HENRY COUNTY HOSPITAL INC: Form 990, tax year 2017
View the entire original 990 at ProPublica ↗
- Organization
- HENRY COUNTY HOSPITAL INC (EIN 34-4477047)
- Tax period
- 2017-11-01 to 2018-10-31
- Filed
- 2019-09-06
- IRS object ID
- 201932499349300248
- Schema version
- 2017v2.3
- 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 I
- Schedule J
- Schedule K
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2019-09-06T13:53:54-05:00 | ReturnTs |
| Tax Period End | 2018-10-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 351178661 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BLUE & CO LLC | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 500 N MERIDIAN ST SUITE 200 | AddressLine1Txt |
| City | INDIANAPOLIS | CityNm |
| State Abbreviation | IN | StateAbbreviationCd |
| ZIP | 46204 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2017-11-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 344477047 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | HENRY COUNTY HOSPITAL INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | HENR | BusinessNameControlTxt |
| Phone | 4195924015 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1600 EAST RIVERVIEW | AddressLine1Txt |
| City | NAPOLEON | CityNm |
| State Abbreviation | OH | StateAbbreviationCd |
| ZIP | 43545 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | KIMBERLY H BORDENKIRCHER | PersonNm |
| Person Title | CEO | PersonTitleTxt |
| Phone | 4195924015 | PhoneNum |
| Signature | 2019-09-06 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | MARGOT BURKE | PreparerPersonNm |
| PTIN | P01588992 | PTIN |
| Phone | 3176334705 | PhoneNum |
| Preparation | 2019-09-05 | PreparationDt |
Filing Security Information FilingSecurityInformation
IP Address IPAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| I Pv4 Address | 38.109.186.2 | IPv4AddressTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| IP | 2019-09-06 | IPDt |
| IP Tm | 11:19:12 | IPTm |
| IP Timezone | ED | IPTimezoneCd |
| Filing License Type | P | FilingLicenseTypeCd |
| At Submission Creation Device Id | DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 | AtSubmissionCreationDeviceId |
| At Submission Filing Device Id | B19D0506B86ED19F1A0FD2AFEEB91090E576B51F | AtSubmissionFilingDeviceId |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2017 | TaxYr |
| Build TS | 2019-02-21 02:37:17Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | KIMBERLY H BORDENKIRCHER | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1600 EAST RIVERVIEW | AddressLine1Txt |
| City | NAPOLEON | CityNm |
| State Abbreviation | OH | StateAbbreviationCd |
| ZIP | 43545 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $30,880,978 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.HENRYCOUNTYHOSPITAL.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1982 | FormationYr |
| Legal Domicile State | OH | LegalDomicileStateCd |
| Activity Or Mission | HENRY COUNTY HOSPITAL PROVIDES QUALITY HEALTHCARE AND WELLNESS SERVICES WHILE EMPHASIZING PATIENT CENTERED CARE AND EXCELLENT CUSTOMER SERVICE. HENRY COUNTY HOSPITAL WILL IMPROVE THE HEALTH OF THE COMMUNITY BY BEING THE BEST PLACE FOR PATIENTS TO RECEIVE CARE, FOR EMPLOYEES TO WORK, AND FOR PHYSICIANS TO PRACTICE MEDICINE. WE ARE COMMITTED TO EACH OTHER AND THE COMMUNITY THROUGH STEWARDSHIP AND COOPERATION; CONTINUAL LEARNING AND INNOVATION; PERSONALIZED SERVICES AND A FAMILY FOCUS. | ActivityOrMissionDesc |
| Voting Members Governing Body | 9 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 8 | VotingMembersIndependentCnt |
| Total Employee | 342 | TotalEmployeeCnt |
| Total Volunteers | 66 | TotalVolunteersCnt |
| Total Gross UBI | $37,730 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | -$14,218 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $112,565 | PYContributionsGrantsAmt |
| CY Contributions Grants | $101,643 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $29,416,638 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $29,501,903 | CYProgramServiceRevenueAmt |
| PY Investment Income | $5,929 | PYInvestmentIncomeAmt |
| CY Investment Income | $7,500 | CYInvestmentIncomeAmt |
| PY Other Revenue | $1,384,741 | PYOtherRevenueAmt |
| CY Other Revenue | $1,236,703 | CYOtherRevenueAmt |
| PY Total Revenue | $30,919,873 | PYTotalRevenueAmt |
| CY Total Revenue | $30,847,749 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $96,373 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $104,239 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $14,901,230 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $16,077,488 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $15,719,119 | PYOtherExpensesAmt |
| CY Other Expenses | $15,052,902 | CYOtherExpensesAmt |
| PY Total Expenses | $30,716,722 | PYTotalExpensesAmt |
| CY Total Expenses | $31,234,629 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $203,151 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$386,880 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $21,976,451 | TotalAssetsBOYAmt |
| Total Assets EOY | $21,647,817 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $10,931,943 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $10,949,161 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $11,044,508 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $10,698,656 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | HENRY COUNTY HOSPITAL PROVIDES QUALITY HEALTHCARE AND WELLNESS SERVICES WHILE EMPHASIZING PATIENT CENTERED CARE AND EXCELLENT CUSTOMER SERVICE.HENRY COUNTY HOSPITAL WILL IMPROVE THE HEALTH OF THE COMMUNITY BY BEING THE BEST PLACE FOR PATIENTS TO RECEIVE CARE, FOR EMPLOYEES TO WORK, AND FOR PHYSICIANS TO PRACTICE MEDICINE. WE ARE COMMITTED TO EACH OTHER AND THE COMMUNITY THROUGH STEWARDSHIP AND COOPERATION; CONTINUAL LEARNING AND INNOVATION; PERSONALIZED SERVICES AND A FAMILY FOCUS. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $2,461,319 | ExpenseAmt |
| Revenue | $6,021,390 | RevenueAmt |
| Desc | 1. SURGERY--PROVIDING PRE-, INTRA-, AND POST PROCEDURE CARE FOR SURGICAL INPATIENTS AND OUTPATIENTS. INCLUDES GENERAL, ORTHOPEDIC, CATARACT, AND ENDOSCOPIC PROCEDURES. SURGICAL CARE SERVICES PERFORMED OVER 1,600 PROCEDURES IN 2018. | Desc |
Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $2,388,342 | ExpenseAmt |
| Revenue | $4,386,707 | RevenueAmt |
| Desc | 2. LABORATORY--PROVIDING SERVICES FOR IP AND OP, EXTENDED CARE FACILITIES, PHYSICIAN OFFICES AND AREA BUSINESSES. THE LABORATORY PROVIDED OVER 124,000 BILLED TESTS IN 2018. | Desc |
Prog Srvc Accom Acty3 ProgSrvcAccomActy3Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $1,853,086 | ExpenseAmt |
| Revenue | $2,862,761 | RevenueAmt |
| Desc | 3. EMERGENCY CARE SERVICES ARE PROVIDED CONTINUALLY TO PATIENTS PRESENTING WITH INJURIES AND ILLNESSES. TOTAL PATIENTS TREATED IN THE EMERGENCY DEPARTMENT TOTALED OVER 8,300 FOR 2018. | Desc |
Prog Srvc Accom Acty Other ProgSrvcAccomActyOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $18,837,616 | ExpenseAmt |
| Grant | $104,239 | GrantAmt |
| Revenue | $17,201,023 | RevenueAmt |
