT SUMMARIZING THE CHARGES AND INSURANCE PAYMENTS, IF APPLICABLE. THIS STATEMENT IS MAILED TO THE GUARANTOR THE DAY AFTER THE ACCOUNT IS FINAL BILLED IN THE HOSPITAL SYSTEM, OR THE DAY FOLLOWING RECEIPT AND SETTLEMENT OF INSURANCE PAYMENT, IF APPLICABLE. IF INSURANCE HAS PENDED PROCESSING OF A CLAIM, HOLDING FOR REQUESTED INFORMATION FROM THE POLICY HOLDER, A LETTER IS SENT TO THE PATIENT/GUARANTOR ASKING THEM TO PROVIDE THE INSURANCE WITH THE REQUESTED INFORMATION AND NOTIFY THE PATIENT ACCOUNTS OFFICE WHEN IT IS COMPLETED. IF THE PATIENT DOES NOT RESPOND TO THE LETTER BY THE DUE DATE, THE ACCOUNT WILL BE CHANGED TO SELF PAY PRIOR TO INSURANCE PAYMENT, AND THE PATIENT WILL BEGIN RECEIVING STATEMENTS. FOLLOWING THE INITIAL SUMMARY STATEMENT, A GUARANTOR STATEMENT IS MAILED TO THE GUARANTOR THE FIRST WEEK OF EACH MONTH, UNTIL THE ACCOUNT IS SETTLED IN FULL, OR REFERRED TO AN OUTSIDE AGENCY FOR COLLECTIONS. THE GUARANTOR STATEMENT LISTS ALL ACCOUNTS WITH AN OUTSTANDING PATIENT BALANCE, EXCLUDING BAD DEBT ACCOUNTS THAT ARE PROCESSING WITH A COLLECTION AGENCY. ACCOUNTS PROCESSING WITH INSURANCE WILL NOT BE INCLUDED ON PATIENT/GUARANTOR STATEMENTS, UNTIL THERE IS A PATIENT BALANCE DUE ON THE ACCOUNT. PHONE CALLS:CHWC WILL ATTEMPT TO MAKE A PHONE CALL TO ALL PATIENTS WITH NO INSURANCE APPROXIMATELY 2 WEEKS AFTER THE DATE OF SERVICE, TO DISCUSS POTENTIAL ENROLLMENT IN AN INSURANCE PLAN THROUGH THE HEALTH INSURANCE MARKETPLACE, OFFER ASSISTANCE WITH MEDICAID ENROLLMENT, FINANCIAL ASSISTANCE OR SETTING UP PAYMENT ARRANGEMENTS. THIS PHONE CALL WILL BE DOCUMENTED ON THE ACCOUNT NOTES. PAYMENT ARRANGEMENT GUIDELINES:THE PATIENT STATEMENT INCLUDES CONTACT INFORMATION FOR THE PATIENT ACCOUNTS BILLING OFFICE. PATIENT REPRESENTATIVES ARE AVAILABLE TO SET UP PAYMENT ARRANGEMENTS WITH THE GUARANTOR. WHEN A GUARANTOR CALLS TO SET UP PAYMENT ARRANGEMENTS, THE GUARANTOR IS ASKED TO PAY IN FULL, AND OFFERED THE OPTION OF A 15% PROMPT PAY DISCOUNT IF PAID IN FULL WITHIN 30 DAYS OF THE FIRST STATEMENT DATE. REQUESTS FOR DISCOUNTS EXCEEDING 15% ARE TO BE APPROVED BY THE PRESIDENT/CEO OR EVP OF FINANCE. IF PAYMENT IN FULL IS NOT POSSIBLE, THE GUARANTOR IS ASKED TO MAKE MONTHLY PAYMENTS TO PAY THE ACCOUNT IN FULL WITHIN 18 MONTHS, AND WITH A MINIMUM PAYMENT OF $50.00 PER MONTH. EXCEPTIONS CAN BE MADE TO THESE PAYMENT GUIDELINES TO ALLOW A SMALLER PAYMENT OR EXTENDED TIME TO PAY OFF THE BILL, IF DETERMINATION IS MADE THAT THE GUARANTOR IS MAKING EVERY EFFORT TO PAY AND AGREES TO INCREASE PAYMENTS IN THE FUTURE, IF THE FINANCIAL CIRCUMSTANCES CHANGE. THE GUARANTOR MAY BE ASKED TO COMPLETE A FINANCIAL APPLICATION TO DETERMINE ELIGIBILITY FOR FINANCIAL ASSISTANCE, IF HE/SHE IS NOT ABLE TO MAKE ACCEPTABLE PAYMENT ARRANGEMENTS. (SEE FINANCIAL ASSISTANCE POLICY). FINAL NOTICE:IF NO PAYMENT IS RECEIVED OR PAYMENT ARRANGEMENT ESTABLISHED BY DAY 63 FROM THE INITIAL STATEMENT DATE, A "PAST DUE LETTER" IS SENT TO THE GUARANTOR WITH