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AVITA HEALTH SYSTEM: Form 990, tax year 2016

View the entire original 990 at ProPublica ↗

Organization
AVITA HEALTH SYSTEM (EIN 27-4385692)
Tax period
2016-07-01 to 2017-06-30
Filed
2018-05-14
IRS object ID
201841349349308429
Schema version
2016v3.0
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 ReturnHeader

FieldValueIRS element (for citing)
Return2018-05-14T15:57:33-05:00ReturnTs
Tax Period End2017-06-30TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

FieldValueIRS element (for citing)
Preparer Firm EIN381357951PreparerFirmEIN

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1PLANTE & MORAN PLLCBusinessNameLine1Txt

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line1250 S High St Suite 100AddressLine1Txt
CityColumbusCityNm
State AbbreviationOHStateAbbreviationCd
ZIP43215ZIPCd
FieldValueIRS element (for citing)
Return Type990ReturnTypeCd
Tax Period Begin2016-07-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN274385692EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1AVITA HEALTH SYSTEMBusinessNameLine1Txt
FieldValueIRS element (for citing)
Business Name ControlAVITBusinessNameControlTxt
Phone4194681244PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1269 PORTLAND WAY SOUTHAddressLine1Txt
CityGALIONCityNm
State AbbreviationOHStateAbbreviationCd
ZIP44833ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonD ERIC DRAIMEPersonNm
Person TitleCFOPersonTitleTxt
Phone4194681244PhoneNum
Signature2018-05-14SignatureDt
Discuss With Paid PreparerYes (1)DiscussWithPaidPreparerInd

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonBernie OstrowskiPreparerPersonNm
PTINP00366367PTIN
Phone6148493000PhoneNum
Preparation2018-05-04PreparationDt
FieldValueIRS element (for citing)
Tax2016TaxYr
Build TS2022-09-23 18:48:47ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Principal OfficerJERRY MORASKOPrincipalOfficerNm

