2017-11-15T11:17:59-06:00 2016-12-31 351178661 Blue & Co LLC 8800 Lyra Drive Suite 450 Columbus OH 43240 990 2016-01-01 340714583 City Hospital Association CITY 3303857200 425 West Fifth Street East Liverpool OH 43920 Keith Richardson CEO 3303857200 2017-11-15 1 Matthew Dasta P00544683 6148852583 2017-11-15 38.109.186.2 2017-11-15 08:42:09 ES P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 76812853BD8C8AE160B802A05CEAE75CC7CF0997 2016 2021-01-29 14:40:06Z east liverpool city hospital Keith Richardson 425 West Fifth Street East Liverpool OH 43920 95346653 0 X WWW.ELCH.ORG X 1905 OH THE ORGANIZATION IS ORGANIZED AND OPERATED TO PROVIDE THE PEOPLE OF THE TRI-STATE AREA HIGH QUALITY HEALTH CARE SERVICES, REGARDLESS OF THE PERSON'S ABILITY TO PAY. THESE SERVICES INCLUDE THE PREVENTION OF ILLNESS, RELIEF OF SUFFERING, HEALTH RESTORATION, AND HEALTH CARE EDUCATION. 10 10 575 17 0 0 0 0 51105500 76234832 884368 450393 2497003 18661428 54486871 95346653 25994 0 0 0 26726704 27676390 0 0 0 40054704 37463607 66807402 65139997 -12320531 30206656 68944950 34457288 36584683 4250632 32360267 30206656 X We will provide high quality, compassionate health care services within the available resources. Healthcare services will be provided to prevent illness, relieve suffering, aid in health restoration and to promote wellness. we will provide services to any person, without discrimination. 0 0 52073937 76547947 CITY HOSPITAL ASSOCIATION DBA EAST LIVERPOOL CITY HOSPITAL PROVIDES QUALITY MEDICAL HEALTHCARE REGARDLESS OF RACE, CREED, SEX, NATIONAL ORIGIN, HANDICAP, AGE, OR ABILITY TO PAY. ALTHOUGH REIMBURSEMENT FOR SERVICES RENDERED IS CRITICAL TO THE OPERATION AND STABILITY OF THE HOSPITAL, IT IS RECOGNIZED THAT NOT ALL INDIVIDUALS POSSESS THE ABILITY TO AFFORD ESSENTIAL MEDICAL SERVICES AND HEALTHCARE EDUCATION. THEREFORE, IN KEEPING WITH THE HOSPITAL'S COMMITMENT TO SERVE ALL MEMBERS OF OUR COMMUNITY WITH FREE CARE AND OR SUBSIDIZED CARE, CARE PROVIDED TO PERSONS COVERED BY GOVERNMENTAL PROGRAMS BELOW COSTS, AND HEALTH ACTIVITIES AND PROGRAMS TO SUPPORT THE COMMUNITY HAVE BEEN CONSIDERED WHERE THE NEED AND AN INDIVIDUAL'S INABILITY TO PAY EXIST. THESE ACTIVITIES INCLUDE WELLNESS PROGRAMS, COMMUNITY EDUCATION PROGRAMS, AND A VARIETY OF BROAD COMMUNITY SUPPORT ACTIVITIES. THE HOSPITAL PROVIDES CARE TO PERSONS COVERED BY GOVERNMENTAL PROGRAMS BELOW COST. RECOGNIZING ITS MISSION TO THE COMMUNITY, SERVICES ARE PROVIDED TO BOTH MEDICARE AND MEDICAID PATIENTS. TO THE EXTENT REIMBURSEMENT IS BELOW COST, THE HOSPITAL CONSIDERS THESE AMOUNTS AS UNCOMPENSATED CARE IN MEETING ITS MISSION TO THE ENTIRE COMMUNITY. THE HOSPITAL IS LOCATED IN EAST LIVERPOOL, OHIO AND SERVICES THE SURROUNDING COMMUNITIES; STAFFING 158 BEDS FOR ACUTE CARE, INTENSIVE CARE, NURSERY, AND SKILLED NURSING IN THIS MEDICALLY UNDERSERVED AREA.DURING 2016, THE HOSPITAL PROVIDED NUMEROUS BENEFITS TO THE SURROUNDING COMMUNITY, INCLUDING FINANCIAL SUPPORT THROUGH THE COMMUNITY BENEFIT INITIATIVE PROGRAM.COMMUNITY EDUCATION AND WELLNESS PROGRAMS - THE HOSPITAL OFFERED THE FOLLOWING TO THE COMMUNITY FREE OR AT A NOMINAL CHARGE:HEALTH FAIRSCPR CLASSESCHILDBIRTH CLASSESGARFIELD ELEMENTARY WELLNESS PROGRAMCOVER THE UNINSURED PROGRAMHEARTSAVER FIRST AID CLASSESADVANCE CARDIAC LIFE SUPPORTHEALTHCARE PROVIDE RECERTIFICATIONBREAST FEEDING SUPPORTPASTORAL OUTREACH PROGRAMSDIABETES EDUCATIONARTHRITIS AQUATICS CLASSESSMOKING CESSATION CLASSESBASICS IN BABYSITTING CLASSESAUTISM SUPPORT GROUPCONDUCTED HOSPITAL TOURS FOR AREA SCHOOLS AND COMMUNITY GROUPS. SERVED AS AN OBSERVATION SITE FOR THE HIGH SCHOOL FOR HEALTH PROFESSIONS DEVELOPED BY THE PUBLIC SCHOOLS. HOSTED SEVERAL SHADOW STUDENTS FROM AREA SCHOOLS. SERVED AS HOST SITE FOR OHIO HIGHER EDUCATION TELECOMMUNICATION SYSTEM.OPERATED A PHYSICIAN REFERRAL LINE FREE TO THE COMMUNITY.HOSTED PROGRAMS FOR STUDENT NURSES AND RADIOLOGY TECHNICIANS IN TRAINING.SALVATION ARMY: PROVIDED FOOD TO NEEDY FAMILIES FOR THANKSGIVING, AND GIFTS TO NEEDY CHILDREN FOR CHRISTMAS.DAY OF CARING, DAY OF GIVING PROGRAM - MONEY AND FOOD DRIVE. 