PIKE HEALTH SERVICES INC: Form 990, tax year 2017
View the entire original 990 at ProPublica ↗
- Organization
- PIKE HEALTH SERVICES INC (EIN 31-1072406)
- Tax period
- 2017-01-01 to 2017-12-31
- Filed
- 2018-11-15
- IRS object ID
- 201803199349313065
- 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 J
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2018-11-15T14:50:53-06:00 | ReturnTs |
| Tax Period End | 2017-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 381357951 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | PLANTE & MORAN PLLC | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 250 S HIGH ST SUITE 100 | AddressLine1Txt |
| City | COLUMBUS | CityNm |
| State Abbreviation | OH | StateAbbreviationCd |
| ZIP | 43215 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2017-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 311072406 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | PIKE HEALTH SERVICES INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | PIKE | BusinessNameControlTxt |
| Phone | 7409472186 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 100 DAWN LANE | AddressLine1Txt |
| City | WAVERLY | CityNm |
| State Abbreviation | OH | StateAbbreviationCd |
| ZIP | 45690 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | LISA CARLSON | PersonNm |
| Person Title | CFO | PersonTitleTxt |
| Phone | 7409472186 | PhoneNum |
| Signature | 2018-11-14 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | BERNIE OSTROWSKI | PreparerPersonNm |
| PTIN | P00366367 | PTIN |
| Phone | 6148493000 | PhoneNum |
| Preparation | 2018-11-14 | PreparationDt |
Filing Security Information FilingSecurityInformation
IP Address IPAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| I Pv4 Address | 67.59.56.30 | IPv4AddressTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| IP | 2018-11-14 | IPDt |
| IP Tm | 09:14:23 | IPTm |
| IP Timezone | ES | IPTimezoneCd |
| Filing License Type | P | FilingLicenseTypeCd |
| At Submission Creation Device Id | DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 | AtSubmissionCreationDeviceId |
| At Submission Filing Device Id | 659185A803CAC309D5C6006E1A9581BBAEEADB71 | AtSubmissionFilingDeviceId |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2017 | TaxYr |
| Build TS | 2019-02-21 02:37:17Z | BuildTS |
Form 990 IRS990
Doing Business As Name DoingBusinessAsName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ADENA PIKE MEDICAL CENTER | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | KATHERINE EDRINGTON | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 100 DAWN LANE | AddressLine1Txt |
| City | WAVERLY | CityNm |
| State Abbreviation | OH | StateAbbreviationCd |
| ZIP | 45690 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $15,602,097 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | ADENA.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1983 | FormationYr |
| Legal Domicile State | OH | LegalDomicileStateCd |
| Activity Or Mission | PIKE HEALTH SERVICES, INC. IS HIGH QUALITY, COMPASSIONATE HEALTHCARE; ACCESSIBLE TO THE COMMUNITY; COMMITTED TO EXCELLENCE; RESPECTFUL OF EACH INDIVIDUAL; AND FOUNDED ON SERVICE TO OTHERS. | ActivityOrMissionDesc |
| Voting Members Governing Body | 9 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 8 | VotingMembersIndependentCnt |
| Total Employee | 163 | TotalEmployeeCnt |
| Total Volunteers | 26 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $27,462 | PYContributionsGrantsAmt |
| CY Contributions Grants | $10,977 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $17,681,971 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $15,456,262 | CYProgramServiceRevenueAmt |
| PY Investment Income | $55,576 | PYInvestmentIncomeAmt |
| CY Investment Income | $44,785 | CYInvestmentIncomeAmt |
| PY Other Revenue | $91,853 | PYOtherRevenueAmt |
| CY Other Revenue | $90,073 | CYOtherRevenueAmt |
| PY Total Revenue | $17,856,862 | PYTotalRevenueAmt |
| CY Total Revenue | $15,602,097 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $15,000 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $8,663,213 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $8,533,779 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $9,930,910 | PYOtherExpensesAmt |
| CY Other Expenses | $9,411,461 | CYOtherExpensesAmt |
| PY Total Expenses | $18,609,123 | PYTotalExpensesAmt |
| CY Total Expenses | $17,945,240 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$752,261 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$2,343,143 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $13,541,381 | TotalAssetsBOYAmt |
| Total Assets EOY | $14,784,509 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $2,006,243 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $761,970 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $11,535,138 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $14,022,539 | NetAssetsOrFundBalancesEOYAmt |
| Mission | PIKE HEALTH SERVICES, INC. IS HIGH QUALITY, COMPASSIONATE HEALTHCARE; ACCESSIBLE TO THE COMMUNITY; COMMITTED TO EXCELLENCE; RESPECTFUL OF EACH INDIVIDUAL; AND FOUNDED ON SERVICE TO OTHERS. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $16,690,260 | ExpenseAmt |
| Grant | $0 | GrantAmt |
| Revenue | $15,480,473 | RevenueAmt |
| Desc | PIKE HEALTH SERVICES, INC. IS A 25- BED CRITICAL ACCESS HOSPITAL AND PHYSICIAN PRACTICE LOCATED IN THE STATE OF OHIO IN PIKE COUNTY. IN 2017, PIKE HEALTH SERVICES, INC. HAD 395 INPATIENT DISCHARGES AND 11,896 EMERGENCY ROOM PATIENTS. ADENA PIKE MEDICAL CENTER PROVIDED CHARITY CARE TO THE COMMUNITY IN THE AMOUNT OF $526,735.DURING THE YEAR, PIKE HEALTH SERVICES, INC PARTICIPATED IN HEALTH FAIRS OFFERING SCREENING AND EDUCATION FOR DIABETES, CHOLESTEROL AND ARTHRITIS FOR BOTH ADULTS AND CHILDREN. | Desc |
| Total Program Service Expenses | $16,690,260 | 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 | 0 | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | Yes (1) | ReportOtherAssetsInd |