US Address USAddress

FieldValueIRS element (for citing)
Address Line1269 PORTLAND WAY SOUTHAddressLine1Txt
CityGALIONCityNm
State AbbreviationOHStateAbbreviationCd
ZIP44833ZIPCd
FieldValueIRS element (for citing)
Gross Receipts$55,305,328GrossReceiptsAmt
Group Return For Affiliates0GroupReturnForAffiliatesInd
Organization501c3Yes (X)Organization501c3Ind
Website AddressN/AWebsiteAddressTxt
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Formation2010FormationYr
Legal Domicile StateOHLegalDomicileStateCd
Activity Or MissionTO IMPROVE THE HEALTH AND WELL-BEING OF THOSE WE SERVE.ActivityOrMissionDesc
Voting Members Governing Body17VotingMembersGoverningBodyCnt
Voting Members Independent17VotingMembersIndependentCnt
Total Employee304TotalEmployeeCnt
Total Volunteers17TotalVolunteersCnt
Total Gross UBI$0TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm$0NetUnrelatedBusTxblIncmAmt
PY Contributions Grants$0PYContributionsGrantsAmt
CY Contributions Grants$0CYContributionsGrantsAmt
PY Program Service Revenue$44,442,818PYProgramServiceRevenueAmt
CY Program Service Revenue$53,983,917CYProgramServiceRevenueAmt
PY Investment Income$0PYInvestmentIncomeAmt
CY Investment Income$4,400CYInvestmentIncomeAmt
PY Other Revenue$1,317,011PYOtherRevenueAmt
CY Other Revenue$1,317,011CYOtherRevenueAmt
PY Total Revenue$45,759,829PYTotalRevenueAmt
CY Total Revenue$55,305,328CYTotalRevenueAmt
PY Grants And Similar Paid$0PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid$0CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members$0PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members$0CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$30,005,107PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$36,589,837CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns$0PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$0CYTotalFundraisingExpenseAmt
PY Other Expenses$15,754,722PYOtherExpensesAmt
CY Other Expenses$18,715,491CYOtherExpensesAmt
PY Total Expenses$45,759,829PYTotalExpensesAmt
CY Total Expenses$55,305,328CYTotalExpensesAmt
PY Revenues Less Expenses$0PYRevenuesLessExpensesAmt
CY Revenues Less Expenses$0CYRevenuesLessExpensesAmt
Total Assets BOY$0TotalAssetsBOYAmt
Total Assets EOY$0TotalAssetsEOYAmt
Total Liabilities BOY$0TotalLiabilitiesBOYAmt
Total Liabilities EOY$0TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$0NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$0NetAssetsOrFundBalancesEOYAmt
MissionTO IMPROVE THE HEALTH AND WELL-BEING OF THOSE WE SERVE.MissionDesc
Significant New Program Srvc0SignificantNewProgramSrvcInd
Significant Change0SignificantChangeInd
Expense$55,305,328ExpenseAmt
Grant$0GrantAmt
Revenue$55,300,928RevenueAmt
DescAVITA PROVIDES MANAGEMENT AND ADMINISTRATIVE SERVICES TO THE VARIOUS TAX EXEMPT ENTITIES WITHIN ITS HEALTH SYSTEM. AVITA PROVIDES SENIOR EXECUTIVE MANAGEMENT AND ADMINISTRATIVE STAFF TO ITS AFFILIATES AND THE FOLLOWING SERVICES: BILLING AND COLLECTION, INFORMATION TECHNOLOGY, HUMAN RESOURCES, ACCOUNTING AND FINANCE, FACILITIES MANAGEMENT (INCLUDING MAINTENANCE) AND OTHER SUPPORT SERVICES NECESSARY FOR THE ADMINISTRATIVE FUNCTIONS OF THE SYSTEM.Desc
Total Program Service Expenses$55,305,328TotalProgramServiceExpensesAmt
Described In Section501c3Yes (1)DescribedInSection501c3Ind
Schedule B Required0ScheduleBRequiredInd
Political Campaign Acty0PoliticalCampaignActyInd
Lobbying Activities0LobbyingActivitiesInd
Subject To Proxy Tax0SubjectToProxyTaxInd
Donor Advised Fund0DonorAdvisedFundInd
Conservation Easements0ConservationEasementsInd
Collections Of Art0CollectionsOfArtInd
Credit Counseling0CreditCounselingInd
Temp Or Permanent Endowments0TempOrPermanentEndowmentsInd
Report Land Building Equipment0ReportLandBuildingEquipmentInd
Report Investments Other Sec0ReportInvestmentsOtherSecInd
Report Program Related Invst0ReportProgramRelatedInvstInd
Report Other Assets0ReportOtherAssetsInd
Report Other Liabilities0ReportOtherLiabilitiesInd
Include FIN48 Footnote0IncludeFIN48FootnoteInd
Independent Audit Fincl Stmt0IndependentAuditFinclStmtInd
Consolidated Audit Fincl StmtYes (1)ConsolidatedAuditFinclStmtInd
School Operating0SchoolOperatingInd
Foreign Office0ForeignOfficeInd
Foreign Activities0ForeignActivitiesInd
More Than5000 K To Org0MoreThan5000KToOrgInd
More Than5000 K To Individuals0MoreThan5000KToIndividualsInd
Professional Fundraising0ProfessionalFundraisingInd
Fundraising Activities0FundraisingActivitiesInd
Gaming Activities0GamingActivitiesInd
Operate Hospital0OperateHospitalInd
Grants To Organizations0GrantsToOrganizationsInd
Grants To Individuals0GrantsToIndividualsInd
Schedule J RequiredYes (1)ScheduleJRequiredInd
Tax Exempt Bonds0TaxExemptBondsInd
Engaged In Excess Benefit Trans0EngagedInExcessBenefitTransInd
PY Excess Benefit Trans0PYExcessBenefitTransInd
Loan Outstanding0LoanOutstandingInd
Grant To Related Person0GrantToRelatedPersonInd
Business Rln With Org Mem0BusinessRlnWithOrgMemInd
Business Rln With Fam Mem0BusinessRlnWithFamMemInd
Business Rln With Officer Ent0BusinessRlnWithOfficerEntInd
Deductible Non Cash Contri0DeductibleNonCashContriInd
Deductible Art Contribution0DeductibleArtContributionInd
Terminate Operations0TerminateOperationsInd
Partial Liquidation0PartialLiquidationInd
Disregarded Entity0DisregardedEntityInd
Related EntityYes (1)RelatedEntityInd
Related Organization Ctrl EntYes (1)RelatedOrganizationCtrlEntInd
Transaction With Control EntYes (1)TransactionWithControlEntInd
Trnsfr Exmpt Non Chrtbl Rltd Org0TrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted Prtshp0ActivitiesConductedPrtshpInd
Schedule O RequiredYes (1)ScheduleORequiredInd
IRP Document184IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Backup Wthld ComplianceYes (1)BackupWthldComplianceInd
Employee304EmployeeCnt
Employment Tax Returns FiledYes (1)EmploymentTaxReturnsFiledInd
Unrelated Bus Incm Over Limit0UnrelatedBusIncmOverLimitInd
Foreign Financial Account0ForeignFinancialAccountInd
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTransInd
Taxable Party Notification0TaxablePartyNotificationInd
Nondeductible Contributions0NondeductibleContributionsInd
Quid Pro Quo Contributions0QuidProQuoContributionsInd
Form8282 Property Disposed Of0Form8282PropertyDisposedOfInd
Rcv Fnds To Pay Prsnl Bnft Cntrct0RcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft Cntrct0PayPremiumsPrsnlBnftCntrctInd
Indoor Tanning Services0IndoorTanningServicesInd
Info In Schedule O Part VIYes (X)InfoInScheduleOPartVIInd
Governing Body Voting Members17GoverningBodyVotingMembersCnt
Independent Voting Member17IndependentVotingMemberCnt
Family Or Business Rln0FamilyOrBusinessRlnInd
Delegation Of Mgmt Duties0DelegationOfMgmtDutiesInd
Change To Org Documents0ChangeToOrgDocumentsInd
Material Diversion Or Misuse0MaterialDiversionOrMisuseInd
Members Or Stockholders0MembersOrStockholdersInd
Election Of Board Members0ElectionOfBoardMembersInd
Decisions Subject To Approva0DecisionsSubjectToApprovaInd
Minutes Of Governing BodyYes (1)MinutesOfGoverningBodyInd
Minutes Of Committees0MinutesOfCommitteesInd
Officer Mailing Address0OfficerMailingAddressInd
Local Chapters0LocalChaptersInd
Form990 Provided To Gvrn BodyYes (1)Form990ProvidedToGvrnBodyInd
Conflict Of Interest PolicyYes (1)ConflictOfInterestPolicyInd
Annual Disclosure Covered PrsnYes (1)AnnualDisclosureCoveredPrsnInd
Regular Monitoring EnfrcYes (1)RegularMonitoringEnfrcInd
Whistleblower PolicyYes (1)WhistleblowerPolicyInd
Document Retention PolicyYes (1)DocumentRetentionPolicyInd
Compensation Process CEOYes (1)CompensationProcessCEOInd
Compensation Process OtherYes (1)CompensationProcessOtherInd
Investment In Joint Venture0InvestmentInJointVentureInd
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1D ERIC DRAIMEBusinessNameLine1Txt
FieldValueIRS element (for citing)
Phone4194685501PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1269 PORTLAND WAY SOUTHAddressLine1Txt
CityGALIONCityNm
State AbbreviationOHStateAbbreviationCd
ZIP44833ZIPCd

