2017-08-07T08:37:52-05:00 2016-12-31 341310124 Rea & Associates Inc 941 Steubenville Ave PO Box 820 Cambridge OH 437250820 990 2016-01-01 341785051 WOOSTER COMMUNITY HOSPITAL FOUNDATION WOOS 3302638148 1761 BEALL AVENUE WOOSTER OH 446912342 TREVA CROSKEY SECRETARY/TREASURER 3302629370 2017-08-01 1 Mary Elizabeth Wright CPA P00099212 7404325658 98.102.154.154 2017-08-01 14:09:23 ED P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 A246232A50E7632ACBDE6C1EF51160067AC710CA 2016 2021-01-29 14:40:06Z WILLIAM SHERON 1761 BEALL AVENUE WOOSTER OH 446912342 16297305 0 X N/A X 1994 OH TO PROVIDE PROGRAMS AND SERVICES IN SUPPORT OF THE OPERATIONS OF WOOSTER COMMUNITY HOSPITAL IN A MANNER THAT PROMOTES THE PUBLIC PURPOSES OF IMPROVING THE DELIVERY OF HEALTHCARE AND WELLNESS SERVICES TO ALL PEOPLE WITHIN THE CITY OF WOOSTER AND SURROUNDING COMMUNITIES. 7 7 147 7 0 0 6259750 7519198 9002565 8659372 618 1005 30963 117730 15293896 16297305 0 0 0 0 9422642 9651018 0 0 0 5499668 6579955 14922310 16230973 371586 66332 3684126 4073019 1605736 1928297 2078390 2144722 TO PROVIDE PROGRAMS AND SERVICES IN SUPPORT OF THE OPERATIONS OF WOOSTER COMMUNITY HOSPITAL IN A MANNER THAT PROMOTES THE PUBLIC PURPOSES OF IMPROVING THE DELIVERY OF HEALTHCARE AND WELLNESS SERVICES TO ALL PEOPLE WITHIN THE CITY OF WOOSTER AND SURROUNDING COMMUNITIES. 0 0 1776018 7519198 THE RECRUITMENT AND RETENTION OF PHYSICIANS, PHYSICIAN ASSISTANTS AND CERTIFIED NURSE PRACTITIONERS. 13592932 8777102 THE PROVISION OF MEDICAL SERVICES TO THE PUBLIC THROUGH THE OPERATION OF BLOOMINGTON MEDICAL SERVICES, LLC. 210000 THE PROVISION OF COMMUNITY HEALTH SUPPORT. 15578950 1 1 0 0 0 0 0 0 0 1 1 0 1 1 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 0 1 36 0 1 147 1 0 0 0 0 0 0 0 0 0 0 X 7 7 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 OH X TREVA CROSKEY 3302638148 1761 BEALL AVENUE WOOSTER OH 44691 THOMAS CAPEK VICE PRESIDENT 1.00 X X 0 0 0 TREVA CROSKEY SECRETARY/TREASURER 1.00 X X 0 0 0 THOMAS ICEMAN PRESIDENT 1.00 X X 0 0 0 JERRY PACKARD TRUSTEE 1.00 X 0 0 0 JOAN KIPER CHAIRMAN 1.00 X 0 0 0 MARY ALICE STREETER TRUSTEE 1.00 X 0 0 0 DAN WAKEFIELD TRUSTEE 1.00 X 0 0 0 WILLIAM SHERON CEO 40.00 X 0 402114 126653 SCOTT BOYES CFO 40.00 X 0 304461 54927 CYRIL OFORI ASSOCIATE 40.00 X 773788 0 86649 GHASEM ASHELFAH ASSOCIATE 40.00 X 367532 0 16765 PAUL MOODISPAW ASSOCIATE 40.00 X 728470 0 93837 DANIEL NEWTON ASSOCIATE 40.00 X 554509 0 35418 BRUCE ARTHUR