| Desc | OTHER SERVICES PROVIDED BY HENRY COUNTY HOSPITAL ARE: MEDICAL IMAGING, INCLUDING X-RAY, CT SCANS, MRI, ULTRASOUND, AND STRESS TESTING; PHARMACY SERVICES; REHAB SERVICES, INCLUDING PHYSICAL THERAPY, OCCUPATIONAL THERAPY, AND SPEECH THERAPY; ONCOLOGY SERVICES; INPATIENT AND INTENSIVE CARE SERVICES; BIRTHING CARE SERVICES; CARDIAC REHAB, EKG, AND RESPIRATORY THERAPY; AND OUTPATIENT DRUG AND ALCOHOL TREATMENT. HENRY COUNTY HOSPITAL PROVIDED OVER 103,000 BILLED DOSES TO PATIENTS THROUGH PHARMACY SERVICES, OVER 640 INPATIENT ADMISSIONS WITH OVER 1,800 DAYS OF CARE, 95 SWING BED PATIENTS WITH OVER 907 DAYS OF CARE, 202 BIRTHS, AND OVER 44,200 OUTPATIENT VISITS IN 2018. | Desc |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Prog Srvc Expense | $18,837,616 | TotalOtherProgSrvcExpenseAmt |
| Total Other Prog Srvc Grant | $104,239 | TotalOtherProgSrvcGrantAmt |
| Total Other Prog Srvc Revenue | $17,201,023 | TotalOtherProgSrvcRevenueAmt |
| Total Program Service Expenses | $25,540,363 | 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 |
| Temp Or Permanent Endowments | Yes (1) | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | Yes (1) | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | Yes (1) | 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 | Yes (1) | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | Yes (1) | TaxExemptBondsInd |
| Invest Tax Exempt Bonds | 0 | InvestTaxExemptBondsInd |
| Escrow Account | 0 | 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 With Officer Ent | 0 | BusinessRlnWithOfficerEntInd |
| 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 | 0 | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 66 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 342 | 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 |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 9 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 8 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | 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 | Yes (1) | InvestmentInJointVentureInd |
| Written Policy Or Procedure | 0 | WrittenPolicyOrProcedureInd |
| States Where Copy Of Return Is Fld | OH | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | DIANE WALTHER | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 4195913826 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1600 EAST RIVERVIEW | AddressLine1Txt |
| City | NAPOLEON | CityNm |
| State Abbreviation | OH | StateAbbreviationCd |
| ZIP | 43545 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (18 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|
| MARVIN BARLOW | ||||||||
| CHAIRMAN | 4.00 | 0.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| JOHN WILHELM | ||||||||
| VICE-CHAIR | 2.00 | 0.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| THOMAS MACK | ||||||||
| SECRETARY | 2.00 | 0.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| RICKY FRUTH | ||||||||
| BOARD MEMBER | 2.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| JIM BURKHART | ||||||||
| BOARD MEMBER | 2.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| BRENT GERKEN | ||||||||
| BOARD MEMBER | 2.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| DR JOSEPH KRUEGER | ||||||||
| BOARD MEMBER-TERM BEGAN JAN'18 | 2.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| MARK ADAMS | ||||||||
| BOARD MEMBER-TERM BEGAN AUG'18 | 2.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| DR RACHEL BOSTELMAN | ||||||||
| BOARD MEMBER-TERM ENDED APR'18 | 2.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| DR EARNST HAFTKOWYCZ | ||||||||
| OB/GYN & BOD-TERM ENDED DEC'17 | 40.00 | 0.00 | Yes (X) | $251,469 | $0 | $18,744 | ||
| KIMBERLY BORDENKIRCHER | ||||||||
| CEO | 40.00 | 0.00 | Yes (X) | Yes (X) | $206,573 | $0 | $29,051 | |
| WILLIAM GRIMM | ||||||||
| CIO | 40.00 | 0.00 | Yes (X) | $130,589 | $0 | $30,887 | ||
| PATRICIA FRANK | ||||||||
| CHIEF NURSING OFFICER | 40.00 | 0.00 | Yes (X) | $113,565 | $0 | $31,752 | ||
| DR DOUGLAS LINDSEY | ||||||||
| PHYSICIAN | 40.00 | 0.00 | $325,578 | $0 | $38,191 | Yes (X) | ||
| DR MORRIS SEAL | ||||||||
| PHYSICIAN | 40.00 | 0.00 | $227,377 | $0 | $20,990 | Yes (X) | ||
| MICHELE JAKUTOWICZ | ||||||||
| PHARMACIST | 40.00 | 0.00 | $128,813 | $0 | $22,932 | Yes (X) | ||
| SARAH HUBER | ||||||||
| MEDICAL IMAGING MANAGER | 40.00 | 0.00 | $119,847 | $0 | $31,481 | Yes (X) | ||
| CHRISTIN MCMULLEN | ||||||||
| PHARMACIST | 40.00 | 0.00 | $114,594 | $0 | $11,508 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $1,618,405 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $235,536 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 10 | 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 |
|---|---|---|---|---|---|
| EMCARE PHYSICIAN SERVICES | |||||
| 1717 MAIN ST STE 5200 | DALLAS | TX | 75201 | EMERGENCY PHYSICIAN SERVICES | $964,595 |
| MERCY MEDICAL PARTNERS NORTHERN REGION | |||||
| 1400 EAST SECOND ST | DEFIANCE | OH | 43512 | ANESTHESIOLOGIST & PHYSICAL COVERAGE | $789,573 |
| CREDIT SOLUTIONS LLC | |||||
| 2277 THUNDERSTICK DR STE 400 | LEXINGTON | KY | 40505 | COLLECTION AGENCY | $313,381 |
| HOSPITAL CARE GROUP PC | |||||
| 6435 W JEFFERSON BLVD | FORT WAYNE | IN | 46804 | INPATIENT PHYSICIAN SERVICES (HOSPITALIS | $291,161 |
| PHARMACY SYSTEMS INC | |||||
| 5050 BRADENTON AVE | DUBLIN | OH | 43017 | MANAGE PHARMACY DIRECTOR | $239,948 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 10 | CntrctRcvdGreaterThan100KCnt |
| Related Organizations | $76,105 | RelatedOrganizationsAmt |
| All Other Contributions | $25,538 | AllOtherContributionsAmt |
| Total Contributions | $101,643 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | PATIENT REVENUE | Desc |
| Business | 900099 | BusinessCd |
| Total Revenue Column | $29,501,903 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $29,501,903 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $29,501,903 | TotalProgramServiceRevenueAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $106,040 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $1,632 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $104,408 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $104,408 | TotalRevenueColumnAmt |
| Exclusion | $104,408 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $7,500 | OtherAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $0 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $7,500 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $7,500 | TotalRevenueColumnAmt |
| Exclusion | $7,500 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Sales Of Inventory | $17,079 | GrossSalesOfInventoryAmt |
| Cost Of Goods Sold | $31,597 | CostOfGoodsSoldAmt |
Net Income Or Loss NetIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$14,518 | TotalRevenueColumnAmt |
| Exclusion | -$14,518 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt | ExclusionExclusionAmt |
|---|---|---|---|---|
| JOINT VENTURES | 900099 | $549,139 | $549,139 | |
| NUTRITION/CAFETERIA | 900099 | $139,105 | $139,105 | |
| 340B REVENUE | 900099 | $114,436 | $114,436 |
Miscellaneous Revenue MiscellaneousRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $344,133 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $306,403 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $37,730 | UnrelatedBusinessRevenueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $1,146,813 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $30,847,749 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $30,471,881 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $37,730 | UnrelatedBusinessRevenueAmt |