Form990 Part VII Section A Form990PartVIISectionAGrp (25 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtAverage Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndOfficerOfficerIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmtHighest Compensated EmployeeHighestCompensatedEmployeeIndFormer Ofcr Director TrusteeFormerOfcrDirectorTrusteeInd
DOUGLAS SCHILLING
CHAIR0.100.10Yes (X)Yes (X)$0$0$0
KYMBERLY FOX
CO-VICE CHAIR0.100.10Yes (X)Yes (X)$0$0$0
JOSEPH SHADEED
CO-VICE CHAIR0.100.10Yes (X)Yes (X)$0$0$0
REX CRAMER
TREASURER0.100.10Yes (X)Yes (X)$0$0$0
LINDA CHAMBERS
SECRETARY0.100.10Yes (X)Yes (X)$0$0$0
JEFFERY A UNDERWOOD
DIRECTOR0.100.10Yes (X)$0$0$0
LINDA H SMITH
DIRECTOR0.100.10Yes (X)$0$0$0
DONALD L PLOTTS
DIRECTOR0.100.10Yes (X)$0$0$0
CHARLES WALKER
DIRECTOR0.100.10Yes (X)$0$0$0
PHILLIP BROWN
DIRECTOR0.100.10Yes (X)$0$0$0
KAY MCDONALD
DIRECTOR0.100.10Yes (X)$0$0$0
JASON MCMULLEN
DIRECTOR0.100.10Yes (X)$0$0$0
ERIC GEYER
DIRECTOR0.100.30Yes (X)$0$0$0
DONALD BARR
DIRECTOR0.100.10Yes (X)$0$0$0
SHERRI CLEVENGER
DIRECTOR0.100.10Yes (X)$0$0$0
BOYD EPPERSON
DIRECTOR0.100.30Yes (X)$0$0$0
MARK SCHNEIDER
DIRECTOR0.100.10Yes (X)$0$0$0
JERRY MORASKO
CEO/EX-OFFICIO PRESIDENT0.100.70Yes (X)Yes (X)$498,470$0$47,050
D ERIC DRAIME
CFO0.100.70Yes (X)Yes (X)$259,664$0$0
MYLES CREED
DIRECTOR OF PHYSICIAN40.000.00$165,788$0$4,482Yes (X)
SHIRLEY FITZ
VP PATIENT CARE40.000.00$164,579$0$1,898Yes (X)
TRACI OSWALD
VP HUMAN RESOURCES40.000.00$166,191$0$1,898Yes (X)
SHELLIE BURGIN
VP PHYSICIAN SERVICES40.000.00$178,425$0$1,898Yes (X)
DR JAMES HEDDLESON
PHYSICIAN40.000.00$917,088$0$1,980Yes (X)
ANDREW DANIELS
COO40.000.00$174,956$0$3,546Yes (X)
FieldValueIRS element (for citing)
Total Reportable Comp From Org$2,525,161TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org$0TotReportableCompRltdOrgAmt
Total Other Compensation$62,752TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K17IndivRcvdGreaterThan100KCnt
Former Ofcr Employees ListedYes (1)FormerOfcrEmployeesListedInd
Total Comp Greater Than150 KYes (1)TotalCompGreaterThan150KInd
Compensation From Other Srcs0CompensationFromOtherSrcsInd