| Report Other Liabilities | 0 | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | 0 | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (1) | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | Yes (1) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (1) | AuditedFinancialStmtAttInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| 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 | 0 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Employee | 163 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| 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 | Yes (1) | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (1) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (1) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | Yes (1) | 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 | 0 | CompensationProcessCEOInd |
| Compensation Process Other | 0 | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SHARON WISECUP VP SYSTEM FINANCE | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 7407794478 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 272 HOSPITAL ROAD | AddressLine1Txt |
| City | CHILLICOTHE | CityNm |
| State Abbreviation | OH | StateAbbreviationCd |
| ZIP | 456019031 | 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 | Former Ofcr Director TrusteeFormerOfcrDirectorTrusteeInd |
|---|---|---|---|---|---|---|---|---|---|
| ANTHONY FISH | |||||||||
| TRUSTEE/CHAIR | 2.00 | 0.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| JEFF GRAHAM | |||||||||
| AHS CEO (JULY-DEC) | 0.00 | 50.00 | Yes (X) | Yes (X) | $0 | $311,630 | $52,015 | ||
| VAL FRANCIS | |||||||||
| TRUSTEE/VICE CHAIR | 2.00 | 0.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| LINDA SHOEMAKER | |||||||||
| TRUSTEE/SECRETARY (JAN-APR) | 2.00 | 0.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| PAUL ADKINS | |||||||||
| TRUSTEE | 2.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |||
| JOSH REMY | |||||||||
| TRUSTEE | 2.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |||
| CONNIE SHELLEY | |||||||||
| TRUSTEE | 2.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |||
| JUDY SCHMITT | |||||||||
| TRUSTEE | 2.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |||
| TONY DIXON | |||||||||
| TRUSTEE | 2.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |||
| TODD BURKITT | |||||||||
| TRUSTEE (JAN-APR) | 2.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |||
| DAVID KESSLER | |||||||||
| CHIEF OF MEDICAL STAFF | 50.00 | 0.00 | Yes (X) | $0 | $351,183 | $3,142 | |||
| RENEA GREGORY | |||||||||
| TRUSTEE | 2.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |||
| LISA CARLSON | |||||||||
| AHS CFO | 0.00 | 50.00 | Yes (X) | $0 | $335,986 | $125,663 | |||
| DAVE ZANNI | |||||||||
| CEO | 50.00 | 0.00 | Yes (X) | $144,273 | $0 | $48,352 | |||
| JOHN FORTNEY | |||||||||
| AHS INTERIM CEO (JAN-JULY) | 0.00 | 50.00 | Yes (X) | $0 | $620,562 | $159,069 | |||
| PAUL MONTAVON | |||||||||
| PHARMACIST | 2.00 | 0.00 | $0 | $104,933 | $17,879 | Yes (X) | |||
| MARK SHUTER | |||||||||
| FORMER AHS CEO | 0.00 | 0.00 | $0 | $648,688 | $0 | Yes (X) | |||
| CATHERINE FARINET | |||||||||
| PHYSICIAN | 50.00 | 0.00 | $0 | $224,154 | $24,175 | Yes (X) | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $144,273 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $2,597,136 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $430,295 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 2 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | Yes (1) | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (2 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| PREMIER PHYSICIAN SERVICES | |||||
| 332 CONGRESS PARK DRIVE | DAYTON | OH | 45459 | ER COVERAGE | $612,707 |
| NTHRIVE INC | |||||
| 200 NORTH POINT CENTER E | ALPHARETTA | GA | 30022 | REVENUE CYCLE MANAGEMENT | $351,275 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 2 | CntrctRcvdGreaterThan100KCnt |
| All Other Contributions | $10,977 | AllOtherContributionsAmt |
| Total Contributions | $10,977 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | NET PATIENT SVC REV | Desc |
| Business | 622110 | BusinessCd |
| Total Revenue Column | $15,456,262 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $15,456,262 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $15,456,262 | TotalProgramServiceRevenueAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $12,702 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $0 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $12,702 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $12,702 | TotalRevenueColumnAmt |
| Exclusion | $12,702 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $44,785 | SecuritiesAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $0 | SecuritiesAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $44,785 | SecuritiesAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $44,785 | TotalRevenueColumnAmt |
| Exclusion | $44,785 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp (2 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | ExclusionExclusionAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|---|
| CAFETERIA REVENUE | 722514 | $49,731 | $49,731 | |
| EHR IMPLEMENTATION | 622110 | $24,211 | $24,211 |
Miscellaneous Revenue MiscellaneousRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $3,429 | TotalRevenueColumnAmt |
| Exclusion | $3,429 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $77,371 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $15,602,097 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $15,480,473 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $110,647 | ExclusionAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $192,625 | TotalAmt |
| Management And General | $192,625 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $6,207,692 | TotalAmt |
