2019-11-14T15:22:01-06:00 2018-12-31 381357951 PLANTE & MORAN PLLC 65 EAST STATE ST STE 600 COLUMBUS OH 43215 990 2018-01-01 341893452 UHHS CSAHS - CUYAHOGA INC UHHS 2168616200 2351 EAST 22ND STREET CLEVELAND OH 44115 JOHN RUSNACZYK PRESIDENT 2168616200 2019-11-14 1 BERNIE OSTROWSKI P00366367 6148493000 2019-11-14 199.33.77.183 2019-11-14 09:34:32 ES P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 88BB8417C17E4C1C3BDD6C18F80F35263914D73F 2018 2020-03-31 21:24:44Z X JOHN RUSNACZYK 2351 EAST 22ND STREET CLEVELAND OH 44115 14537064 0 X N/A X 1999 OH UHHS/CSAHS-CUYAHOGA, INC (CUYAHOGA) IS AN ORGANIZATION JOINTLY OWNED BY THE SISTERS OF CHARITY OF ST. AUGUSTINE HEALTH SYSTEM, INC. AND UNIVERSITY HOSPITALS HEALTH SYSTEM, INC. (THE MEMBERS) OPERATED FOR THE EXCLUSIVE BENEFIT OF THE MEMBERS AND THEIR RELATED SUBSIDIARIES. BOTH MEMBERS ARE TAX-EXEMPT 501(C)3 CHARITABLE ORGANIZATIONS. CUYAHOGA PROVIDES ADMINISTRATIVE SUPPORT SERVICES FOR ORGANIZATIONS OPERATED BY THE MEMBERS. 4 4 0 4 0 0 0 0 14018019 14463260 2849 7776 367955 66028 14388823 14537064 0 0 0 0 5661457 5541402 0 0 0 8508996 9060881 14170453 14602283 218370 -65219 3787021 3588651 2371197 2238046 1415824 1350605 X SEE SCHEDULE OUHHS/CSAHS-CUYAHOGA, INC (CUYAHOGA) IS AN ORGANIZATION JOINTLY OWNED BY THE SISTERS OF CHARITY OF ST. AUGUSTINE HEALTH SYSTEM, INC. AND UNIVERSITY HOSPITALS HEALTH SYSTEM, INC. (THE MEMBERS) OPERATED FOR THE EXCLUSIVE BENEFIT OF THE MEMBERS AND THEIR RELATED SUBSIDIARIES. BOTH MEMBERS ARE TAX-EXEMPT 501(C)3 CHARITABLE ORGANIZATIONS. CUYAHOGA PROVIDES ADMINISTRATIVE SUPPORT SERVICES FOR ORGANIZATIONS OPERATED BY THE MEMBERS. 0 0 14474080 14529288 SEE PART III, LINE 1 MISSION STATEMENT. 14474080 1 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 15 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 X 4 4 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 0 OH X WILLIAM BOTCH 2168616200 2351 EAST 22ND STREET CLEVELAND OH 44115 X MICHAEL SZUBSKI VICE CHAIR 2.00 0.00 X X 0 0 0 MELISSA ROGERS CHAIRPERSON 2.00 0.00 X X 0 0 0 PAUL TAIT SECRETARY 2.00 0.00 X X 0 0 0 JOHN RUSNACZYK PRESIDENT & TREASURER 2.00 0.00 X X 0 0 0 0 0 0 0 0 0 0 MEDICAL INFORMATION TECHNOLOGY PO BOX 74569 CHICAGO IL 60696 IT SUPPORT 1060214 REVENUE GROUP 4780 HINCKLEY INDUSTRIAL PKWY SUITE CLEVELAND OH 44109 COLLECTION SERVICES 870703 REVCARE INC 3250 W MARKET STREET AKRON OH 44333 COLLECTION SERVICES 312932 HUMAN ARC CORPORATION PO BOX 637901 CINCINNATI OH 452637901 COLLECTION SERVICES 311848 BOTTOM LINE SYSTEMS LLC 541 BUTTERMILK PIKE SUITE 401 CRESCENT SPRINGS KY 