Contractor Compensation ContractorCompensationGrp (5 entries)

Address Line1ContractorAddress/USAddress/AddressLine1TxtCityContractorAddress/USAddress/CityNmState AbbreviationContractorAddress/USAddress/StateAbbreviationCdZIPContractorAddress/USAddress/ZIPCdServicesServicesDescCompensationCompensationAmt
MID-AMERICAN THERAPY
7652 EAGLE DRIVEFINDLAYOH45840PHYSICAL THERAPY$1,769,564
GALION ANESTHESIA
1105 DEVONWOOD ROADMANSFIELDOH44907ANESTHESIA$1,724,150
ALLIANCE HEALTHCARE SERVICES
PO BOX 96485CHICAGOIL60693IMAGING SERVICES$258,846
STEVEN CLAUS
800 FORT PICKENS ROAD 904PENSACOLA BEACHFL32561HOSPITALIST$188,639
CDW GOVERNMENT INC
75 REMITTANCE DRIVE SUITE 1515CHICAGOIL60675COMPUTER SERVICES$172,912
FieldValueIRS element (for citing)
Cntrct Rcvd Greater Than100 K12CntrctRcvdGreaterThan100KCnt

Program Service Revenue ProgramServiceRevenueGrp

FieldValueIRS element (for citing)
DescMANAGEMENT FUNCTIONDesc
Business561000BusinessCd
Total Revenue Column$53,983,917TotalRevenueColumnAmt
Related Or Exempt Func Income$53,983,917RelatedOrExemptFuncIncomeAmt
FieldValueIRS element (for citing)
Total Program Service Revenue$53,983,917TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$4,400TotalRevenueColumnAmt
Exclusion$4,400ExclusionAmt

Other Revenue Misc OtherRevenueMiscGrp

FieldValueIRS element (for citing)
DescEHR TECHNOLOGY INCOMEDesc
Business900099BusinessCd
Total Revenue Column$1,317,011TotalRevenueColumnAmt
Related Or Exempt Func Income$1,317,011RelatedOrExemptFuncIncomeAmt
FieldValueIRS element (for citing)
Other Revenue Total$1,317,011OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$55,305,328TotalRevenueColumnAmt
Related Or Exempt Func Income$55,300,928RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt
Exclusion$4,400ExclusionAmt

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

FieldValueIRS element (for citing)
Total$841,610TotalAmt
Program Services$841,610ProgramServicesAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

FieldValueIRS element (for citing)
Total$13,914,564TotalAmt
Program Services$13,914,564ProgramServicesAmt

Pension Plan Contributions PensionPlanContributionsGrp

FieldValueIRS element (for citing)
Total$2,853,542TotalAmt
Program Services$2,853,542ProgramServicesAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

FieldValueIRS element (for citing)
Total$13,380,898TotalAmt
Program Services$13,380,898ProgramServicesAmt

Payroll Taxes PayrollTaxesGrp

FieldValueIRS element (for citing)
Total$5,599,223TotalAmt
Program Services$5,599,223ProgramServicesAmt