| Program Services | $5,735,690 | ProgramServicesAmt |
| Management And General | $472,002 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,704,559 | TotalAmt |
| Program Services | $1,630,480 | ProgramServicesAmt |
| Management And General | $74,079 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $428,903 | TotalAmt |
| Program Services | $397,196 | ProgramServicesAmt |
| Management And General | $31,707 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,720,946 | TotalAmt |
| Program Services | $1,660,296 | ProgramServicesAmt |
| Management And General | $60,650 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $263,939 | TotalAmt |
| Program Services | $243,638 | ProgramServicesAmt |
| Management And General | $20,301 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $360,982 | TotalAmt |
| Program Services | $334,808 | ProgramServicesAmt |
| Management And General | $26,174 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $54,076 | TotalAmt |
| Program Services | $32,835 | ProgramServicesAmt |
| Management And General | $21,241 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $732,580 | TotalAmt |
| Program Services | $678,423 | ProgramServicesAmt |
| Management And General | $54,157 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $47,657 | TotalAmt |
| Program Services | $47,657 | ProgramServicesAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| CORPORATE OVERHEAD ALLO | $3,708,351 | $3,434,204 | $274,147 |
| MEDICAL SUPPLIES | $1,225,937 | $1,221,536 | $4,401 |
| BAD DEBT EXPENSE | $969,114 | $969,114 | |
| FRANCHISE FEES | $327,879 | $304,383 | $23,496 |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $17,945,240 | TotalAmt |
| Program Services | $16,690,260 | ProgramServicesAmt |
| Management And General | $1,254,980 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,719,882 | BOYAmt |
| EOY | $3,727,478 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,193,207 | BOYAmt |
| EOY | $2,057,943 | EOYAmt |
Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $47,508 | BOYAmt |
| EOY | $6,129 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $276,981 | BOYAmt |
| EOY | $246,176 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,397,451 | BOYAmt |
| EOY | $0 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $13,215,528 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $5,356,673 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,009,352 | BOYAmt |
| EOY | $7,858,855 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,897,000 | BOYAmt |
| EOY | $887,928 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $13,541,381 | BOYAmt |
| EOY | $14,784,509 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $729,168 | BOYAmt |
| EOY | $761,970 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,277,075 | BOYAmt |
| EOY | $0 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,006,243 | BOYAmt |
| EOY | $761,970 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $11,525,477 | BOYAmt |
| EOY | $14,012,878 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $9,661 | BOYAmt |
| EOY | $9,661 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $11,535,138 | BOYAmt |
| EOY | $14,022,539 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $13,541,381 | BOYAmt |
| EOY | $14,784,509 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | -$2,343,143 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | $4,830,544 | 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 | $624 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $624 | 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 | THE OHIO HOSPITAL ASSOCIATION DOES LOBBYING ON BEHALF OF HOSPITAL RELATED CAUSES. THIS ACTIVITY IS PAID FOR THROUGH DUES PAID TO THE OHIO HOSPITAL ASSOCIATION. | ExplanationTxt |
Schedule D IRS990ScheduleD
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $350,000 | OtherCostOrOtherBasisAmt |
| Book Value | $350,000 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $6,548,346 | OtherCostOrOtherBasisAmt |
| Depreciation | $1,468,795 | DepreciationAmt |
| Book Value | $5,079,551 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $5,910,786 | OtherCostOrOtherBasisAmt |
| Depreciation | $3,736,403 | DepreciationAmt |
| Book Value | $2,174,383 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $406,396 | OtherCostOrOtherBasisAmt |
| Depreciation | $151,475 | DepreciationAmt |
| Book Value | $254,921 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $7,858,855 | TotalBookValueLandBuildingsAmt |
Other Assets Org OtherAssetsOrgGrp (2 entries)
| DescDesc | Book ValueBookValueAmt |
|---|---|
| GROUND LEASE | $1,855,000 |
| COST REPORT SETTLEMENTS RECEIVABLE | -$967,072 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $887,928 | TotalBookValueOtherAssetsAmt |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (1) | FinancialAssistancePolicyInd |
| Written Policy | Yes (1) | WrittenPolicyInd |
| All Hospitals Policy | Yes (X) | AllHospitalsPolicyInd |
| FPG Reference Free Care | Yes (1) | FPGReferenceFreeCareInd |
| Percent200 | Yes (X) | Percent200Ind |
| FPG Reference Discounted Care | Yes (1) | FPGReferenceDiscountedCareInd |
| Percent400 | Yes (X) | Percent400Ind |
| Free Care Medically Indigent | Yes (1) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (1) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | Yes (1) | ExpensesExceedBudgetInd |
| Unable To Provide Care | 0 | UnableToProvideCareInd |
| Annual Community Bnft Report | Yes (1) | AnnualCommunityBnftReportInd |
