OHIOHEALTH CORPORATION: Form 990, tax year 2016
View the entire original 990 at ProPublica ↗
- Organization
- OHIOHEALTH CORPORATION (EIN 34-4429514)
- Tax period
- 2016-01-01 to 2016-12-31
- Filed
- 2017-11-15
- IRS object ID
- 201703199349310060
- 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
- Form 990
- Schedule A
- Schedule B
- Schedule C
- Schedule D
- Schedule G
- Schedule H
- Schedule J
- Schedule K
- Schedule L
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2017-11-15T13:19:07-06:00 | ReturnTs |
| Tax Period End | 2016-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 351178661 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Blue & Co LLC | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 8800 Lyra Drive Suite 450 | AddressLine1Txt |
| City | Columbus | CityNm |
| State Abbreviation | OH | StateAbbreviationCd |
| ZIP | 43240 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2016-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 344429514 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Van Wert County Hospital Association | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | VANW | BusinessNameControlTxt |
| Phone | 4192388609 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1250 South Washington Street | AddressLine1Txt |
| City | Van Wert | CityNm |
| State Abbreviation | OH | StateAbbreviationCd |
| ZIP | 45891 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | MICHAEL T HOLLIDAY | PersonNm |
| Person Title | VICE PRESIDENT | PersonTitleTxt |
| Phone | 4192388609 | PhoneNum |
| Signature | 2017-11-15 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | Matthew Dasta | PreparerPersonNm |
| PTIN | P00544683 | PTIN |
| Phone | 6148852583 | PhoneNum |
| Preparation | 2017-11-15 | PreparationDt |
Filing Security Information FilingSecurityInformation
IP Address IPAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| I Pv4 Address | 38.109.186.2 | IPv4AddressTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| IP | 2017-11-15 | IPDt |
| IP Tm | 10:05:37 | IPTm |
| IP Timezone | ES | IPTimezoneCd |
| Filing License Type | P | FilingLicenseTypeCd |
| At Submission Creation Device Id | DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 | AtSubmissionCreationDeviceId |
| At Submission Filing Device Id | 9FEB373504FE8B342AC97835986AE0D050CBB823 | AtSubmissionFilingDeviceId |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2016 | TaxYr |
| Build TS | 2021-01-29 14:40:06Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | MICHAEL T HOLLIDAY | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1250 SOUTH WASHINGTON STREET | AddressLine1Txt |
| City | VAN WERT | CityNm |
| State Abbreviation | OH | StateAbbreviationCd |
| ZIP | 45891 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $50,452,733 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | www.vanwerthospital.org | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1905 | FormationYr |
| Legal Domicile State | OH | LegalDomicileStateCd |
| Activity Or Mission | PROVIDE A CONTINUUM OF HEALTH CARE SERVICES IN INPATIENT AND AMBULATORY SETTINGS AND MAINTAIN OR EXTEND ALL NECESSARY ELEMENTS OF CARE TO ADDRESS THE NEEDS OF EVERY PATIENT IN A COMPASSIONATE MANNER. | ActivityOrMissionDesc |
| Voting Members Governing Body | 12 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 9 | VotingMembersIndependentCnt |
| Total Employee | 584 | TotalEmployeeCnt |
| Total Volunteers | 194 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $212,580 | PYContributionsGrantsAmt |
| CY Contributions Grants | $63,898 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $43,787,453 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $46,164,354 | CYProgramServiceRevenueAmt |
| PY Investment Income | $3,495,908 | PYInvestmentIncomeAmt |
| CY Investment Income | $2,036,365 | CYInvestmentIncomeAmt |
| PY Other Revenue | $2,722,457 | PYOtherRevenueAmt |
| CY Other Revenue | $2,175,677 | CYOtherRevenueAmt |
| PY Total Revenue | $50,218,398 | PYTotalRevenueAmt |
| CY Total Revenue | $50,440,294 | 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 | $21,761,966 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $20,631,382 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $27,445,846 | PYOtherExpensesAmt |
| CY Other Expenses | $28,878,000 | CYOtherExpensesAmt |
| PY Total Expenses | $49,207,812 | PYTotalExpensesAmt |
| CY Total Expenses | $49,509,382 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $1,010,586 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $930,912 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $94,520,077 | TotalAssetsBOYAmt |
| Total Assets EOY | $94,866,302 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $12,429,789 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $9,520,775 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $82,090,288 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $85,345,527 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | Van Wert County Hospital will meet the community health care needs by continually endeavoring to improve the quality of patient care we provide within our resource capabilities. Programs and services sponsored by the Van Wert County Hospital will serve as an access point to health care within our community. We accept responsibility for providing community leadership. Van Wert County Hospital assures that health care services provided are available to all members of the communities we serve regardless of race, creed, sex, national origin, or ability to pay, while at the same time respecting both the rights and responsibilities of our patients. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $42,004,318 | ExpenseAmt |
| Revenue | $48,310,390 | RevenueAmt |
| Desc | Inpatient, outpatient, and emergency Care Services | Desc |
| Total Program Service Expenses | $42,004,318 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | Yes (1) | 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 | Yes (1) | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | 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 | Yes (1) | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | Yes (1) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (1) | AuditedFinancialStmtAttInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | Yes (1) | TaxExemptBondsInd |
| Invest Tax Exempt Bonds | 0 | InvestTaxExemptBondsInd |
| Escrow Account | 0 | EscrowAccountInd |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuerInd |
| 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 | Yes (1) | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | Yes (1) | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | Yes (1) | RelatedOrganizationCtrlEntInd |
| Transaction With Control Ent | 0 | TransactionWithControlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 82 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 584 | 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 | 12 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 9 | 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 | Yes (1) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (1) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | Yes (1) | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | 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 |