Fees For Services Legal FeesForServicesLegalGrp

FieldValueIRS element (for citing)
Total$321,588TotalAmt
Program Services$321,588ProgramServicesAmt

Fees For Services Accounting FeesForServicesAccountingGrp

FieldValueIRS element (for citing)
Total$748,820TotalAmt
Program Services$748,820ProgramServicesAmt

Fees For Services Other FeesForServicesOtherGrp

FieldValueIRS element (for citing)
Total$3,009,259TotalAmt
Program Services$3,009,259ProgramServicesAmt

Advertising AdvertisingGrp

FieldValueIRS element (for citing)
Total$525,364TotalAmt
Program Services$525,364ProgramServicesAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$6,181,324TotalAmt
Program Services$6,181,324ProgramServicesAmt

Information Technology InformationTechnologyGrp

FieldValueIRS element (for citing)
Total$3,955,784TotalAmt
Program Services$3,955,784ProgramServicesAmt

Occupancy OccupancyGrp

FieldValueIRS element (for citing)
Total$2,510,282TotalAmt
Program Services$2,510,282ProgramServicesAmt

Travel TravelGrp

FieldValueIRS element (for citing)
Total$102,540TotalAmt
Program Services$102,540ProgramServicesAmt

Interest InterestGrp

FieldValueIRS element (for citing)
Total$1,030,560TotalAmt
Program Services$1,030,560ProgramServicesAmt

Insurance InsuranceGrp

FieldValueIRS element (for citing)
Total$7,140TotalAmt
Program Services$7,140ProgramServicesAmt

Other Expenses OtherExpensesGrp (3 entries)

DescDescTotalTotalAmtProgram ServicesProgramServicesAmt
PHYSICIAN RECRUITING$185,017$185,017
MEDICAL SUPPLIES$138,371$138,371
BAD DEBT EXPENSE-$558-$558

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$55,305,328TotalAmt
Program Services$55,305,328ProgramServicesAmt
Management And General$0ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt
FieldValueIRS element (for citing)
Organization Follows SFAS117Yes (X)OrganizationFollowsSFAS117Ind

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt
FieldValueIRS element (for citing)
Reconcilation Revenue Expnss$0ReconcilationRevenueExpnssAmt
Other Changes In Net Assets$0OtherChangesInNetAssetsAmt
Info In Schedule O Part XIIYes (X)InfoInScheduleOPartXIIInd
Method Of Accounting AccrualYes (X)MethodOfAccountingAccrualInd
Accountant Compile Or Review0AccountantCompileOrReviewInd
FS AuditedYes (1)FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

FieldValueIRS element (for citing)
Consolidated Basis Fincl StmtYes (X)ConsolidatedBasisFinclStmtInd
FieldValueIRS element (for citing)
Audit CommitteeYes (1)AuditCommitteeInd
Federal Grant Audit Required0FederalGrantAuditRequiredInd

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Supporting Organization509a3Yes (X)SupportingOrganization509a3Ind
Supporting Org Type2Yes (X)SupportingOrgType2Ind
Supported Organizations1SupportedOrganizationsCnt

Supported Org Information SupportedOrgInformationGrp

Supported Organization Name SupportedOrganizationName

FieldValueIRS element (for citing)
Business Name Line1GALION COMMUNITY HOSPITALBusinessNameLine1Txt
FieldValueIRS element (for citing)
EIN344451872EIN
Organization Type3OrganizationTypeCd
Governing Document ListedYes (1)GoverningDocumentListedInd
Support$0SupportAmt
Other Support$0OtherSupportAmt
FieldValueIRS element (for citing)
Supported Organizations Total1SupportedOrganizationsTotalCnt
Support Sum$0SupportSumAmt
Other Support Sum$0OtherSupportSumAmt

Form990 Sch A Supporting Org Form990SchASupportingOrgGrp

FieldValueIRS element (for citing)
Listed By Name Governing DocYes (1)ListedByNameGoverningDocInd
Suprt Org No IRS Determination0SuprtOrgNoIRSDeterminationInd
Supported Org Section C4560SupportedOrgSectionC456Ind
Supported Org Not Organized US0SupportedOrgNotOrganizedUSInd
Organization Change Suprt Org0OrganizationChangeSuprtOrgInd
Support Non Supported Org0SupportNonSupportedOrgInd
Payment Substantial Contribtr0PaymentSubstantialContribtrInd
Loan Disqualified Person0LoanDisqualifiedPersonInd
Controlled Disqualified Prsn0ControlledDisqualifiedPrsnInd
Disqualified Prsn Controll Int0DisqualifiedPrsnControllIntInd
Disqualified Prsn Ownr Int0DisqualifiedPrsnOwnrIntInd
Excess Business Holdings Rules0ExcessBusinessHoldingsRulesInd
Contribution Controller0ContributionControllerInd
Contribution Family0ContributionFamilyInd
Contribution35 Controlled0Contribution35ControlledInd
FieldValueIRS element (for citing)
Majority Dir Trst Supported OrgYes (1)MajorityDirTrstSupportedOrgInd