A REQUEST TO PAY IN FULL OR CONTACT PATIENT ACCOUNTS WITHIN 30 DAYS. THE PAST DUE LETTER WILL INCLUDE THE 'PLAIN LANGUAGE SUMMARY". THE PAST DUE LETTER WILL INFORM THE PATIENT THAT THE ACCOUNT WILL BE CONSIDERED FOR COLLECTIONS IF THERE IS NO RESPONSE WITHIN 30 DAYS, AND WILL ALSO LIST THE ECA'S (SEE ECA BELOW) THAT MAY BE INITIATED IF THE GUARANTOR DOES NOT RESPOND. IF THERE IS NO RESPONSE BY THE 38TH DAY FOLLOWING THE DATE OF THE 'PAST DUE LETTER OR ACCEPTABLE PAYMENTS HAVE NOT BEEN ESTABLISHED, THE ACCOUNT IS REVIEWED BY THE PATIENT REPRESENTATIVE TO DETERMINE ELIGIBILITY FOR BAD DEBT AND COLLECTION AGENCY PROCESSING. IF THE PATIENT HAD PREVIOUSLY ESTABLISHED A PAYMENT ARRANGEMENT BUT DID NOT FOLLOW THROUGH WITH TIMELY PAYMENTS, A PHONE CALL TO THE PATIENT WILL BE MADE IN AN ATTEMPT TO RE-ESTABLISH THE PAYMENT ARRANGEMENT. IF THE PATIENT IS NOT ABLE TO BE REACHED AFTER A MINIMUM OF 2 ATTEMPTS, OR IS NOT COOPERATIVE, THE ACCOUNT WILL BE CONSIDERED FOR BAD DEBT/COLLECTIONS DURING THE NEXT TRANSFER OF ACCOUNTS. INVALID ADDRESS OR CONTACT INFORMATION:IF A PATIENT STATEMENT IS RETURNED FOR AN INVALID ADDRESS, THE PATIENT WILL BE CONTACTED BY PHONE TO OBTAIN CORRECT BILLING INFORMATION. IF THERE IS NO VALID PHONE CONTACT, OR THE PATIENT DOESN'T RESPOND TO A PHONE CALL, THE ACCOUNT MAY BE SENT TO THE COLLECTION AGENCY PRIOR TO SENDING A FINAL "PAST DUE LETTER". THE AGENCY WILL ATTEMPT TO LOCATE A VALID ADDRESS FOR THE GUARANTOR. THE AGENCY WILL NOTIFY THE HOSPITAL IF A VALID ADDRESS IS OBTAINED. IF THE PATIENT DOES NOT COOPERATE WITH THE COLLECTION AGENCY REGARDING PAYMENT OR COMPLETION OF A FINANCIAL APPLICATION, THE AGENCY WILL CONTACT THE HOSPITAL SO THAT A FINAL 'PAST DUE LETTER' CAN BE SENT. IF THERE IS NO RESPONSE TO THE PAST DUE LETTER, THE COLLECTION AGENCY MAY CONTINUE WITH APPROPRIATE ECA'S 240 DAYS FROM THE ORIGINAL STATEMENT DATE. THE HOSPITAL AND AGENCY WILL WORK TOGETHER TO ASSURE THE AGENCY HAS THE APPROPRIATE 1ST STATEMENT DATE SINCE THE ACCOUNTS MAY BE INITIALLY SENT TO THE AGENCY PRIOR TO THE NORMAL MINIMUM OF DAY 100. PRESUMPTIVE ELIGIBILITY:AFTER THE COLLECTION AGENCY HAS DETERMINED AN ACCOUNT TO BE UNCOLLECTIBLE, THE ACCOUNT IS SENT TO "I-SOLUTIONS" TO REVIEW AND DETERMINE CHARITY ELIGIBILITY. ANY ACCOUNTS THAT LIST ON THE I-SOLUTIONS REPORT AS "YES" UNDER THE CHARITY COLUMN WILL RECEIVE A CHARITY DISCOUNT EQUAL TO THE "W/O AMOUNT" LISTED ON THE REPORT. ACCOUNTS THAT CONTAIN A POSITIVE "W/O AMOUNT AND FALL IN THE "BD OR "LOW" PROPENSITY TO PAY CATEGORY,, AND ACCOUNTS WITH NO LISTED PROPENSITY TO PAY BUT A POSITIVE "W/O AMOUNT" WILL ALSO RECEIVE A CHARITY DISCOUNT EQUAL TO THE "W/O AMOUNT" LISTED ON THE REPORT. VISITS WITH A PROPENSITY TO PAY "NMD" (NEED MORE DATA) DO NOT RECEIVE A CHARITY ADJUSTMENT.THE ADMISSION AUTHORIZATION FORM INCLUDES A STATEMENT AUTHORIZING THE HOSPITAL TO REVIEW THE GUARANTOR'S CREDIT INFORMATION. IF THIS IS NOT SIGNED BY THE PATIENT OR HIS/HER