2020-11-16T13:01:36-06:00 2019-12-31 861065772 DELOITTE TAX LLP 250 EAST FIFTH STREET SUITE 1900 CINCINNATI OH 45202 990 2019-01-01 341510544 ROBINSON MEMORIAL HOSPITAL FOUNDATION ROBI 3302972331 6847 N CHESTNUT STREET PO BOX 1204 RAVENNA OH 44266 JOHN R GUSZ MD CFO, UHHS 3302972331 2020-11-16 1 REBECCA LYONS P01487105 5137847100 96.28.25.250 2020-11-16 10:20:59 ES P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 CB77A4DBC41034698641BE70F1935717BAC7EE34 2019 2021-01-29 14:40:06Z PORTAGE MEDICAL CENTER FOUNDATION RICHARD J COE 6847 N CHESTNUT STREET PO BOX 1204 RAVENNA OH 44266 1060279 0 X WWW.ROBINSONMEMORIAL.ORG X 1985 OH SUPPORT AND ASSIST THE MISSION OF UNIVERSITY HOSPITALS PORTAGE MEDICAL CENTER. 29 29 0 29 0 0 1194082 931084 0 0 233336 116934 0 0 1427418 1048018 3305948 121638 0 0 132455 143965 0 0 0 26979 18534 3465382 284137 -2037964 763881 6357491 7341653 2118649 1450000 4238842 5891653 SUPPORT AND ASSIST UNIVERSITY HOSPITALS PORTAGE MEDICAL CENTER IN ITS EFFORTS TO SERVE THE NEEDS OF PORTAGE COUNTY RESIDENTS AND ITS SURROUNDING COMMUNITIES BY PROVIDING FUNDING FOR ENHANCED OR ADDITIONAL PROGRAMS THAT OTHERWISE MIGHT NOT BE AVAILABLE. 0 0 256387 103638 THE FOUNDATION GRANTS ASSISTANCE TO UNIVERSITY HOSPITALS PORTAGE MEDICAL CENTER TO FURTHER ENHANCE THE MEDICAL CENTER'S MISSION AND COMMUNITY BENEFIT. 18000 18000 THE FOUNDATION GRANTS SCHOLARSHIPS TO INDIVIDUALS OF THE COMMUNITY. 274387 1 1 0 0 0 0 0 0 0 1 1 0 0 0 1 0 0 1 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 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 X 29 29 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 0 0 0 0 OH X MELANIE GAVIN 2168441000 3605 WARRENSVILLE CENTER ROAD SHAKER HEIGHTS OH 44122 X AMBUSKE GAIL C PHD DIRECTOR 1.00 0.00 X 0 0 0 BENOIT WILLIAM DIRECTOR 1.00 0.00 X 0 0 0 BOND BRADLEY C DIRECTOR 1.00 0.00 X 0 0 0 BOYKIN ROXIA B RN DIRECTOR 1.00 0.00 X 0 0 0 BROWN ALFREDA EDD DIRECTOR 1.00 0.00 X 0 0 0 BURBICK ROBERT L DIRECTOR 1.00 0.00 X 0 0 0 CAN ERROL DIRECTOR 1.00 0.00 X 0 0 0 COE RICHARD J DIRECTOR/ VICE PRESIDENT 1.00 0.00 X X 0 0 0 CONLEY KAREN DIRECTOR (BEGIN 06/19) 1.00 0.00 X 0 0 0 DIX DAVID DIRECTOR 1.00 0.00 X 0 0 0 EGDELL ROBERT W MD DIRECTOR/ TREASURER 1.00 0.00 X X 0 0 0 ENLOW LOIS DIRECTOR 1.00 0.00 X 0 0 0 FERNER GREGORY E MD DIRECTOR 1.00 0.00 X 0 0 0 FLEMING JAMES DIRECTOR 1.00 0.00 X 0 0 0 FOWLER JEFFREY R DIRECTOR 1.00 0.00 X 0 0 0 GIULITTO JUDGE JOSEPH DIRECTOR 1.00 0.00 X 0 0 0 GUSZ JOHN R MD DIRECTOR/ PRESIDENT 1.00 0.00 X X 0 0 0 HAYES JUDGE JERRY L DIRECTOR 1.00 0.00 X 0 0 0 