| Exclusion | $236,495 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $104,239 | TotalAmt |
| Program Services | $104,239 | ProgramServicesAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $667,313 | TotalAmt |
| Program Services | $542,611 | ProgramServicesAmt |
| Management And General | $124,702 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $11,884,716 | TotalAmt |
| Program Services | $9,663,805 | ProgramServicesAmt |
| Management And General | $2,220,911 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $321,969 | TotalAmt |
| Program Services | $261,802 | ProgramServicesAmt |
| Management And General | $60,167 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,384,115 | TotalAmt |
| Program Services | $1,938,593 | ProgramServicesAmt |
| Management And General | $445,522 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $819,375 | TotalAmt |
| Program Services | $666,257 | ProgramServicesAmt |
| Management And General | $153,118 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $58,432 | TotalAmt |
| Management And General | $58,432 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $53,908 | TotalAmt |
| Management And General | $53,908 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,844,444 | TotalAmt |
| Program Services | $4,752,286 | ProgramServicesAmt |
| Management And General | $1,092,158 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $208,597 | TotalAmt |
| Program Services | $169,616 | ProgramServicesAmt |
| Management And General | $38,981 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $70,199 | TotalAmt |
| Program Services | $57,081 | ProgramServicesAmt |
| Management And General | $13,118 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,861,557 | TotalAmt |
| Program Services | $1,513,686 | ProgramServicesAmt |
| Management And General | $347,871 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $69,681 | TotalAmt |
| Program Services | $56,660 | ProgramServicesAmt |
| Management And General | $13,021 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $43,407 | TotalAmt |
| Program Services | $35,295 | ProgramServicesAmt |
| Management And General | $8,112 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $321,264 | TotalAmt |
| Management And General | $321,264 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,170,329 | TotalAmt |
| Program Services | $951,628 | ProgramServicesAmt |
| Management And General | $218,701 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $197,114 | TotalAmt |
| Program Services | $160,279 | ProgramServicesAmt |
| Management And General | $36,835 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| DRUGS AND MEDICAL SUPPL | $4,371,275 | $4,371,275 | |
| FRANCHISE FEE | $419,590 | $419,590 | |
| NUTRITION/WELLNESS | $230,643 | $187,542 | $43,101 |
| DUES AND SUBSCRIPTIONS | $70,004 | $56,922 | $13,082 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $62,458 | TotalAmt |
| Program Services | $50,786 | ProgramServicesAmt |
| Management And General | $11,672 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $31,234,629 | TotalAmt |
| Program Services | $25,540,363 | ProgramServicesAmt |
| Management And General | $5,694,266 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,342 | BOYAmt |
| EOY | $1,492 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $8,229,752 | BOYAmt |
| EOY | $6,844,709 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,849,403 | BOYAmt |
| EOY | $4,029,458 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $653,211 | BOYAmt |
| EOY | $657,834 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $278,268 | BOYAmt |
| EOY | $244,649 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $27,163,974 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $19,705,720 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,774,300 | BOYAmt |
| EOY | $7,458,254 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,114,803 | BOYAmt |
| EOY | $1,215,693 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $75,372 | BOYAmt |
| EOY | $1,195,728 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $21,976,451 | BOYAmt |
| EOY | $21,647,817 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,484,538 | BOYAmt |
| EOY | $3,095,423 | EOYAmt |
Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $8,025,532 | BOYAmt |
| EOY | $7,674,064 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $273,298 | BOYAmt |
| EOY | $114,883 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $148,575 | BOYAmt |
| EOY | $64,791 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $10,931,943 | BOYAmt |
| EOY | $10,949,161 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $10,146,615 | BOYAmt |
| EOY | $9,668,589 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $847,893 | BOYAmt |
| EOY | $980,067 | EOYAmt |
Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $50,000 | BOYAmt |
| EOY | $50,000 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $11,044,508 | BOYAmt |
| EOY | $10,698,656 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $21,976,451 | BOYAmt |
| EOY | $21,647,817 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | -$386,880 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | -$44,209 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | $85,237 | 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
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 | $3,417 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $3,417 | 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 | REPRESENTS PORTION OF ANNUAL DUES PAID TO AMERICAN HOSPITAL ASSOCIATION AND OHIO HOSPITAL ASSOCIATION ESTIMATED TO PERTAIN TO LOBBYING ACTIVITIES. | ExplanationTxt |
Schedule D IRS990ScheduleD
CY Endwmt Fund CYEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $50,000 | BeginningYearBalanceAmt |
| End Year Balance | $50,000 | EndYearBalanceAmt |
CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $50,000 | BeginningYearBalanceAmt |
| End Year Balance | $50,000 | EndYearBalanceAmt |
CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $50,000 | BeginningYearBalanceAmt |
| End Year Balance | $50,000 | EndYearBalanceAmt |
CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $50,000 | BeginningYearBalanceAmt |
| End Year Balance | $50,000 | EndYearBalanceAmt |
CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $50,000 | BeginningYearBalanceAmt |
| End Year Balance | $50,000 | EndYearBalanceAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Prmnnt Endowment Balance EOY | 1.00000 | PrmnntEndowmentBalanceEOYPct |
| Endowments Held Unrelated Org | 0 | EndowmentsHeldUnrelatedOrgInd |
| Endowments Held Related Org | 0 | EndowmentsHeldRelatedOrgInd |
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $153,751 | OtherCostOrOtherBasisAmt |
| Book Value | $153,751 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $18,656,286 | OtherCostOrOtherBasisAmt |
| Depreciation | $13,006,469 | DepreciationAmt |
| Book Value | $5,649,817 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $7,981,638 | OtherCostOrOtherBasisAmt |
| Depreciation | $6,699,251 | DepreciationAmt |
| Book Value | $1,282,387 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $372,299 | OtherCostOrOtherBasisAmt |
| Book Value | $372,299 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $7,458,254 | TotalBookValueLandBuildingsAmt |
Other Securities OtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | INVESTMENT IN JOINT VENTURE | Desc |