52073937 1 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 111 0 1 575 0 0 0 0 0 0 0 0 0 0 0 X 10 10 0 0 0 0 0 0 0 1 1 0 0 0 1 1 1 1 1 1 1 0 OH X Melissa Bracone 3303862633 425 W FIFTH STREET EAST LIVERPOOL OH 43920 Keith Richardson CEO/Secrerary 40.00 X X 253327 0 0 JOSEPH LUDOVICI Trustee 1.00 X X 0 0 0 Pete Wicks Secretary/Treasurer 1.00 X X 0 0 0 Rob O'Hara Trustee 1.00 X 0 0 0 Tammie Mcintosh Vice Chairman 1.00 X X 0 0 0 Joseph Shemasek Chairman 1.00 X X 0 0 0 David Hamilton Treasurer 1.00 X X 0 0 0 Gretchen Nickell DO Trustee 1.00 X 0 0 0 Mark Mangano Trustee 1.00 X 0 0 0 Jay B Votaw DVM Trustee 1.00 X 0 0 0 Jayne Rose CNO 40.00 X 139173 0 0 Todd Morando Director ED 40.00 X 116855 0 0 Frank Mader Director IT 40.00 X 108687 0 0 618042 0 0 4 0 1 0 CARDINAL HEALTH 21377 network pl chicago IL 60673 pharmacy services 2487710 psychiatric resource partners 6100 tower circle drive ste 1000 franlkin TN 37067 behavioral health professional fees 1007627 OHIO VALLEY ANESTHIETISTIS LLC 425 W 5th STREET EAST LIVERPOOL OH 43920 HEALTH CARE PROFESSIONALS 941417 Laboratory Corporation of America 2525 East Royalton Rd Broadview Heights OH 44147 Lab Testing Services 545096 Eagle Hospital Physicians 1 McBride Son Center Drive Suite St Louis MO 63005 Hospitalists Management and Billing Serv 459301 26 NET PATIENT REVENUE 900099 76234832 76234832 76234832 450393 450393 Goodwill Bargain Gain 900099 18239623 18239623 Other Non-Operating Revenue 900099 284920 284920 CAFETERIA INCOME 900099 108690 108690 28195 28195 18661428 95346653 76547947 0 18798706 X 19827731 11896639 7931092 110900 110900 6364881 6364881 1372878 1002201 370677 4170417 2502250 1668167 90 90 29558 29558 10125206 9356213 768993 161468 161468 1430908 858545 572363 74624 44774 29850 141490 141490 618579 618579 2987101 2987101 1409771 1409771 SUPPLIES 7084073 6375666 708407 BAD DEBTS 6727877 6727877 Repairs and Maintenance 1667340 1000404 666936 miscellaneous 691795 553436 138359 143310 123210 20100 65139997 52073937 13066060 0 411281 12540247 8066220 10071657 38804 409414 511848 316257 10415197 2892990 23805586 7522207 34441356 2151617 1445889 1669855 0 68944950 34457288 8235437 775961 26015364 1325581 1008301 3474671 36584683 4250632 X 32218093 30206656 83736 0 58438 0 32360267 30206656 68944950 34457288 X 30206656 -32360267 X X 0 1 X 1 0 X 994627 994627 5309031 825000 4484031 253305 66667 186638 3858234 2001323 1856911 7522207 Notes Under Revolving Credit 2769511 Capital Leases 915119 Related Party Payables -209959 3474671 1 1 1 X 1 X 1 1 0 0 525633 525633 0.00810 18114323 14938477 3175846 0.04880 18639956 14938477 3701479 0.05690 2399148 935448 1463700 0.02250 2399148 935448 1463700 0.02250 21039104 15873925 5165179 0.07940 0 6727877 20341307 15082943 5258364 X 1 1 2 1 elch rehab 15655 st rte 170 east liverpool OH 43920 pt, ot, speech services 2 elch 5th street east liverpool OH 43920 X X dsh EAST LIVERPOOL CITY HOSPITAL 1 0 0 1 X X X X X X X X X 16 1 1 0 1 X HTTP://WWW.ELCH.ORG/COMMUNITYHEALTH/ X 1 16 1 HTTP://WWW.ELCH.ORG/COMMUNITYHEALTH/ 0 1 X 100.000000000000 100.000000000000 X X 1 1 1 X HTTP://WWW.ELCH.ORG/PATIENTS-VISITORS/INSURANCE-FINANCIAL-INFO/FINANCIAL-AI X 1 X 1 X X X X 1 0 1 EAST LIVERPOOL CITY HOSPITAL Part V, Section B, Line 6a: Salem Regional Medical Center EAST LIVERPOOL CITY HOSPITAL Part V, Section B, Line 24: All Patients are billed the same gross charge. Discounts are applied at the time of payment. Part II, Community Building Activities: Ongoing efforts and evaluation of management, staff, physicians