HORKY KAREN W DIRECTOR (END 06/19) 1.00 0.00 X 0 0 0 JOY DAVID DIRECTOR 1.00 0.00 X 0 0 0 MADONIO CHARLES DIRECTOR 1.00 0.00 X 0 0 0 MANN NEIL JR DIRECTOR 1.00 0.00 X 0 0 0 MEYERS JEFFREY G DIRECTOR 1.00 0.00 X 0 0 0 MYERS KATHY DIRECTOR (END 06/19)/ SECRETARY 1.00 0.00 X X 0 0 0 OLEFIR BRANDY R RN DIRECTOR 1.00 0.00 X 0 0 0 RIEMENSCHNEIDER DANIEL R DIRECTOR 1.00 0.00 X 0 0 0 RYAN JOHN DIRECTOR 1.00 0.00 X 0 0 0 SORRICK ROXANNE DIRECTOR 1.00 0.00 X 0 0 0 VARLOTTA LORI E PHD DIRECTOR 1.00 0.00 X 0 0 0 WELLING NORMA DIRECTOR 1.00 0.00 X 0 0 0 WHITE EDDYE RENEE DIRECTOR 1.00 0.00 X 0 0 0 0 0 0 0 0 0 0 0 454210 476874 6377 931084 129195 129195 12261 -12261 -12261 -12261 1048018 0 0 116934 103638 103638 18000 18000 134480 126411 8069 -1843 -1732 -111 11328 10648 680 1473 1385 88 3768 3542 226 PURCHASED SERVICES 6955 6538 417 CATERING 4270 4014 256 DONOR RECOGNITION 1379 1296 83 PRINTING 515 484 31 174 163 11 284137 274387 9750 0 826951 1193222 37864 8321 8321 0 0 5530040 6110067 500 500 6357491 7341653 668649 1450000 1450000 2118649 1450000 X 504737 1373596 3734105 4518057 4238842 5891653 6357491 7341653 763881 888930 0 X 0 1 X 1 0 X X 1 UNIVERSITY HOSPITALS PORTAGE MEDICAL CENTER 451382538 3 1 103638 0 1 103638 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 3734106 905430 587187 708666 4518057 4254529 1165981 -177049 1509355 3734106 3413865 1134266 385993 679595 4254529 3249144 71521 122149 28949 3413865 3201970 262523 -55350 13500 146499 3249144 0.13470 0.86530 0 0 8321 8321 0 0 LONG TERM PLEDGES PAYABLE 1450000 1450000 PART V, LINE 4: THE ENDOWMENT FUNDS SUPPORT INDIGENT PROGRAMS, SUCH AS HOME CARE, HOSPICE AND SCHOLARSHIP PROGRAMS FOCUSED ON ENHANCING CAREERS IN HEALTH CARE AND CONTINUING EDUCATION PROGRAMS FOR THE MEDICAL CENTER. 1 UNIVERSITY HOSPITAL PORTAGE MEDICAL CENTER 3605 WARRENSVILLE CENTER ROAD SHAKER HEIGHTS OH 44122 461382538 501 (C)(3) 103638 GENERAL SUPPORT 1 0 SCHOLARSHIPS 15 18000 PART I, LINE 2: ROBINSON MEMORIAL HOSPITAL FOUNDATION HAS A PROCESS WHERE WE RECEIVE AND REVIEW REQUESTS FOR FUNDING, WHICH INCLUDES OUR SENIOR LEADERS. IN THAT REVIEW PROCESS WE CHECK TO BE SURE THE ORGANIZATION IS MISSION ALIGNED TO ROBINSON MEMORIAL HOSPITAL FOUNDATION AND REVIEW HISTORICAL GIVING. MUCH OF OUR SUPPORT IS REVIEWED BOTH INTERNALLY AND WITH THE EXTERNAL GROUP ON AN ANNUAL BASIS. FORM 990, PART VI, SECTION A, LINE 6 THE FOUNDATION IS ORGANIZED AS A SUBSIDIARY OF ROBINSON HEALTH SYSTEM, INC. (SOLE MEMBER). FORM 990, PART VI, SECTION A, LINE 7A ROBINSON HEALTH SYSTEM, INC. (SOLE MEMBER) ELECTS THE