Form990 Schedule A Part VI Form990ScheduleAPartVIGrp

FieldValueIRS element (for citing)
Form And Line ReferencePART IV:FormAndLineReferenceDesc
ExplanationAVITA PROVIDES MANAGEMENT AND ADMINISTRATIVE SERVICES TO THE VARIOUS TAX EXEMPT ENTITIES WITHIN ITS HEALTH SYSTEM. AVITA PROVIDES SENIOR EXECUTIVE MANAGEMENT AND ADMINISTRATIVE STAFF TO ITS AFFILIATES AND THE FOLLOWING SERVICES: BILLING AND COLLECTION, INFORMATION TECHNOLOGY, HUMAN RESOURCES, ACCOUNTING AND FINANCE, FACILITIES MANAGEMENT (INCLUDING MAINTENANCE) AND OTHER SUPPORT SERVICES NECESSARY FOR THE ADMINISTRATIVE FUNCTIONS OF THE SYSTEM.ExplanationTxt

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Club Dues Or FeesYes (X)ClubDuesOrFeesInd
Written Policy Ref T And E ExpnssYes (1)WrittenPolicyRefTAndEExpnssInd
Substantiation RequiredYes (1)SubstantiationRequiredInd
Compensation CommitteeYes (X)CompensationCommitteeInd
Compensation SurveyYes (X)CompensationSurveyInd
Board Or Committee ApprovalYes (X)BoardOrCommitteeApprovalInd
Severance PaymentYes (1)SeverancePaymentInd
Supplemental Nonqual Rtr PlanYes (1)SupplementalNonqualRtrPlanInd
Equity Based Comp Arrngm0EquityBasedCompArrngmInd
Comp Based On Revenue Of Flng Org0CompBasedOnRevenueOfFlngOrgInd
Comp Bsd On Rev Related Orgs0CompBsdOnRevRelatedOrgsInd
Comp Bsd Net Earns Flng Org0CompBsdNetEarnsFlngOrgInd
Comp Bsd Net Earns Rltd Orgs0CompBsdNetEarnsRltdOrgsInd
Any Non Fixed PaymentsYes (1)AnyNonFixedPaymentsInd
Initial Contract Exception0InitialContractExceptionInd

Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (8 entries)

TitleTitleTxtBase Compensation Filing OrgBaseCompensationFilingOrgAmtCompensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmtBonus Filing OrganizationBonusFilingOrganizationAmountBonus Related OrganizationsBonusRelatedOrganizationsAmtOther Compensation Filing OrgOtherCompensationFilingOrgAmtOther Compensation Rltd OrgsOtherCompensationRltdOrgsAmtDeferred Compensation Flng OrgDeferredCompensationFlngOrgAmtDeferred Comp Rltd OrgsDeferredCompRltdOrgsAmtNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmtNontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmtTotal Compensation Filing OrgTotalCompensationFilingOrgAmtTotal Compensation Rltd OrgsTotalCompensationRltdOrgsAmtComp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmtComp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt
JERRY MORASKO
CEO/EX-OFFICIO PRESIDENT$453,470$0$45,000$0$0$0$45,000$0$2,050$0$545,520$0$0$0
D ERIC DRAIME
CFO$226,004$0$33,660$0$0$0$0$0$0$0$259,664$0$0$0
MYLES CREED
DIRECTOR OF PHYSICIAN$120,148$0$45,640$0$0$0$0$0$4,482$0$170,270$0$0$0
SHIRLEY FITZ
VP PATIENT CARE$145,538$0$19,041$0$0$0$0$0$1,898$0$166,477$0$0$0
TRACI OSWALD
VP HUMAN RESOURCES$145,012$0$21,179$0$0$0$0$0$1,898$0$168,089$0$0$0
SHELLIE BURGIN
VP PHYSICIAN SERVICES$155,473$0$22,952$0$0$0$0$0$1,898$0$180,323$0$0$0
DR JAMES HEDDLESON
PHYSICIAN$403,082$0$514,006$0$0$0$0$0$1,980$0$919,068$0$0$0
ANDREW DANIELS
COO$0$0$0$0$174,956$0$0$0$3,546$0$178,502$0$0$0