REPRESENTATIVE, THE VISIT WILL NOT BE SENT TO I-SOLUTIONS FOR REVIEW. IT WILL BE FORWARDED DIRECTLY TO THE COLLECTION AGENCY. THE ADMISSIONS OFFICE WILL SEND A TICKLER NOTE TO PATIENT ACCOUNTS, STATING THAT THE PATIENT REFUSED TO SIGN THE AUTHORIZATION. ACCOUNTS RECEIVING A DISCOUNT BASED ON PRESUMPTIVE ELIGIBILITY ARE ELIGIBLE TO APPLY FOR AN ADDITIONAL DISCOUNT, IF A FINANCIAL APPLICATION IS COMPLETED WITHIN 240 DAYS FROM THE 1ST STATEMENT DATE. |
| PART VI, LINE 2: | THE WILLIAMS COUNTY PARTNERS FOR HEALTH COMMITTEE PRESENTS THE 2019 WILLIAMS COUNTY COMMUNITY HEALTH ASSESSMENT. THE DATA CONTAINED IN THIS REPORT IS A SCIENTIFICALLY VALID SAMPLING CONDUCTED EVERY THREE YEARS IN THE COMMUNITY TO BETTER IDENTIFY AND UNDERSTAND HEALTH ISSUES FACING WILLIAMS COUNTY RESIDENTS. THROUGH A COMBINED EFFORT BY THE WILLIAMS COUNTY HEALTH DEPARTMENT, COMMUNITY HOSPITALS AND WELLNESS CENTERS BRYAN AND MONTPELIER, AND THE MANY ORGANIZATIONS LISTED IN THIS PUBLICATION, WE ARE ABLE TO PROVIDE VALUABLE INFORMATION BOTH TO INDIVIDUAL RESIDENTS AND ORGANIZATIONS IN THE COMMUNITY. IN THE PAST, THIS INFORMATION HAS HELPED TO EDUCATE CITIZENS ABOUT THEIR COMMUNITY AND WE HOPE YOU FIND THE NEW REPORT HELPFUL IN THAT REGARD. IN THE 2019 REPORT YOU WILL FIND THAT IN MANY WAYS THE HEALTH OF OUR COMMUNITY IS VERY GOOD AND RANKS HIGHER THAN BOTH THE NATION AND STATE AVERAGES. IN OTHER AREAS, YOU WILL FIND WE STILL HAVE CHALLENGES THAT NEED TO BE ADDRESSED FOR THE BETTERMENT OF OUR COMMUNITY. WHETHER YOU USE THIS INFORMATION TO APPLY FOR GRANTS OR JUST BECOME MORE INFORMED WE HOPE THAT YOU FIND THIS REPORT USEFUL FOR YOUR PURPOSES. |
| PART VI, LINE 3: | ALL PATIENTS REGISTERING FOR EMERGENCY OR MEDICALLY NECESSARY CARE WILL BE OFFERED A FINANCIAL APPLICATION AND "PLAIN LANGUAGE SUMMARY" AT THE TIME OF REGISTRATION. CHWC WILL ALSO FOLLOW UP WITH UNINSURED PATIENTS WITHIN 3 TO 4 WEEKS OF SERVICE, IF A FINANCIAL APPLICATION IS NOT RECEIVED OR MEDICAID APPLICATION IS NOT COMPLETED BY THAT DATE. FOLLOW UP CONSISTS OF A PHONE CALL TO OFFER THE PATIENT ASSISTANCE WITH THE MEDICAID APPLICATION AND DISCUSS FINANCIAL ASSISTANCE OPTIONS.PATIENT BILLING STATEMENTS INCLUDE ON THE BACK SIDE, INFORMATION ON THE HCAP AND HOSPITAL FINANCIAL ASSISTANCE PROGRAMS, INCLUDING CURRENT POVERTY LEVELS, AS REQUIRED BY HCAP POLICY. THE OPTIONS FOR REQUESTING A FINANCIAL APPLICATION ARE ALSO LISTED ON THE STATEMENT. REFERENCE TO THE FINANCIAL ASSISTANCE INFORMATION WILL BE CLEARLY NOTED ON THE FRONT SIDE OF THE STATEMENT. THE PLAIN LANGUAGE SUMMARY, FINANCIAL APPLICATION, BILLING AND COLLECTIONS POLICY, AND THIS FINANCIAL ASSISTANCE POLICY ARE DISPLAYED ON THE HOSPITAL WEBSITE. IN COMPLIANCE WITH THE 5-PERCENT/1000 PERSON THRESHOLD UNDER THE HHS GUIDANCE SAFE HARBOR AND 501R REGULATIONS, THE SPANISH VERSION OF THE FAP, FINANCIAL APPLICATION AND PLAIN LANGUAGE SUMMARY IS ALSO AVAILABLE AT ALL HOSPITAL LOCATIONS AND ON THE HOSPITAL WEBSITE. SIGNAGE IS POSTED