with feedback from patients and community. Demographic research and studies also utilized to determine type and quantity of services needed by specialty to best serve our community. Part III, Line 2: Although not described in the footnotes to the hospital'S financial statements, the practice of the hospital is to record bad debt expense at the unpaid balances after contractual discounts for patient'S with insurance and at the full or discounted charge level for those who do not have insurance. The hospital negotiates with payers to come up with a fair discounted rate to be paid for services rendered. These discounts are not recorded as bad debt expenses. Similarly for patients without any insurance, the hospital offers several different discount programs, based upon financial need, to these patients and once again these discounts are not recorded as bad debts. For patients who do not meet or do not follow-through to demonstrate financial hardship, the hospital does expect to be reimbursed at our full charge level. All of the remaining balances that are not paid are recorded as bad debts.The hospital has costed the bad debt expense in line 2 of this section at the full unpaid contracted rate for patients with insurance as this represents the "CONTRACTED COST" for the service and thus not applicable to an overall cost-to-charge ration. For patients with no insurance, the costs on line 2 represent the full charge levels multiplied by the overall cost-to-charge ratio from the audited financial statements.The criteria the hospital uses for distinguishing between charity care and bad debt is that in order for a patient to qualify as charity care, they must share their financial information and show that they fall within the federal poverty guidelines. Thus the hospital believes that 23% of the figure recorded as bad debt expense on line 2 would qualify for charity care if the patients had shared their financial information. This percentage was derived from demographic studies of the community for families falling below the federal poverty guidelines in our market area. Thus this amount should be included in the total community benefit provided by the hospital. Part III, Line 4: Although not described in the footnotes to the hospital'S financial statements, the practice of the hospital is to record bad debt expense at the unpaid balances after contractual discounts for patient'S with insurance and at the full or discounted charge level for those who do not have insurance. The hospital negotiates with payers to come up with a fair discounted rate to be paid for services rendered. These discounts are not recorded as bad debt expenses. Similarly for patients without any insurance, the hospital offers several different discount programs, based upon financial need, to these patients and once again these discounts are not recorded as bad debts. For patients who do not meet or do not follow-through to demonstrate financial hardship, the hospital does expect to be reimbursed at our full charge level. All of the remaining balances that are not paid are recorded as bad debts.The hospital has costed the bad debt expense in line 2 of this section at the full unpaid contracted rate for patients with insurance as this represents the "CONTRACTED COST" for the service and thus not applicable to an overall cost-to-charge ration. For patients with no insurance, the costs on line 2 represent the full charge levels multiplied by the overall cost-to-charge ratio from the audited financial statements.The criteria the hospital uses for distinguishing between charity care and bad debt is that in order for a patient to qualify as charity care, they must share their financial information and show that they fall within the federal poverty guidelines. Thus the hospital believes