| Report Publically Available | Yes (1) | ReportPublicallyAvailableInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $607,805 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $196,919 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $410,886 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.02420 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $5,572,737 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $3,195,311 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $2,377,426 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.14000 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $6,180,542 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $3,392,230 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $2,788,312 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.16420 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $6,185 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $6,185 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00040 | TotalExpensePct |
Subsidized Health Services SubsidizedHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $526,464 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $526,464 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.03100 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $532,649 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $532,649 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.03140 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $6,713,191 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $3,392,230 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $3,320,961 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.19560 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 0 | BadDebtExpenseReportedInd |
| Bad Debt Expense | $969,114 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $284,760 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $6,814,605 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $7,088,501 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$273,896 | 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 | 0 | 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 | PIKE HEALTH SERVICES INC | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 100 DAWN LANE | AddressLine1Txt |
| City | WAVERLY | CityNm |
| State Abbreviation | OH | StateAbbreviationCd |
| ZIP | 45690 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | WWW.ADENA.ORG | WebsiteAddressTxt |
| State License | ST. REG. NUM. 1299 | StateLicenseNum |
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| 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 | PIKE HEALTH SERVICES 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 | 0 | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (1) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | ADENA.ORG/INSIDE/PAGE.DT/CHNA | OwnWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Rpt Available Thru Other Method | Yes (X) | RptAvailableThruOtherMethodInd |
| Implementation Strategy Adopt | Yes (1) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 16 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (1) | StrategyPostedWebsiteInd |
| Strategy Website URL | HTTPS://WWW.ADENA.ORG/INSIDE/PAGE.DT/CHNA | 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 | 200.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 400.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| 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 | HTTP://WWW.ADENA.ORG/INSIDE/PAGE.DT/FINANCIAL-AID | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | HTTP://WWW.ADENA.ORG/INSIDE/PAGE.DT/FINANCIAL-AID | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | HTTP://WWW.ADENA.ORG/INSIDE/PAGE.DT/FINANCIAL-AID | 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 |
| FAP Actions On Nonpayment | Yes (1) | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | 0 | CollectionActivitiesInd |
| Made Effort Orally Notify | Yes (X) | MadeEffortOrallyNotifyInd |
| Processed FAP Application | Yes (X) | ProcessedFAPApplicationInd |
| Other Actions Taken | Yes (X) | OtherActionsTakenInd |
| 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 (4 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PIKE HEALTH SERVICES, INC. | PART V, SECTION B, LINE 5: ADENA PIKE MEDICAL CENTER CAPTURED THE BROAD INTERESTS OF THE COMMUNITY FOR THE CHNA THROUGH TWO METHODS: SURVEY AND INTERVIEWS. A HEALTH NEEDS SURVEY WAS WIDELY DISTRIBUTED TO THE PIKE COUNTY COMMUNITY THROUGH PAPER AND WEB FORM. IN ADDITION TO THE SURVEYS, INTERVIEWS WITH LOCAL COMMUNITY LEADERS, INCLUDING CIVIC, PUBLIC HEALTH AND EMERGENCY RESPONSE WERE REQUESTED AND/OR CONDUCTED TO GAIN FURTHER KNOWLEDGE OF SURVEY TOPICS. |
| PIKE HEALTH SERVICES, INC. | PART V, SECTION B, LINE 7D: HARD COPIES OF THE CHNA REPORT WERE PRINTED AND SENT TO COMMUNITY LEADERS AND AGENCIES. |
| PIKE HEALTH SERVICES, INC. | PART V, SECTION B, LINE 11: OBESITY - ADVOCACYARMC CONTRIBUTES THE TIME OF TWO EMPLOYEES WHO DEDICATED A TOTAL OF 2 HOURS PER MONTH TO PARTICIPATING IN COMMITTEE MEETINGS AND COORDINATING PROJECTS FOR THE PIKE COUNTY HEALTH COALITION.ARMC DEPLOYED REGIONAL PUBLIC SERVICE ANNOUNCEMENTS VIA LOCAL RADIO AND SOCIAL MEDIA FOCUSED ON NUTRITION AND FITNESS EDUCATION AND AWARENESS.OBESITY - EDUCATIONAPMC CONTRIBUTED THE TIME OF TWO EMPLOYEES FOR A TOTAL OF FOUR HOURS TO THE HEART HEALTH PROGRAM COORDINATED BY THE PIKE COUNTY OSU EXTENSION.ARMC AND APMC COORDINATED A REGIONAL DIABETES AWARENESS EXPO DELIVERED AT THE JACKSON COUNTY YMCA IN MARCH 2017 WHERE A TOTAL OF 75 PARTICIPANTS WERE PROVIDED FOUR HOURS OF EDUCATION ON DIABETES MANAGEMENT, INCLUDING MEDICATION, NUTRITION, COOKING, AND FITNESS.OBESITY - PROGRAMMINGADENA HEALTH SYSTEM COORDINATED A HEALTHY KIDS EVENT AT THE PIKE COUNTY FAIR WHERE A TOTAL OF 150 CHILDREN WERE PROVIDED 45 MINUTES OF HEALTHY COOKING INSTRUCTION FOLLOWED BY THIRTY MINUTES OF NUTRITION, FITNESS AND WELLBEING EDUCATION. ADENA HEALTH SYSTEM ENGAGED A TOTAL OF 675 EMPLOYEES AND COMMUNITY MEMBERS IN THE 12 WEEK FITNESS CHALLENGE, MOVE MORE WHERE THOSE REACHING STEP BENCHMARKS HAD THE OPPORTUNITY TO WIN PRIZES AND EARN INCENTIVES.OBESITY - FINANCIAL SUPPORTADENA HEALTH SYSTEM PARTNERED WITH THE PIKE COUNTY OSU EXTENSION TO FUND THE FOOD RX AND FRUIT & VEGGIE PERKS PROGRAM WHICH PROVIDED 25 INDIVIDUAL ADENA PATIENTS AND COMMUNITY SNAP