| States Where Copy Of Return Is Fld | OH | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | Michael Holliday | PersonNm |
| Phone | 4192388609 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1250 South Washington Street | AddressLine1Txt |
| City | Van Wert | CityNm |
| State Abbreviation | OH | StateAbbreviationCd |
| ZIP | 45891 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (21 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | OfficerOfficerInd | Key EmployeeKeyEmployeeInd | Highest Compensated EmployeeHighestCompensatedEmployeeInd | Former Ofcr Director TrusteeFormerOfcrDirectorTrusteeInd |
|---|---|---|---|---|---|---|---|---|---|
| Charles Hoehn DPM | |||||||||
| Physician | 40.00 | Yes (X) | $280,644 | $0 | $5,602 | ||||
| Jon Bagley | |||||||||
| Trustee | 2.00 | Yes (X) | $0 | $0 | $0 | ||||
| Barb Kohnen | |||||||||
| TRustee | 2.00 | Yes (X) | $0 | $0 | $0 | ||||
| Eric Jelinger MD | |||||||||
| Trustee | 2.00 | Yes (X) | $0 | $0 | $0 | ||||
| Todd Wolfrum | |||||||||
| Trustee | 2.00 | Yes (X) | $0 | $0 | $0 | ||||
| Aaron Mechling | |||||||||
| Trustee | 2.00 | Yes (X) | $0 | $0 | $0 | ||||
| Mike Keysor | |||||||||
| SECRETARY | 2.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | |||
| Gary Clay | |||||||||
| CHAIRPERSON | 2.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | |||
| Tim Jurczyk | |||||||||
| VICE CHAIRPERSON | 2.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | |||
| TOM TURNWALD | |||||||||
| TRustee | 2.00 | Yes (X) | $0 | $0 | $0 | ||||
| CHARLES FKOCH | |||||||||
| TRustee | 2.00 | Yes (X) | $0 | $0 | $0 | ||||
| Michael Holliday | |||||||||
| CFO | 40.00 | $316,937 | $0 | $4,785 | Yes (X) | ||||
| JAMES W POPE | |||||||||
| CEO | 40.00 | $196,359 | $0 | $4,371 | Yes (X) | ||||
| Scott Jarvis MD | |||||||||
| Physician | 40.00 | $169,129 | $0 | $881 | Yes (X) | ||||
| Jennifer Hohman MD | |||||||||
| Physician | 40.00 | $205,336 | $0 | $10,728 | Yes (X) | ||||
| Jocelyn Wray MD | |||||||||
| Physician | 40.00 | $168,397 | $0 | $10,530 | Yes (X) | ||||
| JIANMING HAN MD | |||||||||
| PHysician | 40.00 | $253,154 | $0 | $5,603 | Yes (X) | ||||
| ALBERTO DELGADO MD | |||||||||
| Physician | 40.00 | $354,427 | $0 | $11,546 | Yes (X) | ||||
| Thomas Conte MD | |||||||||
| Physician | 40.00 | $286,056 | $0 | $0 | Yes (X) | ||||
| Jerry Sell MD | |||||||||
| Physician | 40.00 | $404,407 | $0 | $2,160 | Yes (X) | ||||
| MARK MINICK | |||||||||
| FORMER CEO | 40.00 | $332,924 | $0 | $0 | Yes (X) | ||||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $2,967,770 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $56,206 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 20 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | Yes (1) | 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 |
|---|---|---|---|---|---|
| THERAPY SOLUTIONS | |||||
| 120 W MAIN STREET | VAN WERT | OH | 45891 | PHYSICAL THERAPY SERVICES | $2,047,673 |
| PHOENIX PHYSICIANS | |||||
| 3114 CROADSDAILE DRIVE SUITE 200 | DURHAM | NC | 27705 | ER PHYSICIAN SERVICES | $784,752 |
| siemens medical solutions usa | |||||
| 51 valley stream parkway | malvern | PA | 19355 | information systems | $729,275 |
| PHILLIPS HEALTHCARE | |||||
| 3000 MINUTEMAN RD | ANDOVER | MA | 01810 | EQUIPMENT SUPPORT | $260,988 |
| West Central Ohio Hospital Consortium | |||||
| 4197 Fulton Rd Suite C | Canton | OH | 44718 | MRI Services | $224,010 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 16 | CntrctRcvdGreaterThan100KCnt |
| All Other Contributions | $63,898 | AllOtherContributionsAmt |
| Total Contributions | $63,898 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | PATIENT SERVICE REVENUE | Desc |
| Business | 900099 | BusinessCd |
| Total Revenue Column | $46,164,354 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $46,164,354 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $46,164,354 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $161,934 | TotalRevenueColumnAmt |
| Exclusion | $161,934 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $17,541 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $0 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $17,541 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $17,541 | TotalRevenueColumnAmt |
| Exclusion | $17,541 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $1,871,401 | SecuritiesAmt |
| Other | $3,030 | OtherAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $0 | SecuritiesAmt |
| Other | $0 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $1,871,401 | SecuritiesAmt |
| Other | $3,030 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $1,874,431 | TotalRevenueColumnAmt |
| Exclusion | $1,874,431 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Fundraising Gross Income | $24,539 | FundraisingGrossIncomeAmt |
| Fundraising Direct Expenses | $12,439 | FundraisingDirectExpensesAmt |
Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $12,100 | TotalRevenueColumnAmt |
| Exclusion | $12,100 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| Misc | 900099 | $1,776,228 | $1,776,228 |
| nutrition | 900099 | $254,384 | $254,384 |
| Wellness Programs | 900099 | $101,376 | $101,376 |
Miscellaneous Revenue MiscellaneousRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $14,048 | TotalRevenueColumnAmt |
| Exclusion | $14,048 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $2,146,036 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $50,440,294 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $48,296,342 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $2,080,054 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $16,423,407 | TotalAmt |
| Program Services | $12,481,789 | ProgramServicesAmt |
| Management And General | $3,941,618 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,207,975 | TotalAmt |
| Program Services | $3,198,061 | ProgramServicesAmt |
| Management And General | $1,009,914 | ManagementAndGeneralAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $316,993 | TotalAmt |
| Program Services | $316,993 | ProgramServicesAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $14,013,605 | TotalAmt |
| Program Services | $14,013,605 | ProgramServicesAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $6,326 | TotalAmt |
| Program Services | $5,567 | ProgramServicesAmt |
| Management And General | $759 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $73,101 | TotalAmt |
| Program Services | $55,557 | ProgramServicesAmt |
| Management And General | $17,544 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,807,905 | TotalAmt |
| Program Services | $1,482,482 | ProgramServicesAmt |
| Management And General | $325,423 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $159,289 | TotalAmt |
| Program Services | $47,787 | ProgramServicesAmt |
| Management And General | $111,502 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $120,046 | TotalAmt |
| Program Services | $91,235 | ProgramServicesAmt |
| Management And General | $28,811 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,156,651 | TotalAmt |