ASSOCIATE 40.00 X 481371 0 30323 MARK TERELETSKY ASSOCIATE 40.00 X 355299 0 13475 3260969 706575 458047 17 0 1 0 OSU SPECIALTY CARE NETWORK 660 ACKERMAN RD COLUMBUS OH 432183104 MEDICAL SERVICES 2430563 DAVID AKWAINHA KITTOE DBA DAVEN MED 3487 EAST GALLOWAY DRIVE RICHFIELD OH 44286 MEDICAL SERVICES 338516 HEALTH CAROUSEL LLC PO BOX 714309 CINCINNATI OH 452714309 MEDICAL SERVICES 204640 PRAKASH CHAND MD INC 125 EAST BROAD ST SUITE 122 ELYRIA OH 44035 MEDICAL SERVICES 122380 AUTUMN WHITE 2251 FRIAR TUCK CIRCLE WOOSTER OH 446912023 MEDICAL SERVICES 104572 5 7411250 107948 7519198 PATIENT REVENUE 621110 8659372 8659372 8659372 1005 1005 REPAYMENT 900099 117730 117730 117730 16297305 8777102 0 1005 X 860437 860437 7579790 7579790 1210791 1210791 7668 7668 1885 1885 3300835 3300835 328181 328181 72003 72003 347787 347787 PHYSICIAN ADVANCES AND 1776018 1776018 COMMUNITY SUPPORT 210000 210000 SUPPLIES 201083 201083 REPAIRS AND MAINTENANCE 113206 113206 221289 221289 16230973 15578950 652023 0 1374061 1485025 827040 1106709 657266 553287 162409 135435 895547 707467 186814 188080 11048 11048 210058 210058 255430 383377 3684126 4073019 1605736 1928297 1605736 1928297 X 2078390 2144722 2078390 2144722 3684126 4073019 66332 0 X X 0 1 X 1 0 X 5502056 5524931 6210688 6259750 7519198 31016623 5502056 5524931 6210688 6259750 7519198 31016623 31016623 632 1044 212 618 1005 3511 55849 8543 750 30963 117730 213835 31233969 39875558 0.99300 0.99650 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 10048 10048 10000 350 -202 100 10048 10000 10000 1.00000 1 0 895547 707467 188080 188080 INVESTMENT IN ELINCX 210058 F 210058 457 (F) CONTRIBUTIONS 383377 383377 X Part V, Line 4: THE ENDOWMENT FUNDS WERE ESTABLISHED TO GROW FOR THE PURPOSE OF PROVIDING FINANCIAL RESOURCES FOR THE FOUNDATION IN THE FUTURE. Part X, Line 2: FEDERAL INCOME TAX: THE ORGANIZATION IS TAX EXEMPT UNDER SECTION 501 (C)(3) OF THE INTERNAL REVENUE CODE. WITH FEW EXCEPTIONS THE ORGANIZATION IS NO LONGER SUBJECT TO INCOME TAX EXAMINATIONS BY THE U.S. FEDERAL, STATE, OR LOCAL AUTHORITIES FOR THE YEARS BEFORE 2013. X X 0 1 0 1 0 0 0 0 0 WILLIAM SHERON CEO 0 402114 0 0 0 0 0 0 0 126653 0 528767 0 0 SCOTT BOYES CFO 0 304461 0 0 0 0 0 37100 0 17827 0 359388 0 0 CYRIL OFORI ASSOCIATE 773788 0 0 0 0 0 58599 0 28050 0 860437 0 0 0 GHASEM ASHELFAH ASSOCIATE 367532 0 0 0 0 0 0 0 16765 0 384297 0 0 0 PAUL MOODISPAW ASSOCIATE 728470 0 0 0 0 0 57532 0 36305 0 822307 0 