2016-11-08T08:29:47-06:00 2015-12-31 381357951 PLANTE & MORAN PLLC 65 EAST STATE ST STE 600 COLUMBUS OH 43215 990 2015-01-01 341893452 UHHSCSAHS - CUYAHOGA INC UHHS 4407402165 6935 TREELINE DRIVE NO J BRECKSVILLE OH 441413393 ALLEN TRACY PRESIDENT 4407402165 2016-08-01 1 BERNIE OSTROWSKI P00366367 6148493000 2015 2017-02-10 21:41:12Z ALLEN TRACY 6935 TREELINE DRIVE NO J BRECKSVILLE OH 441413393 14689545 0 X N/A X 1999 OH UHHS/CSAHS-CUYAHOGA, INC (CUYAHOGA) IS AN ORGANIZATION JOINTLY OWNED BY THE SISTERS OF CHARITY HEALTH SYSTEM AND UNIVERSITY HOSPITALS HEALTH SYSTEM, INC. (THE MEMBERS) OPERATED FOR THE EXCLUSIVE BENEFIT OF THE MEMBERS AND THEIR RELATED SUBSIDIARIES. BOTH MEMBERS ARE TAX-EXEMPT 501(C)3 CHARITABLE ORGANIZATIONS. CUYAHOGA PROVIDES ADMINISTRATIVE SUPPORT SERVICES FOR ORGANIZATIONS OPERATED BY THE MEMBERS. 4 4 0 4 0 0 0 0 16119226 14637163 73 342 30151 52040 16149450 14689545 0 0 0 0 6309350 6009468 0 0 0 9951479 8787940 16260829 14797408 -111379 -107863 4649676 3394673 3261395 2114255 1388281 1280418 X UHHS/CSAHS-CUYAHOGA, INC (CUYAHOGA) IS AN ORGANIZATION JOINTLY OWNED BY THE SISTERS OF CHARITY HEALTH SYSTEM AND UNIVERSITY HOSPITALS HEALTH SYSTEM, INC. (THE MEMBERS) OPERATED FOR THE EXCLUSIVE BENEFIT OF THE MEMBERS AND THEIR RELATED SUBSIDIARIES. BOTH MEMBERS ARE TAX-EXEMPT 501(C)3 CHARITABLE ORGANIZATIONS. CUYAHOGA PROVIDES ADMINISTRATIVE SUPPORT SERVICES FOR ORGANIZATIONS OPERATED BY THE MEMBERS. 0 0 14797408 14689203 SEE PART III, LINE 1 MISSION STATEMENT. 14797408 1 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 4 0 1 0 0 0 0 0 0 0 0 0 0 0 X 4 4 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 0 OH X STEVEN SNYDER 4407403403 6935 TREELINE DRIVE BRECKSVILLE OH 441413393 X ALLEN TRACY VICE CHAIR AND PRESIDENT & CEO 2.00 X X 0 0 0 MELISSA ROGERS CHAIRPERSON 2.00 X X 0 0 0 PAUL TAIT SECRETARY 2.00 X X 0 0 0 JOHN RUSNACZYK TREASURER 2.00 X X 0 0 0 0 0 0 0 0 0 0 MEDICAL INFORMATION TECHNOLOGY PO BOX 74569 CHICAGO IL 60696 IT SUPPORT 1023774 REVENUE GROUP 4780 HINCKLEY INDUSTRIAL PKWY SUITE CLEVELAND OH 44109 COLLECTION SERVICES 747123 HUMAN ARC CORPORATION PO BOX 637901 CINCINNATI OH 452637901 COLLECTION SERVICES 486542 REVCARE INC 3250 W MARKET STREET AKRON OH 44333 COLLECTION SERVICES 370331 QUADAX INC 3690 ORANGE PLACE 270 BEACHWOOD OH 44122 COLLECTION SERVICES 173097 8 MEMBER REVENUES 561000 14637163 14637163 14637163 342 342 ADMIN BILLINGS 900099 52040 52040 52040 14689545 14689203 0 342 4675617 4675617 261023 261023 731055 731055 341773 341773 326 326 30200 