| Program Services | $1,639,055 | ProgramServicesAmt |
| Management And General | $517,596 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $353,392 | TotalAmt |
| Program Services | $325,121 | ProgramServicesAmt |
| Management And General | $28,271 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| supplies - medical and | $6,059,731 | $5,150,771 | $908,960 |
| miscellaneous | $1,759,247 | $1,334,042 | $425,205 |
| Bad Debt Expense | $1,602,091 | $1,602,091 | |
| nutrition services | $250,722 | $190,549 | $60,173 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $198,901 | TotalAmt |
| Program Services | $69,613 | ProgramServicesAmt |
| Management And General | $129,288 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $49,509,382 | TotalAmt |
| Program Services | $42,004,318 | ProgramServicesAmt |
| Management And General | $7,505,064 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $38,474 | BOYAmt |
| EOY | $74,391 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,113,902 | BOYAmt |
| EOY | $1,133,303 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $8,978 | BOYAmt |
| EOY | $4,413 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,046,337 | BOYAmt |
| EOY | $5,336,895 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $595,115 | BOYAmt |
| EOY | $990,684 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $554,708 | BOYAmt |
| EOY | $870,442 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $65,369,718 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $48,457,750 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $16,997,157 | BOYAmt |
| EOY | $16,911,968 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $62,437,367 | BOYAmt |
| EOY | $64,113,170 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $951,908 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,728,039 | BOYAmt |
| EOY | $4,479,128 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $94,520,077 | BOYAmt |
| EOY | $94,866,302 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,418,631 | BOYAmt |
| EOY | $5,099,194 | EOYAmt |
Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,011,451 | BOYAmt |
| EOY | $3,748,506 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $874,234 | BOYAmt |
| EOY | $650,057 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $125,473 | BOYAmt |
| EOY | $23,018 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $12,429,789 | BOYAmt |
| EOY | $9,520,775 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $78,313,766 | BOYAmt |
| EOY | $81,542,169 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $153,717 | BOYAmt |
| EOY | $140,141 | EOYAmt |
Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,622,805 | BOYAmt |
| EOY | $3,663,217 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $82,090,288 | BOYAmt |
| EOY | $85,345,527 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $94,520,077 | BOYAmt |
| EOY | $94,866,302 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $930,912 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | $2,324,327 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | $0 | OtherChangesInNetAssetsAmt |
| 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) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | 0 | VolunteersInd |
| Paid Staff Or Management | 0 | PaidStaffOrManagementInd |
| Media Advertisements | 0 | MediaAdvertisementsInd |
| Mailings Members | 0 | MailingsMembersInd |
| Publications Or Broadcast | 0 | PublicationsOrBroadcastInd |
| Grants Other Organizations | 0 | GrantsOtherOrganizationsInd |
| Direct Contact Legislators | 0 | DirectContactLegislatorsInd |
| Rallies Demonstrations | 0 | RalliesDemonstrationsInd |
| Other Activities | Yes (1) | OtherActivitiesInd |
| Other Activities | $1,898 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $1,898 | TotalLobbyingExpendituresAmt |
| Not Described Section501c3 | 0 | NotDescribedSection501c3Ind |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Part II-B, Line 1: | FormAndLineReferenceDesc |
| Explanation | 3.6% of dues paid to the ohio hospital association that is used for political purposes. | ExplanationTxt |
Schedule D IRS990ScheduleD
CY Endwmt Fund CYEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $8,265,020 | BeginningYearBalanceAmt |
| Contributions | $40,340 | ContributionsAmt |
| Investment Earnings Or Losses | $492,559 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $170,971 | OtherExpendituresAmt |
| Administrative Expenses | $44,171 | AdministrativeExpensesAmt |
| End Year Balance | $8,582,777 | EndYearBalanceAmt |
CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $8,378,579 | BeginningYearBalanceAmt |
| Contributions | $176,554 | ContributionsAmt |
| Investment Earnings Or Losses | -$84,547 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $160,748 | OtherExpendituresAmt |
| Administrative Expenses | $8,582,777 | AdministrativeExpensesAmt |
| End Year Balance | $8,265,020 | EndYearBalanceAmt |
CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $8,263,214 | BeginningYearBalanceAmt |
| Contributions | $44,140 | ContributionsAmt |
| Investment Earnings Or Losses | $302,638 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $187,515 | OtherExpendituresAmt |
| Administrative Expenses | $43,898 | AdministrativeExpensesAmt |
| End Year Balance | $8,378,579 | EndYearBalanceAmt |
CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $7,628,802 | BeginningYearBalanceAmt |
| Contributions | $1,365 | ContributionsAmt |
| Investment Earnings Or Losses | $781,521 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $111,189 | OtherExpendituresAmt |
| Administrative Expenses | $37,285 | AdministrativeExpensesAmt |
| End Year Balance | $8,263,214 | EndYearBalanceAmt |
CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $6,717,856 | BeginningYearBalanceAmt |
| Contributions | $86,376 | ContributionsAmt |
| Investment Earnings Or Losses | $1,031,004 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $172,628 | OtherExpendituresAmt |
| Administrative Expenses | $33,806 | AdministrativeExpensesAmt |
| End Year Balance | $7,628,802 | EndYearBalanceAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Board Designated Balance EOY | 0.57000 | BoardDesignatedBalanceEOYPct |
| Prmnnt Endowment Balance EOY | 0.43000 | PrmnntEndowmentBalanceEOYPct |
| Endowments Held Unrelated Org | 0 | EndowmentsHeldUnrelatedOrgInd |
| Endowments Held Related Org | 0 | EndowmentsHeldRelatedOrgInd |
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $943,059 | OtherCostOrOtherBasisAmt |
| Book Value | $943,059 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $29,662,542 | OtherCostOrOtherBasisAmt |
| Depreciation | $24,272,480 | DepreciationAmt |
| Book Value | $5,390,062 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $34,363,380 | OtherCostOrOtherBasisAmt |
| Depreciation | $24,185,270 | DepreciationAmt |
| Book Value | $10,178,110 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $400,737 | OtherCostOrOtherBasisAmt |
| Book Value | $400,737 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $16,911,968 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (3 entries)
| DescDesc | AmtAmt |
|---|---|
| interest rate swap | $18,988 |