| Book Value | $1,215,693 | BookValueAmt |
| Method Valuation | C | MethodValuationCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Securities | $1,215,693 | TotalBookValueSecuritiesAmt |
Other Assets Org OtherAssetsOrgGrp (5 entries)
| DescDesc | Book ValueBookValueAmt |
|---|---|
| BOARD DESIGNATED ASSETS | $24,076 |
| DONOR RESTRICTED ASSETS | $50,000 |
| DEPOSITS | $1,000 |
| CLINIC RENT RECEIVABLE | $1,100 |
| THIRD PARTY RECEIVABLE | $1,119,552 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $1,195,728 | TotalBookValueOtherAssetsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | DUE TO/FROM RELATED PARTIES | Desc |
| Amt | $64,791 | Amt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $64,791 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART V, LINE 4: | THE INTENDED USE OF THE ENDOWMENT FUNDS IS TO SUPPORT OPERATIONS OF THE HOSPITAL AS DIRECTED BY THE HOSPITAL BOARD. |
| PART X, LINE 2: | ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA REQUIRE MANAGEMENT TO EVALUATE TAX POSITIONS TAKEN AND RECOGNIZE A TAX LIABILITY IF AN UNCERTAIN POSITION HAS BEEN TAKEN THAT MORE LIKELY THAN NOT WOULD NOT BE SUSTAINED UPON EXAMINATION BY VARIOUS FEDERAL AND STATE TAXING AUTHORITIES. MANAGEMENT HAS ANALYZED THE TAX POSITIONS TAKEN BY THE ORGANIZATION AND HAS CONCLUDED THAT AS OF OCTOBER 31, 2018 AND 2017, THERE ARE NO UNCERTAIN POSITIONS TAKEN OR EXPECTED TO BE TAKEN THAT WOULD REQUIRE RECOGNITION OF A LIABILITY OR DISCLOSURE IN THE ACCOMPANYING FINANCIAL STATEMENTS. THE ORGANIZATION IS SUBJECT TO ROUTINE AUDITS BY TAXING JURISDICTIONS; HOWEVER, THERE ARE CURRENTLY NO AUDITS FOR ANY TAX PERIODS IN PROGRESS. |
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 |
| Percent100 | Yes (X) | Percent100Ind |
| FPG Reference Discounted Care | Yes (1) | FPGReferenceDiscountedCareInd |
| Percent250 | Yes (X) | Percent250Ind |
| Free Care Medically Indigent | Yes (1) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (1) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | 0 | ExpensesExceedBudgetInd |
| Annual Community Bnft Report | 0 | AnnualCommunityBnftReportInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 320 | PersonsServedCnt |
| Total Community Benefit Expns | $709,432 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,054,552 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00000 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 2128 | PersonsServedCnt |
| Total Community Benefit Expns | $4,651,784 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $2,505,643 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $2,146,141 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.06870 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 2448 | PersonsServedCnt |
| Total Community Benefit Expns | $5,361,216 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $3,560,195 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $2,146,141 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.06870 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 112630 | PersonsServedCnt |
| Total Community Benefit Expns | $58,498 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $180 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $58,318 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00190 | TotalExpensePct |
Health Professions Education HealthProfessionsEducationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 1 | PersonsServedCnt |
| Total Community Benefit Expns | $2,848 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $2,848 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00010 | TotalExpensePct |
Subsidized Health Services SubsidizedHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 1590 | PersonsServedCnt |
| Total Community Benefit Expns | $526,128 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $411,022 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $115,106 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00370 | TotalExpensePct |
Cash And In Kind Contributions CashAndInKindContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 6632 | PersonsServedCnt |
| Total Community Benefit Expns | $13,405 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $13,405 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00040 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 120853 | PersonsServedCnt |
| Total Community Benefit Expns | $600,879 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $411,202 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $189,677 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00610 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 123301 | PersonsServedCnt |
| Total Community Benefit Expns | $5,962,095 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $3,971,397 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $2,335,818 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.07480 | TotalExpensePct |
Community Support CommunitySupportGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 20 | ActivitiesOrProgramsCnt |
| Persons Served | 23497 | PersonsServedCnt |
| Total Community Benefit Expns | $22,473 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $22,473 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00070 | TotalExpensePct |
Health Improvement Advocacy HealthImprovementAdvocacyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 1 | ActivitiesOrProgramsCnt |
| Persons Served | 300 | PersonsServedCnt |
| Total Community Benefit Expns | $966 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $966 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00000 | TotalExpensePct |
Total Communtity Building Acty TotalCommuntityBuildingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 21 | ActivitiesOrProgramsCnt |
| Persons Served | 23797 | PersonsServedCnt |
| Total Community Benefit Expns | $23,439 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $23,439 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00070 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (1) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $2,239,044 | BadDebtExpenseAmt |
| Reimbursed By Medicare | $7,364,592 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $10,847,408 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$3,482,816 | 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 | 1 | HospitalFacilitiesCnt |
Hospital Facilities HospitalFacilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | HENRY COUNTY HOSPITAL INC | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1600 EAST RIVERVIEW AVE | AddressLine1Txt |
| City | NAPOLEON | CityNm |
| State Abbreviation | OH | StateAbbreviationCd |
| ZIP | 43545 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | WWW.HENRYCOUNTYHOSPITAL.ORG | WebsiteAddressTxt |
| State License | 1198 | StateLicenseNum |
| Critical Access Hospital | Yes (X) | CriticalAccessHospitalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | HENRY COUNTY HOSPITAL INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| First Licensed CY Or PY | 0 | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | 0 | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | Yes (1) | CHNAConductedInd |
| Community Definition | Yes (X) | CommunityDefinitionInd |
| Community Demographics | Yes (X) | CommunityDemographicsInd |
| Existing Resources | Yes (X) | ExistingResourcesInd |