0 0 DANIEL NEWTON ASSOCIATE 554509 0 0 0 0 0 10600 0 24818 0 589927 0 0 0 BRUCE ARTHUR ASSOCIATE 481371 0 0 0 0 0 10600 0 19723 0 511694 0 0 0 MARK TERELETSKY ASSOCIATE 355299 0 0 0 0 0 0 0 13475 0 368774 0 0 0 Part I, Line 4b THE FOLLOWING EMPLOYEES WERE COVERED UNDER A 457(F) PLAN: CYRIL OFORI $ 47,999 PAUL MOODISPAW $ 46,931 JAMES SLABY $ 13,950 Part I, Line 5 BASED ON PHYSICIAN RVU'S ABOVE A PREDETERMINED LEVEL. Form 990, Part VI, Section B, line 11b THE COMPLETED RETURN IS PRESENTED TO THE BOARD. THE BOARD REVIEWS THE RETURN, ADDRESSES ANY QUESTIONS, AND PROPOSES NECESSARY REVISIONS PRIOR TO FILING. Form 990, Part VI, Section B, line 12c EMPLOYEES MUST SIGN ANNUAL DISCLOSURE STATEMENTS, DISCLOSING ANY POTENTIAL CONFLICTS OF INTEREST. DUE TO THE SMALL SIZE OF THE COMMUNITY, THE FOUNDATION'S MANAGEMENT WOULD LIKELY BECOME AWARE OF ANY CONFLICTS OF INTEREST UPON THEIR CREATION. Form 990, Part VI, Section B, line 15 COMPENSATION FOR SENIOR MANAGEMENT IS BASED ON OHA COMPARABILITY DATA. COMPENSATION FOR THE ORGANIZATION'S CEO IS DETERMINED BY THE HOSPITAL BOARD. Form 990, Part VI, Section C, line 19 THE FOUNDATION MAINTAINS PERTINENT PUBLIC RECORDS AND RELEASES THEM TO THE PUBLIC UPON REQUEST. Form 990, Part IX, line 11g MEDICAL SERVICE PROVIDERS: Program service expenses 3,300,835. Management and general expenses 0. Fundraising expenses 0. Total expenses 3,300,835. 990, PART XI LINE 2C A COMMITTEE ASSUMES RESPONSIBILITY OF THE OVERSIGHT OF THE AUDIT AND THE INDEPENDENT ACCOUNTANT. THIS PROCESS HAS NOT CHANGED FROM PRIOR YEARS BLOOMINGTON MEDICAL SERVICES LLC 1761 BEALL AVENUE WOOSTER OH 44691 261803679 PROVIDING MEDICAL SERVICES OH 8659372 2742739 N/A WOOSTER COMMUNITY HOSPITAL 1761 BEALL AVENUE WOOSTER OH 44691 346003129 TO OPERATE A HOSPITAL IN ORDER TO PROVIDE MEDICAL SERVICES TO THE COMMUNITY OH GOVERMENTAL ENTITY N/A 0 ELINCX 1761 BEALL AVENUE WOOSTER OH 44691 273235984 TO OPERATE A REGIONAL HEALTH INFORMATION ORGANIZATION OH 501(C)(3) 509(A)(2) WOOSTER COMMUNITY HOSPITAL FOUNDATION 1 WAYNE NETWORK 1761 BEALL AVENUE WOOSTER OH 44691 270014500 PROVIDE HEALTHCARE UTILIZATION AND CARE COORDINATION SERVICES TO EMPLOYERS OH N/A C 2657 136284 1.00000 0 0 0 1 0 0 0 0 0 0 0 1 1 1 0 1 1 0 0 0 WOOSTER COMMUNITY HOSPITAL C 7411250 ACTUAL WOOSTER COMMUNITY HOSPITAL K 250771 ACTUAL wOOSTER COMMUNITY HOSPITAL O 2584103 ACTUAL woOSTER COMMUNITY HOSPITAL P 472360 ACTUAL WOOSTER COMMUNITY HOSPITAL M 258500 ACTUAL