| ESTIMATED LIABILITY CLAIMS | $54,005 |
| related party payable | -$49,975 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $23,018 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part V, Line 4: | THE INVESTMENT INCOME GENERATED BY THE ENDOWMENT FUNDS DISTRIBUTED TO THE HOSPITAL IS ABLE TO BE USED FOR GENERAL OPERATING AND CAPITAL EQUIPMENT NEEDS. |
| Part X, Line 2: | ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA REQUIRE MANAGEMENT TO EVALUATE TAX POSITIONS TAKEN AND RECOGNIZE A TAX LIABILITY IF AN UNCERTAIN POSITION HAS BEEN TAKEN THAT MORE LIKELY THAN NOT WOULD NOT BE SUSTAINED UPON EXAMINATION BY VARIOUS FEDERAL AND STATE TAXING AUTHORITIES. MANAGEMENT HAS ANALYZED THE TAX POSITIONS TAKEN BY THESE ENTITIES AND HAS CONCLUDED THAT AS OF DECEMBER 31, 2016 AND 2015, THERE ARE NO UNCERTAIN TAX POSITIONS TAKEN OR EXPECTED TO BE TAKEN THAT WOULD REQUIRE RECOGNITION OF A LIABILITY OR DISCLOSURE IN THE ACCOMPANYING CONSOLIDATED FINANCIAL STATEMENTS. THE ENTITIES ARE SUBJECT TO ROUTINE AUDITS BY TAXING JURISDICTIONS; HOWEVER, THERE ARE CURRENTLY NO AUDITS FOR ANY TAX PERIODS IN PROGRESS. |
Schedule G IRS990ScheduleG
Fundraising Event Information FundraisingEventInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Event1 | GOLF OUTING | Event1Nm |
| Gross Receipts Event1 | $24,539 | GrossReceiptsEvent1Amt |
| Gross Revenue Event1 | $24,539 | GrossRevenueEvent1Amt |
| Non Cash Prizes Event1 | $1,422 | NonCashPrizesEvent1Amt |
| Food And Beverage Event1 | $4,554 | FoodAndBeverageEvent1Amt |
| Entertainment Event1 | $6,463 | EntertainmentEvent1Amt |
| Gross Receipts Total | $24,539 | GrossReceiptsTotalAmt |
| Gross Revenue Total Events | $24,539 | GrossRevenueTotalEventsAmt |
| Non Cash Prizes Total Events | $1,422 | NonCashPrizesTotalEventsAmt |
| Food And Beverage Total Events | $4,554 | FoodAndBeverageTotalEventsAmt |
| Entertainment Total Events | $6,463 | EntertainmentTotalEventsAmt |
| Direct Expense Summary Events | $12,439 | DirectExpenseSummaryEventsAmt |
| Net Income Summary | $12,100 | NetIncomeSummaryAmt |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (1) | FinancialAssistancePolicyInd |
| Written Policy | Yes (1) | WrittenPolicyInd |
| FPG Reference Free Care | Yes (1) | FPGReferenceFreeCareInd |
| Percent100 | Yes (X) | Percent100Ind |
| FPG Reference Discounted Care | Yes (1) | FPGReferenceDiscountedCareInd |
| Percent200 D | Yes (X) | Percent200DInd |
| Free Care Medically Indigent | Yes (1) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (1) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | 0 | ExpensesExceedBudgetInd |
| Annual Community Bnft Report | Yes (1) | AnnualCommunityBnftReportInd |
| Report Publically Available | Yes (1) | ReportPublicallyAvailableInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 223 | PersonsServedCnt |
| Total Community Benefit Expns | $73,907 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $73,907 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00150 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 12174 | PersonsServedCnt |
| Total Community Benefit Expns | $6,764,163 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $2,480,196 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $4,283,967 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.08650 | TotalExpensePct |
Unreimbursed Costs UnreimbursedCostsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 98 | PersonsServedCnt |
| Total Community Benefit Expns | $215,039 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $95,860 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $119,179 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00240 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 12495 | PersonsServedCnt |
| Total Community Benefit Expns | $7,053,109 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $2,576,056 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $4,477,053 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.09040 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 14 | ActivitiesOrProgramsCnt |
| Persons Served | 4788 | PersonsServedCnt |
| Total Community Benefit Expns | $2,486 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $4,265 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00000 | TotalExpensePct |
Health Professions Education HealthProfessionsEducationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 2 | ActivitiesOrProgramsCnt |
| Persons Served | 133 | PersonsServedCnt |
| Total Community Benefit Expns | $133 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $133 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00000 | TotalExpensePct |
Cash And In Kind Contributions CashAndInKindContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 1 | ActivitiesOrProgramsCnt |
| Persons Served | 0 | PersonsServedCnt |
| Total Community Benefit Expns | $26,771 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $26,771 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00050 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 17 | ActivitiesOrProgramsCnt |
| Persons Served | 4921 | PersonsServedCnt |
| Total Community Benefit Expns | $29,390 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $4,265 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $26,904 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00050 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 17 | ActivitiesOrProgramsCnt |
| Persons Served | 17416 | PersonsServedCnt |
| Total Community Benefit Expns | $7,082,499 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $2,580,321 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $4,503,957 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.09090 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (1) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $1,602,091 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $12,015 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $14,003,055 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $18,318,986 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$4,315,931 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | Yes (X) | CostToChargeRatioInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | Yes (1) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (1) | FinancialAssistancePrvsnInd |
Management Co And Jnt Ventures ManagementCoAndJntVenturesGrp (9 entries)
| Primary ActivitiesPrimaryActivitiesTxt | Org Profit Or OwnershipOrgProfitOrOwnershipPct | Physicians Profit Or OwnershipPhysiciansProfitOrOwnershipPct |
|---|---|---|
| 1 Van Wert Medical Services | ||
| Medical Professional Services | 1.00000 | |
| 2 Sarah Jane Living Center | ||
| Long Term Alzheimer's Care | 0.50000 | |
| 3 Home Health Care Solutions | ||
| Home Healthcare Services | 0.50000 | |
| 4 Therapy Solutions | ||
| Physical Therapy Solutions | 0.50000 | |
| 5 Community Care Systems | ||
| Managed Care Contracting | 0.50000 | 0.50000 |
| 6 DELPHOS REAL ESTATE LLC | ||
| REAL ESTATE | 0.50000 | |
| 7 CONVOY HEALTH FACILITIES LLC | ||
| HEALTH FACILITY | 0.50000 | |
| 8 WEST CENTRAL OHIO HOSPITAL CONSORTIUM LTD | ||
| HEALTHCARE FACILITIES | 0.33330 | |
| 9 NEW VISION MEDICAL LABORATORIES LLC | ||
