2017-11-15T17:16:50-06:00 2016-12-31 341827159 GILMORE JASION MAHLER LTD 1715 INDIAN WOOD CIRCLE STE 100 MAUMEE OH 43537 990 2016-01-01 341116795 HOSPITAL COUNCIL OF NORTHWEST OHIO HOSP 4198420800 3231 CENTRAL PARK WEST No 200 TOLEDO OH 43617 w scott fry president & CEO 4198420800 2017-11-15 1 HEIDI FERGUSON P00410007 4197942000 2017-11-15 24.52.84.186 2017-11-15 17:14:13 ES P DF5ED3CD6892D17832E25DCC863F5AC327F085B7 4B844F0A4D155C2D7FC562F4C78D4A933969B36E 2016 2017-02-10 21:41:12Z w scott fry 3231 CENTRAL PARK WEST No 200 TOLEDO OH 43617 7037687 0 X WWW.HCNO.ORG X 1973 OH SEE BELOW.THE HOSPITAL COUNCIL OF NORTHWEST OHIO IS A MEMBER DRIVEN ORGANIZATION THAT REPRESENTS AND ADVOCATES ON BEHALF OF ITS MEMBER HOSPITALS AND HEALTH SYSTEMS AND PROVIDES COLLABORATIVE OPPORTUNITIES TO ENHANCE THE HEALTH STATUS OF THE CITIZENS OF NORTHWEST OHIO. THE HOSPITAL COUNCIL IS DEDICATED TO: -BRINGING TOGETHER NORTHWEST OHIO'S HEALTH CARE LEADERS. -PROVIDING COLLABORATIVE OPPORTUNITIES TO ADDRESS HEALTHCARE PROVIDERS' SHARED CONCERNS. -DEVELOPING CREATIVE HEALTH-RELATED INITIATIVES TO IMPROVE THE REGION'S HEALTH STATUS. -PROVIDING EDUCATIONAL PROGRAMS FOR THE HEALTHCARE SECTOR. 21 20 53 44 0 0 2302039 4288814 2850540 2717184 1410 5107 37173 26363 5191162 7037468 1314753 1642310 0 0 2289207 2784164 0 0 0 1178284 1070918 4782244 5497392 408918 1540076 4776997 6492865 1205176 1380968 3571821 5111897 X The Hospital Council of Northwest Ohio is a member driven organization that represents and advocates on behalf of its member hospitals and health systems and provides collaborative opportunities to enhance the health status of the citizens of Northwest Ohio. See Schedule O The hospital council is dedicateD to: -BRINGING TOGETHER NORTHWEST OHIO'S HEALTH CARE LEADERS. -PROVIDING COLLABORATIVE OPPORTUNITIES TO ADDRESS HEALTHCARE PROVIDERS' SHARED CONCERNS. -DEVELOPING CREATIVE HEALTH-RELATED INITIATIVES TO IMPROVE THE REGION'S HEALTH STATUS. -PROVIDING EDUCATIONAL PROGRAMS FOR THE HEALTHCARE SECTOR. 0 0 5119851 1642310 2743547 -PROVIDING COLLABORATIVE OPPORTUNITIES TO ADDRESS HEALTHCARE PROVIDERS' SHARED CONCERNS.-DEVELOPING, implementing, and securing funding for CREATIVE HEALTH-RELATED INITIATIVES TO IMPROVE THE REGION'S HEALTH STATUS.-PROVIDING EDUCATIONAL PROGRAMS FOR THE HEALTHCARE SECTOR. 5119851 1 1 0 1 0 0 0 0 0 0 1 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 32 0 1 53 1 0 0 0 0 0 0 0 0 0 0 X 21 20 0 0 0 0 1 1 1 1 1 0 0 0 1 1 1 1 1 1 1 0 X W SCOTT FRY 4198420800 3231 CENTRAL PARK WEST TOLEDO OH 43617 Bradley Bertke Trustee 4.00 X 0 0 0 Holly Bristoll Trustee 4.00 X 0 0 0 Kim Bordenkircher Trustee 4.00 X 0 0 0 Lynn Detterman Immediate Past Chair 4.00 X 0 0 0 Michael Winthrop Treasurer 4.00 X 0 0 0 Pam Jensen Trustee 4.00 X 0 0 0 Phil Ennen Trustee 4.00 X 0 0 0 Scott C Malaney Trustee 4.00 X 0 0 0 Sonya Selhorst Trustee 4.00 X 0 0 0 Stanley Korducki Trustee 4.00 X 0 0 0 Lorna Strayer Trustee 4.00 X 0 0 0 Jeffrey Dempsey Trustee 4.00 X 0 0 0 Kerry Tirman Trustee 4.00 X 0 0 0 Randall Ruge Trustee 4.00 X 0 0 0 Darrin Arquette Trustee 4.00 X 0 0 0 Neeraj Kanwal Trustee 4.00 X 0 0 0 Arturo Polizzi Trustee 4.00 X 0 0 0 David Morlock Trustee 4.00 X 0 0 0 Daniel Barbee Trustee 4.00 X 0 0 0 Dawn Buskey Trustee 4.00 X 0 0 0 Daniel L Wakeman Chairman 4.00 X X 0 0 0 J Todd Almendinger Secretary 4.00 X X 0 0 0 Patti Finn Chair-Elect 4.00 X X 0 0 0 W Scott Fry President & CEO 23.75 16.25 X X 133919 91534 72596 Jan Ruma Vice President 44.00 X 187114 0 62068 Kathy Silvestri Director-Health Planning 41.00 X 101882 0 28424 422915 91534 163088 3 0 1 0 0 50000 2394442 1844372 4288814 Contract Income 900099 2147882 2147882 Membership Dues 900099 569302 569302 2717184 4136 4136 1190 219 971 971 971 26363 26363 26363 7037468 2743547 0 5107 1600557 1600557 41753 41753 298050 184791 113259 1779589 1688235 91354 118110 114613 3497 433437 395865 37572 154978 137930 17048 9100 9100 23444 23444 293983 273878 20105 5967 1768 4199 269737 241811 27926 92629 86691 5938 125327 117189 8138 56133 53011 3122 31577 22326 9251 542 542 6121 5080 1041 17793 16138 1655 Program Expense 131026 131026 ORG DUES AND MEMBership 4900 4579 321 TRAINING 2483 2468 15 subscriptions 156 142 14 5497392 5119851 377541 0 2304580 4169683 1001305 1002188 511281 552544 928837 742991 7185 7990 93538 76069 23809 17469 4776997 6492865 210939 295513 974924 1073940 19313 11515 1205176 1380968 X 2787249 2845569 784572 2266328 3571821 5111897 4776997 6492865 1540076 0 X X 0 1 X 1 1 1 X 1846679 1756767 2017852 2302039 4288814 12212151 1846679 1756767 2017852 2302039 4288814 12212151 12212151 1882 1565 1239 1410 4136 10232 42653 51293 44660 37173 26363 202142 12424525 12514358 0.98290 0.97880 X Schedule A, Part II, Line 10, Explanation of Other Income: Reimbursement Income - 2012 Amount: $ 28,463. 2013 Amount: $ 36,968. 2014 Amount: $ 34,110. 2015 Amount: $ 33,054. 2016 Amount: $ 22,244. Special Event Income - 2012 Amount: $ 14,190. 2013 Amount: $ 14,325. 2014 Amount: $ 10,550. Miscellaneous - 2015 Amount: $ 4,119. 2016 Amount: $ 4,119. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 1 557 0 0 1 607 0 1 9 1173 0 Part II-B, Line 1: line 1i, other activities: Food/beverages for meetings ($9) 0 0 35928 19721 16207 57610 56348 1262 17469 X 7210271 172803 172803 7037468 0 7037468 5720195 222803 222803 5497392 0 5497392 Part X, Line 2: Management of the Organization is required to determine whether a tax position of the Organization is more likely than not to be sustained upon examination by the applicable taxing authority, including resolution of any related appeals or litigation processes, based on the technical merits of the position. Management of the Organization is not aware of any tax positions for which it is reasonably possible that the total amounts of unrecognized tax benefits will significantly change in the next twelve months. However, management's conclusions may be subject to review and adjustment at a later date based on factors including, but not limited to, new tax laws, regulations, and administrative interpretations (including relevant court decisions). The Organization's federal tax returns for the prior three years remain subject to examination by the Internal Revenue Service. No interest or penalties were incurred or recognized in 2016 or 2015. Part XI, Line 2d - Other Adjustments: Intercompany Transactions 172,803. Part XII, Line 2d - Other Adjustments: Intercompany Transactions 222,803. 1 Adelante Inc 520 Broadway Toledo OH 43604 341826214 501(c)(3) 32700 Support Blanchard Valley Health System 1900 South Main Street Findlay OH 45840 341369963 501(c)(3) 7500 Support Bluffton Hospital 139 Garau Street Bluffton OH 45817 341369963 501(c)(3) 7500 Support Care Coordination Systems LLC 75 E Market Street Akron OH 44308 461234542 46380 Support Toledo-Lucas County CareNet Inc 3231 Central Park West Dr Room/suit 200 toledo OH 43617 431986672 501(c)(3) 89170 Support Communica Inc 31 N Erie Street Toledo OH 43604 341634112 37035 Support Community Hospitals and Wellness CentersBryan 433 W HIGH STREET Bryan OH 43506 341048666 501(c)(3) 10000 Support Community Hospitals and Wellness CentersMontpelier 909 Snyder Montpelier OH 43543 341048666 501(c)(3) 7500 Support Community Memorial Hosptial 208 N Columbus Street Hicksville OH 43526 346401873 7500 Support Dental Center of Northwest Ohio 2138 Madison Ave Toledo OH 43604 344441883 501(c)(3) 41914 Support East Toledo Family Center 1020 Varland Avenue Toledo OH 43605 344429426 501(c)(3) 113790 Support Erie County General Health District 420 Superior Street Sandusky OH 44870 346400428 27375 Support Firelands Regional Medical Center 1111 Hayes Ave Sandusky OH 44870 344428218 501(c)(3) 10000 Support Fisher-Titus Medical Center 272 Benedict ave Norwalk OH 44857 344430716 501(c)(3) 13897 Support Fulton County Health Center 725 South Shoop Avenue WaUseon OH 43567 344428214 501(c)(3) 6147 Support Heartbeat of Toledo 4041 W Sylvania Avenue Toledo OH 43623 237404777 501(c)(3) 34115 Support Henry County Hospital 1600 East Riverview Avenue Napoleon OH 43545 344477047 501(c)(3) 10718 Support Kent State University PO Box 5190 232 Schwartz Center Kent OH 44242 346402079 501(c)(3) 59076 Support Lima Memorial Health System 1001 Bellefontaine Ave Lima OH 45804 341883284 501(c)(3) 7482 Support Lucas County Regional Health District 635 N Erie Street Toledo OH 43604 346400806 221833 Support Magruder Hospital 615 Fulton Street Port Clinton OH 43452 344441792 501(c)(3) 7500 Support Memorial Hospital 715 South Taft Avenue Fremont OH 43420 344430849 501(c)(3) 7500 Support Mercy Hospital of Defiance 1404 E Second Street Defiance OH 43512 020701635 501(c)(3) 7500 Support Mercy Hospital of Tiffin 45 St Lawrence Drive Tiffin OH 44883 344431174 501(c)(3) 7379 Support Mercy Hospital of Willard 1100 Neal Zick Road Willard OH 448901611 341477110 501(c)(3) 10000 Support Mercy St Vincent Medical Center 2213 Cherry Street Toledo OH 43608 344428250 501(c)(3) 161405 Support Mercy St Anne Hospital 3404 Sylvania Avenue Toledo OH 43623 311556401 501(c)(3) 7656 Support Mercy St Charles Hospital 2600 Navarre Avenue Oregon OH 43616 344445373 501(c)(3) 7590 Support Neighborhood Health Association 313 Jefferson avenue Toledo OH 43604 237272741 501(c)(3) 51760 Support OE Meyer Company PO Box 479 Sandusky OH 44871 341602304 19572 Support Pathway 505 Hamilton Street Toledo OH 43604 346562552 501(c)(3) 34185 Support Paulding Community Hospital 1035 W Wayne Street Paulding OH 45879 346405718 7500 Support Promedica Bay Park HOSPITAL 2801 Bay Park Drive Oregon OH 43616 341883132 501(c)(3) 21070 Support Promedica Defiance Regional Hospital 1200 Ralston avenue Defiance OH 43512 344446484 501(c)(3) 6925 Support Promedica Flower HOSPITAL 5200 Harroun Road Sylvania OH 43560 344428794 501(c)(3) 8815 Support Promedica Fostoria Community Hospital 501 Van Buren Street Fostoria OH 44830 340898745 501(c)(3) 10000 Support Promedica Physicians Group Inc 3949 Sunforest Court Toledo OH 43623 341899439 501(c)(3) 30180 Support Promedica St Lukes Hospital 5901 Monclova rd Maumee OH 43537 344428232 501(c)(3) 9000 Support Promedica Toledo Hospital 2142 North Cove Blvd Toledo OH 43606 344428256 501(c)(3) 115152 Support Salvation Army 620 Erie Street Toledo OH 43604 135562351 501(c)(3) 6230 Support Sandusky County EMS 2100 Countryside Place Fremont OH 43420 346401312 8000 Support Seneca Medical Inc PO Box 636696 Cincinnati OH 452636696 341633185 11775 Support Senior Independence Home Health & Hospice 1730 Reynolds Road Toledo OH 43614 344429863 501(c)(3) 16515 Support St Rita's Medical Center 730 W Market Street Lima OH 45801 341105619 501(c)(3) 12751 Support The Bellevue Hospital 1400 West Main Bellevue OH 44811 344428205 501(c)(3) 9488 Support The University Church 4747 Hill Avenue Toledo OH 43615 352484010 23285 Support University of Toledo Grants Accounting 2801 West Bancroft MS 455 Toledo OH 43606 346401483 501(c)(3) 22515 Support Van Wert County Hospital 1250 South Washington Street Van Wert OH 45891 344429514 501(c)(3) 9833 Support Wood County Hospital 950 W Wooster Street Bowling Green OH 43402 344440884 501(c)(3) 11942 Support YMCA & JCC of Greater Toledo 1500 N Superior Street 2nd Floor Toledo OH 43604 344428262 501(c)(3) 49238 Support Mercy Foundation 2213 Cherry Street Suite 307 ACC Toledo OH 43608 201072726 501(c)(3) 17520 SUPPORT 41 10 Gift Cards 894 9840 Baby Supplies 109 1803 Actual Cost Car Seats, clippers, ointments, etc. Survey Incentives 15055 30110 Part I, Line 2: The Program staff work closely with each sub grantee regarding paperwork needed. All sub grantees must submit documentation for reimbursement of all expenditures. When necessary, the Assistant Controller tracks expenditures to ensure adherence to the budget; in addition, the program director works with finance to oversee the grant and mantain compliance with applicable mandates. Each sub-grantee must submit a budget spending plan for approval, prior to receiving their first payment. The spending plans give an estimate "date to be spent" for each line item. Sub grantees turn in quarterly reports, and the Program Director and Specialist review their spent funds to date. Sub grantees must submit receipts for expenses, at which time a check for reimbursement will be disbursed. X X X 0 0 0 0 0 0 0 0 0 W Scott Fry President & CEO 118326 80876 7425 5075 8168 5583 20888 14277 22234 15197 177041 121008 0 0 Jan Ruma Vice President 175373 0 10775 0 966 0 23461 0 38607 0 249182 0 0 0 Form 990, Part VI, Section A, line 6 Area hospitals comprise the membership of Hospital Council of Northwest Ohio. Form 990, Part VI, Section A, line 7a These member hospitals may elect one or more members of the governing body. Form 990, Part VI, Section A, line 7b The governing decisions of the filing entity are subject to approval by the member hospitals. Form 990, Part VI, Section B, line 11b The organization's signing officer scans the form 990 for completeness prior to signature, in addition to relying upon the independent accountant for accuracy. Form 990, Part VI, Section B, line 12c the organization regularly and consistently monitors and enforces compliance with the conflict of interest policy. Form 990, Part VI, Section B, line 15 The governing body uses a process for determining compensation of the organization's CEO or top management officials which includes a comparison to other organizations, salary surveys, and contemporaneous substantiation of the deliberation and decision on an annual basis. The organization uses a process for determining compensation of the organization's officers or key employees which includes a review and approval by the CEO, use of management surveys, and contemporaneous substantiation of the deliberation and decision on an annual basis. Form 990, Part VI, Section C, line 19 The organization's governing documents, conflict of interest policy, and financial statements are available upon request. FORM 990, PART XII, LINE 2C: The organization has a committee that assumes repsonsibility for oversight of the audit of its financial statements and selection of an independent accountant. Northwest ohio shared services 3231 central park west dr toledo OH 43617 341388279 purchase corporation OH N/A C 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 1 0 1 0 0 Northwest Ohio Shared Services Inc L 130487 Northwest Ohio Shared Services Inc O 125513 northwest Ohio Shared Services Inc O 90815