Supplemental Information Detail SupplementalInformationDetail (3 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
Part I, Line 1aA MEMBERSHIP AT THE LOCAL COUNTRY CLUB IS PAID FOR THE CEO, JERRY MORASKO. THIS BENEFIT HAS NOT BEEN TREATED AS TAXABLE COMPENSATION.
Part I, Lines 4a-b457(F)- SUBJECT TO SUBSTANTIAL RISK OF FORFEITURE JERRY MORASKO- $45,000 ANDREW DANIELS RECEIVED SEVERANCE PAYMENTS IN THE AMOUNT OF $174,956.
Part I, Line 7PHYSICIAN'S QUALIFY FOR BONUSES BASED ON THEIR TARGET RVU'S. THIS TARGET IS FIGURED BY TAKING THEIR YEARLY SALARY AND DIVIDING IT BY THE RVU RATE WHICH COMES FROM MGMA GUIDELINES. PHYSICIAN BONUSES VARY BASED ON THEIR CONTRACT. THESE BONUSES ARE ACCRUED ON A MONTHLY BASIS AND PAID ON A QUARTERLY BASIS BASED ON PHYSICIAN'S CONTRACT TERM UNLESS THE PHYSICIAN IS NOT LIKELY TO MEET THE YEARLY TARGET. THE OFFICERS' BONUSES ARE BASED ON EACH INDIVIDUAL'S GOALS ESTABLISHED AT THE START OF THE FISCAL YEAR. THE OFFICERS' CAN RECEIVE UP TO A CERTAIN PERCENTAGE OF THEIR WAGES. BONUSES ARE PAID OUT ONCE A YEAR AFTER THE FISCAL YEAR RESULTS HAVE BEEN DETERMINED.

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (7 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
Form 990, Part VI, Section A, line 8bTHE ORGANIZATION DOES NOT HAVE SUB-COMMITTEES WITH THE AUTHORITY TO ACT ON BEHALF OF THE GOVERNING BODY.
Form 990, Part VI, Section B, line 11bTHE FORM 990 IS PROVIDED TO THE BOARD OF DIRECTORS AND SENT TO THE EXECUTIVE COMMITTEE FOR THEIR REVIEW PRIOR TO FILING. THE BOARD EXECUTIVE COMMITTEE APPROVES THE FORM 990 FOLLOWING REVIEW, AS AUTHORIZED BY THE FULL GOVERNING BODY.
Form 990, Part VI, Section B, line 12cTHE CONFLICT OF INTEREST POLICY COVERS ALL BOARD OF DIRECTORS AND OFFICERS OF THE CORPORATION. CONFLICT OF INTEREST SURVEYS ARE REVIEWED BY BOARD CHAIRMAN AND THE CEO TO ENSURE COMPLIANCE. VARIOUS RESTRICTIONS ARE IMPOSED ON INDIVIDUALS WITH POTENTIAL CONFLICTS OF INTEREST (I.E. INABILITY TO VOTE) UNTIL DECISION HAS BEEN MADE ON POTENTIAL CONFLICT. AVITA HEALTH SYSTEM HAS ADOPTED THIS POLICY.
Form 990, Part VI, Section B, line 15THE PROCESS FOR DETERMINING COMPENSATION CONSISTED OF BOARD EXECUTIVE COMMITTEE REVIEW OF OHIO HOSPITAL ASSOCIATION COMPENSATION SURVEYS, AND THE COMMITTEE DETERMINES EXECUTIVE COMPENSATION BASED ON THIS COMPARABILITY DATA. CONTEMPORANEOUS MINUTES ARE KEPT OF MEETINGS HELD BY THE EXECUTIVE COMMITTEE REGARDING DECISIONS AND DELIBERATIONS OF THIS PROCESS. THIS PROCESS WAS LAST COMPLETED IN 2016.
Form 990, Part VI, Section C, line 19NO DOCUMENTS ARE AVAILABLE TO THE PUBLIC, OTHER THAN THE FINANCIAL STATEMENTS WHICH ARE ATTACHED TO GALION COMMUNITY HOSPITAL'S FORM 990.
FORM 990, PART XI, LINE 2CTHE ORGANIZATION HAS A FINANCE COMMITTEE WHICH OVERSEES THE AUDIT OF THE FINANCIAL STATEMENTS. THIS PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR.
FORM 990, PART IXAVITA HEALTH SYSTEM REPORTS EMPLOYEE BENEFIT AND RETIREMENT EXPENSES FOR COMMUNITY HEALTH ASSOCIATES, INC. AND GALION COMMUNITY HOSPITAL IN PART IX.

