AVITA HEALTH SYSTEM: Form 990, tax year 2015
View the entire original 990 at ProPublica ↗
- Organization
- AVITA HEALTH SYSTEM (EIN 27-4385692)
- Tax period
- 2015-07-01 to 2016-06-30
- Filed
- 2017-05-15
- IRS object ID
- 201701359349302945
- Schema version
- 2015v3.0
- 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
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2017-05-15T10:40:15-05:00 | ReturnTs |
| Tax Period End | 2016-06-30 | 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 | 2015-07-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 274385692 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | AVITA HEALTH SYSTEM | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | AVIT | BusinessNameControlTxt |
| Phone | 4194681244 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 269 PORTLAND WAY SOUTH | AddressLine1Txt |
| City | GALION | CityNm |
| State Abbreviation | OH | StateAbbreviationCd |
| ZIP | 44833 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | D ERIC DRAIME | PersonNm |
| Person Title | CFO | PersonTitleTxt |
| Phone | 4194681244 | PhoneNum |
| Signature | 2017-05-12 | 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 | 2017-05-05 | PreparationDt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2015 | TaxYr |
| Build TS | 2021-01-29 14:40:06Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | JERRY MORASKO | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 269 PORTLAND WAY SOUTH | AddressLine1Txt |
| City | GALION | CityNm |
| State Abbreviation | OH | StateAbbreviationCd |
| ZIP | 44833 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $45,759,829 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | N/A | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 2010 | FormationYr |
| Legal Domicile State | OH | LegalDomicileStateCd |
| Activity Or Mission | TO IMPROVE THE HEALTH AND WELL-BEING OF THOSE WE SERVE. | ActivityOrMissionDesc |
| Voting Members Governing Body | 18 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 18 | VotingMembersIndependentCnt |
| Total Employee | 268 | TotalEmployeeCnt |
| Total Volunteers | 18 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $0 | PYContributionsGrantsAmt |
| CY Contributions Grants | $0 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $21,667,058 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $44,442,818 | CYProgramServiceRevenueAmt |
| PY Investment Income | $0 | PYInvestmentIncomeAmt |
| CY Investment Income | $0 | CYInvestmentIncomeAmt |
| PY Other Revenue | $1,302,652 | PYOtherRevenueAmt |
| CY Other Revenue | $1,317,011 | CYOtherRevenueAmt |
| PY Total Revenue | $22,969,710 | PYTotalRevenueAmt |
| CY Total Revenue | $45,759,829 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | 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 | $12,072,452 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $30,005,107 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $10,897,258 | PYOtherExpensesAmt |
| CY Other Expenses | $15,754,722 | CYOtherExpensesAmt |
| PY Total Expenses | $22,969,710 | PYTotalExpensesAmt |
| CY Total Expenses | $45,759,829 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $0 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $0 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $0 | TotalAssetsBOYAmt |
| Total Assets EOY | $0 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $0 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $0 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $0 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $0 | NetAssetsOrFundBalancesEOYAmt |
| Mission | TO IMPROVE THE HEALTH AND WELL-BEING OF THOSE WE SERVE. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $45,759,829 | ExpenseAmt |
| Grant | $0 | GrantAmt |
| Revenue | $45,759,829 | RevenueAmt |