| MEDICAL LABORATORIES | 0.20000 | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital Facilities | 1 | HospitalFacilitiesCnt |
Hospital Facilities HospitalFacilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | VAN WERT COUNTY HOSPITAL | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1250 washington street | AddressLine1Txt |
| City | van wert | CityNm |
| State Abbreviation | OH | StateAbbreviationCd |
| ZIP | 45891 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | THE VAN WERT COUNTY HOSPITAL ASSOCIATION | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| First Licensed CY Or PY | 0 | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | 0 | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | Yes (1) | CHNAConductedInd |
| Community Definition | Yes (X) | CommunityDefinitionInd |
| Community Demographics | Yes (X) | CommunityDemographicsInd |
| Existing Resources | Yes (X) | ExistingResourcesInd |
| How Data Obtained | Yes (X) | HowDataObtainedInd |
| Community Health Needs | Yes (X) | CommunityHealthNeedsInd |
| Other Health Issues | Yes (X) | OtherHealthIssuesInd |
| Community Hlth Needs Id Process | Yes (X) | CommunityHlthNeedsIdProcessInd |
| Consulting Process | Yes (X) | ConsultingProcessInd |
| Prior CHNA Impact | Yes (X) | PriorCHNAImpactInd |
| CHNA Conducted | 15 | CHNAConductedYr |
| Take Into Account Others Input | Yes (1) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | 0 | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | Yes (1) | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (1) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | http://www.vanwerthospital.org | OwnWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Implementation Strategy Adopt | Yes (1) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 15 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (1) | StrategyPostedWebsiteInd |
| Strategy Website URL | http://www.vanwerthospital.org | StrategyWebsiteURLTxt |
| Organization Incur Excise Tax | 0 | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (1) | EligCriteriaExplainedInd |
| FPG Family Incm Lmt Free Dscnt | Yes (X) | FPGFamilyIncmLmtFreeDscntInd |
| FPG Family Incm Lmt Free Care | 100.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 200.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Income Level Criteria | Yes (X) | IncomeLevelCriteriaInd |
| Medical Indigency Criteria | Yes (X) | MedicalIndigencyCriteriaInd |
| Insurance Status Criteria | Yes (X) | InsuranceStatusCriteriaInd |
| Explained Basis | Yes (1) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (1) | AppFinancialAsstExplnInd |
| Described Info | Yes (X) | DescribedInfoInd |
| Described Suprt Doc | Yes (X) | DescribedSuprtDocInd |
| Includes Publicity Measures | Yes (1) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | http://vanwerthospital.org/patients/patient-financial-services | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | http://vanwerthospital.org/patients/printable-forms | FAPAppAvailableOnWebsiteURLTxt |
| FAP Actions On Nonpayment | Yes (1) | FAPActionsOnNonpaymentInd |
| Collection Activities | 0 | CollectionActivitiesInd |
| Nondis Emergency Care Policy | Yes (1) | NondisEmergencyCarePolicyInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | 0 | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| THE VAN WERT COUNTY HOSPITAL ASSOCIATION | Part V, Section B, Line 5: The project was conducted as a joint effort including the Center for Social Research at Indiana University-Purdue University Fort Wayne(IPFW), the Van Wert County Health Department, Van Wert County Hospital, Van Wert County Family and Childrens First Council, Family Healthcare of Northwest Ohio, Village of Ohio City, Van Wert City Schools, Crestview Local Schools, and Lincolnview Local Schools. The Center for Social Research utilized the Total Design Method research methodology, which is a methodology consisting of a mailed survey approach that resulted in a 40.31% response rate. The Van Wert County Health Collaborative was formed to review, plan and implement strategies to address the community health needs identified as a result of the assessment. This Collaborative consisted of 47 community leaders representing 38 community agencies. Throughout the process, the National Association of City County Health Officer's strategic planning tool, Mobilizing for Action through Planning and Partnerships was used. |
| THE VAN WERT COUNTY HOSPITAL ASSOCIATION | Part V, Section B, Line 6b: The Center for Social Research at Indiana University, Purdue University Fort Wayne (IPFW) and the Van Wert County Health Department. |
| THE VAN WERT COUNTY HOSPITAL ASSOCIATION | Part V, Section B, Line 11: Adult Keys Issues not selected: Access to Care--data supporting concern is lacking, outside scope of collaborative, too costly to address. Mental Health--managed by Westwood Behavioral Health and primary care docs, ties in to substance abuse efforts in plan. Chronic Disease--will be impacted by action plan steps towards obesity. Homelessness and unemployment--lack opf concrete data, Local One Stop agency deals with unemployment, otherwise not in our scope. Cardiovascular Disease--will be impacted by action plan steps towards obesity. Domestic Violence--addressed by Westwood Behavioral Health and courts. Youth Issues not selected--Mental Health--community partnerships already in place with mental health agency, health department, and schools. Parenting/Brken Family--Schools working with Lima agency for screening and assistance. Bullying--many programs in place locally to address through grants, behavioral health agency,and schools. Teen Parenting--local progams already exist. Poverty/Hunger--local programs already exist. Driving Safety--lack of data to act upon. Booster Seat Use--health department and hospital provide safety checks and reduced cost car seats. Access to Dental--current moble dental unit comes to Family Health Care Clinic infrequently, Family Health Care Clinic looking for funding to address issue, hospital considering how it may join to provide assistance with this issue over it's next planning cycle. |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 2 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp (2 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | FacilityFacilityTxt |
|---|---|---|---|---|
| 1 - SARAH JANE LIVING CENTER | ||||
| 328 W 2ND ST | DELPHOS | OH | 45833 | LONG TERM ALZHEIMERS CARE |
| 2 - VANCREST OF CONVOY | ||||
| 510 TULLY DR | CONVOY | OH | 45832 | LONG TERM NURSING CARE |
Supplemental Information Detail SupplementalInformationDetail (11 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part I, Line 3c: | THE ORGANIZATION USED THE FPG TO DETERMINE ELIGIBILITY FOR FREE AND DISCOUNTED CARE. |
| Part I, Line 7: | THE ORGANIZATION REPORTS BAD DEBTS AS AN OPERATING EXPENSE. THE COSTING METHODOLOGY USED IN REPORTING BAD DEBT DATA IS A COST TO CHARGE RATIO METHODOLOGY. THE ORGANIZATION DOES NOT CLAIM BAD DEBT EXPENSE AS A COMMUNITY BENEFIT. |