AT ALL 3 HOSPITAL BUILDINGS IN CUSTOMER AREAS INCLUDING ADMISSIONS OFFICE, BILLING OFFICE, CASHIER AREA AND EMERGENCY DEPARTMENT. THE SIGNAGE WILL PROVIDE INFORMATION ON THE HOSPITAL FINANCIAL PROGRAM AND THE APPLICATION PROCESS.COPIES OF THE FINANCIAL APPLICATION AND PLAIN LANGUAGE SUMMARY ARE DISTRIBUTED TO THE COMPASSION CLINIC IN WILLIAMS COUNTY. THIS IS A 'FREE CLINIC AND PATIENTS ARE ENCOURAGED TO COMPLETE THE APPLICATION IF THEY NEED FOLLOW UP SERVICES AT THE HOSPITAL. CHWC WILL PERIODICALLY INCLUDE INFORMATION ON THE HOSPITAL FINANCIAL ASSISTANCE POLICIES, IN THE QUARTERLY NEWSLETTER THAT IS MAILED TO RESIDENTS IN THE 4 COUNTY AREA. |
| PART VI, LINE 4: | HOSPITALS ARE LOCATED IN BRYAN AND MONTPELIER, OHIO, IN ADDITION TO A MEDICAL CENTER LOCATED IN ARCHBOLD. CHWC SERVICES THE FOLLOWING THREE COUNTIES: WILLIAMS, DEFIANCE AND FULTON. APPROXIMATELY 17.9% OF THE POPULATION IS 65 YEARS OR OLDER, 19.5% IS BELOW POVERTY LEVEL, AND 10.8% ARE WITHOUT HEALTH INSURANCE UNDER AGE 65. |
| PART VI, LINE 5: | TEN OUT OF 11 OF THE ORGANIZATION'S BOARD RESIDES IN THE ORGANIZATION'S PRIMARY SERVICE AREA, WITH NONE BEING EMPLOYEES BESIDES THE PRESIDENT, INDEPENDENT CONTRACTORS OR RELATED TO THE MANAGEMENT TEAM AND ONLY TWO BEING ON THE MEDICAL STAFF. TEN OF THE ELEVEN BOARD MEMBERS ARE VOLUNTEER POSITIONS WITH NO PAY.THE HOSPITAL PROVIDES THE HIGHEST QUALITY OF CARE IN THE MOST EFFICIENT MANNER POSSIBLE. CHWC TYPICALLY RUNS AROUND A 1% OPERATING MARGIN. WE TAKE INTO CONISDERATION THE COMMUNITIES FEEDBACK ON SERVICES THEY WOULD LIKE PROVIDED LOCALLY AND ASSESS IF WE CAN PROVIDE THEM WITH THE UPMOST QUALITY AND EFFICIENCY. |
| PART VI, LINE 6: | NOT APPLICABLE |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Committee | Yes (X) | CompensationCommitteeInd |
| Form990 Of Other Organizations | Yes (X) | Form990OfOtherOrganizationsInd |
| Written Employment Contract | Yes (X) | WrittenEmploymentContractInd |
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | Yes (1) | 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 (8 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| DAVID COOLEY MD | ||||||||||||||
| PHYSICIAN | $656,858 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $11,148 | $0 | $668,006 | $0 | $0 | $0 |
| JODI TINKEL MD | ||||||||||||||
| PHYSICIAN | $616,205 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $616,205 | $0 | $0 | $0 |
| MICHAEL NOSANOV | ||||||||||||||
| PHYSICIAN | $605,750 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $10,104 | $0 | $615,854 | $0 | $0 | $0 |
| HANAN BAZZI MD | ||||||||||||||
| PHYSICIAN | $426,358 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $22,128 | $0 | $448,486 | $0 | $0 | $0 |
| CHAD D TINKEL | ||||||||||||||
| PRESIDENT/SECRETARY, CEO | $335,674 | $0 | $0 | $0 | $0 | $0 | $19,000 | $0 | $21,420 | $0 | $376,094 | $0 | $0 | $0 |
| SCOTT FREDERICK MD | ||||||||||||||