30200 501898 501898 335590 335590 2974349 2974349 388279 388279 21491 21491 5631 5631 1221558 1221558 80683 80683 COLLECTION FEES 2737317 2737317 BANK FEES 479802 479802 DUES/SUBSCRIPTIONS 9102 9102 EMPLOYEE RECRUITING 1500 1500 214 214 14797408 14797408 0 0 763209 155527 1174828 951723 623533 618072 20349751 18680400 2088106 1669351 4649676 3394673 2342439 2114255 918956 0 3261395 2114255 X 1388281 1280418 1388281 1280418 4649676 3394673 -107863 0 X X 0 1 X 1 0 X X X 2 SISTERS OF CHARITY OF ST AUGUSTINE 340714763 1 1 0 0 UNIVERSITY HOSPITALS CLEVELAND MEDICAL CENTER 341567805 3 1 0 0 2 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 SCHEDULE A - PART I LINE 11B SUPPORT THAT IS PROVIDED BY UHHS/CSAHS-CUYAHOGA, INC ARE IN THE FORM OF SERVICES (I.E. ACCOUNTING, BILLING AND COLLECTIONS) TO THE MEMBER ORGANIZATIONS. SCHEDULE A - SECTION C. LINE 1 TWO MEMBERS OF THE BOARD ARE OFFICERS OF THE SUPPORTED ORGANIZATIONS OF SISTERS OF CHARITY OF ST. AUGUSTINE HEALTH SYSTEM, INC. (SCHS) AND UNIVERSITY HOSPITAL HEALTH SYSTEM, INC. (UHHS). THE OTHER TWO BOARD MEMBERS ARE OFFICERS FOR ORGANIZATIONS RELATED TO THE SUPPORTED ORGANIZATIONS. SINCE THE SUPERVISION OF THE LATTER TWO BOARD MEMBERS IS IN LINE WITH THE CONTROL OF THE SUPPORTED ORGANIZATIONS, UHHS/SCHS ARE DEEMED TO HAVE SUPERVISION AND CONTROL OF THE UHHS/CSAHS-CUYAHOGA, INC AND ARE PROPERLY CLASSIFIED AS A TYPE II SUPPORTING ORGANIZATION. 91531 88618 2913 19660986 18591782 1069204 597234 597234 1669351 X 14689545 0 14689545 0 14689545 14797408 0 14797408 0 14797408 PART X, LINE 2: THE COMPANY IS A NONPROFIT, TAX-EXEMPT ORGANIZATION AND ACCORDINGLY, NO TAX PROVISION IS REFLECTED IN THE FINANCIAL STATEMENTS. WITH FEW EXCEPTIONS, THE COMPANY IS NO LONGER SUBJECT TO U.S. FEDERAL, STATE AND LOCAL,OR NON-U.S. INCOME TAX EXAMINATIONS BY TAX AUTHORITIES FOR YEARS BEFORE 2012. ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA REQUIRE MANAGEMENT TO EVALUATE TAX POSITIONS TAKEN BY THE COMPANY AND RECOGNIZE A TAX LIABILITY IF THE COMPANY HAS TAKEN AN UNCERTAIN TAX POSITION THAT MORE LIKELY THAN NOT WOULD NOT BE SUSTAINED UPON EXAMINATION BY THE INTERNAL REVENUE SERVICE OR OTHER APPLICABLE TAXING AUTHORITIES. MANAGEMENT HAS ANALYZED THE TAX POSITIONS TAKEN BY THE COMPANY AND HAS CONCLUDED THAT AS OF DECEMBER 31, 2015, THERE ARE NO UNCERTAIN TAX POSITIONS TAKEN OR EXPECTED TO BE TAKEN THAT WOULD REQUIRE RECOGNITION OF A LIABILITY OR DISCLOSURE IN THE FINANCIAL STATEMENTS. FORM 990, PART VI, SECTION A, LINE 6 THE ORGANIZATION HAS TWO CORPORATE