BENEFICIARIES A TOTAL OF $250 OF FRESH FRUITS AND VEGETABLES.RESPIRATORY - ADVOCACYAPMC CONTRIBUTED THE TIME OF ONE EMPLOYEE WHO DEDICATED A TOTAL OF 4 HOURS TO PARTICIPATING IN COMMITTEE MEETINGS AND COORDINATING PROJECTS FOR PIKE COUNTY SMOKING CESSATION COALITION.RESPIRATORY - PROGRAMMINGADENA HEALTH SYSTEM COORDINATED THE ADENA QUIT CLINIC WHICH PROVIDED A TOTAL OF 19 PATIENTS (INCLUDING THOSE FROM PIKE COUNTY) TOBACCO CESSATION COUNSELING, SUPPORT AND NICOTINE REPLACEMENT EDUCATION BY ADENA PHARMACISTS. THE ADENA CANCER CENTER PROVIDED A TOTAL OF 787 PATIENTS FROM THE REGION INCLUDING PIKE, HIGHLAND AND ROSS COUNTIES WITH FREE LUNG CANCER SCREENINGS IN 2017 WHICH RESULTED IN 7 POSITIVE CANCER RESULTS.RESPIRATORY - FINANCIAL SUPPORTADENA HEALTH SYSTEM PROVIDED $10,000 IN SUPPORT FOR RELAY FOR LIFE WHICH ENGAGED THE ROSS, PIKE AND HIGHLAND COMMUNITIES IN CANCER AWARENESS (INCLUDING LUNG CANCER) AND FUNDRAISING FOR RESEARCH.MENTAL HEALTH - ADVOCACYARMC DEPLOYED PUBLIC SERVICE ANNOUNCEMENTS VIA LOCAL RADIO AND SOCIAL MEDIA FOCUSED ON MENTAL HEALTH AWARENESS.MENTAL HEALTH - PROGRAMMINGTHE ADENA HEALTH SYSTEM HOUSES A VICTIM'S ADVOCATE TEAM IN THE ARMC EMERGENCY DEPARTMENT WHICH PROVIDED 81 VICTIMS (INCLUDING THOSE FROM PIKE COUNTY) OF SEXUAL ASSAULT (ADULT AND PEDIATRIC), DOMESTIC VIOLENCE, CHILD ABUSE, ELDER ABUSE, HUMAN TRAFFICKING AND HATE CRIMES WITH MENTAL HEALTH REFERRAL, SAFETY NET AND SUPPORT SERVICES FREE OF CHARGE, VALUED AT $205,000. MENTAL HEALTH - FINANCIAL SERVICESADENA HEALTH SYSTEM PROVIDED $8,000 IN SUPPORT TO THE SCIOTO PAINT VALLEY MENTAL HEALTH CENTER TO COMPLETE AN ASSESSMENT AND STRATEGIC PLAN FOR THE REGIONAL 211 RESOURCE REFERRAL LINE THAT SUPPORTS SIX COUNTIES INCLUDING ROSS, PIKE AND HIGHLAND.INFANT MORTALITY/CHILD SAFETY - ADVOCACYARMC DEPLOYED PUBLIC SERVICE ANNOUNCEMENTS ACROSS THE HEALTH SYSTEM AND CLINICS FOCUSED ON SAFE SLEEP AWARENESS.INFANT MORTALITY/CHILD SAFETY - PROGRAMMINGTHE ADENA CENTERING PREGNANCY PROGRAM PROVIDED A TOTAL OF 25 HIGH-RISK PREGNANCY PATIENTS (INCLUDING THOSE FROM PIKE COUNTY) WITH PREGNANCY EDUCATION AND SUPPORT DURING A TOTAL 7 ONGOING MONTHLY CLASSES.INFANT MORTALITY/CHILD SAFETY - FINANCIAL SERVICESADENA HEALTH SYSTEM PROVIDED A TOTAL OF 8 CRIBS AND 1212 SLEEP SACKS FOR SOME OF THE 947 BABIES BORN AT THE ADENA WOMEN'S AND CHILDREN'S CENTER IN 2017. PATIENTS COME FROM MULTIPLE COUNTIES INCLUDING ROSS, PIKE AND HIGHLAND.ADDITIONAL INITIATIVES AND RESOURCESRESIDENCY CLINICTHE ADENA FAMILY MEDICINE - RESIDENCY OPERATED A CLINIC IN 2017 PROVIDING AFFORDABLE, QUALITY HEALTH CARE FOR RESIDENTS OF ADENA HEALTH SYSTEMS PRIMARY SERVICE REGION INCLUDING PIKE, HIGHLAND AND ROSS COUNTIES. THE CLINIC PAIRED ACCESSIBLE PRIMARY CARE MEDICAL SERVICES PROVIDED BY PHYSICIAN INTERNS AND RESIDENTS OF ADENA'S GRADUATE MEDICAL EDUCATION PROGRAM, FAMILY AND INTERNAL MEDICINE PRECEPTORS AND A CERTIFIED NURSE PRACTITIONER ALSO PROVIDING SERVICES TO PATIENTS IN THE CLINIC. A TOTAL OF 2,502 PATIENTS, MOSTLY FROM SEVEN COUNTIES (ROSS, FAYETTE, VINTON, PICKAWAY, PIKE, HIGHLAND AND JACKSON) MADE A TOTAL OF 5,878 VISITS TO THE RESIDENCY CLINIC IN 2017.ADENA SPORTS MEDICINE ATHLETIC TRAINING PROGRAMTHE ADENA HEALTH SYSTEM PROVIDED MORE THAN $465,878 IN ATHLETIC INJURY PREVENTION, DIAGNOSIS, AND EVALUATION SERVICES TO 10 LOCAL PUBLIC HIGH SCHOOLS WITHIN THE SERVICE REGION IN 2017. A TOTAL OF 8 ATHLETIC TRAINERS WORK WITHIN THE SCHOOL'S ATHLETIC DEPARTMENTS AND FOCUS ON EDUCATING STUDENTS, PARENTS AND COACHES ON SPORTS MEDICINE TOPICS, INCLUDING CONCUSSION IDENTIFICATION AND TREATMENT. THE STAFF IS ALSO READILY AVAILABLE AT ATHLETIC EVENTS AND PROVIDES YEARLY SPORTS PHYSICALS TO MORE THAN 1,200 STUDENTS IN PIKE, ROSS, AND JACKSON COUNTIES. A TOTAL OF 2 TRAINERS AT 2 SCHOOLS PROVIDED $91,348 IN SUPPORT IN PIKE COUNTY.COMMUNITY COLLABORATIONSCOMMUNITY DEVELOPMENTTHE ADENA HEALTH SYSTEM PROVIDED $750 OF SUPPORT TO THE PIKE COUNTY YMCA ANNUAL EFFORT.ECONOMIC DEVELOPMENTTHE ADENA HEALTH SYSTEM PROVIDED $250 OF SUPPORT TO THE OHIO VALLEY REGIONAL DEVELOPMENT COMMISSION (OVRDC LOCATED IN PIKE COUNTY) IN 2017.ORAL HEALTH INITIATIVETHE ADENA PIKE MEDICAL CENTER PARTNERED WITH THE PIKE COUNTY ROTARY TO PROVIDE A TOTAL OF 600 PIKE COUNTY ELEMENTARY STUDENTS WITH TOOTHBRUSHES AND TOOTHPASTE ($1,404) AS PART OF A COUNTY ORAL HEALTH INITIATIVE. |
| PIKE HEALTH SERVICES, INC. | PART V, SECTION B, LINE 16J: WWW.ADENA.ORG/FILES/RESOURCES/ADENAFINAIDFORMFINAL.PDF |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | 1 - ADENA FAMILY MEDICINE - PIKETON | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 100 INDIAN RIDGE DRIVE | AddressLine1Txt |
| City | PIKETON | CityNm |
| State Abbreviation | OH | StateAbbreviationCd |
| ZIP | 45661 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | PHYSICIAN OFFICES | FacilityTxt |
Supplemental Information Detail SupplementalInformationDetail (11 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 6A: | ADENA HEALTH SYSTEM EIN: 31-4379443 |
| PART I, LINE 7: | THE COST-TO-CHARGE RATIO DERIVED FROM WORKSHEET 2 WAS USED TO CONVERT CHARGES TO COSTS IN LINE 7A AND 7B. ACTUAL COSTS WERE USED IN LINE 7E. |
| PART I, LN 7 COL(F): | BAD DEBT EXPENSE OF $969,114 WAS DEDUCTED FROM TOTAL OPERATING EXPENSES WHEN CALCULATING THE PERCENTAGES IN THIS COLUMN. |
| PART III, LINE 2: | THE BAD DEBT EXPENSE LISTED ON PART III, LINE 2 IS DERIVED FROM THE FINANCIAL STATEMENTS WITH THE COST TO CHARGE RATIO AGREED. |
| PART III, LINE 3: | THE HOSPITAL DEVELOPED, WITH THE HELP OF AN OUTSIDE VENDOR, A NEW PRESUMPTIVE CHARITY POLICY. THE HOSPITAL SENDS A QUARTERLY FILE OF ALL SELF-PAY BALANCES TO THE VENDOR. AFTER THE VENDOR PERFORMS THE CREDIT ANALYSIS, THE VENDOR CATEGORIZES THE CLAIMS INTO THREE CATEGORIES, A CATEGORY THAT WOULD NOT BE ELIGIBLE FOR CHARITY BASED ON THE HOSPITALS CHARITY POLICY, A GROUP THAT WOULD BE ELIGIBLE FOR A 60% CHARITY WRITEOFF, AND A THIRD CATEGORY THAT WOULD BE ELIGIBLE FOR A 100% WRITE OFF. THE HOSPITAL ASSUMES ALL OF THESE AMOUNTS IN THE THE LAST TWO CATEGORIES TO BE PRESUMPTIVE CHARITY. |