Schedule R IRS990ScheduleR

Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (5 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdExempt Code SectionExemptCodeSectionTxtPublic Charity StatusPublicCharityStatusTxtBusiness Name Line1DirectControllingEntityName/BusinessNameLine1TxtControlled OrganizationControlledOrganizationInd
GALION COMMUNITY HOSPITAL
269 PORTLAND WAY SOUTHGALIONOH44833344451872HOSPITAL SERVICESOH501 (C)(3)Line 3AVITA HEALTH SYSTEMYes (1)
COMMUNITY HEALTH ASSOCIATES INC
955 BUCYRUS ROADGALIONOH44833341784017PHYSICIAN OFFICEOH501 (C)(3)Line 12a, IGALION COMMUNITY HOSPITALYes (1)
NORTH CENTRAL OHIO FAMILY CARE CENTER INC
269 PORTLAND WAY SOUTHGALIONOH44833341807906PHYSICIAN OFFICEOH501 (C)(3)Line 12a, IGALION COMMUNITY HOSPITALYes (1)
AVITA HEALTH FOUNDATION
269 PORTLAND WAY SOUTHGALIONOH44833200934451FOUNDATIONOH501 (C)(3)Line 7GALION COMMUNITY HOSPITALYes (1)
CRAWFORD COUNTY SHARED HEALTH SERVICES INC
1220 NORTH MARKET STREETGALIONOH44833341484014HOME HEALTH & HOSPICEOH501 (C)(3)Line 10GALION COMMUNITY HOSPITALYes (1)

Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp (3 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdDirect Controlling NADirectControllingNACd
GALION COMMUNITY PAIN MANAGEMENT LLC
269 PORTLAND WAY SOUTHGALIONOH44833300602607HOSPITAL SUPPORTOHN/A
GALION COMMUNITY VASCULAR SERVICES LLC
269 PORTLAND WAY SOUTHGALIONOH44833611613817HOSPITAL SUPPORTOHN/A
AMERICAN SURGICAL SPINE SERVICES
629 N SANDUSKY AVEBUCYRUSOH44820371786727HOSPITAL SUPPORTOHN/A
FieldValueIRS element (for citing)
Receipt Of Int Annts Rnts Rylts0ReceiptOfIntAnntsRntsRyltsInd
Gift Grnt Or Cap Contri To Oth Org0GiftGrntOrCapContriToOthOrgInd
Gift Grnt Cap Contri From Oth Org0GiftGrntCapContriFromOthOrgInd
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrgInd
Loans Or Guarantees From Oth Org0LoansOrGuaranteesFromOthOrgInd
Div Related Organization0DivRelatedOrganizationInd
Asset Sale To Other Org0AssetSaleToOtherOrgInd
Asset Purchase From Other Org0AssetPurchaseFromOtherOrgInd
Asset Exchange0AssetExchangeInd
Rental Of Facilities To Oth Org0RentalOfFacilitiesToOthOrgInd
Rental Of Fclts From Oth Org0RentalOfFcltsFromOthOrgInd
Perform Of Services For Oth OrgYes (1)PerformOfServicesForOthOrgInd
Perform Of Services By Other Org0PerformOfServicesByOtherOrgInd
Sharing Of Facilities0SharingOfFacilitiesInd
Paid Employees SharingYes (1)PaidEmployeesSharingInd
Reimbursement Paid To Other Org0ReimbursementPaidToOtherOrgInd
Reimbursement Paid By Other Org0ReimbursementPaidByOtherOrgInd
Transfer To Other OrgYes (1)TransferToOtherOrgInd
Transfer From Other OrgYes (1)TransferFromOtherOrgInd

Transactions Related Org TransactionsRelatedOrgGrp (4 entries)

Transaction TypeTransactionTypeTxtInvolvedInvolvedAmtMethod Of Amount DeterminationMethodOfAmountDeterminationTxt
GALION COMMUNITY HOSPITAL
S$5,913,525FORGIVENESS OF PAYABLE
GALION COMMUNITY HOSPITAL
L$52,454,792MANAGEMENT FEE
GALION COMMUNITY HOSPITAL
R$15,860,927FORGIVENESS OF PAYABLE
GALION COMMUNITY HOSPITAL
S$85,333FORGIVENESS OF PAYABLE