41017 COLLECTION SERVICES 284798 9 MEMBERSHIP REVENUES 561000 14463260 14463260 14463260 7776 7776 ADMIN BILLINGS 900099 66028 66028 66028 14537064 14529288 0 7776 4482889 4482889 268963 268963 453296 453296 336254 336254 73355 73355 20300 20300 470941 470941 421902 421902 3129230 3129230 705295 705295 25658 25658 10442 10442 14681 14681 748871 748871 68601 68601 COLLECTION FEES 3329210 3329210 BANK FEES 39302 39302 DUES/SUBSCRIPTIONS 1278 1278 1815 1815 14602283 14474080 128203 0 178512 995524 1523943 1206077 776174 604608 21665900 20883458 1308392 782442 3787021 3588651 1956181 2140304 415016 97742 2371197 2238046 X 1415824 1350605 1415824 1350605 3787021 3588651 -65219 0 X X 0 1 X 1 0 X X X 2 SISTERS OF CHARITY OF ST AUGUSTINE HEALTH SYSTEM INC 340714763 1 1 0 0 UNIVERSITY HOSPITAL HEALTH SYSTEM INC 341576805 3 1 0 0 2 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 SCHEDULE A - PART 1 LINE 12B SUPPORT THAT IS PROVIDED BY UHHS/CSAHS - CUYAHOGA INC. ARE IN THE FORM OF SERVICES (I.E. ACCOUNTING, BILLING AND COLLECTIONS) TO THE MEMBER ORGANIZATIONS. SCHEDULE A - SECTION C LINE 1 THREE MEMBERS OF THE BOARD ARE OFFICERS OF THE SUPPORTED ORGANIZATIONS OF SISTERS OF CHARITY OF ST. AUGUSTINE HEALTH SYSTEM, INC (SCHS) (ONE BOARD MEMBER) AND UNIVERSITY HOSPITAL HEALTH SYSTEM, INC (UHHS) (TWO BOARD MEMBERS). THE OTHER BOARD MEMBER IS AN OFFICER FOR ORGANIZATIONS RELATED TO SCHS. SINCE THE SUPERVISION OF THE LATTER BOARD MEMBER IS IN LINE WITH THE CONTROL OF THE SUPPORTED ORGANIZATIONS, UHHS/SCHS ARE DEEMED TO HAVE SUPERVISION AND CONTROL OF THE UHHS/CSAHS-CUYAHOGA, INC AND ARE PROPERLY CLASSIFIED AS TYPE II SUPPORTING ORGANIZATION. 91531 91531 0 21461187 20791927 669260 113182 113182 782442 14537064 0 14537064 0 14537064 14602283 0 14602283 0 14602283 FORM 990, PART VI, SECTION A, LINE 6 THE ORGANIZATION HAS TWO CORPORATE MEMBERS: SISTERS OF CHARITY OF ST. AUGUSTINE HEALTH SYSTEM, INC. AND UNIVERSITY HOSPITALS HEALTH SYSTEM, INC. FORM 990, PART VI, SECTION A, LINE 7A THE ORGANIZATION'S MEMBERS MAY APPOINT THEIR RESPECTIVE MEMBERS TO THE GOVERNING BODY. FORM 990, PART VI, SECTION A, LINE 7B CERTAIN DECISIONS OF THE GOVERNING BODY, SUCH AS APPROVAL OF BUDGETS, CAPITAL EXPENDITURES AND ACQUISITION OF LAND, MUST BE APPROVED BY THE BOARD OF THE MEMBER ORGANIZATION. FORM 990, PART VI, SECTION B, LINE 11B AFTER THE 990 RETURN IS REVIEWED INTERNALLY; IT IS SUBMITTED FOR REVIEW TO OUR TAX ADVISORS. THEY REVIEW FOR COMPLETENESS AND COMMUNICATE ANY CONCERNS THAT THEY IDENTIFY WITHIN THE DOCUMENTS AND WORKSHEETS OF THE TAX RETURN. ITEMS