| Part I, Ln 7 Col(f): | The Association provides care to patients who meet certain criteria under its charity care policy without charge or at amounts less than its established rates. Because the Association does not pursue collection of amounts determined to qualify as charity, such amounts are not reported as revenue. Bad debts are shown as an expense valued as revenue not received and written off as revenue. Management estimates an allowance for doutful accounts based upon factors unique to the Association's operations. |
| Part II, Community Building Activities: | THE COUMADIN THERAPY CLINIC IS SLATED TO BE OPERATTIONAL DECEMBER 1 HELPING PATIENTS Manage THE MEDICATION AND UNDERLYING CONDITIONS THEY HAVE. DENTAL CARE FOR THE UNINSURED AND UNDERINSURED IS A MAJOR NEED IN THE COMMUNITY. THE HOSPITAL IS DEVELOPING A DENTAL CLINIC TO MEET THESE NEEDS AND ALLOW paTIENTS TO RECEIVE APPROPRIATE TREATMENt IN AN APPROPRIATE CARE SETTING. CURRENTLY, MANY OF THESE PATIENTS SEEK TREATMENT FOR THEIR CONDITIONS THROUGH THE EMERGENCY ROOM.THE HOSPITAL ALSO PARTICIPATES IN INITIATIVES WITH OTHER PROVIDERS AND AFFILIATES IN PROVISION OF SERVICES AND/OR DONATIONS. THE PROVISIONS OF LOW COST HEALTH SCREENING SERVICES IN COLLABORATION WITH OTHER ORGANIZATIONS HELP US IDENTIFY CONDITIONS ON A PROACTIVE BASIS TO BETTER IMPROVE OUR CITIZEN'S HEALTH OR MANAGEMENT OF CHRONIC DISEASES. THE CO-ORDINATION OF CARE THROUGH OUR HOME HEALTH REHABILITATIVE AND LONG TERM CARE PROVIDERS SERVE TO BETTER MEET THE NEEDS OF OUR PATIENTS AND POPULATION. OUR REGIONAL LABORATORY INITIATIVE HAS SHORTENED TURNAROUND TIME FOR TESTS AND HAS LOWERED COST TO OUR PATIENTS. THE HOSPITAL ALSO PARTICIPATES IN ECONOMIC DEVELOPMENT EFFORTS THROUGH ITS MEMBERSHIP IN THE CHAMBER OF COMMERCE AND OTHER ORGANIZATIONS. |
| Part III, Line 4: | THE ORGANIZATION REPORTS BAD DEBTS AS AN OPERATING EXPENSE. THE COSTING METHODOLOGY USED IN REPORTING BAD DEBT DATA IS A COST TO CHARGE RATIO METHODOLOGY. THE ORGANIZATION DOES NOT CLAIM BAD DEBT EXPENSE AS A COMMUNITY BENEFIT. |
| Part III, Line 8: | THE ORGANIZATION DOES NOT CONSIDER THE MEDICARE SHORTFALL AS A COMMUNITY BENEFIT. |
| Part III, Line 9b: | FOLLOWING THE GUIDELINES AND PROCESSES AS INDICATED IN QUESTION 3, PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE, THE ORGANIZATION APPROPRIATELY IDENTIFIES ACCOUNTS AS TO THE TYPE OF ASSISTANCE QUALIFIED FOR. THE AMOUNTS ELIGIBLE FOR ASSISTANCE ARE WRITTEN OFF TO THE APPROPRIATE PROGRAM AND COLLECTION ACTIVITY CEASES IN REGARD TO THOSE AMOUNTS. THE GOAL OF THE ORGANIZATION'S POLICIES IS TO INDENTIY ACCOUNTS ELIGIBLE FOR ASSISTANCE AND BRING THE ACCOUNT TO AN APPROPRIATE CONCLUSION AS EARLY IN THE BILLING CYCLE AS POSSIBLE. |
| Part VI, Line 2: | THE ORGANIZATION USES A VARIETY OF METHODS TO ASSESS HEALTH CARE NEEDS. DATA PROVIDED BY THE STATE OF OHIO IS USED TO DETERMINE EPIDEMIOLOGIES RELATED TO CHRONIC CONDITIONS AND CANCER REGISTRIES PROVIDING PREVALENCE. INTERNAL DATA IS ALSO USED AS WELL AS INPUT FROM OTHER PROVIDERS. THE HOSPITAL ALSO USES PATIENT ORIGIN DATA PROVIDED BY THE OHIO HOSPITAL ASSOCIATION TO DETERMINE CURRENT TREATMENT PATTERNS AND DIAGNOSIS FOR CURRENT RESIDENTS BEING TREATED IN VAN WERT COUNTY HOSPITAL AND OTHER SURROUNDING PROVIDERS. THE HOSPITAL ALSO SPONSORS A NUMBER OF HEALTH FAIRS/ASSESSMENTS TO BOTH ADULT AND PEDIATRIC POPULATIONS OF VAN WERT THAT IS ALSO EXAMINED FOR FREQUENCY AND NEEDS. A NUMBER OF STAFF AS WELL AS BOARD OF TRUSTEES MEMBERS ALSO SERVED ON COMMUNITY HEALTH PROVIDER BOARDS AND PROVIDE INPUT TO THE PLANNING PROCESS.THE HOSPITAL PARTICIPATED IN A Community-WIDE HEALTH CARE NEEDS ASSESSMENT PROJECT WITH COLLABORATING AGENCIES WITHIN THE AREA. AS A RESULT OF THIS EFFORT, OBESITY AND SUBSTANCE ABUSE ARE THE NEEDS IDENTIFIED BY THE COALITION THAT WILL HAVE THE FOCUS OF ATTENTION OF PROGRAMS AND SERVICES TO IMPROVE THE COMMUNITY IN THESE AREAS. THE HOSPITAL IS ALSO SUBSCRIBED TO A NUMBER OF BENCHMARKING ORGANIZATIONS THAT PROVIDE BEST OF INDUSTRY APPLICATIONS TO ASSESS METHODOLOGIES FOR TREATING OUR RESIDENTS. |
| Part VI, Line 3: | Patient education of eligibility for assistance begins at the patient access to care areas. Informational signage is posted in all patient access areas identifying financial assistance programs and instructions of how to seek out these programs. Similar information is also found in patient informational brochures provided to patients prior to the rendering of care based upon the type of care being provided. Also, available at all patient access points are the patient financial assistance brochure.Patient registration staff at all patient access points are trained in the patient financial assistance programs available at the hospital. They become a valuable resource to patients directing them to the programs they may qualify for and the process with which to seek the appropriate assistance.The hospital utilizes the hospital website as an on-line and technologically current source of financial assistance information for patients that prefer finding educational information in this format. Financial assistance programs, policies, eligibility criteria, and on-line applications for the various programs are available.Patient billing statements provide another avenue for educating patients as to financial assistance programs available and how to contact the hospital to determine eligibility. This information is located on the back of each billing statement received by the patient.The existence of a financial counselor in the patient accounting function is another mechanism utilized in educating patients regarding financial assistance available for hospital services. All uninsured or self-pay potential accounts are identified to the financial counselor upon patient registration. Patients may be contacted upon completion of services. All patients that were not contacted upon completion of services receive a financial assistance application through the mail that includes information regarding all financial assistance programs. The counselor provides follow-up and assistance to identify the patient with the appropriate financial assistance program. |
| Part VI, Line 4: | Van Wert County Hospital is located in the rural county of Van Wert, Ohio that boarders the Indiana state line along Allen County Indiana. Our primary service area comprises Van Wert and some portions of Paulding, Putnam and Mercer Counties. Ohio numerically this breaks down to approximately 50,000 residents in our primary market area. The hospital is located within the city of Van Wert, which possesses a population of 10,700. Our population is predominantly white (97.1%) with Hispanic (1.9%) a mix of minorities comprise the remainder. Van Wert is rural in nature with employment not only in agricultural services but also in the manufacturing and service sector. Our county has seen increased unemployment due to the loss of manufacturing jobs related to the auto sector. The unemployment rate and the Affordable Care Act has increased the number of citizens covered under the Medicaid program and qualifying for the hospital's charity care program as well as increasing Bad Debt ( 4.6% of the population is below FPG). Like many Midwest communities the region is experiencing aging populations of 19.6% over 65 and 28.9% 45-64 according to the 2010 census. The hospital also has facilities in the communities of Convoy and Delphos providing long term care to these groups. Behavioral risk factors include (Behavioral Risk Survey) smoking (19.8%), alcohol abuse (16%) and obesity at (36.3%) these behavioral risk factors influence the incidence of chronic diseases we treat. |