| PART III, LINE 4: | WE DO NOT HAVE SEPARATE FINANCIAL STATEMENTS FOR ADENA PIKE MEDICAL CENTER. IT IS INCLUDED IN THE CONSOLIDATED STATEMENTS OF ADENA HEALTH SYSTEM. THE FOOTNOTE IN OUR FINANCIAL STATEMENTS INCLUDES THE FOLLOWING ABOUT OUR BAD DEBT EXPENSE AND ALLOWANCE FOR UNCOLLECTIBLES. "AN ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS IS ESTABLISHED ON AN AGGREGATE BASIS BY USING HISTORICAL WRITE-OFF FACTORS APPLIED TO UNPAID ACCOUNTS BASED ON AGING. LOSS RATE FACTORS ARE BASED ON HISTORICAL LOSS EXPERIENCE AND ADJUSTED FOR ECONOMIC CONDITIONS AND OTHER TRENDS AFFECTING THE SYSTEM'S ABILITY TO COLLECT OUTSTANDING AMOUNTS. UNCOLLECTIBLE ACCOUNTS ARE WRITTEN OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS IN THE PERIOD THEY ARE DETERMINED TO BE UNCOLLECTIBLE. AN ALLOWANCE FOR CONTRACTUAL ADJUSTMENTS AND INTERIM PAYMENT ADVANCES IS ESTABLISHED BASED ON EXPECTED PAYMENT RATES FROM PAYORS UTILIZING CURRENT REIMBURSEMENT METHODOLOGIES AND PAYMENT RATES. FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS (WHICH INCLUDES BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND COPAYMENT BALANCES DUE FOR WHICH THIRDPARTY COVERAGE EXISTS FOR PART OF THE BILL), THE SYSTEM RECORDS A SIGNIFICANT PROVISION FOR BAD DEBTS IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST EXPERIENCE, WHICH INDICATES THAT MANY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. THE DIFFERENCE BETWEEN THE STANDARD RATES (OR THE DISCOUNTED RATES, IF NEGOTIATED) AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS IN THE PERIOD THEY ARE DETERMINED TO BE UNCOLLECTIBLE." |
| PART III, LINE 8: | THE ADENA HEALTH SYSTEM SERVICE AREA IS A RURAL 13 COUNTY AREA IN SOUTHERN OHIO. ADENA HEALTH SYSTEM HAS EVALUATED THE COMMUNITY HEALTH NEEDS AND HAS IMPORTANT PROGRAMS AND SERVICES THAT ARE DESIGNED TO MEET THE NEEDS OF ADENA'S BROAD SERVICE AREA. HOWEVER, ONE OF THE MOST SIGNIFICANT HEALTH NEEDS MET BY ADENA IS THE IDENTIFICATION OF PHYSICIAN AND ADVANCED PRACTICE PROVIDERS FOR EACH SPECIALTY OF CARE. ADENA RECRUITS, SUPPORTS, AND PROVIDES THE INFRASTRUCTURE FOR PROVIDERS IN SPECIALTIES RANGING FROM PRIMARY CARE TO INTERVENTIONAL CARDIOLOGY. IN ADENA'S RURAL, APPALACHIAN SERVICE AREA, PHYSICIAN AND OTHER KEY CLINICAL AND SUPPORT STAFF ARE DIFFICULT TO RECRUIT AND RETAIN WHICH ELEVATES THE MARKET SALARY FOR SPECIALIZED STAFF. THE MEDICARE TWO PERCENT SEQUESTRATION IS ALSO A COMPONENT OF THE SHORTFALL CALCULATION. BASED ON THESE ISSUES, WE BELIEVE SERVICE TO OUR MEDICARE POPULATION, THAT RESULTED IN A MEDICARE SHORTFALL OF $273,896, IS A COMMUNITY BENEFIT. ALSO, THE HOSPITAL USED THE METHODOLOGY REQUIRED FOR COMPLETING THE MEDICARE COST REPORT WHEN DETERMINING THE AMOUNT ON PART III - LINE 6.PRIOR YEAR SETTLEMENTS FOR MEDICARE-RELATED SERVICES THAT WERE BOOKED IN THE CURRENT TAX YEAR ARE ALSO INCLUDED IN THE CURRENT TAX YEAR CALCULATION. |
| PART VI, LINE 3: | THE AVAILABILITY OF FINANCIAL ASSISTANCE IS COMMUNICATED IN THE FOLLOWING MANNER: 1. STATEMENTS FROM ADENA AS WELL AS COLLECTION VENDORS EXPLAIN AND LIST THE 100% AND 60% ASSISTANCE GUIDELINES ON THE BACKSIDE OF THE STATEMENT. 2. THERE IS SIGNAGE EXPLAINING THE PROGRAM AT ALL THE REGISTRATION AREAS. 3. A CONTRACTED VENDOR SUPPLIES STAFF AT THE CASHIER AREA TO EXPLAIN OPTIONS AVAILABLE TO THE PATIENT. 4. WE SEND AN APPLICATION WITH THE SELF-PAY DISCOUNT LETTERS IN CASE THE PATIENT/GUARANTOR CAN'T SET UP A PAYMENT PLAN. 5. THE CUSTOMER SERVICE STAFF IS EDUCATED ON ALL THE OPTIONS AND CAN EXPLAIN THE PROGRAMS WHEN PATIENTS CALL. 6. OUR PHYSICIAN OFFICES, AS WELL AS COLLECTION VENDORS HAVE FINANCIAL AID APPLICATIONS AVAILABLE. 7. LASTLY, WE UTILIZE A "HINDSIGHT" VENDOR THAT SCREENS ALL BAD DEBT ACCOUNTS, AFTER THE YEAR-END, AGAINST THE STATE MEDICAID ELIGIBILITY AND FEDERAL POVERTY GUIDELINES TO ATTEMPT ONE LAST EFFORT TO OBTAIN FINANCIAL ASSISTANCE FOR INDIVIDUALS. |
| PART VI, LINE 4: | PIKE COUNTY, HOME OF THE ADENA PIKE MEDICAL CENTER (APMC), IS LOCATED IN SOUTH CENTRAL OHIO. IT IS PART OF THE 2ND CONGRESSIONAL DISTRICT AND IS ONE OF OHIO'S 32 APPALACHIAN COUNTIES. IT CONTAINS THE POPULATION PATTERNS AND DISTINCT ECONOMIC CONDITIONS INHERENT OF THIS REGION OF THE U.S AND FACES SIMILAR CHALLENGES IN DIVERSIFYING ITS ECONOMY TO IMPROVE THE LIVES OF ITS 28,160 RESIDENTS.THERE ARE 10,816 HOUSEHOLDS IN PIKE COUNTY. THE AVERAGE HOUSEHOLD SIZE IS 2.61 PEOPLE, COMPARABLE WITH THE REST OF THE 12 COUNTY SERVICE REGION AND OHIO. THE AVERAGE FAMILY SIZE IS AS WELL WITH 3.11 PEOPLE.MORE THAN 22% OF THE ADULTS IN PIKE COUNTY HAVE NOT GRADUATED FROM HIGH SCHOOL. THIS PERCENTAGE IS HIGHER THAN THE AVERAGES FOR THE REGION (18.9%), OHIO (12.2%) AND THE NATION (14.6%). LESS THAN 12% HAVE A COLLEGE DEGREE. MORE THAN 12% OF THE POPULATION OF PIKE COUNTY IS ESTIMATED TO BE FUNCTIONALLY ILLITERATE, OR LACKING THE READING AND WRITING SKILLS SUFFICIENT FOR ORDINARY PRACTICAL NEEDS. THE UNEMPLOYMENT RATE IN PIKE COUNTY (10.7%) IS CONSIDERABLY HIGHER THAN THE REGIONAL (6.8%), STATE (6%) AND U.S. (7.7%) AVERAGES. IN ADDITION, MORE THAN 44.5% OF THE POPULATION IS NOT IN THE WORKFORCE. THIS IS HIGHER THAN THE STATE (35.4%) AND NATIONAL AVERAGES (35.2%). THE TOP FIVE EMPLOYMENT INDUSTRIES IN PIKE COUNTY ARE MANAGEMENT/BUSINESS/SCIENCE (28.9%), SERVICE (21.5%) SALES (23%), PRODUCTION/TRANSPORTATION SERVICES (19.2%), SALES (18.2%), AND NATURAL RESOURCES/CONSTRUCTION/MAINTENANCE. PIKE COUNTY HAS A GREATER PERCENTAGE OF PEOPLE EMPLOYED IN PRODUCTION, TRANSPORTATION AND MATERIAL MOVING OCCUPATIONS (19.2%) THAN THE REGIONAL, STATE AND NATIONAL AVERAGES. THE PER CAPITA MEDIAN AND MEAN HOUSEHOLD INCOMES IN PIKE COUNTY OHIO ARE MUCH LOWER THAN THE STATE AND U.S. AVERAGES. POVERTY RATES ARE ALSO HIGHER THAN REGIONAL, STATE AND NATIONAL AVERAGES. ACCESS TO EMPLOYMENT IN PIKE COUNTY IS ALSO LOWER THAN OTHER COUNTIES IN THE REGION.PIKE COUNTY AND ITS ENTIRE SURROUNDING SERVICE REGION HAVE A HIGHER PREVALENCE OF DISABILITY THAN THE REST OF OHIO. SEVEN OF THE 12 COUNTIES IN THE SERVICE REGION, INCLUDING PIKE COUNTY, HAVE DISABILITY PREVALENCE RATES OF 16.7% - 22%. |