BOARD OF DIRECTORS, INCLUDING THE DESIGNATION OF THE DIRECTORS TO BE THE CHAIRPERSON AND VICE CHAIRPERSON OF THE BOARD. FORM 990, PART VI, SECTION A, LINE 7B CERTAIN GOVERNING RESPONSIBILITIES ARE RESERVED AT THE MEMBER LEVEL (ROBINSON HEALTH SYSTEM, INC.). EXAMPLES INCLUDE APPROVING MATTERS RELATING TO FINANCES AND FINANCING, INVESTMENTS, LEGAL MATTERS, MATERIAL ASSET SALES AND TRANSFERS, AND STRATEGIC PLANNING. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 IS PREPARED BY AN INDEPENDENT THIRD-PARTY PUBLIC ACCOUNTING FIRM. MANAGEMENT REVIEWS THE 990 BEFORE THE COMPLETE COPY IS MADE AVAILABLE TO THE FOUNDATION BOARD BEFORE FILING. FORM 990, PART VI, SECTION B, LINE 12C THE SYSTEM HAS ADOPTED SIX CONFLICT OF INTEREST POLICIES THAT SET FORTH GUIDELINES RELATED TO TRANSACTIONS WITH DISQUALIFIED PERSONS (AS DEFINED IN APPLICABLE FEDERAL REGULATION). THESE POLICIES APPLY TO ALL EMPLOYEES, EMPLOYED PHYSICIANS AND OTHER LICENSED PRACTITIONERS (EXCLUDING PHYSICIAN TRAINEES), DIRECTORS, OFFICERS, AND RELATED PARTIES TO UH AND ITS WHOLLY-OWNED SUBSIDIARIES. UH REGULARLY AND CONSISTENTLY MONITORS AND ENFORCES COMPLIANCE WITH THE CONFLICT OF INTEREST POLICIES. DESIGNATED INDIVIDUALS, (E.G., UH MANAGEMENT, DIRECTORS, EMPLOYED PHYSICIANS, AND ADVANCED PRACTICE PROFESSIONALS), ARE REQUIRED TO COMPLETE AN ANNUAL DISCLOSURE AND PROVIDE INFORMATION REGARDING ANY INTERESTS THAT MAY BE POTENTIAL CONFLICTS PURSUANT TO THE CONFLICT OF INTEREST POLICIES. THEY ARE REQUIRED TO PROVIDE ANY CHANGES OR NEW DISCLOSURES SHOULD THEY OCCUR. ALL DISCLOSURES AND SUBSEQUENT UPDATES TO DISCLOSURES ARE REVIEWED BY THE UH COMPLIANCE AND ETHICS DEPARTMENT. BOARD-LEVEL AND KEY PERSONNEL CONFLICTS ARE REVIEWED AND APPROVED, IF APPROPRIATE, BY THE AUDIT AND COMPLIANCE COMMITTEE OF THE UH BOARD AND/OR THE UH BOARD. IF A CONFLICT EXISTS WITH A DIRECTOR, CERTAIN RESTRICTIONS MAY BE IMPOSED, SUCH AS EXCUSING THE DIRECTOR FROM THE ROOM DURING DISCUSSION AND/OR VOTING WITH REGARD TO A PROPOSED TRANSACTION. EDUCATION REGARDING CONFLICTS OF INTEREST IS INCLUDED IN THE ANNUAL COMPLIANCE TRAINING THAT INCLUDES ALL DIRECTORS, EMPLOYEES, PHYSICIANS AND LICENSED PRACTITIONERS. FORM 990, PART VI, SECTION C, LINE 19 THE GOVERNING DOCUMENTS, FINANCIAL STATEMENTS AND CONFLICT OF INTEREST POLICY FOR ROBINSON MEMORIAL HOSPITAL FOUNDATION ARE AVAILABLE UPON REQUEST. ROBINSON HEALTH SYSTEM INC (DBA UH PORTAGE MEDICAL CENTER) 6847 N CHESTNUT STREET RAVENNA OH 44266 461382538 HEALTH CARE OH 501 (C) (3) LINE 3 UHHS 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0