IDENTIFIED ARE REVIEWED BY STAFF AND ANY NEEDED CORRECTIONS ARE MADE. THE RETURN IS THEN PROVIDED TO THE PRESIDENT FOR REVIEW AND APPROVAL. IT IS THEN SUBMITTED TO THE BOARD FOR REVIEW. FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION HAS IN PLACE A CONFLICT OF INTEREST POLICY AS WELL AS A NON-RETALIATION POLICY (WHISTLE-BLOWER) MANAGED THROUGH THE COMPLIANCE OFFICER. THE CONFLICT OF INTEREST FORMS ARE SENT OUT ANNUALLY TO ADMINISTRATION, AND OTHER LEADERSHIP EMPLOYEES AS WELL AS BOARD MEMBERS. THE FORMS ARE RETURNED TO ADMINISTRATION. ONCE RETURNED, THEY ARE REVIEWED BY THE COMPLIANCE OFFICER AND THE PRESIDENT TO DETERMINE IF ANYTHING WOULD BE DEEMED A POTENTIAL CONFLICT OF INTEREST. IF THERE IS A CONFLICT, THE PRESIDENT, COMPLIANCE OFFICER, AND EMPLOYEE/INDIVIDUAL MEET TO DISCUSS. THE RESULTS OF THOSE MEETINGS ARE AN AGENDA ITEM AT THE ORGANIZATION'S ADMINISTRATIVE COMPLIANCE MEETING AND IT IS FURTHER DISCUSSED THERE. ONCE A DECISION IS MADE REGARDING THE CONFLICT, FOLLOW-UP IS MADE BY THE COMPLIANCE OFFICER/PRESIDENT WITH THE EMPLOYEE, IF APPROPRIATE. THE ORGANIZATION ALSO DISCUSSES THE RESULTS OF THE CONFLICT OF INTEREST WITH THE BOARD OF TRUSTEES. FORM 990, PART VI, SECTION C, LINE 18 FORMS 990 AND 1023 ARE AVAILABLE TO PUBLIC UPON REQUEST AT THE ORGANIZATION'S OFFICE INDICATED ON PAGE ONE OF THE RETURN. FORM 990, PART VI, SECTION C, LINE 19 GOVERNING DOCUMENTS, THE FINANCIAL STATEMENTS, AND THE CONFLICT OF INTEREST POLICY ARE AVAILABLE TO THE PUBLIC UPON REQUEST AT THE ORGANIZATION'S OFFICE INDICATED ON PAGE ONE OF THE RETURN. SCHEDULE R, PART II UHHS/CSAHS - CUYAHOGA, INC. HAS TWO CORPORATE MEMBERS, UNIVERSITY HOSPITALS HEALTH SYSTEM, INC. AND THE SISTERS OF CHARITY OF ST. AUGUSTINE HEALTH SYSTEM, INC. THE ENTIRE BOARD OF UHHS/CSAHS-CUYAHOGA, INC. ARE EMPLOYEES OF ONE OF THE CORPORATE MEMBERS OR A RELATED ORGANIZATION OF ONE OF THE CORPORATE MEMBERS AND THEREFORE RECEIVE COMPENSATION FROM ONE OF THE CORPORATE MEMBERS. NEITHER CORPORATE MEMBER MEETS THE NECESSARY ELEMENT OF CONTROL TO BE CONSIDERED A RELATED ORGANIZATION AND ARE THEREFORE NOT REPORTED ON SCHEDULE R. ACCORDINGLY, THERE IS NO COMPENSATION REPORTED FOR THE BOARD MEMBERS SINCE THEY ARE NOT COMPENSATED BY THE ORGANIZATION OR A RELATED ORGANIZATION. AS A RESULT, ALL FOUR BOARD MEMBERS HAVE BEEN LISTED ON FORM 990, PART VI, AND LINE B AS NOT LACKING INDEPENDENCE. UHHSCSAHS - CUYAHOGA HOLDING COMPANY INC 6935 TREELINE DR STE J BRECKSVILLE OH 44141 341895400 HOLDING CO OH UHHSCSAHS CUYAHOGA INC C 1.00000 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0