| How Data Obtained | Yes (X) | HowDataObtainedInd |
| Community Health Needs | Yes (X) | CommunityHealthNeedsInd |
| Other Health Issues | Yes (X) | OtherHealthIssuesInd |
| Community Hlth Needs Id Process | Yes (X) | CommunityHlthNeedsIdProcessInd |
| Consulting Process | Yes (X) | ConsultingProcessInd |
| Prior CHNA Impact | Yes (X) | PriorCHNAImpactInd |
| CHNA Conducted | 16 | CHNAConductedYr |
| Take Into Account Others Input | Yes (1) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | 0 | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | Yes (1) | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (1) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | SEE PART V SUPPLEMENTAL FACILITY INFO | OwnWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Implementation Strategy Adopt | Yes (1) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 16 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (1) | StrategyPostedWebsiteInd |
| Strategy Website URL | SEE PART V SUPPLEMENTAL FACILITY INFO | StrategyWebsiteURLTxt |
| Organization Incur Excise Tax | 0 | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (1) | EligCriteriaExplainedInd |
| FPG Family Incm Lmt Free Dscnt | Yes (X) | FPGFamilyIncmLmtFreeDscntInd |
| FPG Family Incm Lmt Free Care | 100.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 250.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Income Level Criteria | Yes (X) | IncomeLevelCriteriaInd |
| Medical Indigency Criteria | Yes (X) | MedicalIndigencyCriteriaInd |
| Insurance Status Criteria | Yes (X) | InsuranceStatusCriteriaInd |
| Underinsurance Stat Criteria | Yes (X) | UnderinsuranceStatCriteriaInd |
| Residency Criteria | Yes (X) | ResidencyCriteriaInd |
| Explained Basis | Yes (1) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (1) | AppFinancialAsstExplnInd |
| Described Info | Yes (X) | DescribedInfoInd |
| Described Suprt Doc | Yes (X) | DescribedSuprtDocInd |
| Provided Hospital Contact | Yes (X) | ProvidedHospitalContactInd |
| Provided Nonprofit Contact | Yes (X) | ProvidedNonprofitContactInd |
| Includes Publicity Measures | Yes (1) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | SEE PART V PAGE 8 | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | SEE PART V PAGE 8 | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | SEE PART V PAGE 8 | FAPSummaryOnWebsiteURLTxt |
| FAP Avlbl On Request No Charge | Yes (X) | FAPAvlblOnRequestNoChargeInd |
| FAP App Avlbl On Request No Chrg | Yes (X) | FAPAppAvlblOnRequestNoChrgInd |
| FAP Sum Avlbl On Request No Chrg | Yes (X) | FAPSumAvlblOnRequestNoChrgInd |
| Notified FAP Copy Bill Display | Yes (X) | NotifiedFAPCopyBillDisplayInd |
| Communtity Notified FAP | Yes (X) | CommuntityNotifiedFAPInd |
| FAP Translated | Yes (X) | FAPTranslatedInd |
| Other Publicity | Yes (X) | OtherPublicityInd |
| FAP Actions On Nonpayment | Yes (1) | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | 0 | CollectionActivitiesInd |
| Provided Written Notice | Yes (X) | ProvidedWrittenNoticeInd |
| Made Effort Orally Notify | Yes (X) | MadeEffortOrallyNotifyInd |
| Nondis Emergency Care Policy | Yes (1) | NondisEmergencyCarePolicyInd |
| Look Back Medicare Private | Yes (X) | LookBackMedicarePrivateInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | 0 | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (8 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| HENRY COUNTY HOSPITAL, INC. | PART V, SECTION B, LINE 5: 95% CONFIDENCE RATE THAT RESPONSES REPRESENT ENTIRE COUNTY. SEE EXPLANATION PARAGRAPH FOR PART VI LINE 2 FOR ADDITIONAL INFORMATION REGARDING THE CHNA. |
| HENRY COUNTY HOSPITAL, INC. | PART V, SECTION B, LINE 6B: HENRY COUNTY HOSPITAL'S CHNA WAS CONDUCTED WITH THE HENRY COUNTY HEALTH DEPARTMENT, FOUR COUNTY ADAMHS BOARD, UNITED WAY OF HENRY COUNTY, AND COMMUNITY HEALTH SERVICES. |
| HENRY COUNTY HOSPITAL, INC. | PART V, SECTION B, LINE 11: THE HENRY COUNTY HEALTH PARTNERS; INITIAL EFFORTS WILL FOCUS IN THREE AREAS:1. RISK FACTORS FOR OBESITY - INCREASE ACCESS TO AFFORDABLE HEALTHY FOOD, INCREASE NUTRITION EDUCATION, EXPAND THE AVAILABILITY OF AND PARTICIPATION IN PHYSICAL ACTIVITY & PHYSCIAL EDUCATION AND ENGAGE COMMUNITY STAKEHOLDERS AS PARTNERS IN THE CREATION & SUSTAINABILITY OF A HEALTHY COMMUNITY. IN 2018, THE COMMUNITY WELCOMED AN ADDITIONAL GYM LOCATION WITHIN THE COMMUNITY, ANYTIME FITNESS. NUTRITION EDUCATION CONTINUED WITHIN THE FOUR COUNTY SCHOOLS FROM KINDERGARTEN-4TH GRADE. 5TH GRADERS AT THE AREA SCHOOLS LEARN ABOUT THE BENEFITS OF PHYSICAL ACTIVITY BY PARTICIPATING IN A COMMUNITY-WIDE EXERCISE CHALLENGE HOSTED BY THE UNITED WAY OF HENRY COUNTY, COMING ALIVE. IN ADDITION, ALL AREA ELEMENTARY STUDENTS HAVE CONTINUAL ACCESS TO GONOODLE, A PROGRAM THAT COMBINES LEARNING WITH PHYSICAL ACTIVITY.2. HEALTHCARE ACCESS & COST - HELP MORE HENRY COUNTY RESIDENTS OBTAIN HEALTH INSURANCE COVERAGE, INCREASE THE NUMBER OF PRIMARY CARE PROVIDERS AVAILABLE IN HENRY COUNTY, INCREASE LINKAGES AMONG PRIMARY CARE PROVIDER & COMMUNITY AGENCIES & ORGANIZATIONS, CONNECT HENRY COUNTY RESIDENTS WITH PRIMARY CARE PROVIDERS & HELP RESIDENTS USE HEALTH INSURANCE & HEALTH CARE SERVICES MORE EFFECTIVELY. IN 2018, HENRY COUNTY HOSPITAL BEGAN TO RECRUIT FOR AN ADDITIONAL FAMILY PRACTICE PHYSICIAN. THE HENRY COUNTY HEALTH DEPARTMENT CONTINUED PROMOTING THE SERVICES OF A COMMUNITY HEALTH WORKER THROUGH THE PATHWAY PROGRAM, WHOSE PRIMARY JOB RESPONSIBILITY IS TO HELP RESIDENTS LIVE A HEALTHIER LIFE. THEY CAN CONNECT YOU TO COMMUNITY RESOURCES, PROVIDE SUPPORT AND BASIC HEALTH EDUCATION, MAKE SURE YOU GET TO THE DOCTOR, AND PROVIDE INFORMATION BASED ON YOUR UNIQUE NEEDS.3. BEHAVIORAL HEALTH ISSUES - INCREASE THE NUMBER OF HENRY COUNTY SUICIDE SURVIVORS WHO GET INTO TREATMENT TO 51% BY 2018, PRIMARY CARE PROVIDERS IN HENRY COUNTY WILL PERFORM A DEPRESSION SCREENING ON 51% OF THEIR PATIENTS BY 2018, & DECREASE YOUTH WHO "FELT SAD OR HOPELESS" ALMOST EVERY DAY FOR 2 WEEKS OR MORE IN A ROW TO LESS THAN 15% BY 2018. HENRY COUNTY HOSPITAL SENDS A STAFF REPRESENTATIVE TO THE SUICIDE PREVENTION MEETING HOSTED BY NAMI. IN ADDITION, THE NORTHWEST OHIO L.O.S.S. TEAM CONTINUED TO WORK WITH LOCAL LAW ENFORCEMENT AND WAS PRESENT AT THE SCENE OF EVERY SUICIDE OR ATTEMPTED SUICIDE TO SUPPORT THE VICTIMS' FAMILIES. |
| HENRY COUNTY HOSPITAL, INC. | PART V, SECTION B, LINE 13B: FOR ELIGIBILITY GUIDELINES, A SLIDING SCALE IS USED FOR DISCOUNTED CARE IF THE PATIENT IS OVER OUR 250% FEDERAL POVERTY GUIDELINES. |
| HENRY COUNTY HOSPITAL, INC. | PART V, SECTION B, LINE 16J: PAPER COPIES OF THE FAP ARE AVAILABLE AT ACCESS POINTS THROUGHOUT THE HOSPITAL, AS WELL AS AT THE SENIOR CENTER, HEALTH DEPARTMENT, JOBS & FAMILY SERVICES, CHURCHES, AND FISH PROGRAM (FOOD BANK). |
| HENRY COUNTY HOSPITAL, INC.: | FORM 990, SCHEDULE H, PART V, LINE 7A, CHNA URL: HTTPS://WWW.HENRYCOUNTYHOSPITAL.ORG/PATIENTS-VISITORS/COMMUNITY-HEALTH-ASSESSMENT.ASPX |
| HENRY COUNTY HOSPITAL, INC.: | FORM 990, SCHEDULE H, LINE 16A, FAP URL:HTTPS://WWW.HENRYCOUNTYHOSPITAL.ORG/PATIENTS-VISITORS/PATIENT-FINANCIAL-SERVICES.ASPXFORM 990, SCHEDULE H, LINE 16B, FAP APPLICATION URL:HTTPS://WWW.HENRYCOUNTYHOSPITAL.ORG/PATIENTS-VISITORS/PATIENT-FINANCIAL-SERVICES.ASPXFORM 990, SCHEDULE H, LINE 16C, PLAIN LANGUAGE SUMMARY OF FAP URL:HTTPS://WWW.HENRYCOUNTYHOSPITAL.ORG/PATIENTS-VISITORS/PATIENT-FINANCIAL-SERVICES.ASPX |