| PART VI, LINE 5: | ADENA PIKE MEDICAL CENTER WORKS TO PROMOTE THE HEALTH OF ITS COMMUNITY THROUGH A VARIETY OF MEANS, INCLUDING BOARD MEMBERS, ADMINISTRATIONS, EMPLOYEES AND VOLUNTEERS. THE 2017 BOARD OF TRUSTEES OF ADENA PIKE MEDICAL CENTER WAS COMPRISED OF NINE MEMBERS. ONE OF THE BOARD MEMBERS IS AN EMPLOYEE OF ADENA HEALTH SYSTEM. ALL OR 100% OF THE BOARD MEMBERS RESIDE IN PIKE COUNTY OHIO. |
| PART VI, LINE 6: | FOUNDED IN 1895, ADENA HEALTH SYSTEM IS AN INDEPENDENT, NOT-FOR-PROFIT HEALTHCARE ORGANIZATION BASED IN CHILLICOTHE, OH. THE HEALTH SYSTEM INCLUDES THREE HOSPITALS AND SIX REGIONAL CLINICS, WITH A TOTAL OF 311 BEDS. ADENA SERVES THE NEEDS OF NEARLY 500,000 PEOPLE IN 13 COUNTIES, LIVING IN OHIO'S APPALACHIAN REGION. OUR FACILITIES INCLUDE: ADENA REGIONAL MEDICAL CENTER: A 261-BED INPATIENT HOSPITAL IN CHILLICOTHE, OH FEATURING AN EMERGENCY DEPARTMENT, DIAGNOSTIC AND TREATMENT SERVICES, ADVANCED SURGICAL SUITES, INTENSIVE/CARDIAC CARE, MEDICAL OFFICE BUILDING AND THE ADENA HEALTH PAVILION, WHICH INCLUDES OUTPATIENT SURGERY, PHYSICIAN OFFICES AND THE ADENA SLEEP CENTER. IN 2011, ADENA INVESTED $21 MILLION IN THE CONSTRUCTION OF A 35,000 SQUARE-FOOT CANCER CENTER TO PROVIDE PATIENTS WITH ACCESS TO CANCER DIAGNOSIS AND TREATMENT AT A FACILITY NEAR THEIR HOMES. THE CANCER CENTER OPENED IN JANUARY 2012. GREENFIELD AREA MEDICAL CENTER AND PIKE HEALTH SERVICES, INC.: BOTH ARE CRITICAL ACCESS HOSPITALS, EACH WITH A 25-BED INPATIENT FACILITY IN GREENFIELD, OH AND WAVERLY, OH, RESPECTIVELY. EACH FEATURES AN EMERGENCY DEPARTMENT, INPATIENT CARE INCLUDING REHABILITATION AND MEDICAL/SURGICAL, DIAGNOSTIC AND TREATMENT SERVICES, AS WELL AS FAMILY PRACTICE AND SPECIALTY PHYSICIANS. THESE TWO HOSPITALS DIRECTLY BENEFIT HIGHLAND COUNTY (GREENFIELD AREA MEDICAL CENTER) AND PIKE COUNTY (PIKE HEALTH SERVICES, INC.) AS WELL AS SURROUNDING COMMUNITIES. ADENA HEALTH CENTERS: LOCATED IN CHILLICOTHE AND WITH REGIONAL SITES IN CIRCLEVILLE, JACKSON, OAK HILL, WELLSTON, HILLSBORO, WASHINGTON COURT HOUSE AND WAVERLY, OH. OUR HEALTH CENTERS INCLUDE PHYSICIAN OFFICES, DIAGNOSTIC AND TREATMENT SERVICES, PHYSICAL, OCCUPATION AND SPEECH THERAPIES. URGENT CARE SERVICES ARE OFFERED IN CHILLICOTHE, HILLSBORO, AND WAVERLY. ADENA HOME CARE AND HOSPICE: PROVIDES HIGHLY PERSONALIZED, QUALITY CARE TO PATIENTS OF FOUR SERVICE LINES -- HOME HEALTH, HOSPICE, HOME RESPIRATORY AND HOME INFUSION. ADENA REHABILITATION AND WELLNESS CENTER: PROVIDES PHYSICAL, OCCUPATIONAL, MASSAGE AND INDUSTRIAL REHABILITATION, AS WELL AS ORTHOPEDICS, SPORTS MEDICINE, WOMEN'S HEALTH, VESTIBULAR, FIBROMYALGIA AND CHRONIC PAIN PROGRAMS, AS WELL AS INDUSTRIAL AND SPECIALIZED HAND PROGRAMS. ADENA COUNSELING CENTER: PROVIDES A WIDE RANGE OF OUTPATIENT COUNSELING SERVICES, INCLUDING GROUP, INDIVIDUAL AND FAMILY COUNSELING. A VARIETY OF SUPPORT GROUPS ALSO MEET AT THE CENTER. OFF-CAMPUS PHYSICIAN OFFICES: A NUMBER OF PHYSICIAN OFFICES ARE LOCATED THROUGHOUT THE REGION SERVED BY ADENA. THESE INCLUDE OFFICES FOR FAMILY PHYSICIANS, ENDOCRINOLOGISTS, GERONTOLOGISTS AND UROLOGISTS. TELEMEDICINE: IN 2011, THE HEALTH SYSTEM CONTINUED ITS AFFILIATION WITH THE SOUTHERN OHIO HEALTH CARE NETWORK (SOHCN), A COLLABORATION OF THE REGION'S THREE LARGEST HEALTHCARE PROVIDERS. THIS PARTNERSHIP HAS RESULTED IN THE CONSTRUCTION OF AN EXPANSIVE FIBER OPTIC BROADBAND TELECOMMUNICATIONS NETWORK TO SERVE THE HEALTHCARE AND EDUCATIONAL NEEDS OF PEOPLE LIVING IN OHIO'S APPALACHIAN REGION. THROUGH THIS TECHNOLOGY, TELEMEDICINE IS ENABLING PATIENTS TO BE ON ADENA'S CAMPUS, BUT TREATED BY PHYSICIANS OUTSIDE THE REGION. ADENA HAS TELEMEDICINE RELATIONSHIPS WITH OHIO STATE UNIVERSITY MEDICAL CENTER, RIVERSIDE METHODIST HOSPITAL, AND NATIONWIDE CHILDREN'S HOSPITAL IN COLUMBUS. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Club Dues Or Fees | Yes (X) | ClubDuesOrFeesInd |
| Written Policy Ref T And E Expnss | Yes (1) | WrittenPolicyRefTAndEExpnssInd |
| Substantiation Required | Yes (1) | SubstantiationRequiredInd |
| Severance Payment | Yes (1) | 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 | Yes (1) | 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| JEFF GRAHAM | ||||||||||||||
| AHS CEO (JULY-DEC) | $0 | $311,630 | $0 | $0 | $0 | $0 | $0 | $50,254 | $0 | $1,761 | $0 | $363,645 | $0 | $0 |
| DAVID KESSLER | ||||||||||||||
| CHIEF OF MEDICAL STAFF | $0 | $294,606 | $0 | $17,822 | $0 | $38,755 | $0 | $0 | $0 | $3,142 | $0 | $354,325 | $0 | $0 |
| LISA CARLSON | ||||||||||||||
| AHS CFO | $0 | $231,066 | $0 | $100,000 | $0 | $4,920 | $0 | $115,304 | $0 | $10,359 | $0 | $461,649 | $0 | $0 |
| DAVE ZANNI | ||||||||||||||
| CEO | $134,881 | $0 | $0 | $0 | $9,392 | $0 | $34,593 | $0 | $13,759 | $0 | $192,625 | $0 | $0 | $0 |
| JOHN FORTNEY | ||||||||||||||
| AHS INTERIM CEO (JAN-JULY) | $0 | $491,426 | $0 | $0 | $0 | $129,136 | $0 | $136,363 | $0 | $22,706 | $0 | $779,631 | $0 | $0 |
| MARK SHUTER | ||||||||||||||
| FORMER AHS CEO | $0 | $0 | $0 | $0 | $0 | $648,688 | $0 | $0 | $0 | $0 | $0 | $648,688 | $0 | $0 |
| CATHERINE FARINET | ||||||||||||||
| PHYSICIAN | $0 | $196,432 | $0 | $17,822 | $0 | $9,900 | $0 | $0 | $0 | $24,175 | $0 | $248,329 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail (4 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 1A | DAVE ZANNI IS REIMBURSED FOR HIS ROTARY CLUB DUES. THIS IS NOT TREATED AS TAXABLE COMPENSATION. |
| PART I, LINE 3 | THE TOP MANAGEMENT OFFICIAL AT ADENA PIKE MEDICAL CENTER HAS HIS COMPENSATION REVIEWED ANNUALLY BY ADENA HEALTH SYSTEM, A RELATED PARTY. THE SYSTEM UTILIZES A SEPARATE TPA MANAGEMENT COMPENSATION CONSULTING FIRM THAT USES SEVERAL AVAILABLE MARKET STUDIES FOR APPLICABLE POSITIONS IN COMPARABLE MARKETS. THIS PROCESS WAS LAST UNDERTAKEN IN 2016. |