| Part VI, Line 5: | The Van Wert County Hospital Association Board of Trustees is comprised of volunteers from our community. The majority of these members live and work within the community and are involved with other non-profit agencies. Senior leadership also lives in the primary service area. This "spirit" of community based healthcare resides in our Board of Trustees and is further evidenced by our open medical staff. The accommodation of specialty services not currently present in our area being provided through a Specialty Clinic of the hospital which include Neurology, Neurosurgery, Immunology, and ENT services. The hospital associated personnel also sit on other community based governance boards (United Way, American Red Cross, Chamber of Commerce, Wright State University Regional Campus, Public Access television, American Cancer Society & Van Wert Economic Development to name a few). Through physician recruitment we have brought in a number of new specialties including obstetrics and additional laparoscopic surgical procedures. We also provide a loan forgiveness program for residents interested in becoming physicians and returning to our area. Our Wellness Center provides health, education, and social programs for targeted populations. We have joined a Regional Stroke Network as well as participating in a number of patient and educational support groups (Better Breathers, Stroke Support Group, Better Parenting). The hospital also participates in health professions educational programs. A number of our physicians provide training for senior medical students through the Lima Area Health Education Committee. A number of nursing educational program use our hospital to do their clinical rotations. The hospital on average spends in excess of 1 million dollars in new diagnostic technologies and other health related equipment to better diagnose and treat our clients. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Substantiation Required | Yes (1) | SubstantiationRequiredInd |
| Compensation Committee | Yes (X) | CompensationCommitteeInd |
| Independent Consultant | Yes (X) | IndependentConsultantInd |
| Form990 Of Other Organizations | Yes (X) | Form990OfOtherOrganizationsInd |
| Written Employment Contract | Yes (X) | WrittenEmploymentContractInd |
| 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 (11 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Charles Hoehn DPM | ||||||||||||||
| Physician | $280,644 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $5,602 | $0 | $286,246 | $0 | $0 | $0 |
| Michael Holliday | ||||||||||||||
| CFO | $316,937 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $4,785 | $0 | $321,722 | $0 | $0 | $0 |
| JAMES W POPE | ||||||||||||||
| CEO | $196,359 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $4,371 | $0 | $200,730 | $0 | $0 | $0 |
| Scott Jarvis MD | ||||||||||||||
| Physician | $169,129 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $881 | $0 | $170,010 | $0 | $0 | $0 |
| Jennifer Hohman MD | ||||||||||||||
| Physician | $205,336 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $10,728 | $0 | $216,064 | $0 | $0 | $0 |
| Jocelyn Wray MD | ||||||||||||||
| Physician | $168,397 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $10,530 | $0 | $178,927 | $0 | $0 | $0 |
| JIANMING HAN MD | ||||||||||||||
| PHysician | $253,154 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $5,603 | $0 | $258,757 | $0 | $0 | $0 |
| ALBERTO DELGADO MD | ||||||||||||||
| Physician | $354,427 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $11,546 | $0 | $365,973 | $0 | $0 | $0 |
| Thomas Conte MD | ||||||||||||||
| Physician | $286,056 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $286,056 | $0 | $0 | $0 |
| Jerry Sell MD | ||||||||||||||
| Physician | $404,407 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $2,160 | $0 | $406,567 | $0 | $0 | $0 |
| MARK MINICK | ||||||||||||||
| FORMER CEO | $332,924 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $332,924 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Part I, Line 4b | FormAndLineReferenceDesc |
| Explanation | MARK MINICK - SUPPLEMENTAL NON-QUALIFIED RETIREMENT PLAN - ACTUARIAL DETERMINED CATCH UP ANNUAL FUNDING FOR PLAN BENEFIT UNDER TERMS OF INCENTIVE AGREEMENT | ExplanationTxt |
Schedule K IRS990ScheduleK
Tax Exempt Bonds Issues TaxExemptBondsIssuesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
Issuer Name IssuerName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | county of van wert ohio | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Issued | 2009-10-29 | BondIssuedDt |
| Issue Price | $10,755,255 | IssuePriceAmt |
| Purpose | finance acquisition, construction, & equipping of hospital facilities | PurposeDesc |
| Defeased | 0 | DefeasedInd |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuerInd |
| Pool Financing | 0 | PoolFinancingInd |
Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Total Proceeds | $10,755,255 | TotalProceedsAmt |
| Issuance Costs From Proceeds | $57,604 | IssuanceCostsFromProceedsAmt |
| Capital Expenditures | $10,697,651 | CapitalExpendituresAmt |
| Substantial Completion | 2010 | SubstantialCompletionYr |
| Current Refunding | Yes (1) | CurrentRefundingInd |
| Advance Refunding | 0 | AdvanceRefundingInd |
| Final Allocation Made | Yes (1) | FinalAllocationMadeInd |
| Adequate Books And Rec Maint | Yes (1) | AdequateBooksAndRecMaintInd |
Tax Exempt Bonds Private Bus Use TaxExemptBondsPrivateBusUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Owning Bond Financed Property | 0 | OwningBondFinancedPropertyInd |
| Any Lease Arrangements | 0 | AnyLeaseArrangementsInd |
| Mgmt Contract Bond Fincd Prop | 0 | MgmtContractBondFincdPropInd |
| Any Research Agreements | 0 | AnyResearchAgreementsInd |
| Bond Iss Meet Prvt Sec Pymt Test | 0 | BondIssMeetPrvtSecPymtTestInd |
| Change In Use Bond Financed Prop | 0 | ChangeInUseBondFinancedPropInd |
| Procs Nonqualified Bond Remdtd | Yes (1) | ProcsNonqualifiedBondRemdtdInd |
Tax Exempt Bonds Arbitrage TaxExemptBondsArbitrageGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Form8038 T Filed | 0 | Form8038TFiledInd |
| Rebate Not Due Yet | 0 | RebateNotDueYetInd |
| Exception To Rebate | 0 | ExceptionToRebateInd |
| No Rebate Due | 0 | NoRebateDueInd |
| Variable Rate Issue | Yes (1) | VariableRateIssueInd |
| Hedge Identified In Bks And Rec | Yes (1) | HedgeIdentifiedInBksAndRecInd |
Hedge Provider Name HedgeProviderName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | First Financial | BusinessNameLine1Txt |
| Business Name Line2 | Bank | BusinessNameLine2Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Term Of Hedge | 4.800000000000 | TermOfHedgePct |
| Superintegrated Hedge | 0 | SuperintegratedHedgeInd |
| Hedge Terminated | 0 | HedgeTerminatedInd |
| Gross Proceeds Invested In GIC | 0 | GrossProceedsInvestedInGICInd |
| Gross Proceeds Invested | 0 | GrossProceedsInvestedInd |