| Desc | AVITA 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 | $45,759,829 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | 0 | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | 0 | 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 | 0 | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | 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 | 0 | OperateHospitalInd |
| 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 | Yes (1) | RelatedOrganizationCtrlEntInd |
| Transaction With Control Ent | Yes (1) | TransactionWithControlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 184 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 268 | 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 | 18 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 18 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | 0 | MembersOrStockholdersInd |
| Election Of Board Members | 0 | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | 0 | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | 0 | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (1) | CompensationProcessOtherInd |
| Investment In Joint Venture | 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 | D ERIC DRAIME | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 4194685501 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 269 PORTLAND WAY SOUTH | AddressLine1Txt |
| City | GALION | CityNm |
| State Abbreviation | OH | StateAbbreviationCd |
| ZIP | 44833 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (26 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 | Key EmployeeKeyEmployeeInd | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|---|
| LINDA CHAMBERS | |||||||||
| SECRETARY | 0.10 | 0.10 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| REX CRAMER | |||||||||
| TREASURER | 0.10 | 0.10 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| JOSEPH SHADEED | |||||||||
| VICE CHAIR | 0.10 | 0.10 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| DOUGLAS SCHILLING | |||||||||
| CHAIR | 0.10 | 0.30 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| JEFFERY A UNDERWOOD | |||||||||
| DIRECTOR | 0.10 | 0.10 | Yes (X) | $0 | $0 | $0 | |||
| LINDA H SMITH | |||||||||
| DIRECTOR | 0.10 | 0.10 | Yes (X) | $0 | $0 | $0 | |||
| DONALD L PLOTTS | |||||||||
| DIRECTOR | 0.10 | 0.10 | Yes (X) | $0 | $0 | $0 | |||
| CHARLES WALKER | |||||||||
| DIRECTOR | 0.10 | 0.10 | Yes (X) | $0 | $0 | $0 | |||
| KYMBERLY FOX | |||||||||
| DIRECTOR | 0.10 | 0.10 | Yes (X) | $0 | $0 | $0 | |||
| PHILLIP BROWN | |||||||||
| DIRECTOR | 0.10 | 0.10 | Yes (X) | $0 | $0 | $0 | |||
| KAY MCDONALD | |||||||||
| DIRECTOR | 0.10 | 0.10 | Yes (X) | $0 | $0 | $0 | |||
| ALAN BASINGER | |||||||||
| DIRECTOR | 0.10 | 0.10 | Yes (X) | $0 | $0 | $0 | |||
| JASON MCMULLEN | |||||||||
| DIRECTOR | 0.10 | 0.10 | Yes (X) | $0 | $0 | $0 | |||
| ERIC GEYER | |||||||||
| DIRECTOR | 0.10 | 0.30 | Yes (X) | $0 | $0 | $0 | |||
| DONALD BARR | |||||||||
| DIRECTOR | 0.10 | 0.10 | Yes (X) | $0 | $0 | $0 | |||
| SHERRI CLEVENGER | |||||||||
| DIRECTOR | 0.10 | 0.10 | Yes (X) | $0 | $0 | $0 | |||
| BOYD EPPERSON | |||||||||
| DIRECTOR | 0.10 | 0.10 | Yes (X) | $0 | $0 | $0 | |||
| MARK SCHNEIDER | |||||||||
| DIRECTOR | 0.10 | 0.10 | Yes (X) | $0 | $0 | $0 | |||
| JERRY MORASKO | |||||||||
| EX-OFFICIO PRESIDENT/CEO | 0.10 | 40.60 | Yes (X) | $430,008 | $0 | $80,366 | |||
| D ERIC DRAIME | |||||||||
| CFO | 0.10 | 40.60 | Yes (X) | $238,303 | $0 | $1,042 | |||
| ANDREW DANIELS | |||||||||
| COO | 0.10 | 40.00 | $214,770 | $0 | $5,800 | Yes (X) | |||
| MYLES CREED | |||||||||
| DIRECTOR OF PHYSICIAN RECRUITMENT | 40.00 | 0.00 | $168,301 | $0 | $6,417 | Yes (X) | |||
| SHIRLEY FITZ | |||||||||
| VP PATIENT CARE | 40.00 | 0.00 | $155,025 | $0 | $2,526 | Yes (X) | |||
| TRACI OSWALD | |||||||||
| VP HUMAN RESOURCES | 40.00 | 0.00 | $155,751 | $0 | $2,568 | Yes (X) | |||
| SHELLIE BURGIN | |||||||||
| VP PHYSICIAN SERVICES | 40.00 | 40.60 | $153,750 | $0 | $2,184 | Yes (X) | |||
| DR JAMES HEDDLESON | |||||||||
| PHYSICIAN | 40.00 | 0.00 | $958,782 | $0 | $2,267 | Yes (X) | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $2,474,690 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $103,170 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 12 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| GALION ANESTHESIA | |||||
| 1105 DEVONWOOD ROAD | MANSFIELD | OH | 44907 | ANESTHESIA | $1,878,452 |
| MID-AMERICAN THERAPY | |||||
| 7652 EAGLE DRIVE | FINDLAY | OH | 45840 | PHYSICAL THERAPY | $1,670,702 |
| HOLLAND SQUARE GROUP | |||||
| 115 PENN WARREN DRIVE | BRENTWOOD | TN | 37027 | TRAINING | $426,357 |
| ALLIANCE HEALTHCARE SERVICES | |||||
| PO BOX 96485 | CHICAGO | IL | 60693 | IMAGING SERVICES | $393,765 |
| CDW GOVERNMENT INC | |||||
| 75 REMITTANCE DRIVE SUITE 1515 | CHICAGO | IL | 60675 | COMPUTER SERVICES | $373,605 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 22 | CntrctRcvdGreaterThan100KCnt |
Program Service Revenue ProgramServiceRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | MANAGEMENT FUNCTION | Desc |
| Business | 561000 | BusinessCd |
| Total Revenue Column | $44,442,818 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $44,442,818 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $44,442,818 | TotalProgramServiceRevenueAmt |
Other Revenue Misc OtherRevenueMiscGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | EHR TECHNOLOGY INCOME | Desc |
| Business | 900099 | BusinessCd |
| Total Revenue Column | $1,317,011 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $1,317,011 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $1,317,011 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $45,759,829 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $45,759,829 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $0 | ExclusionAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $970,288 | TotalAmt |
| Program Services | $970,288 | ProgramServicesAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $12,139,645 | TotalAmt |
| Program Services | $12,139,645 | ProgramServicesAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,544,726 | TotalAmt |
| Program Services | $2,544,726 | ProgramServicesAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $9,677,933 | TotalAmt |
| Program Services | $9,677,933 | ProgramServicesAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,672,515 | TotalAmt |
| Program Services | $4,672,515 | ProgramServicesAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $383,929 | TotalAmt |
| Program Services | $383,929 | ProgramServicesAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $571,143 | TotalAmt |
| Program Services | $571,143 | ProgramServicesAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,878,792 | TotalAmt |
| Program Services | $2,878,792 | ProgramServicesAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $510,186 | TotalAmt |
| Program Services | $510,186 | ProgramServicesAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,646,313 | TotalAmt |
| Program Services | $4,646,313 | ProgramServicesAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,227,845 | TotalAmt |
| Program Services | $3,227,845 | ProgramServicesAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,316,828 | TotalAmt |
| Program Services | $2,316,828 | ProgramServicesAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $97,026 | TotalAmt |
| Program Services | $97,026 | ProgramServicesAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $805,274 | TotalAmt |
| Program Services | $805,274 | ProgramServicesAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $9,522 | TotalAmt |
| Program Services | $9,522 | ProgramServicesAmt |
Other Expenses OtherExpensesGrp (2 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt |
|---|---|---|
| RECRUITMENT | $184,043 | $184,043 |
| MEDICAL SUPPLIES | $123,821 | $123,821 |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $45,759,829 | TotalAmt |
| Program Services | $45,759,829 | ProgramServicesAmt |
| Management And General | $0 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $0 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | $0 | 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) |
|---|---|---|
| Supporting Organization509a3 | Yes (X) | SupportingOrganization509a3Ind |
| Supporting Org Type2 | Yes (X) | SupportingOrgType2Ind |
| Supported Organizations | 1 | SupportedOrganizationsCnt |
Supported Org Information SupportedOrgInformationGrp
Supported Organization Name SupportedOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | GALION COMMUNITY HOSPITAL | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 344451872 | EIN |
| Organization Type | 3 | OrganizationTypeCd |
| Governing Document Listed | Yes (1) | GoverningDocumentListedInd |
| Support | $0 | SupportAmt |
| Other Support | $0 | OtherSupportAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Supported Organizations Total | 1 | SupportedOrganizationsTotalCnt |
| Support Sum | $0 | SupportSumAmt |
| Other Support Sum | $0 | OtherSupportSumAmt |
Form990 Sch A Supporting Org Form990SchASupportingOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Listed By Name Governing Doc | Yes (1) | ListedByNameGoverningDocInd |
| Suprt Org No IRS Determination | 0 | SuprtOrgNoIRSDeterminationInd |
| Supported Org Section C456 | 0 | SupportedOrgSectionC456Ind |
| Supported Org Not Organized US | 0 | SupportedOrgNotOrganizedUSInd |
| Organization Change Suprt Org | 0 | OrganizationChangeSuprtOrgInd |
| Support Non Supported Org | 0 | SupportNonSupportedOrgInd |
| Payment Substantial Contribtr | 0 | PaymentSubstantialContribtrInd |
| Loan Disqualified Person | 0 | LoanDisqualifiedPersonInd |
| Controlled Disqualified Prsn | 0 | ControlledDisqualifiedPrsnInd |
| Disqualified Prsn Controll Int | 0 | DisqualifiedPrsnControllIntInd |
| Disqualified Prsn Ownr Int | 0 | DisqualifiedPrsnOwnrIntInd |
| Excess Business Holdings Rules | 0 | ExcessBusinessHoldingsRulesInd |
| Contribution Controller | 0 | ContributionControllerInd |
| Contribution Family | 0 | ContributionFamilyInd |
| Contribution35 Controlled | 0 | Contribution35ControlledInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Majority Dir Trst Supported Org | Yes (1) | MajorityDirTrstSupportedOrgInd |
Form990 Schedule A Part VI Form990ScheduleAPartVIGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART IV: | FormAndLineReferenceDesc |
| Explanation | AVITA 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
| 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 |
| Compensation Committee | Yes (X) | CompensationCommitteeInd |
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | Yes (1) | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (8 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| JERRY MORASKO | ||||||||||||||
| EX-OFFICIO PRESIDENT/CEO | $398,708 | $0 | $30,000 | $0 | $1,300 | $0 | $80,000 | $0 | $366 | $0 | $510,374 | $0 | $0 | $0 |
| D ERIC DRAIME | ||||||||||||||
| CFO | $207,701 | $0 | $30,602 | $0 | $0 | $0 | $0 | $0 | $1,042 | $0 | $239,345 | $0 | $0 | $0 |
| ANDREW DANIELS | ||||||||||||||
| COO | $185,393 | $0 | $26,777 | $0 | $2,600 | $0 | $0 | $0 | $5,800 | $0 | $220,570 | $0 | $0 | $0 |
| MYLES CREED | ||||||||||||||
| DIRECTOR OF PHYSICIAN RECRUITMENT | $113,401 | $0 | $54,900 | $0 | $0 | $0 | $0 | $0 | $6,417 | $0 | $174,718 | $0 | $0 | $0 |
| SHIRLEY FITZ | ||||||||||||||
| VP PATIENT CARE | $135,363 | $0 | $18,362 | $0 | $1,300 | $0 | $0 | $0 | $2,526 | $0 | $157,551 | $0 | $0 | $0 |
| TRACI OSWALD | ||||||||||||||
| VP HUMAN RESOURCES | $134,039 | $0 | $20,412 | $0 | $1,300 | $0 | $0 | $0 | $2,568 | $0 | $158,319 | $0 | $0 | $0 |
| SHELLIE BURGIN | ||||||||||||||
| VP PHYSICIAN SERVICES | $133,324 | $0 | $19,126 | $0 | $1,300 | $0 | $0 | $0 | $2,184 | $0 | $155,934 | $0 | $0 | $0 |
| DR JAMES HEDDLESON | ||||||||||||||
| PHYSICIAN | $400,005 | $0 | $558,777 | $0 | $0 | $0 | $0 | $0 | $2,267 | $0 | $961,049 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 1A | A MEMBERSHIP AT THE LOCAL COUNTRY CLUB IS PAID FOR THE CEO, JERRY MORASKO. THIS BENEFIT HAS NOT BEEN TREATED AS TAXABLE COMPENSATION. |
| PART I, LINE 4B | 457(F)- SUBJECT TO SUBSTANTIAL RISK OF FORFEITURE JERRY MORASKO- $80,000 |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (7 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 8B | THE ORGANIZATION DOES NOT HAVE SUB-COMMITTEES WITH THE AUTHORITY TO ACT ON BEHALF OF THE GOVERNING BODY. |
| FORM 990, PART VI, SECTION B, LINE 11 | THE 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 12C | THE 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 15 | THE 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 JUNE OF 2015 FOR 2016 COMPENSATION. |
| FORM 990, PART VI, SECTION C, LINE 19 | NO 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 2C | THE 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 IX | AVITA 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/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 |
|---|---|---|---|---|---|---|---|---|---|---|
| GALION COMMUNITY HOSPITAL | ||||||||||
| 269 PORTLAND WAY SOUTH | GALION | OH | 44833 | 344451872 | HOSPITAL SERVICES | OH | 501 (C)(3) | LINE 3 | AVITA HEALTH SYSTEM | Yes (1) |
| COMMUNITY HEALTH ASSOCIATES INC | ||||||||||
| 955 BUCYRUS ROAD | GALION | OH | 44833 | 341784017 | PHYSICIAN OFFICE | OH | 501 (C)(3) | LINE 11A, I | GALION COMMUNITY HOSPITAL | Yes (1) |
| NORTH CENTRAL OHIO FAMILY CARE CENTER INC | ||||||||||
| 269 PORTLAND WAY SOUTH | GALION | OH | 44833 | 341807906 | PHYSICIAN OFFICE | OH | 501 (C)(3) | LINE 11A, I | GALION COMMUNITY HOSPITAL | Yes (1) |
| AVITA HEALTH FOUNDATION | ||||||||||
| 269 PORTLAND WAY SOUTH | GALION | OH | 44833 | 200934451 | FOUNDATION | OH | 501 (C)(3) | LINE 7 | GALION COMMUNITY HOSPITAL | Yes (1) |
| CRAWFORD COUNTY SHARED HEALTH SERVICES INC | ||||||||||
| 1220 NORTH MARKET STREET | GALION | OH | 44833 | 341484014 | HOME HEALTH & HOSPICE | OH | 501 (C)(3) | LINE 9 | GALION COMMUNITY HOSPITAL | Yes (1) |
Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp (3 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Direct Controlling NADirectControllingNACd |
|---|---|---|---|---|---|---|---|
| GALION COMMUNITY PAIN MANAGEMENT LLC | |||||||
| 269 PORTLAND WAY SOUTH | GALION | OH | 44833 | 300602607 | HOSPITAL SUPPORT | OH | N/A |
| GALION COMMUNITY VASCULAR SERVICES LLC | |||||||
| 269 PORTLAND WAY SOUTH | GALION | OH | 44833 | 611613817 | HOSPITAL SUPPORT | OH | N/A |
| AMERICAN SURGICAL SPINE SERVICES | |||||||
| 629 N SANDUSKY AVE | BUCYRUS | OH | 44820 | 371786727 | HOSPITAL SUPPORT | OH | N/A |
| 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 | Yes (1) | 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 | 0 | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | Yes (1) | TransferToOtherOrgInd |
| Transfer From Other Org | Yes (1) | TransferFromOtherOrgInd |
Transactions Related Org TransactionsRelatedOrgGrp (3 entries)
| Transaction TypeTransactionTypeTxt | InvolvedInvolvedAmt | Method Of Amount DeterminationMethodOfAmountDeterminationTxt |
|---|---|---|
| GALION COMMUNITY HOSPITAL | ||
| L | $44,442,818 | MANAGEMENT FEE |
| GALION COMMUNITY HOSPITAL | ||
| S | $21,910,423 | FORGIVENESS OF PAYABLE |
| GALION COMMUNITY HOSPITAL | ||
| R | $733,770 | FORGIVENESS OF PAYABLE |