that 23% of the figure recorded as bad debt expense on line 2 would qualify for charity care if the patients had shared their financial information. This percentage was derived from demographic studies of the community for families falling below the federal poverty guidelines in our market area. Thus this amount should be included in the total community benefit provided by the hospital. Part III, Line 8: The hospital contends that the entire amount of the Medicare surplus should also be considered as a community benefit. The reason for this is that the Medicare rates are set unilaterally by the federal government and the hospital agrees to service these patients at these rates as part of our mission and service to the community.The cost included on line 6 comes from the Medicare cost report which the federal government has set up as their way to capture and segregate the costs of services provided to Medicare patients. Part III, Line 9b: the hospital practice is that upon verification that a patient qualifies for charity or financial assistance, the hospital discontinues collection efforts and makes the appropriate adjustment to the patient's account based upon the patient's individual circumstances. Part VI, Line 2: ONGOING EFFORTS AND EVALUATION OF MANAGEMENT, STAFF, PHYSICIANS WITH FEEDBACK FROM PATIENTS AND COMMUNITY. DEMOGRAPHIC RESEARCH AND STUDIES ALSO UTILIZED TO DETERMINE TYPE AND QUANTITY OF SERVICES NEEDED BY SPECIALTY TO BEST SERVE OUR COMMUNITY. Part VI, Line 3: Information regarding financial assistance and charity care is made available at time of registration, on the hospital's website, and on patient statements. Applications are also made available to patients at time of registration if appropriate. Part VI, Line 4: East Liverpool City Hospital is the only hospital within 20 miles of the city. The hospital serves patients within a 10-15 mile radius including patients from neighboring Pennsylvania and West Virginia. Most residents have lived here all their lives and the community served is comprised of a significant bias of senior citizens. Part VI, Line 5: East Liverpool City Hospital has an open medical staff, a community board of trustees and is extremely generous with funding community charities and donating employee time to serve the general population of the area served. Part VI, Line 6: not applicable Disclosure pursuant to Revenue Procedure 2015-21: Professional advisors to Prime Healthcare Foundation, Inc., the indirect sole member of the hospital, recently identified that the existing financial assistance policy ("FAP") did not contain every provision required under Treasury Regulations Section 1.501(r)-4 (e.g., excluded providers list) and may not have been consistently available on the hospital's website. These issues were identified by auditors on July 21, 2017 and by legal counsel on August 4, 2017. Efforts have been underway since then to prepare a revised systemwide FAP that meets the requirements of the final regulations as well as applicable state laws for the various hospitals across the Foundation health system. This revised FAP will be presented shortly for review and approval by the governing body at the earliest opportunity and will be translated into languages spoken by significant hospital populations. The revised FAP will be widely publicized, including on the hospital's website, in paper form by mail and in key hospital areas such as admissions and emergency room, through inclusion of information in billing statements, and conspicuous signage at the facility. It was also brought to the attention of management that the FAP, Plain Language Summary, and application form have inadvertently not been consistently posted on the hospital's website. The dates during which this problem existed are not clear. As of November 15, 2017, this has been corrected and the FAP is posted on the hospital's website. Safeguards have been put in place to communicate with responsible personnel and highlight the importance of web access, and the newly-revised FAP will contain an explicit procedural requirement that the policy be posted on the hospital's website. Despite these inadvertent failures, the hospital has consistently had a financial assistance program in effect that is consistent with the intent of Code Section 501(r) and has publicized the availability of charity care and discounted care through a written summary notice provided to all patients (including in languages spoken by significant hospital populations), conspicuous notices posted in the emergency department and admissions office, and notices (including translations) included in billing statements to patients who have not provided proof of insurance. Therefore the hospital does not believe there have been qualifying individuals who were unaware of the program. X X 1 1 X X X 0 0 0 0 0 0 0 0 0 Keith Richardson CEO/Secrerary 253327 0 0 0 0 0 0 0 0 0 253327 0 0 0 Part I, Line 1a city hospital association allows companion travel by executives only when it serves a justified business purpose. if it is later determined that there was not a justified business purpose, this will result in taxable compensation to the executive in question. city hospital provides a membership to an area social club in order for executives to conduct hospital business. any personal use by the executives in included in that executive's taxable wages. Form 990, Part VI, Section B, line 11b information was compiled by the finance department and reviewed by a third party cpa firm. a formal board review did not occur this year due to time constraints. Form 990, Part VI, Section B, line 12c all duality of interest or possible conflict of interest, on the part of any members of the board of trustees, on any issue, should be disclosed to the other members of the board of trustees and made a matter of record. any member of the board of trustees having a duality of interest or possible conflict of interest, on any matter should not vote or use his/her personal influence on the matter. the minutes of the meeting should reflect that a disclosure was made and the abstention from voting. Form 990, Part VI, Section B, line 15 For the CEO, Executive Director or top management: established by board personnel compensation committee and reviewed and approved by the entire board in executive session. For other officers or key employees: submitted and reviewed by board chairman and then presented by board executive committee for review and approval. the last review was completed in november, 2012. Form 990, Part VI, Section C, line 19 the documents are available upon request Form 990, Part IX, line 11g collections: Program service expenses 204,931. Management and general expenses 0. Fundraising expenses 0. Total expenses 204,931. PURCHASED SERVICES: Program service expenses 1,153,489. Management and general expenses 768,993. Fundraising expenses 0. Total expenses 1,922,482. Other Fees: Program service expenses 7,997,793. Management and general expenses 0. Fundraising expenses 0. Total expenses 7,997,793. Form 990, Part XI, line 9: change in restricted net assets due to Reorganization -32,360,267. transfer to affiliates Form 990, Part XII, Line 2c: The process has not changed from the previous year. River Valley Physicians LLC 425 w fifth east liverpool OH 43920 203986815 Healthcare OH 501(c)(3) Line 3 Prime Healthcare Foundation 0 ohio valley home health services 15679 st rte 170 east liverpool OH 43920 341014198 HOME HEALTH SERVICES OH 501(c)(3) Line 10 Prime Healthcare Foundation 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0