| HENRY COUNTY HOSPITAL, INC.: | FORM 990, SCHEDULE H, PART V, LINE 10A, IMPLEMENTATION STRATEGY URL:HTTPS://WWW.HENRYCOUNTYHOSPITAL.ORG/PATIENTS-VISITORS/COMMUNITY-HEALTH-ASSESSMENT.ASPX |
Supplemental Information Detail SupplementalInformationDetail (13 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 3C: | IN ADDITION TO THE FPG, THE ORGANIZATION USES THE FOLLOWING CRITERIA TO DETERMINE ELIGIBILITY FOR FINANCIAL ASSISTANCE: A SLIDING SCALE FOR DISCOUNTED CARE IF THE PATIENT IS OVER THE 250% FEDERAL POVERTY GUIDELINES, MEDICAL INDIGENCY, INSURANCE STATUS, UNDERINSURANCE STATUS, AND RESIDENCY. |
| PART I, LINE 7: | THE COST TO CHARGE RATIO METHOD WAS USED TO CALCULATE THE CHARITY CARE AND CERTAIN OTHER COMMUNITY BENEFITS AT COST. |
| PART I, LN 7 COL(F): | WE ESTIMATE THAT APPROXIMATELY 0% OF THE ACCOUNTS SENT TO BAD DEBT MAY QUALIFY FOR FINANCIAL ASSISTANCE IF THE PATIENT WOULD APPLY OR FULLY COMPLETE THE APPLICATION. WE ASSIST OUR PATIENTS EARLY IN THE PROCESS TO QUALIFY THEM FOR MEDICAID OR FINANCIAL ASSISTANCE, SO WE DEEM OUR PERCENTAGE TO BE LOW. |
| PART II, COMMUNITY BUILDING ACTIVITIES: | IN ORDER TO HELP COMBAT RISK FACTORS OF OBESITY HENRY COUNTY HOSPITAL SPONSORS AND PARTICIPATES IN A VARIETY OF COMMUNITY EVENTS AT WHICH TIME HEALTHY ACTIVITY AND GOOD NUTRITION IS PROMOTED. THE BELOW EVENTS ARE EXAMPLES: KIDZ FEST: PRESENTING SPONORS. OFFERED HEALTHY EATING INFORMATION, BUILD YOUR OWN GRANOLA ACTIVITY AND OBSTACLE COURSES. HENRY COUNTY RELAY FOR LIFE - CORPORATE SPONSOR. OFFERED INFORMATION ON CANCER PREVENTION AND DISPLAYED A LARGE INFLATABLE COLON THAT ALLOWED FOR ATTENDEES TO WALK THROUGH AND SEE WHAT COLON CANCER LOOKS LIKE INTERNALLY. SYMPHONY OF TREES - PARTICIPATE BY HAVING TWO MEMBERS OF THE STAFF SIT ON THE SYMPHONY OF TREES BOARD. THE SYMPHONY OF TREES IS A NON-PROFIT ORGANIZATION THAT PROVIDES FUNDS TO PROTECT AND SUPPORT THE CHILDREN OF NORTHWEST OHIO THROUGH THREE BENEFITTING AGENCIES; HENRY COUNTY CASA, THE CENTER FOR CHILD AND FAMILY ADVOCACY AND HENRY COUNTY HOSPITAL. NAPOLEON TRIATHALON AND OTHER RACE SPONSORSHIPS - PREMIER SPONSOR OF THE NAPOLEON TRIATHALON, CORPORATE SPONSOR FOR OTHER LOCAL RACES. UNITED WAY COMING ALIVE - COMING ALIVE IS A COMMUNITY WIDE EXERCISE PROGRAM AND HENRY COUNTY HOSPITAL IS A PROUD SPONSOR AND PARTICIPANT. HENRY COUNTY HOSPITAL'S FITNESS INSTRUCTOR ATTENDS AREA SCHOOLS AND PROVIDES EDUCATION TO THE STUDENTS REGARDING THE IMPORTANCE OF PHYSICAL ACTIVITY. AFTER SCHOOL PROGRAMMING - FITNESS INSTRUCTORS AND REGISTERED DIETITIANS EMPLOYED BY HENRY COUNTY HOSPITAL PARTICIPATED IN AN AFTER SCHOOL PROGRAM WHERE THEY DISCUSSED THE IMPORTANCE OF EXERCISE AS WELL AS PROVIDED COOKING DEMONSTRATIONS AND SAMPLES. AMERICAN HEART ASSOCIATION HEART WALK SPONSOR. SPONSORED AND PROVIDED STAFF TO LEAD THE WARM UP. BLESSINGS IN A BACKPACK - PURCHASED BACKPACKS TO BE USED BY A LOCAL SCHOOL DISTRICT THAT SENDS HOME FOOD ON FRIDAY FOR CHILDREN IN NEED. SPONSORSHIP OF LOCAL GOLF OUTINGS. IN ORDER TO IMPROVE HEALTHCARE ACCESS HENRY COUNTY HOSPITAL PARTICIPATED IN THE FOLLOWING: FREE COMMUNITY HEALTH SCREENINGS - OFFERED 100 FREE BLOOD DRAWS THAT INCLUDED LIPID PROFILES AND METABOLIC PANELS. FREE MONTHLY BLOOD PRESSURE SCREENINGS AT HENRY COUNTY SENIOR CENTER AND RIVERVIEW TERRACE APARTMENTS (SENIOR LIVING FACILITY). FREE USE OF LANGUAGE LINE SERVICES. FREE BLOOD PRESSURE SCREENINGS AT LOCAL HEALTH FAIRS AND THE HENRY COUNTY FAIR. HENRY COUNTY TRANSPORTATION NETWORK - WORK WITH THE HENRY COUNTY TRANSPORTATION NETWORK TO PROVIDE FREE TRANSPORTATION FOR PATIENTS TO AND FROM THE HENRY COUNTY HOSPITAL. SPORTS PHYSICALS - PROVIDE PHYSICALS AT LOCAL SCHOOLS AND DONATE THE MONEY BACK TO THE SCHOOLS. PRENATAL CLASSES - PROVIDE FREE PRENATAL CLASSES, BREASTFEEDING CLASSES AND LACTATION CONSULTATIONS. POISON PREVENTION WEEK - HOST AREA PRESCHOOLS AT THE HOSPITAL WHERE AN EDUCATIONAL PRESENTATION IS GIVEN, HANDOUTS AND GAMES. THEN THE CHILDREN ARE TAKEN ON TOURS TO FAMILIARIZE THEM WITH THE HOSPITAL SO IF THEY EVER HAVE TO COME THEY FEEL COMFORTABLE. THE FOLLOWING ACTIVITIES HELP ENSURE ACCESS TO BEHAVIORAL HEALTH SERVICES: WORK WITH A NON-PROFIT AGENCY, SUFFICIENT GRACE MINISTRIES TO OFFER STAFF EDUCATION REGARDING PROVIDING SUPPORT TO MOTHERS/FAMILIES WHO HAVE HAD A MISCARRIAGE OR STILLBIRTH. THIS ORGANIZATION ALSO PROVIDES MOTHERS/FAMILIES KEEPSAKE ITEMS AND EXTRA SUPPORT IF THEY WOULD LIKE. |
| PART III, LINE 2: | MANAGEMENT ESTIMATES AN ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS RECEIVABLE BASED ON AN EVALUATION OF HISTORICAL LOSSES, CURRENT ECONCOMIC CONDITIONS, AND OTHER FACTORS UNIQUE TO THE HOSPITAL'S CUSTOMER BASE. |
| PART III, LINE 3: | NO OTHER BAD DEBT AMOUNTS HAVE BEEN INCLUDED AS COMMUNITY BENEFIT. THE HOSPITAL HAS A DETAILED FINANCIAL ASSISTANCE POLICY WHICH STATES THAT TO PARTICIPATE IN CHARITY CARE, CANDIDATES MUST COOPERATE FULLY. IN ADDITION, THE HOSPITAL EDUCATES PATIENTS WITH LIMITED ABILITY TO PAY REGARDING FINANCIAL ASSISTANCE. FOR THIS REASON, THE ORGANIZATION BELIEVES IT ACCURATELY CAPTURES ALL CHARITY CARE DEDUCTIONS PROVIDED ACCORDING TO THE FINANCIAL ASSISTANCE POLICY AND THE AMOUNT OF BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S CHARITY CARE POLICY IS NEGLIGIBLE. |
| PART III, LINE 4: | THE FOOTNOTE EXPLAINING THE METHODOLOGY USED TO ESTIMATE THE AMOUNT OF THE ORGANIZATION'S BAD DEBT CAN BE FOUND ON PAGE 9 OF THE AUDITED FINANCIAL STATEMENTS UNDER THE HEADING "ALLOWANCE FOR DOUBTFUL ACCOUNTS." |
| PART III, LINE 8: | HENRY COUNTY HOSPITAL PROVIDES CARE TO THE MEDICARE POPULATION OF HENRY COUNTY, OHIO AND THE SURROUNDING AREA. IF THE HOSPITAL DID NOT PARTICIPATE IN MEDICARE, THOSE PATIENTS WOULD NEED TO SEEK CARE OUTSIDE OF HENRY COUNTY. THE MEDICARE SHORTFALL IS A BENEFIT THAT HENRY COUNTY HOSPITAL PROVIDES TO THE MEDICARE BENEFICIARIES IN THE COMMUNITY HENRY COUNTY HOSPITAL SERVES. THE SOURCE USED TO DETERMINE THE AMOUNT OF MEDICARE ALLOWABLE COSTS REPORTED FOR PART III, SECTION B, MEDICARE HAS BEEN PROVIDED FROM THE YEAR ENDED OCTOBER 31, 2018 REPORT: HOSPITAL STATEMENT OF REIMBURSABLE COST. |
| PART III, LINE 9B: | PER THE FINANCIAL ASSISSTANCE POLICY: NO PATIENT SEEKING MEDICAL SERVICE THAT CAN BE PROVIDED BY THE HOSPTIAL WILL BE DENIED ACCESS TO THOSE SERVICES SOLELY BECAUSE OF THE INABILTIY TO PAY FOR THOSE SERVICES. IF THE PATIENT IS KNOWN TO QUALIFY FOR FINANCIAL ASSISTANCE THE HOSPITAL DOES NOT SEND THEM TO COLLECTIONS BUT WORKS WITH THE PATIENT TO COMPLETE THE REQUIRED FINANCIAL ASSISTANCE APPLICATION. |