| PHYSICIAN | $339,343 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $23,942 | $0 | $363,285 | $0 | $0 | $0 |
| WADE PATRICK | ||||||||||||||
| VP/CIO | $248,357 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $16,158 | $0 | $264,515 | $0 | $0 | $0 |
| JANICE DAVID | ||||||||||||||
| VP PATIENT CARE | $222,081 | $0 | $0 | $0 | $0 | $0 | $19,000 | $0 | $9,960 | $0 | $251,041 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART I, LINE 3 | FormAndLineReferenceDesc |
| Explanation | THE FOLLOWING INDVIDUALS PARTICIPATED IN A 457(B) RETIREMENT PLAN: JANICE DAVID AND CHAD D. TINKEL. A $19,000 CONTRIBUTION WAS MADE TO 457(B) PLAN. THESE AMOUNTS HAVE BEEN PROPERLY INCLUDED IN OFFICERS' COMPENSATION ON SCHEDULE J, PART II, COLUMN B(III). THE HOSPITAL HAS A SUPPLEMENTAL EXECUTIVE RETENTION PLAN FOR THESE EXECUTIVES UNDER IRC SECTION 457(B). THE AMOUNTS DEFERRED UNDER THIS PLAN WILL BE TAXABLE TO THE EXECUTIVE WHEN VESTED AND THERE IS NO LONGER A SUBSTANTIAL RISK OF FORFEITURE. IN ORDER TO HAVE THE RIGHT TO FUTURE PAYMENT OF ANY EMPLOYER DEFERRAL, THE EXECUTIVE WILL HAVE TO REMAIN IN SERVICE UNTIL THE ACCOUNT BECOMES VESTED AS PROVIDED IN THE PLAN DOCUMENT. | ExplanationTxt |
Schedule K IRS990ScheduleK
Tax Exempt Bonds Issues TaxExemptBondsIssuesGrp (4 entries)
| Bond ReferenceBondReferenceCd | Bond Issuer EINBondIssuerEIN | Bond IssuedBondIssuedDt | Issue PriceIssuePriceAmt | PurposePurposeDesc | DefeasedDefeasedInd | On Behalf Of IssuerOnBehalfOfIssuerInd | Pool FinancingPoolFinancingInd |
|---|---|---|---|---|---|---|---|
| CITY OF BRYAN OH | |||||||
| A | 346400228 | 2008-07-01 | $10,000,000 | SEE PART VI | 0 | 0 | 0 |
| VILLAGE OF ARCHBOLD OH | |||||||
| B | 346400063 | 2008-08-20 | $10,000,000 | SEE PART VI | 0 | 0 | 0 |
| CITY OF BRYAN OH | |||||||
| C | 346400228 | 2016-06-15 | $10,000,000 | SEE PART VI | 0 | 0 | 0 |
| COUNTY OF WILLIAMS OH | |||||||
| D | 346401595 | 2016-06-30 | $10,000,000 | SEE PART VI | 0 | 0 | 0 |
Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp (4 entries)
| Bond ReferenceBondReferenceCd | Total ProceedsTotalProceedsAmt | Capital ExpendituresCapitalExpendituresAmt | Substantial CompletionSubstantialCompletionYr | Refunding Tax Exempt BondsRefundingTaxExemptBondsInd | Refunding Taxable BondsRefundingTaxableBondsInd | Final Allocation MadeFinalAllocationMadeInd | Adequate Books And Rec MaintAdequateBooksAndRecMaintInd |
|---|---|---|---|---|---|---|---|
| A | $10,208,153 | $10,208,153 | 2011 | 0 | 0 | Yes (1) | Yes (1) |
| B | $10,208,153 | $10,208,153 | 2011 | 0 | 0 | Yes (1) | Yes (1) |
| C | $10,000,000 | $10,000,000 | Yes (1) | 0 | Yes (1) | Yes (1) | |
| D | $10,000,000 | $10,000,000 | 2011 | Yes (1) | 0 | Yes (1) | Yes (1) |
Tax Exempt Bonds Private Bus Use TaxExemptBondsPrivateBusUseGrp (4 entries)