| PART I, LINE 4A | MARK SHUTER RECEIVED SEVERANCE PAYMENTS IN THE AMOUNT OF $630,000. |
| PART I, LINE 6 | IF THE NET EARNINGS TARGET WAS ACHIEVED FOR THE ADENA HEALTH SYSTEM, COMPENSATION WAS PAID OUT BASED ON FOUR PILLARS, INCLUDING: A PERCENTAGE OF OPERATING INCOME, PATIENT SATISFACTION, EMPLOYEE SATISFACTION, AND QUALITY MEASURES. |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (10 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 3 | THE RELATED ORGANIZATION, ADENA HEALTH SYSTEM, PAID AN EXECUTIVE CONSULTING SERVICES FIRM, TATUM, FOR CFO DUTIES. LISA CARLSON WAS PAID $127,430 FROM TATUM FROM JANUARY TO JUNE FOR HER ROLE AS CHIEF FINANCIAL OFFICER. |
| FORM 990, PART VI, SECTION A, LINE 6 | THE SOLE MEMBER OF PIKE HEALTH SERVICES IS ADENA HEALTH SYSTEM. |
| FORM 990, PART VI, SECTION A, LINE 7A | THE BOARD OF THE ORGANIZATION NOMINATES TRUSTEES, AND ADENA HEALTH SYSTEM, AS THE SOLE MEMBER OF THE ORGANIZATION, ELECTS THE TRUSTEES. |
| FORM 990, PART VI, SECTION A, LINE 7B | CERTAIN GOVERNANCE DECISIONS ARE RESERVED FOR ADENA HEALTH SYSTEM AS THE SOLE MEMBER OF THE ORGANIZATION, SUCH AS THE ELECTION OF MEMBERS OF THE BOARD OF TRUSTEES OF THE ORGANIZATION, APPROVAL OF STRATEGIC PLANS OF THE ORGANIZATION, AND APPROVAL OF AMENDMENTS TO THE ORGANIZATION'S ARTICLES OF INCORPORATION AND CODE OF REGULATIONS. ADENA HEALTH SYSTEM CAN ACT ON THESE RIGHTS BY A VOTE AT ANY MEETING, AN ACTION WITHOUT A MEETING, OR THROUGH OTHER AUTHORIZED MEANS. |
| FORM 990, PART VI, SECTION B, LINE 11B | THE 990 WAS REVIEWED AT A BOARD MEETING AND COPIES OF THE FORM 990 WERE PROVIDED TO THE BOD MEMBERS. |
| FORM 990, PART VI, SECTION B, LINE 12C | THE CORPORATE COMPLIANCE OFFICE OF ADENA HEALTH SYSTEM ANNUALLY COORDINATES THE DISTRIBUTION AND RETURN OF THE CONFLICT OF INTEREST STATEMENTS. ALL CONFLICTS ARE REVIEWED, AND THE CORPORATE COMPLIANCE OFFICE IS RESPONSIBLE FOR REVIEWING THE RESPONSES AND COMMUNICATING ANY EXTRA STEPS THAT NEED TO TAKE PLACE REGARDING ANY OF THE RESPONSES. AT EVERY BOARD MEETING AND COMMITTEE OF THE BOARD, THE AGENDA ITEM OF CONFLICT OF INTEREST IS INCLUDED AND CALLED OUT. CONFLICTED BOARD MEMBERS ABSTAIN FROM VOTING ON THE PARTICULAR ITEMS. ANY MEMBER ABSTAINING FROM VOTING IS DOCUMENTED IN THE MINUTES. FRONT LINE SUPERVISORS UP THROUGH THE CEO AND BOARD MEMBERS ARE SUBJECT TO THE CONFLICT OF INTEREST POLICY. |
| FORM 990, PART VI, SECTION B, LINE 15 | THE TOP MANAGEMENT OFFICIAL AT ADENA PIKE MEDICAL CENTER HAS HIS COMPENSATION REVIEWED ANNUALLY BY ADENA HEALTH SYSTEM, A RELATED PARTY. THE SYSTEM UTILIZES A SEPARATE TPA MANAGEMENT COMPENSATION CONSULTING FIRM THAT USES SEVERAL AVAILABLE MARKET STUDIES FOR APPLICABLE POSITIONS IN COMPARABLE MARKETS. THIS PROCESS WAS LAST UNDERTAKEN IN 2016. |
| FORM 990, PART VI, SECTION C, LINE 19 | THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST. |
| FORM 990, PART XI, LINE 9: | TRANSFER (TO) FROM RELATED ORGANIZATION 4,830,544. |
| FORM 990, PART XII, LINE 2C: | THE ADENA HEALTH SYSTEM'S AUDIT COMMITTEE ENGAGES THE INDEPENDENT AUDIT FIRM FOR THE AUDIT, REVIEWS RESULTS, AND REPORTS TO THE BOARD. ADENA HEALTH SYSTEM'S BOARD OF DIRECTORS OVERSEES THE AUDIT PROCESS AND APPROVES THE INDEPENDENT AUDIT FIRM. PIKE HEALTH SERVICES IS PART OF ADENA HEALTH SYSTEM'S CONSOLIDATED AUDIT. THIS PROCESS HAS NOT CHANGED FROM PRIOR YEAR. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (4 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Controlled OrganizationControlledOrganizationInd | Direct Controlling NADirectControllingNACd |
|---|---|---|---|---|---|---|---|---|---|---|---|
| GREENFIELD AREA MEDICAL CENTER | |||||||||||
| 550 MIRABEAU ST | GREENFIELD | OH | 45123 | 310993422 | HOSPITAL | OH | 501(C)(3) | 3 | ADENA HEALTH SYSTEM | Yes (1) | |
| ADENA HEALTH FOUNDATION | |||||||||||
| 242 HOSPITAL ROAD | CHILLICOTHE | OH | 45601 | 753008742 | FUNDRAISING | OH | 501(C)(3) | 12A | ADENA HEALTH SYSTEM | Yes (1) | |
| SOUTHERN OHIO HEALTHCARE NETWORK | |||||||||||
| 550 MIRABEAU ST | GREENFIELD | OH | 45123 | 261566590 | FIBEROPTIC NETWORK GRANTS | OH | 501(C)(3) | 12A | ADENA HEALTH SYSTEM | Yes (1) | |
| ADENA HEALTH SYSTEM | |||||||||||
| 242 HOSPITAL ROAD | CHILLICOTHE | OH | 45601 | 314379443 | HOSPITAL | OH | 501(C)(3) | 3 | 0 | N/A | |
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp
Related Organization Name RelatedOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ADENA CARE | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 272 HOSPITAL ROAD | AddressLine1Txt |
| City | CHILLICOTHE | CityNm |
| State Abbreviation | OH | StateAbbreviationCd |
| ZIP | 45601 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 453980850 | EIN |
| Primary Activities | SEE SCHEDULE R, PART VII | PrimaryActivitiesTxt |
| Legal Domicile State | OH | LegalDomicileStateCd |
| Direct Controlling NA | N/A | DirectControllingNACd |
| Entity Type | C | EntityTypeTxt |
| Controlled Organization | Yes (1) | ControlledOrganizationInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | 0 | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | 0 | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | 0 | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | 0 | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | 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 | Yes (1) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | Yes (1) | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | Yes (1) | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | Yes (1) | TransferToOtherOrgInd |
| Transfer From Other Org | Yes (1) | TransferFromOtherOrgInd |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | SCHEDULE R, PART IV, COLUMN (B) | FormAndLineReferenceDesc |
| Explanation | THE PRIMARY ACTIVITY OF ADENA CARE IS TO DEVELOP STRATEGIC RELATIONSHIPS TO THE SERVICE AREAS MAJOR EMPLOYERS THROUGH HEALTH MANAGEMENT AND WELLNESS SERVICES. | ExplanationTxt |