| Written Proc To Monitor Reqs | 0 | WrittenProcToMonitorReqsInd |
Procedures Corrective Action ProceduresCorrectiveActionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Procedures Corrective Action | 0 | ProceduresCorrectiveActionInd |
Schedule L IRS990ScheduleL
Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp (3 entries)
| Relationship DescriptionRelationshipDescriptionTxt | TransactionTransactionDesc | Sharing Of RevenuesSharingOfRevenuesInd | TransactionTransactionAmt |
|---|---|---|---|
| Aaron Mechling | |||
| Hospital Board of Trustee Member and Partner in Kaiser Mechling Group | Hospital maintains investment account with Kaiser Mechling Group as representatives for Morgan Stanley | 0 | |
| Jon Bagley | |||
| Hospital Board of Trustee Member and Operations Officer for Joint Venture | Hospital and Vancrest Health System are involved in several joint venture companies relating to home health care,therapy, alzheimers care and long term care services. | 0 | |
| dr eric jelinger | |||
| Board of trustees and radiology group owner | Hospital Contracts with Corporation in which Dr. Jelinger is the principle owner for Radiology Professional Services | 0 | $432,250 |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (9 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Form 990, Part VI, Section A, line 6 | ANY PERSON, AGE 18 OR OLDER AND RESIDING IN VAN WERT COUNTY HOSPITAL'S GEOGRAPHIC SERVICE AREA, WHO SHALL HAVE CONTRIBUTED THE SUM OF ONE DOLLAR OR MORE TO THE ASSOCIATION DURING THE CALENDAR YEAR, SHALL BE A MEMBER. A CONTRBUTION OF TWENTY-FIVE DOLLARS AT ANY TIME SHALL CONSTITUTE A LIFE MEMBERSHIP. |
| Form 990, Part VI, Section A, line 7a | THE BOARD OF TRUSTEES SHALL BE ELECTED BY THE MEMBERS OF THE ASSOCIATION AT THE REGULAR ANNUAL MEETING. ONE SHALL BE APPOINTED BY THE VAN WERT COUNTY board of commissioners. |
| Form 990, Part VI, Section A, line 7b | SUBJECT TO THE ARTICLES OF INCORPORATION AND THIS CODE OF REGULATIONS, EACH MEMBER OF THE ASSOCIATION IN GOOD STANDING SHALL BE QUALIFIED TO VOTE ON ANY ISSUES THAT MAY PROPERLY COME BEFORE ANY MEETING OF THE MEMBERS OF THE ASSOCIATION. |
| Form 990, Part VI, Section B, line 11b | THE PROCESS OF REVIEWING THE FORM 990 ENTAILS A DETAILED REVIEW BY THE ORGANIZATION'S ACCOUNTING DEPARTMENT. The audit committee reviews and approves the 990. It is then presented to the full board during a regularly scheduled board meeting. |
| Form 990, Part VI, Section B, line 12c | The written conflict of interest policy is regularly and consistently monitored by the Chairperson of the Board of Trustees and the President & CEO. The scope of this policy includes all staff and Board of Trustees members. A conflict of interest questionnaire is completed on an annual basis and reviewed by the Executive Committee. Any issues that arise are addressed with the individual at that point. Any issues that arise thoughout the year are dealt with as necessary. This may involve declaring the conflict of interest and abstaining from discussion or a vote on specific topics. This could also take the form of recusing oneself from part or a whole meeting as necessary and required depending upon the topic for discusion and/or action. |
| Form 990, Part VI, Section B, line 15 | The compensation committee contracts with an outside, independent firm to provide a compensation study and evaluation. THE COMMITTEE THEN USES THE RESULTS OF THE STUDY IN CONSULTATION WITH THE COMPENSATION FIRM AND THEN COMPENSATION PHILOSOPHY POLICY TO MAKE COMPENSATION DECISIONS. the last compensation review was performed in july, 2012. |
| Form 990, Part VI, Section C, line 19 | There is an annual report prepared that includes a statement of operations. |
| Form 990, Part IX, line 11g | purchased services: Program service expenses 10,677,065. Management and general expenses 0. Fundraising expenses 0. Total expenses 10,677,065. professional fees: Program service expenses 3,336,540. Management and general expenses 0. Fundraising expenses 0. Total expenses 3,336,540. |
| 990T | in the past the organization has filed a 990-T, however, this organization is no longer required to file that form as it has no unrelated business income to report. |
Schedule R IRS990ScheduleR
Id Disregarded Entities IdDisregardedEntitiesGrp
Disregarded Entity Name DisregardedEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Van Wert Medical Services | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 140 Fox Road | AddressLine1Txt |
| City | Van Wert | CityNm |
| State Abbreviation | OH | StateAbbreviationCd |
| ZIP | 45891 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 202812541 | EIN |
| Primary Activities | Medical Professional Services | PrimaryActivitiesTxt |
| Legal Domicile State | OH | LegalDomicileStateCd |
| Total Income | $0 | TotalIncomeAmt |
| End Of Year Assets | $2,490,856 | EndOfYearAssetsAmt |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Wholly Owned | BusinessNameLine1Txt |
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 | Predominant Income TypePredominantIncomeTypeTxt | Share Of Total IncomeShareOfTotalIncomeAmt | Disproportionate AllocationsDisproportionateAllocationsInd | General Or Managing PartnerGeneralOrManagingPartnerInd | OwnershipOwnershipPct |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| SARAH JANE LIVING CENTER | ||||||||||||
| 1250 S Washington St | van wert | OH | 45891 | 311684009 | Long Term Alzheimers Care | OH | N/A | RELATED | $98,738 | 0 | 0 | 0.50000 |
| Home Health Care Solutions | ||||||||||||
| 1250 S Washington St | van wert | OH | 45891 | 200330544 | Home Health Care solutions | OH | N/A | RELATED | $120,924 | 0 | 0 | 0.50000 |
| Therapy Solutions | ||||||||||||
| 1250 S Washington St | van wert | OH | 45891 | 201417403 | Physical Therapy Services | OH | N/A | RELATED | $51,210 | 0 | 0 | 0.50000 |
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp
Related Organization Name RelatedOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Community Care Systems Inc | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1250 S Washington St | AddressLine1Txt |
| City | van wert | CityNm |
| State Abbreviation | OH | StateAbbreviationCd |
| ZIP | 45891 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 341783212 | EIN |
| Primary Activities | HEALTHCARE MANAGEMENT SERVICES | PrimaryActivitiesTxt |
| Legal Domicile State | OH | LegalDomicileStateCd |
| Direct Controlling NA | N/A | DirectControllingNACd |
| Entity Type | C | EntityTypeTxt |
| Ownership | 0.50000 | OwnershipPct |
| Controlled Organization | 0 | ControlledOrganizationInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | Yes (1) | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | Yes (1) | 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 | Yes (1) | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | 0 | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | 0 | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | 0 | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | 0 | SharingOfFacilitiesInd |
| Paid Employees Sharing | 0 | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | Yes (1) | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |