2017-10-30T15:05:53-05:00 2016-12-31 990 2016-01-01 341013695 The Assumption Village ASSU 3305490740 9800 Market Street North Lima OH 44452 Anthony Seminaro Region CFO 2017-10-30 2016 2021-01-29 14:40:06Z Donald Kline 1044 BELMONT AVENUE YOUNGSTOWN OH 44501 14168583 false 0928 X www.HMPartners.org X 1974 OH THE ASSUMPTION VILLAGE OFFERS BOTH ASSISTED LIVING AND LONG-TERM NURSING CARE FOR PATIENTS IN A COMFORTABLE AND WARM ATMOSPHERE. IT IS MEDICARE AND MEDICAID APPROVED. 13 11 282 11 0 0 13229 73968 13583645 13865941 0 191413 228674 13788287 14168583 0 0 7845562 8560226 0 0 6630283 6535852 14475845 15096078 -687558 -927495 9614759 9880929 8114557 7901013 1500202 1979916 The Assumption Village extends the healing ministry of Jesus by improving the health of our communities with emphasis on people who are poor and underserved. false false 13088508 0 13865941 THE ASSUMPTION VILLAGE IS A LONG-TERM CARE FACILITY OFFERING MULTI-LEVEL SERVICES, INCLUDING INTERMEDIATE CARE, SKILLED NURSING CARE, ASSISTED LIVING, AND AN ALZHEIMER'S/DEMENTIA SPECIAL CARE UNIT. THE ASSUMPTION VILLAGE PARTICIPATES IN THE MEDICARE AND MEDICAID PROGRAMS. 13088508 true true false false false false false false false false true false false false true true false true false false false false false false false false false false false true false false false false false false false false false false false false false true false false false true 0 0 282 true false false false false false false false false false false X 13 11 false false false false true true true true true false false true true true true true true false false false X Travis Crum 5139525000 1701 Mercy Health Place Cincinnati OH 45237 ROBERT SHRODER PRES & CEO YOUNGSTOWN REGION, SVP MERCY HEALTH (END 2/16) 1.0 48.0 X X 0 634795 11338 DONALD KLINE PRES & CEO YOUNGSTOWN REGION, SVP MERCY HEALTH (BEGIN 2/16) 1.0 51.0 X X 0 517820 249239 SR CAROLE ANNE GRISWOLD HM SECRETARY 1.0 3.0 X X 0 0 0 BETTY JO LICATA CHAIRPERSON 1.0 2.0 X X 0 0 0 SHELLEY TAYLOR-ODILLE TREASURER 1.0 2.0 X X 0 0 0 MARTHA BUSHEY VICE CHAIRPERSON 1.0 2.0 X X 0 0 0 SR MARYANN GOLONKA HM TRUSTEE 1.0 2.0 X 0 0 0 BRIAN CORBIN TRUSTEE 1.0 3.0 X 0 0 0 SCOTT SCHULICK TRUSTEE 1.0 2.0 X 0 0 0 SAM KOOPERMAN TRUSTEE 1.0 2.0 X 0 0 0 BRIAN SMITH TRUSTEE, EVP & COO, MERCY HEALTH 0.5 48.0 X 0 1036023 74867 CONSUELO MENDEZ MD TRUSTEE 1.0 2.0 X 0 0 0 WENDY WEBB TRUSTEE 1.0 2.0 X 0 0 0 RICHARD ADKINSON TRUSTEE 1.0 1.0 X 0 0 0 MATTHEW LOVE MERCY HEALTH YOUNGSTOWN SVP & CFO 1.0 41.0 X 0 574463 103674 MELESSA SCATTINO Executive Director LTC 20.0 20.0 X 0 102471 26635 0 2865572 465753 0 false true false 0 X 73968 73968 NET PATIENT SERVICE REVENUE 621990 13835340 13835340 LAB REVENUE 621500 30601 30601 0 0 0 0 13865941 0 0 0 0 BEAUTY/BARBER SHOP 812900 64138 64138 CAFETERIA 722210 7315 7315 TV and telephone 900099 4790 4790 152431 0 0 152431 228674 14168583 13865941 0 228674 X 5918654 5030856 887798 349026 296672 52354 1877028 1595474 281554 415518 353191 62327 19567 19567 5715 4858 857 2901847 2467726 434121 0 327131 278061 49070 5035 4280 755 492806 418885 73921 7533 6403 1130 296429 251965 44464 544397 462737 81660 80907 68771 12136 Dues and subscriptions 17473 14852 2621 Medical Supplies 543916 543916 DIETARY expense 599213 599213 State Assessments 672309 672309 21574 18339 3235 0 15096078 13088508 2007570 0 800 800 -28989 48573 1075575 1300328 0 0 0 1400 18352717 9821489 8565973 8531228 0 0 0 0 9614759 9880929 1324681 1553085 6789876 6347928 8114557 7901013 X 1500202 1979916 1500202 1979916 9614759 9880929 X -927495 1407209 X false true X true false X 1201 26759 5753 13229 73968 120910 12542132 12136454 12576155 13583645 13865941 64704327 0 0 0 12543333 12163213 12581908 13596874 13939909 64825237 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 64825237 887 118 0 0 0 1005 0 887 118 0 0 0 1005 0 194374 175424 244461 191413 228674 1034346 12738594 12338755 12826369 13788287 14168583 65860588 0.9843 0.9857 0.0000 0.0001 X Schedule A, Part III, Line 12 Other Income DESCRIPTION - OTHER EXCLUDED REVENUE, COLUMN A - 194374.0, COLUMN B - 175424.0, COLUMN C - 244461.0, COLUMN D - 191413.0, COLUMN E - 228674.0, COLUMN F - 1034346.0; RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 440000 440000 14592002 7287669 7304333 564390 309191 255199 2756325 2224629 531696 8531228 NOTES PAYABLE TO AFFILIATE 6347928 6347928 X Schedule D, Part X, Line 2 FIN 48 (ASC 740) footnote THE COMPANY (MERCY HEALTH AND AFFILIATED ENTITIES) COMPLETED AN ANALYSIS OF ITS TAX POSITIONS IN ACCORDANCE WITH APPLICABLE ACCOUNTING GUIDANCE AT DECEMBER 31, 2016 AND 2015, AND DETERMINED THAT NO AMOUNTS WERE REQUIRED TO BE RECOGNIZED IN THE CONSOLIDATED FINANCIAL STATEMENTS AT DECEMBER 31, 2016 OR 2015. false true false false false false false false false ROBERT SHRODER PRES & CEO YOUNGSTOWN REGION, SVP MERCY HEALTH (END 2/16) 0 77143 0 0 0 557652 0 86 0 11252 0 646133 0 0 DONALD KLINE PRES & CEO YOUNGSTOWN REGION, SVP MERCY HEALTH (BEGIN 2/16) 0 512008 0 0 0 5812 0 220941 0 28298 0 767059 0 0 BRIAN SMITH TRUSTEE, EVP & COO, MERCY HEALTH 0 771014 0 0 0 265009 0 35344 0 39523 0 1110890 0 67437 MATTHEW LOVE MERCY HEALTH YOUNGSTOWN SVP & CFO 0 453405 0 0 0 121058 0 75455 0 28219 0 678137 0 0 Schedule J, Part I, Line 4b Terms and conditions of The Mercy Health SERP Plan The Mercy Health SERP plan is a deferred compensation plan which provides supplemental retirement benefits to persons selected by the Board of Trustees or its delegate. It provides annual credits of a specified percentage of compensation and annual interest credits. Participants vest 50%, 75%, and 100% in their accounts after 5, 6, and 7 years of service, respectively, vesting occurs earlier for death or total disability or reaching age 60 while employed, or involuntary termination of employment within 24 months after a change in control of the organization or due to position elimination, payments during employment are made for required tax withholdings. Payment of the vested account balance in a lump sum occurs after termination of employment. Amounts includible as taxable compensation for listed individuals due to SERP participation in the reporting year were as follows: Robert Shroder $552,440; Brian Smith $119,659. Schedule J, Part I, Line 4b Terms and conditions of the Lima Market SERP THE LIMA MARKET 457(F) PLAN PROVIDES A FLEXIBLE BENEFIT ALLOWANCE TO PERSONS SELECTED BY THE BOARD OF TRUSTEES OR ITS DELEGATE. THIS ALLOWANCEMAY BE ALLOCATED AMONG VARIOUS INSURANCE AND DEFERRED COMPENSATION BENEFIT OPTIONS. THE PLAN IS NO LONGER ACCEPTING NEW PARTICIANTS AND THE CESSATION OF CONTRIBUTIONS HAS OCCURRED. AMOUNTS INCLUDIBLE IN TAXABLE COMPENSATION FOR LISTED PARTICIPATING INDIVIDUALS IN THE REPORTING YEAR WERE AS FOLLOWS: BRIAN SMITH $67,437. Schedule J, Part I, Line 4b Terms and conditions of the Mercy Health System SERP The Mercy Health System SERP is a non-qualified deferred compensation plan which provides supplemental retirement benefits to persons selected by the Board of Trustees or its delegate. The plan provides for annual credits of a specified percentage of an eligible participants base salary paid in a plan year and interest credits. Plan participants vest in plan credits after completing a three year class vesting schedule or earlier for death or total disability or reaching age 60 while employed, or due to involuntary separation of employment other than for cause. Payments during employment are made for required tax withholding and reduce the participants account balance. Distribution of the vested account balance in a lump sum occurs after termination of employment. Amounts includible as taxable compensation for listed individuals due to SERP participation in the reporting year were as follows: Matthew Love $0; Donald Kline $0. Schedule J, Part I, Line 3 Arrangement used to establish the top management official's compensation The compensation of the organization's President and CEO, Robert Shroder, succeeded by Donald Kline, is determined by Mercy Health, a related tax-exempt organization. Mercy Health utilizes a compensation committee, an independent compensation consultant, a compensation survey, and approval by board or compensation committee when determining Mr. Shroder's and Mr. Kline's compensation. Schedule J, Part I, Line 4b Supplemental nonqualified retirement plan The Youngstown Market SERP Plan is a deferred compensation plan which provides supplemental retirement benefits to persons selected by the Mercy Health Youngstown LLC Board of trustees or its delegate. The plan is no longer accepting new participants and cessation of contributions has occurred. Participants vest 100% in their accounts after three years of service, except for participants who had attained at least ten years of service at plan inception, who had immediate vesting. Vesting occurs earlier upon death or total disability. Payments are made during employment for required tax withholding. The vested account balance is paid as a lump sum after termination of employment. Amounts includible as taxable compensation for listed individuals due to SERP participation in the reporting year are as follows: Matthew Love $0; Donald Kline $0. Form 990, Part VI, Line 15 Compensation THE COMPENSATION OF THE CEO OR TOP MANAGEMENT OFFICIAL IS DETERMINED BY MERCY HEALTH, A RELATED TAX-EXEMPT ORGANIZATION. THE COMPENSATION OF OFFICERS OR KEY EMPLOYEES IS DETERMINED BY MERCY HEALTH YOUNGSTOWN LLC, A RELATED TAX-EXEMPT ORGANIZATION. Form 990, Part VI, Line 6 Classes of members or stockholders MERCY HEALTH YOUNGSTOWN LLC IS THE SOLE MEMBER OF THE ASSUMPTION VILLAGE. Form 990, Part VI, Line 7a Members or stockholders electing members of governing body Mercy Health elects all board members who have full voting rights. Form 990, Part VI, Line 7b Decisions requiring approval by members or stockholders Certain matters require approval of the Mercy Health Corporate Member, Mercy Health Governing Body, or the Mercy Health CEO. The regulations of the organization describe the level of approval required for various decisions. Form 990, Part VI, Line 11b Review of form 990 by governing body The Form 990 is prepared by Mercy Health's tax department and reviewed by management. Once the Form 990 is reviewed by all applicable parties a final version is provided to all members of the Governing Body prior to filing. Form 990, Part VI, Line 12c Conflict of interest policy All board members are covered by the Mercy Health conflict of interest policy which requires disclosure on an annual basis. All potential conflicts of interest are reviewed by the Mercy Health Corporate Compliance Officer. At the beginning of each board meeting all board members are required to disclose any conflicts of interest. Board members determined to have a conflict of interest are prohibited from participating in deliberations and decision-making for the transaction in which the conflict exists. Form 990, Part VI, Line 19 Required documents available to the public THE SYSTEM-WIDE CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE POSTED ON THE MERCY HEALTH WEBSITE. Form 990, Part VIII, Line 11d Other Miscellaneous Revenue Other operating revenue - Total Revenue: 152431, Related or Exempt Function Revenue: , Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: 152431; Form 990, Part IX, Line 11g Other Fees Medical Professional Fees - Total Expense: 7700, Program Service Expense: 7700, Management and General Expenses: , Fundraising Expenses: ; Consulting - Total Expense: 27428, Program Service Expense: 23314, Management and General Expenses: 4114, Fundraising Expenses: ; Intercompany - Total Expense: 131004, Program Service Expense: 111353, Management and General Expenses: 19651, Fundraising Expenses: ; Affiliate Assessment - Total Expense: 1188702, Program Service Expense: 1010397, Management and General Expenses: 178305, Fundraising Expenses: ; Other - Total Expense: 1410132, Program Service Expense: 1198613, Management and General Expenses: 211519, Fundraising Expenses: ; Maintenance and service agreements - Total Expense: 136881, Program Service Expense: 116349, Management and General Expenses: 20532, Fundraising Expenses: ; Form 990, Part XI, Line 9 Other changes in net assets or fund balances Elimination of intercompany balances - 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