2020-07-09T07:12:59-05:00 2019-06-30 381357951 PLANTE & MORAN PLLC 250 S HIGH ST SUITE 100 COLUMBUS OH 43215 990 2018-07-01 311156690 HOLZER HEALTH SYSTEM HOLZ 7404465060 100 JACKSON PIKE GALLIPOLIS OH 45631 MICHAEL HAYNES CFO 7404465060 2020-06-03 1 AMY CIMINELLO P00796388 6148493000 2020-06-03 107.214.141.134 2020-06-03 10:24:59 ED P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 F51046F0BD5714FDBFEEE435C204D6AFFC186FF5 2018 2021-01-29 14:40:06Z MICHAEL CANADY 100 JACKSON PIKE GALLIPOLIS OH 45631 127016784 0 X WWW.HOLZER.ORG X 1985 OH THE PRIMARY EXEMPT PURPOSE OF HOLZER HEALTH SYSTEM IS TO ACT AS THE MANAGING PARENT, SOLE VOTING MEMBER OF THE FOLLOWING 501(C)(3) ENTITIES, WHOSE PRIMARY PURPOSES ARE TO MEET THE HEALTHCARE NEEDS OF THEIR COMMUNITIES: HOLZER HOSPITAL FOUNDATION, HOLZER MEDICAL CENTER-JACKSON, HOLZER SENIOR CARE CENTER, HOLZER ASSISTED LIVING-GALLIPOLIS, HOLZER ASSISTED LIVING-JACKSON, HOLZER FOUNDATION AND HOLZER VANGUARD, A FOR-PROFIT SUBSIDIARY (COLLECTIVELY REFERRED TO AS CONSOLIDATED). 22 0 791 79 0 0 0 0 120917659 126670705 159551 -16331 17332 17325 121094542 126671699 0 0 0 0 89775890 90054684 0 0 7778 72369882 72531326 162145772 162586010 -41051230 -35914311 166770527 170186750 157085875 159131290 9684652 11055460 FRIENDLY VISITS, EXCELLENT CARE; EVERY PATIENT, EVERY TIME. 0 0 7445300 0 4024716 HOLZER HEALTH SYSTEM PROVIDED MANAGEMENT SERVICES/REAL ESTATE TO ITS SUBSIDIARIES WHOSE EXEMPT PURPOSES ARE TO MEET THE HEALTHCARE NEEDS OF THEIR COMMUNITIES. 1075702 0 892248 HOLZER DENTAL CLINIC-JACKSON STRIVES TO IMPROVE THE DENTAL HEALTH STATUS OF THE PEOPLE AND COMMUNITIES WE SERVE. 94315382 0 121753741 HOLZER CLINIC, LLC IS A MULTIPLE DISCIPLINE HEALTH CARE SYSTEM OF OVER 128 BOARD CERTIFIED PHYSICIANS PROVIDING CARE IN MORE THAN THIRTY-FOUR AREAS OF EXPERTISE. 102836384 1 0 0 0 0 0 0 0 0 0 1 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 0 0 1 62 0 1 791 1 0 0 0 0 0 0 0 0 0 0 0 0 X 22 0 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X MICHAEL HAYNES CFO 7404465060 100 JACKSON PIKE GALLIPOLIS OH 45631 STEVE CHAPMAN TRUSTEE 1.00 3.00 X X 24000 0 0 BRENT SAUNDERS CHAIRMAN 46.00 4.00 X X 446229 0 1719 LARRY KID TREASURER 1.00 3.00 X X 24000 0 0 DR MICHAEL CANADY CEO 46.00 4.00 X X 559980 0 0 DANNY HOLSCHUH TRUSTEE 1.00 3.00 X 24000 0 0 GARY ROACH TRUSTEE 1.00 3.00 X 24000 0 0 PAUL REED TRUSTEE 1.00 3.00 X 24000 0 0 BOB GRILLO TRUSTEE 1.00 3.00 X 24000 0 0 DR RODNEY STOUT TRUSTEE - CMO 49.00 1.00 X 414444 0 0 DR LANCE BROY TRUSTEE 49.00 1.00 X 352333 0 0 DR DANIELLE