| Bond ReferenceBondReferenceCd | Owning Bond Financed PropertyOwningBondFinancedPropertyInd | Any Lease ArrangementsAnyLeaseArrangementsInd | Mgmt Contract Bond Fincd PropMgmtContractBondFincdPropInd | Engage Bond Counsel ContractsEngageBondCounselContractsInd | Any Research AgreementsAnyResearchAgreementsInd | Private Bus Use By OthersPrivateBusUseByOthersPct | Total Private Business UseTotalPrivateBusinessUsePct | Bond Iss Meet Prvt Sec Pymt TestBondIssMeetPrvtSecPymtTestInd | Change In Use Bond Financed PropChangeInUseBondFinancedPropInd | Procs Nonqualified Bond RemdtdProcsNonqualifiedBondRemdtdInd | Private Bus Concerning UBIPrivateBusConcerningUBIPct |
|---|---|---|---|---|---|---|---|---|---|---|---|
| A | 0 | 0 | Yes (1) | Yes (1) | 0 | 0.01240 | 0.01240 | 0 | 0 | Yes (1) | |
| B | 0 | 0 | Yes (1) | Yes (1) | 0 | 0.00000 | 0.00000 | 0 | 0 | Yes (1) | 0.00000 |
| C | 0 | Yes (1) | Yes (1) | Yes (1) | 0 | 0.31000 | 0.31000 | 0 | 0 | Yes (1) | |
| D | 0 | Yes (1) | Yes (1) | Yes (1) | 0 | 0.01240 | 0.01240 | 0 | 0 | Yes (1) |
Tax Exempt Bonds Arbitrage TaxExemptBondsArbitrageGrp (4 entries)
| Bond ReferenceBondReferenceCd | Form8038 T FiledForm8038TFiledInd | Rebate Not Due YetRebateNotDueYetInd | Exception To RebateExceptionToRebateInd | No Rebate DueNoRebateDueInd | Variable Rate IssueVariableRateIssueInd | Hedge Identified In Bks And RecHedgeIdentifiedInBksAndRecInd | Gross Proceeds Invested In GICGrossProceedsInvestedInGICInd | Gross Proceeds InvestedGrossProceedsInvestedInd | Written Proc To Monitor ReqsWrittenProcToMonitorReqsInd | Term Of HedgeTermOfHedgePct | Superintegrated HedgeSuperintegratedHedgeInd | Hedge TerminatedHedgeTerminatedInd |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| (no name) | ||||||||||||
| A | 0 | 0 | Yes (1) | Yes (1) | Yes (1) | 0 | 0 | 0 | Yes (1) | |||
| (no name) | ||||||||||||
| B | 0 | 0 | Yes (1) | Yes (1) | Yes (1) | 0 | 0 | 0 | Yes (1) | |||
| FIFTH THIRD BANK | ||||||||||||
| C | 0 | Yes (1) | Yes (1) | 0 | Yes (1) | Yes (1) | 0 | 0 | Yes (1) | 1.400000000000 | 0 | 0 |
| FIFTH THIRD BANK | ||||||||||||
| D | 0 | Yes (1) | Yes (1) | 0 | Yes (1) | Yes (1) | 0 | 0 | Yes (1) | 1.400000000000 | 0 | 0 |
Procedures Corrective Action ProceduresCorrectiveActionGrp (4 entries)
| Bond ReferenceBondReferenceCd | Procedures Corrective ActionProceduresCorrectiveActionInd |
|---|---|
| A | Yes (1) |
| B | Yes (1) |
| C | Yes (1) |
| D | Yes (1) |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | FORM 990, SCHEDULE K, PART II | FormAndLineReferenceDesc |
| Explanation | PART II, LINE 3, COLUMN A: TOTAL PROCEEDS OF ISSUE ARE $10,208,153, WHICH ARE SALE PROCEEDS OF $10,000,000 PLUS INVESTMENT EARNINGS OF $208,153. PART II, LINE 3, COLUMN B: TOTAL PROCEEDS OF ISSUE ARE $10,208,153 WHICH ARE SALE PROCEEDS OF $10,000,000 PLUS INVESTMENT EARNINGS OF $208,153. PART III, LINE 4, COLUMN D: PRIVATE BUSINESS USE OF 1.24% IS A RESULT OF A DISCRETE PAIN MANAGEMENT AREA WITHIN THE BOND-FINANCED PROJECT. PART IV, LINE 2C, COLUMN A: REBATE COMPUTATION WAS PERFORMED ON 02/04/2013. PART IV, LINE 2C, COLUMN B: REBATE COMPUTATION WAS PERFORMED ON 02/04/2013. | ExplanationTxt |