| PART VI, LINE 2: | EVERY THREE YEARS HENRY COUNTY HOSPITAL WORKS IN CONJUNCTION WITH THE HENRY COUNTY HEALTH DEPARTMENT AND OTHER COMMUNITY PARTNERS TO COMPLETE A COMPREHENSIVE COMMUNITY HEALTH ASSESSMENT. THIS COMMUNITY HEALTH ASSESSMENT PROVIDES VITAL INFORMATION TO THE HOSPITAL AND ENABLES HEALTH PROFESSIONALS TO DETERMINE THE NEEDS OF THE COMMUNITY. FROM THE COMMUNITY HEALTH ASSESSMENT THE FOLLOWING GOALS WERE DETERMINED: RISK FACTORS FOR OBESITY GOAL: PROMOTE HEALTHY LIFESTYLES TO REDUCE OBESITY AND ITS RISK FACTORS AMONG HENRY COUNTY RESIDENTS. BEHAVIORAL HEALTH ISSUES GOAL: TO PROTECT THE HEALTH, SAFETY AND QUALITY OF LIFE OF HENRY COUNTY RESIDENTS BY ENSURING ACCESS TO BEHAVIORAL HEALTH SERVICES. HEALTHCARE ACCESS AND COST GOAL: TO IMPROVE HENRY COUNTY RESIDENTS' ACCESS TO COMPREHENSIVE, QUALITY AND AFFORDABLE HEALTH CARE SERVICES. INDIVIDUAL WORK GROUPS HAVE BEEN ASSIGNED TO WORK ON EACH OF THE ABOVE GOALS. THESE WORK GROUPS DEVELOP AND CARRY OUT TACTICS THAT HELP IMPACT THE SPECIFIC GOAL THEY HAVE BEEN ASSIGNED. THE OBJECTIVES/PROGRAMS THAT WE ARE UTILIZING TO MEET THESE GOALS ARE CURRENTLY:- SUPPORT AND IMPROVE THE SUMMER NUTRITION (AND PHYSICAL ACTIVITY) PROGRAM SUPPORT HENRY COUNTY HOSPITAL IN ITS JOURNEY TO BECOME A BABY - FRIENDLY HOSPITAL (WHICH FOCUSES ON BREASTFEEDING).- ENCOURAGE/ENGAGE WORKPLACE WELLNESS THROUGHOUT THE COMMUNITY BY ASSISTING LOCAL ORGANIZATIONS IN BECOMING FIT-FRIENDLY (AMERICAN HEART ASSOCIATION'S WORKPLACE WELLNESS PROGRAM). IN ADDITION, FEEDBACK IS GATHERED FROM PATIENTS USING PROFESSIONAL RESOURCE CONSULTANTS SURVEYING SERVICES. THIS FEEDBACK GIVES HENRY COUNTY EMPLOYEES AN OPPORTUNITY TO BEST MEET THE PATIENTS' NEEDS. THE USE OF FOCUS GROUPS IS ALSO UTILIZED TO GATHER INFORMATION FROM SPECIFIC COMMUNITY GROUPS AND PATIENTS OF SPECIFIC SERVICE LINES. |
| PART VI, LINE 3: | AT THE TIME OF SERVICE, EACH SELF PAY PATIENT IS GIVEN A PACKET UPON DISCHARGE. THE PACKET INCLUDES AN HCAP APPLICATION (<100% FEDERAL POVERTY GUIDELINES) WITH DIRECTIONS, FINANCIAL ASSISTANCE PROGRAM INFORMATION, INCOME GUIDELINES FOR PROGRAMS, AND THE CONTACT INFORMATION FOR THE FINANCIAL COUNSELOR. EACH BILLING STATEMENT THAT IS SENT OUT TO PATIENTS CONTAINS THE HOSPITAL HCAP APPLICATION AND FINANCIAL COUNSELOR CONTACT INFORMATION. SIGNAGE IS ALSO POSTED IN THE HOSPITAL PER STATE OF OHIO REQUIREMENTS REGARDING FREE CARE. |
| PART VI, LINE 4: | HENRY COUNTY IS LOCATED IN NORTHWEST OHIO, COMPOSED OF THIRTEEN TOWNSHIPS AND NINE MUNICIPALITIES. HENRY COUNTY IS RICH IN AGRICULTURE, BUSINESS, CHURCHES, SCHOOLS, AND COMMUNITY ORGANIZATIONS. THE POPULATION OFHENRY COUNTY IS NEARLY 27,000. THE RACIAL MAKEUP OF THE COUNTY WAS 97% WHITE, 0.8% BLACK OR AFRICAN AMERICAN, 0.5% NATIVE AMERICAN, 0.5% ASIAN, 1.2% FROM OTHER RACES, AND 1.1% FROM TWO OR MORE RACES. 7.8% OF THE POPULATION WERE HISPANIC OR LATINO OF ANY RACE. 95.9% SPOKE ENGLISH, 2.7% SPANISH AND 0.8% GERMAN AS THEIR FIRST LANGUAGE. THE MEDIAN INCOME FOR A HOUSEHOLD IN THE COUNTY WAS $58,070, AND THE MEDIAN INCOME FOR A FAMILY WAS $68,966. MALES HAD A MEDIAN INCOME OF $45,809 VERSUS $32,502 FOR FEMALES. THE PER CAPITA INCOME FOR THE COUNTY WAS $27,325. ABOUT 5.30% OF FAMILIES AND 9.00% OF THE POPULATION WERE BELOW THE POVERTY LINE, INCLUDING 10.1% OF THOSE UNDER AGE 18 AND 4.20% OF THOSE AGE 65 OR OVER. |
| PART VI, LINE 5: | HENRY COUNTY HOSPITAL IS ACTIVE IN THE COMMUNITY BY PARTICIPATING IN HEALTH FAIRS, PROVIDING EDUCATION TO THE COMMUNITY, PROVIDING SCHOOL NURSES IN TWO OF THE FOUR SYSTEMS IN THE COUNTY, SUPPORTING OUR PATIENTS WITH TRANSPORTATION NEEDS, AND PROMOTING FITNESS AND WELLNESS CLASSES. THE HOSPITAL SUPPORTS THE EMPLOYEES BY PROMOTING WELLNESS ACTIVITIES, SUCH AS BREAK FOR HEALTH, HEALTHY EATING, AND "DRINK MORE WATER" CHALLENGES. OUR BOARD OF TRUSTEES IS MADE UP OF COMMUNITY MEMBERS WHO ACT IN THE BEST INTEREST OF OUR PATIENT POPULATION. EACH MEMBER BRINGS A UNIQUE PERSPECTIVE FROM THEIR OWN POSITIONS IN THE COMMUNITY THAT ENABLES THEM TO BE ACTIVELY ENGAGED IN ADMINISTERING THEIR DUTIES AS A BOARD. THE HOSPITAL WORKS COLLABORATIVELY WITH THE HENRY COUNTY HEALTH DEPARTMENT, THE UNITED WAY, AND OTHERS IN PROMOTING HEALTHY LIVING. AS AN EXAMPLE, THE HOSPITAL IS WORKING TO INCREASE THE NUMBER OF BREAST-FED BABIES WITH THE ASSISTANCE OF WIC (WOMEN, INFANTS AND CHILDREN) STAFF, BIRTHING CARE SERVICES NURSES, AND PATIENTS.SENIOR LEADERS IN THE ORGANIZATION PARTICIPATE ON THE FOLLOWING BOARDS AND COMMITTEES THAT CONTINUE TO MEET THE NEEDS OF THE RESIDENTS OF HENRY COUNTY AND SURROUNDING AREAS: AMERICAN CANCER SOCIETY VOLUNTEER LEADERSHIP COUNCIL, HENRY COUNTY HEALTH PARTNERS, BREAST & COLON COALITION, SYMPHONY OF TREES BOARD OF DIRECTORS, AMERICAN HEART ASSOCIATION HEART WALK/EXECUTIVE LEADERSHIP COMMITTEE, SUICIDE PREVENTION, COMMUNITY HEALTH SERVICES, LUTHERAN HOME STRATEGIC VISIONING COMMITTEE, LUTHERAN HOME AT NAPOLEON - MEETING OF THE MINISTRY BOARD OF DIRECTORS, FAMILY & CHILDREN FIRST COUNCIL AND TOGETHER WE CAN MAKE A DIFFERENCE - MENTORING PROGRAM. |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Records Maintained | 0 | GrantRecordsMaintainedInd |
Recipient Table RecipientTable
Recipient Business Name RecipientBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | HENRY COUNTY HOSPITAL FOUNDATION INC | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1600 EAST RIVERVIEW | AddressLine1Txt |
| City | NAPOLEON | CityNm |
| State Abbreviation | OH | StateAbbreviationCd |
| ZIP | 43545 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Recipient EIN | 341919852 | RecipientEIN |
| IRC Section | 501C3 | IRCSectionDesc |
| Cash Grant | $104,239 | CashGrantAmt |
| Purpose Of Grant | SUPPORT THE WORK OF THE FOUNDATION | PurposeOfGrantTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total501c3 Org | 1 | Total501c3OrgCnt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Idemnification Gross Up Pmts | Yes (X) | IdemnificationGrossUpPmtsInd |
| Club Dues Or Fees | Yes (X) | ClubDuesOrFeesInd |
| Written Policy Ref T And E Expnss | Yes (1) | WrittenPolicyRefTAndEExpnssInd |
| Substantiation Required | Yes (1) | SubstantiationRequiredInd |
| Compensation Committee | Yes (X) | CompensationCommitteeInd |
| Form990 Of Other Organizations | Yes (X) | Form990OfOtherOrganizationsInd |
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | 0 | 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 (7 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| DR EARNST HAFTKOWYCZ | ||||||||||||||
| OB/GYN & BOD-TERM ENDED DEC'17 | $251,469 | $0 | $0 | $0 | $0 | $0 | $7,432 | $0 | $11,312 | $0 | $270,213 | $0 | $0 | $0 |
| KIMBERLY BORDENKIRCHER | ||||||||||||||
| CEO | $206,097 | $0 | $0 | $0 | $476 | $0 | $5,972 | $0 | $23,079 | $0 | $235,624 | $0 | $0 | $0 |
| WILLIAM GRIMM | ||||||||||||||
| CIO | $130,589 | $0 | $0 | $0 | $0 | $0 | $2,639 | $0 | $28,248 | $0 | $161,476 | $0 | $0 | $0 |
| DR DOUGLAS LINDSEY | ||||||||||||||
| PHYSICIAN | $325,578 | $0 | $0 | $0 | $0 | $0 | $8,000 | $0 | $30,191 | $0 | $363,769 | $0 | $0 | $0 |
| DR MORRIS SEAL | ||||||||||||||
| PHYSICIAN | $227,377 | $0 | $0 | $0 | $0 | $0 | $6,774 | $0 | $14,216 | $0 | $248,367 | $0 | $0 | $0 |
| MICHELE JAKUTOWICZ | ||||||||||||||
| PHARMACIST | $128,813 | $0 | $0 | $0 | $0 | $0 | $3,793 | $0 | $19,139 | $0 | $151,745 | $0 | $0 | $0 |
| SARAH HUBER | ||||||||||||||
| MEDICAL IMAGING MANAGER | $119,847 | $0 | $0 | $0 | $0 | $0 | $3,565 | $0 | $27,916 | $0 | $151,328 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART I, LINE 1A | FormAndLineReferenceDesc |
| Explanation | THE HOSPITAL GROSSES UP THE PERSONAL USE OF A BUSINESS OWNED VEHICLE FOR KIM BORDENKIRCHER, CEO. THIS BENEFIT IS INCLUDED IN TAXABLE COMPENSATION. THE HOSPITAL PAYS DUES FOR THE ROTARY CLUB FOR KIM BORDENKIRCHER, CEO. THIS BENEFIT IS NOT INCLUDED IN TAXABLE COMPENSATION. | ExplanationTxt |
Schedule K IRS990ScheduleK
Tax Exempt Bonds Issues TaxExemptBondsIssuesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
Issuer Name IssuerName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | HENRY COUNTY OHIO | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Issuer EIN | 346400633 | BondIssuerEIN |
| Bond Issued | 2010-12-16 | BondIssuedDt |
| Issue Price | $10,680,000 | IssuePriceAmt |