CAPPELLETTI TRUSTEE 49.00 1.00 X 410086 0 0 DR SCOTT DAVIS TRUSTEE 50.00 0.00 X 319585 0 0 DR RENUKA KANDULA TRUSTEE 49.00 1.00 X 298202 0 0 DR PHIL LONG TRUSTEE 49.00 1.00 X 644463 0 0 DR JARED SHEETS TRUSTEE 49.00 1.00 X 332040 0 0 DR LOUIS WICKAS TRUSTEE 50.00 0.00 X 431152 0 0 JOHN CUNNINGHAM TRUSTEE - EVP POPULATION H 50.00 0.00 X 304957 0 0 STEPHEN DOYLE - PART YEAR TRUSTEE - CNO 50.00 0.00 X 265013 0 0 LISA DETTY TRUSTEE - CNO 50.00 0.00 X 126811 0 0 LISA HALLEY TRUSTEE - CAO 50.00 0.00 X 250001 0 1518 TODD FOWLER TRUSTEE - EVP AMBULARTORY 50.00 0.00 X 319998 0 0 BRAD MUNN TRUSTEE 1.00 3.00 X 24000 0 0 ROBBIE PUGH TRUSTEE 1.00 1.00 X 24000 0 0 TOM WISEMAN TRUSTEE 1.00 3.00 X 24000 0 0 MICHAEL HAYNES CFO 46.00 4.00 X 319998 0 0 DEAN SICILIANO PHYSICIAN 50.00 0.00 X 1172082 0 0 DR ROBERT BRADLEY PHYSICIAN 50.00 0.00 X 950262 0 0 DR STEVEN CONLEY PHYSICIAN 50.00 0.00 X 1027259 0 0 NIRAV PAREKH PHYSICIAN 50.00 0.00 X 774961 0 0 RAMESH CHANDRA PHYSICIAN 50.00 0.00 X 842071 0 0 CHRISTOPHER MEYER FORMER CEO - HHS 0.00 0.00 X 0 129921 0 10777927 129921 3237 182 1 1 0 OHIO VALLEY PHYSICIANS INC PO BOX 390 HUNTINGTON WV 25708 EMERGENCY DEPT. STAFFING 16662694 NTHRIVE PO BOX 733492 DALLAS TX 753733492 MEDICAL CODING & MANAGEMENT SERVICES 2192139 EDGEWATER CONSTRUCTION OF ROSS CO LLC 1957 US HWY 23 WAVERLY OH 45690 CONTRACTORS 484041 WEATHERBY LOCUMS INC PO BOX 972633 DALLAS TX 753972633 PHYSICIAN STAFFING 432245 IRAD SERVICES INC 1811 GOLDEN MILE HIGHWAY SUITE B PITTSBURGH PA 15239 RADIOLOGY PHYSICIAN SERVICES 320113 12 NET PATIENT SERVICE REVENUE 621110 120216399 120216399 RENTAL INCOME 531120 3431749 3431749 MANAGEMENT FEES 561000 2530274 2530274 INVESTMENTS IN JVS 523930 492283 492283 126670705 324551 324551 21528 4203 17325 17325 17325 340882 -340882 -340882 -340882 126671699 126670705 0 994 X 6037078 6037078 69619610 50441106 19178504 240937 130971 109966 10472395 4661957 5810438 3684664 2083604 1601060 3776183 1572374 2203809 -32280 14555 -46835 502147 205000 297147 27549948 17789427 9760521 7778 7778 6073070 3405362 2667708 5738083 90586 5647497 574527 395298 179229 817029 327809 489220 10078395 7760450 2317945 2939781 188534 2751247 1580835 1411168 169667 BAD DEBT EXPENSE 11180684 11180684 MEDICAL SUPPLIES 1113755 1101856 11899 DUES AND MEMBERSHIPS 221997 61975 160022 PROPERTY TAX 210345 133 210212 199049 13535 185514 162586010 102836384 59741848 7778 11538729 11509146 18388568 20717575 1830936 1397260 99652183 24887147 76426007 74765036 4459151 4577378 955403 569112 3904000 3904000 18812055 18812055 30455678 33935188 166770527 170186750 30166400 28768856 117224276 115115712 3913803 4183105 5781396 11063617 157085875 159131290 X 9684652 11055460 9684652 11055460 166770527 170186750 X -35914311 45874 37239245 X X 0 1 X 1 0 X X 4 HOLZER HOSPITAL FOUNDATION 314379491 3 1 0 32871245 HOLZER MEDICAL CENTER-JACKSON 311724085 3 1 0 4368000 HOLZER SENIOR CARE CENTER 311534051 10 1 0 0 HOLZER HERITAGE FOUNDATION 310927482 7 1 0 0 4 0 37239245 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 X 1 1 SCHEDULE A, PART IV, SECTION D, LINE 3: HOLZER HEALTH SYSTEMS' BOARD OVERLAPS WITH THE BOARD OF THE SUPPORTING ORGANIZATION. THIS OVERLAP CAUSES THE SUPPORTED ORGANIZATION TO HAVE A SIGNIFICANT VOICE OVER THE HOLZER HEALTH SYSTEMS. SCHEDULE A, PART IV, SECTION E, LINE 3A: HOLZER HEALTH SYSTEM IS THE SOLE MEMBER OF EACH OF ITS SUPPORTED ORGANIZATIONS. SCHEDULE A, PART IV, SECTION E, LINE 3B: DECISIONS MADE BY THE BOARD OF DIRECTORS OF EACH SUPPORTED ORGANIZATION CAN BE OVERRULED BY THE BOARD OF DIRECTORS OF HOLZER HEALTH SYSTEM. 1 3964 3964 0 PART II-B, LINE 1: A PORTION OF DUES PAID TO THE OHIO HOSPITAL ASSOCIATION ARE CONSIDERED LOBBYING ACTIVITIES. IN TOTAL $67,183 WERE PAID TO OHA OF WHICH $3,964 ARE CONSIDERED LOBBYING ACTIVITIES. 6699795 6699795 85347929 22258002 63089927 7125075 2622549 4502526 479384 6596 472788 74765036 RELATED PARTY RECEIVABLES 16235707 FUNDS HELD BY TRUSTEES UNDER BOND INDENTURE 17699481 33935188 RELATED PARTY PAYABLES 11063617 11063617 X X 1 0 0 0 0 0 0 1 0 BRENT SAUNDERS CHAIRMAN 405662 0 40567 0 0 0 0 0 1719 0 447948 0 0 0 DR MICHAEL CANADY CEO 559980 0 0 0 0 0 0 0 0 0 559980 0 0 0 DR RODNEY STOUT TRUSTEE - CMO 414444 0 0 0 0 0 0 0 0 0 414444 0 0 0 DR LANCE BROY TRUSTEE 352333 0 0 0 0 0 0 0 0 0 352333 0 0 0 DR DANIELLE CAPPELLETTI TRUSTEE 410086 0 0 0 0 0 0 0 0 0 410086 0 0 0 DR SCOTT DAVIS TRUSTEE 319585 0 0 0 0 0 0 0 0 0 319585 0 0 0 DR RENUKA KANDULA TRUSTEE 298202 0 0 0 0 0 0 0 0 0 298202 0 0 0 DR PHIL LONG TRUSTEE 644463 0 0 0 0 0 0 0 0 0 644463 0 0 0 DR JARED SHEETS TRUSTEE 332040 0 0 0 0 0 0 0 0 0 332040 0 0 0 DR LOUIS WICKAS TRUSTEE 431152 0 0 0 0 0 0 0 0 0 431152 0 0 0 JOHN CUNNINGHAM TRUSTEE - EVP POPULATION H 304957 0 0 0 0 0 0 0 0 0 304957 0 0 0 STEPHEN DOYLE - PART YEAR TRUSTEE - CNO 265013 0 0 0 0 0 0 0 0 0 265013 0 0 0 LISA HALLEY TRUSTEE - CAO 250001 0 0 0 0 0 0 0 1518 0 251519 0 0 0 TODD FOWLER TRUSTEE - EVP AMBULARTORY 319998 0 0 0 0 0 0 0 0 0 319998 0 0 0 MICHAEL HAYNES CFO 319998 0 0 0 0 0 0 0 0 0 319998 0 0 0 DEAN SICILIANO PHYSICIAN 1172082 0 0 0 0 0 0 0 0 0 1172082 0 0 0 DR ROBERT BRADLEY PHYSICIAN 950262 0 0 0 0 0 0 0 0 0 950262 0 0 0 DR STEVEN CONLEY PHYSICIAN 1027259 0 0 0 0 0 0 0 0 0 1027259 0 0 0 NIRAV PAREKH PHYSICIAN 774961 0 0 0 0 0 0 0 0 0 774961 0 0 0 RAMESH CHANDRA PHYSICIAN 842071 0 0 0 0 0 0 0 0 0 842071 0 0 0 CHRISTOPHER MEYER FORMER CEO - HHS 0 0 0 0 0 129921 0 0 0 0 0 129921 0 0 PART I, LINE 4A DURING THE YEAR CHRISTOPHER MEYER RECEIVED SEVERAL INSTALLMENT PAYMENTS FOR SEVERANCE TOTALING $129,921 PART I, LINE 7 BONUS AMOUNTS ARE BASED ON MEETING THRESHOLDS INCLUDED IN CONTRACTS AND ARE ULTIMATELY AT THE BOARD'S DISCRETION. THE BONUSES RECEIVED IN THE CURRENT YEAR INCLUDE: BRENT SAUNDERS: $40,567 A COUNTY OF GALLIA OHIO- BONDS SERIES 2012 A20 316400068 36381PAP2 2012-03-27 155315000 SEE SCHEDULE O 0 0 0 A 155315478 11233473 3087477 106281906 3817000 2012 1 0 0 1 A 0 0 0 0 0.00000 0.00000 0.00000 0 0 0 A 0 0 1 0 0 0 0 0 0 A 1 SCHEDULE K, PART I DESCRIPTION OF PURPOSE: (A) CURRENTLY REFUNDED THE ENTITY'S (I) SERIES 1998 BONDS ISSUED ON OCTOBER 1, 1998; (II) SERIES 2009 BONDS, ISSUED ON NOVEMBER 3, 2009, WHICH WERE A REISSUANCE OF THE SERIES 2005 BONDS ISSUES ON MARCH 10, 2005; AND (III) VARIOUS TAXABLE OBLIGATIONS; AND (B) ACQUISITION OF HOSPITAL FACILITIES INCLUDING A CLINIC AND FUTURE CAPITAL EQUIPMENT ACQUISITIONS AND FACILITY RENOVATIONS; AND CANCER CENTER PROJECT. FORM 990, PART VI, SECTION B, LINE 11B THE CONTROLLER AND THE CFO REVIEW FORM 990 AND A COPY WILL BE PROVIDED TO ALL BOARD MEMBERS PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION FOLLOWS THE ADOPTED POLICIES OF HOLZER MEDICAL CENTER- JACKSON AND HOLZER HOSPITAL FOUNDATION, RELATED TAX-EXEMPT ORGANIZATIONS. CONFLICT OF INTEREST STATEMENTS ARE COMPLETED ANNUALLY BY ALL BOARD MEMBERS AND OFFICERS, AND ARE REVIEWED BY THE CONFLICT OF INTEREST REVIEW COMMITTEE. MEMBERS OF THE BOARD ARE AWARE THAT THEY SHOULD DISCLOSE CONFLICTS WHEN THEY ARISE, AND MEMBERS ABSTAIN FROM PARTICIPATING IN DISCUSSIONS OR VOTING ON MATTERS WHERE A CONFLICT IS PRESENT. FORM 990, PART VI, SECTION B, LINE 15 THE HOLZER HEALTH SYSTEM BOARD APPROVES COMPENSATION OF THE CEO AND OTHER OFFICERS. THE BOARD UTILIZES WAGE RECOMMENDATIONS FROM AN UNRELATED CONSULTANT TO DETERMINE THE COMPENSATION. THE CEO MAY BE INVOLVED IN DETERMINING OTHER OFFICERS' COMPENSATION, HOWEVER THE ULTIMATE DECISION RESTS WITH THE BOARD. THE PROCESS WAS LAST UNDERTAKEN DURING 2019. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. THE ORGANIZATION DOES NOT HAVE ITS OWN CONFLICT OF INTEREST POLICY. FORM 990, PART IX, LINE 11G OUTSIDE SERVICES: PROGRAM SERVICE EXPENSES 17,408,983. MANAGEMENT AND GENERAL EXPENSES 6,940,144. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 24,349,127. FOOD: PROGRAM SERVICE EXPENSES 11,788. MANAGEMENT AND GENERAL EXPENSES 226,793. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 238,581. RECRUITMENT: PROGRAM SERVICE EXPENSES 208,720. MANAGEMENT AND GENERAL EXPENSES 73,384. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 282,104. LICENSURE FEES: PROGRAM SERVICE EXPENSES 74,654. MANAGEMENT AND GENERAL EXPENSES 299,434. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 374,088. CONTRACT LABOR: PROGRAM SERVICE EXPENSES 85,282. MANAGEMENT AND GENERAL EXPENSES 2,220,766. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,306,048. FORM 990, PART XI, LINE 9: TRANSFERS TO/FROM AFFILIATES 37,239,245. FORM 990, PART XI, LINE 2C THE AUDIT OVERSIGHT PROCESS AND THE PROCESS OF SELECTION OF AN INDEPENDENT ACCOUNTANT HAVE NOT CHANGED FROM THE PRIOR YEAR. FORM 990, PART VI, LINE 16 THE ORGANIZATION DOES NOT HAVE IN PLACE A WRITTEN POLICY TO EVALUATE ITS PARTICIPATION IN JOINT VENTURES, HOWEVER IT MAKES SURE TO TAKE THE NECESSARY PRECAUTIONS TO SAFEGUARD ITS TAX-EXEMPT STATUS. IN ADDITION, LEGAL COUNSEL IS CONSULTED BEFORE CONSIDERING A NEW JOINT VENTURE. HOLZER DENTAL CLINIC JACKSON 100 JACKSON PIKE GALLIPOLIS OH 45631 275346256 HEALTHCARE OH 892248 820465 HOLZER HEALTH SYSTEM HOLZER CLINIC LLC 90 JACKSON PIKE GALLIPOLIS OH 45631 310917085 PHYSICIAN PRACTICES OH 121754248 26277168 HOLZER HEALTH SYSTEM HOLZER HERITAGE FOUNDATION 100 JACKSON PIKE GALLIPOLIS OH 45631 310927482 CONTINUING ADVANCEMENT OF HEALTH AND MEDICAL CARE OH 501(C)(3) LINE 10 HOLZER HEALTH SYSTEM 1 HOLZER MEDICAL CENTER - JACKSON 100 JACKSON PIKE GALLIPOLIS OH 45631 311724085 HEALTH CARE OH 501(C)(3) LINE 3 HOLZER HEALTH SYSTEM 1 HOLZER SENIOR CARE CENTER 380 COLONIAL DRIVE BIDWELL OH 45614 311534051 SKILLED NURSING FACILITY OH 501(C)(3) LINE 10 HOLZER HEALTH SYSTEM 1 HOLZER HOSPITAL FOUNDATION 100 JACKSON PIKE GALLIPOLIS OH 45631 314379491 HEALTH CARE OH 501(C)(3) LINE 3 HOLZER HEALTH SYSTEM 1 HOLZER VANGUARD INC 100 JACKSON PIKE GALLIPOLIS OH 45631 311192567 STOCK HOLDING COMPANY OH HOLZER HEALTH SYSTEM C 1371101 4389671 1.00000 1 1 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0 1 HOLZER HOSPITAL FOUNDATION L 33320698 ACCRUAL TRANSACTION HOLZER MEDICAL CENTER- JACKSON L 4368000 ACCRUAL TRANSACTION HOLZER HOSPITAL FOUNDATION A -557629 ACCRUAL TRANSACTION HOLZER HOSPITAL FOUNDATION K 108176 ACCRUAL TRANSACTION