Schedule L IRS990ScheduleL
Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp (2 entries)
| Relationship DescriptionRelationshipDescriptionTxt | TransactionTransactionAmt | TransactionTransactionDesc | Sharing Of RevenuesSharingOfRevenuesInd |
|---|---|---|---|
| PPG OHIOMIDWEST COMMUNITY HEALTH ASSOCIATES | |||
| SEE SCH L, PART V | $1,320,998 | DR. WATSON AND DR. BUMB ARE BOTH VOTING MEMBERS OF CHWC AND VOTING MEMBERS OF PPG OHIO/MCHA. | 0 |
| JODI TINKEL | |||
| SEE SCH L, PART V | $612,517 | JODI TINKEL IS THE SPOUSE OF CHAD TINKEL, PRESIDENT/CEO. | 0 |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (8 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 2 | DRS. WATSON AND BUMB HAVE A BUSINESS RELATIONSHIP WITH THE PHYSICIAN GROUP MCHA/PPG-OH. |
| FORM 990, PART VI, SECTION A, LINE 3 | DRS. BUMB AND WATSON PROVIDE SERVICES AS CHIEF AND VICE-CHIEF OVER THE MEDICAL STAFF, THROUGH THEIR OUTSIDE EMPLOYER. THE AMOUNTS ARE $6,000 AND $12,000 RESPECTIVELY. |
| FORM 990, PART VI, SECTION B, LINE 11B | PRIOR TO FILING, FORM 990 IS PROVIDED TO THE BOARD, AND A SUMMARY OF THE DISCLOSURES AND CHANGES TO THE FORM IS PRESENTED BY THE PREPARERS OF THE TAX RETURN (PLANTE & MORAN) AT A MONTHLY BOARD MEETING. IF A BOARD MEMBER IS NOT IN ATTENDANCE FOR THIS PRESENTATION, THAT INDIVIDUAL WILL RECEIVE A COPY OF FORM 990 AT A LATER DATE, PRIOR TO FILING. |
| FORM 990, PART VI, SECTION B, LINE 12C | OFFICERS AND VOTING MEMBERS OF THE BOARD ARE COVERED BY THE CONFLICT OF INTEREST POLICY, WHICH THEY SIGN ON AN ANNUAL BASIS. CONFLICTS OF INTEREST ARE REVIEWED ON A CASE BY CASE BASIS. IF A TRANSACTION ARISES THAT WOULD RESULT IN A CONFLICT, THE INTERESTED INDIVIDUAL SIGNS A CONFLICT OF INTEREST STATEMENT NOTING THAT THEY ARE NOT INDEPENDENT WITH RESPECT TO THE TRANSACTION, AND THEY ABSTAIN FROM VOTING ON THAT MATTER. THE POLICY IS MONITORED BY ALL BOARD MEMBERS AND OFFICERS. THE POLICY IS REVIEWED WITH ANY NEW BOARD MEMBERS OR OFFICERS. |
| FORM 990, PART VI, SECTION B, LINE 15 | THE CEO'S COMPENSATION IS REVIEWED ANNUALLY AND APPROVED BY THE COMPENSATION COMMITTEE. THE VICE AND ASSISTANT VICE PRESIDENTS' COMPENSATIONS ARE REVIEWED ANNUALLY AND APPROVED BY THE COMPENSATION COMMITTEE. THE DECISIONS REGARDING COMPENSATION ARE DOCUMENTED IN THE MINUTES FROM THE COMPENSATION COMMITTEE MEETINGS. OHA SURVEY DATA IS USED FOR COMPARABILITY PURPOSES. SIMILAR HOSPITALS' 990'S ARE REVIEWED FOR COMPARABILITY PURPOSES. THE PROCESS WAS LAST UNDERTAKEN FOR THE PRESIDENT, VICE AND ASSSISTANT PRESIDENTS IN DECEMBER 2020. |
| FORM 990, PART VI, SECTION C, LINE 19 | THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. |
| FORM 990, PART VII, LINE 16: | CHWC DID NOT ENTER INTO ANY NEW JOINT VENTURES DURING THE YEAR. WHEN THE PAIN MANAGEMENT JOINT VENTURE WAS ESTABLISHED CHWC HAD OUTSIDE LEGAL COUNCIL REVIEW AND APPROVE THE DOCUMENTS. |