| Purpose | BQ PRIVATE PLACEMENT WITH SWAP PAYOFF AND REFINANCING OF 2006 BOND ISSUE | PurposeDesc |
| Defeased | 0 | DefeasedInd |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuerInd |
| Pool Financing | 0 | PoolFinancingInd |
Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Retired | $2,420,000 | RetiredAmt |
| Total Proceeds | $10,680,000 | TotalProceedsAmt |
| Refunding Escrow | $9,952,500 | RefundingEscrowAmt |
| Issuance Costs From Proceeds | $135,325 | IssuanceCostsFromProceedsAmt |
| Capital Expenditures | $592,175 | CapitalExpendituresAmt |
| Substantial Completion | 2011 | SubstantialCompletionYr |
| Current Refunding | Yes (1) | CurrentRefundingInd |
| Advance Refunding | 0 | AdvanceRefundingInd |
| Final Allocation Made | Yes (1) | FinalAllocationMadeInd |
| Adequate Books And Rec Maint | Yes (1) | AdequateBooksAndRecMaintInd |
Tax Exempt Bonds Private Bus Use TaxExemptBondsPrivateBusUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Owning Bond Financed Property | 0 | OwningBondFinancedPropertyInd |
| Any Lease Arrangements | 0 | AnyLeaseArrangementsInd |
| Mgmt Contract Bond Fincd Prop | 0 | MgmtContractBondFincdPropInd |
| Any Research Agreements | 0 | AnyResearchAgreementsInd |
| Bond Iss Meet Prvt Sec Pymt Test | 0 | BondIssMeetPrvtSecPymtTestInd |
| Change In Use Bond Financed Prop | 0 | ChangeInUseBondFinancedPropInd |
| Procs Nonqualified Bond Remdtd | 0 | ProcsNonqualifiedBondRemdtdInd |
Tax Exempt Bonds Arbitrage TaxExemptBondsArbitrageGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Form8038 T Filed | 0 | Form8038TFiledInd |
| Rebate Not Due Yet | Yes (1) | RebateNotDueYetInd |
| Exception To Rebate | 0 | ExceptionToRebateInd |
| No Rebate Due | 0 | NoRebateDueInd |
| Variable Rate Issue | 0 | VariableRateIssueInd |
| Hedge Identified In Bks And Rec | 0 | HedgeIdentifiedInBksAndRecInd |
| Gross Proceeds Invested In GIC | 0 | GrossProceedsInvestedInGICInd |
| Gross Proceeds Invested | 0 | GrossProceedsInvestedInd |
| Written Proc To Monitor Reqs | 0 | WrittenProcToMonitorReqsInd |
Procedures Corrective Action ProceduresCorrectiveActionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Procedures Corrective Action | Yes (1) | ProceduresCorrectiveActionInd |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (7 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION B, LINE 11B | THE FINANCE COMMITTEE OF THE BOARD REVIEWS THE FORM 990 BEFORE FILING AT A REGULARLY SCHEDULED MEETING, TYPICALLY THE FOURTH MONDAY OF THE MONTH. THE FORM 990 THEN GOES TO THE FULL BOARD AT THE FOLLOWING BOARD MEETING FOR REVIEW, TYPICALLY THE FIRST MONDAY OF THE MONTH. |
| FORM 990, PART VI, SECTION B, LINE 12C | THE WRITTEN CONFLICT OF INTEREST POLICY IS REGULARLY AND CONSISTENTLY MONITORED AND COMPLIANCE ENFORCED BY THE CEO. THE SCOPE OF THIS POLICY INCLUDES BOARD MEMBERS AND THE LEADERSHIP TEAM. THE POLICY IS IN PLACE TO IDENTIFY POTENTIAL CONFLICTS OF INTEREST AND PROVIDE A MECHANISM TO MANAGE POTENTIAL CONFLICTS OF INTERESTS. THE COVERED PERSONS ARE TO IDENTIFY POTENTIAL CONFLICTS AND NOT PARTICIPATE IN DISCUSSIONS AND DECISIONS RELATED TO THE IDENTIFIED CONFLICTS. A SELF DISCLOSURE FROM COVERED PERSONS TO THE CEO AND THE BOARD IS REQUIRED ON ANY POTENTIAL CONFLICTS OF INTEREST. THE COVERED PERSONS ARE TO RECUES FROM PARTICIPATING IN ANY DELIBERATION OR DECISIONS ON SUCH TRANSACTIONS. |
| FORM 990, PART VI, SECTION B, LINE 15 | THE CEO'S COMPENSATION IS DETERMINED BY BOARD OF DIRECTORS REVIEW. THE BOARD OF DIRECTORS USES THE OHIO HOSPITAL ASSOCIATION COMPENSATION DATA, COMPARABLE DATA OF OUR SURROUNDING HOSPITALS, AND INTERNAL EQUITY TO DETERMINE THE COMPENSATION OF THE CEO. THE FINAL DETERMINATION OF THE COMPENSATION IS APPROVED BY BOARD VOTE. THE COMPENSATION OF OTHER OFFICERS OR KEY EMPLOYEES OF THE ORGANIZATION IS DONE BY SIMILAR REVIEW OF COMPARABLE WAGE DATA FROM THE OHIO HOSPITAL ASSOCIATION AND THE HOSPITAL COUNCIL OF NORTHWEST OHIO. THE MANAGER OF HUMAN RESOURCES MAKES A COMPENSATION RECOMMENDATION BASED ON THE DATA AND INTERNAL EQUITY TO THE CEO. THE CEO AUTHORIZES THE COMPENSATION BASED ON THE DATA AND THE RECOMMENDATION. |
| FORM 990, PART VI, SECTION C, LINE 19 | THE ORGANIZATION DOES NOT MAKE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY OR FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC. |
| FORM 990, PART IX, LINE 11G | OTHER PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 2,283,997. MANAGEMENT AND GENERAL EXPENSES 524,903. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,808,900. PHYSICIAN SERVICES: PROGRAM SERVICE EXPENSES 2,468,289. MANAGEMENT AND GENERAL EXPENSES 567,255. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,035,544. |
| FORM 990, PART XI, LINE 9: | INTEREST IN FOUNDATION NET ASSETS 132,174. TRANSFER OF AUXILIARY NET ASSETS TO FOUNDATION -46,937. |
| FORM 990, PART XII, LINE 2C: | THE PROCESS HAS NOT CHANGED FROM THE PREVIOUS YEAR. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp
Disregarded Entity Name DisregardedEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | HENRY COUNTY HOSPITAL FOUNDATION INC | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1600 EAST RIVERVIEW | AddressLine1Txt |
| City | NAPOLEON | CityNm |
| State Abbreviation | OH | StateAbbreviationCd |
| ZIP | 43545 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 341919852 | EIN |
| Primary Activities | TO RAISE FUNDS AND PROVIDE FINANCIAL ASSISTANCE TO HENRY COUNTY HOSPITAL. | PrimaryActivitiesTxt |
| Legal Domicile State | OH | LegalDomicileStateCd |
| Exempt Code Section | 501(C)(3) | ExemptCodeSectionTxt |
| Public Charity Status | LINE 12A, I | PublicCharityStatusTxt |
| Direct Controlling NA | N/A | DirectControllingNACd |
| Controlled Organization | 0 | ControlledOrganizationInd |
Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp
Related Organization Name RelatedOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | HENRY COUNTY PAIN MANAGEMENT LLC | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1600 E RIVERVIEW AVE | AddressLine1Txt |
| City | NAPOLEON | CityNm |
| State Abbreviation | OH | StateAbbreviationCd |
| ZIP | 43545 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 462262320 | EIN |
| Primary Activities | MEDICAL PAIN MANAGEMENT | PrimaryActivitiesTxt |
| Legal Domicile State | OH | LegalDomicileStateCd |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | HENRY COUNTY HOSPITAL | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Predominant Income Type | RELATED | PredominantIncomeTypeTxt |
| Share Of Total Income | $349,323 | ShareOfTotalIncomeAmt |
| Share Of EOY Assets | $209,117 | 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 | Yes (1) | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | Yes (1) | 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 | 0 | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | 0 | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | 0 | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | 0 | SharingOfFacilitiesInd |
| Paid Employees Sharing | 0 | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |
Transactions Related Org TransactionsRelatedOrgGrp (2 entries)
| Transaction TypeTransactionTypeTxt | InvolvedInvolvedAmt | Method Of Amount DeterminationMethodOfAmountDeterminationTxt |
|---|---|---|
| HENRY COUNTY HOSPITAL FOUNDATION INC | ||
| B | $104,239 | CASH |
| HENRY COUNTY HOSPITAL FOUNDATION INC | ||
| C | $76,105 | CASH |