| FORM 990, PART XII, LINE 2C: | THE ORGANIZATION HAS AN AUDIT COMMITTEE THAT OVERSEES THE AUDIT AND SELECTION OF AN INDEPENDENT ACCOUNTANT. THIS PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp
Disregarded Entity Name DisregardedEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SHARE FOUNDATION | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 433 WEST HIGH STREET | AddressLine1Txt |
| City | BRYAN | CityNm |
| State Abbreviation | OH | StateAbbreviationCd |
| ZIP | 43506 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 341596175 | EIN |
| Primary Activities | ASSIST COMMUNITY HOSPITALS AND WELLNESS CENTERS WITH FUNDRAISING | PrimaryActivitiesTxt |
| Legal Domicile State | OH | LegalDomicileStateCd |
| Exempt Code Section | 501(C)(3) | ExemptCodeSectionTxt |
| Public Charity Status | 11A | PublicCharityStatusTxt |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | COMMUNITY HOSPITALS AND WELLNESS CENTERS | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Controlled Organization | Yes (1) | ControlledOrganizationInd |
Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp
Related Organization Name RelatedOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | COMMUNITY HOSPITALS & WELLNESS CENTERS PAIN MANAGEMENT LLC | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 433 WEST HIGH STREET | AddressLine1Txt |
| City | BRYAN | CityNm |
| State Abbreviation | OH | StateAbbreviationCd |
| ZIP | 43506 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 461084537 | EIN |
| Primary Activities | MEDICAL SERVICES | PrimaryActivitiesTxt |
| Legal Domicile State | OH | LegalDomicileStateCd |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | COMMUNITY HOSPITALS & WELLNESS CENTERS | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Predominant Income Type | RELATED | PredominantIncomeTypeTxt |
| Share Of Total Income | $1,049,641 | ShareOfTotalIncomeAmt |
| Share Of EOY Assets | $609,119 | ShareOfEOYAssetsAmt |
| Disproportionate Allocations | 0 | DisproportionateAllocationsInd |
| General Or Managing Partner | Yes (1) | GeneralOrManagingPartnerInd |
| Ownership | 0.51000 | OwnershipPct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | 0 | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | 0 | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | 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 | Yes (1) | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (1) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | Yes (1) | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | Yes (1) | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |
Transactions Related Org TransactionsRelatedOrgGrp (3 entries)
| Transaction TypeTransactionTypeTxt | InvolvedInvolvedAmt | Method Of Amount DeterminationMethodOfAmountDeterminationTxt |
|---|---|---|
| CHWC PAIN MANAGEMENT LLC | ||
| Q | $1,035,889 | ACTUAL EXPENSES |
| CHWC PAIN MANAGEMENT LLC | ||
| O | $521,361 | ACTUAL EXPENSES |
| CHWC PAIN MANAGEMENT LLC | ||
| K | $171,363 | ACTUAL EXPENSES |