MEMBERS: SISTERS OF CHARITY HEALTH SYSTEM AND UNIVERSITY HOSPITALS HEALTH SYSTEM. FORM 990, PART VI, SECTION A, LINE 7A THE ORGANIZATION'S MEMBERS MAY ELECT MEMBERS OF THE GOVERNING BODY. FORM 990, PART VI, SECTION A, LINE 7B CERTAIN DECISIONS OF THE GOVERNING BODY, SUCH AS APPROVAL OF BUDGETS, CAPITAL EXPENDITURES AND ACQUISITION OF LAND, MUST BE APPROVED BY THE BOARD OF THE MEMBER ORGANIZATION. FORM 990, PART VI, SECTION B, LINE 11 AFTER THE 990 RETURN IS REVIEWED INTERNALLY; IT IS SUBMITTED FOR REVIEW TO OUR TAX ADVISORS. THEY REVIEW FOR COMPLETENESS AND COMMUNICATE ANY CONCERNS THAT THEY IDENTIFY WITHIN THE DOCUMENTS AND WORKSHEETS OF THE TAX RETURN. ITEMS IDENTIFIED ARE REVIEWED BY STAFF AND ANY NEEDED CORRECTIONS ARE MADE. THE RETURN IS THEN PROVIDED TO THE PRESIDENT FOR REVIEW AND APPROVAL. IT IS THEN SUBMITTED TO THE BOARD FOR REVIEW. FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION HAS IN PLACE A CONFLICT OF INTEREST POLICY AS WELL AS A NON-RETALIATION POLICY (WHISTLE-BLOWER) MANAGED THROUGH THE COMPLIANCE OFFICER. THE CONFLICT OF INTEREST FORMS ARE SENT OUT ANNUALLY TO ADMINISTRATION, AND OTHER LEADERSHIP EMPLOYEES AS WELL AS BOARD MEMBERS. THE FORMS ARE RETURNED TO ADMINISTRATION. ONCE RETURNED, THEY ARE REVIEWED BY THE COMPLIANCE OFFICER AND CEO TO DETERMINE IF ANYTHING WOULD BE DEEMED A POTENTIAL CONFLICT OF INTEREST. IF THERE IS A CONFLICT, THE CEO, COMPLIANCE OFFICER AND EMPLOYEE/INDIVIDUAL MEET TO DISCUSS. THE RESULTS OF THOSE MEETINGS ARE AN AGENDA ITEM AT THE ORGANIZATION'S ADMINISTRATIVE COMPLIANCE COMMITTEE MEETING AND IT IS FURTHER DISCUSSED THERE. ONCE A DECISION IS MADE REGARDING THE CONFLICT, FOLLOW-UP IS MADE BY THE COMPLIANCE OFFICER/CEO WITH THE EMPLOYEE, IF APPROPRIATE. THE ORGANIZATION ALSO DISCUSSES THE RESULTS OF THE CONFLICT OF INTERESTS WITH THE BOARD OF TRUSTEES. FORM 990, PART VI, SECTION C, LINE 18 FORMS 990 AND 1023 ARE AVAILABLE TO PUBLIC UPON REQUEST AT THE FINANCIAL SERVICE CENTER LOCATION. FORM 990, PART VI, SECTION C, LINE 19 GOVERNING DOCUMENTS, THE FINANCIAL STATEMENTS, AND THE CONFLICT OF INTEREST POLICY ARE AVAILABLE TO PUBLIC UPON REQUEST AT THE FINANCIAL SERVICE CENTER LOCATION. SCHEDULE R, PART II UHHS/CSAHS - CUYAHOGA, INC. HAS TWO CORPORATE MEMBERS, UNIVERSITY HOSPITALS HEALTH SYSTEM AND THE SISTERS OF CHARITY OF ST. AUGUSTINE. THE ENTIRE BOARD OF UHHS/CSAHS - CUYAHOGA, INC. ARE EMPLOYEES OF ONE OF THE CORPORATE MEMBERS AND THEREFORE RECEIVE COMPENSATION FROM ONE OF THE CORPORATE MEMBERS. NEITHER CORPORATE MEMBER MEETS THE NECESSARY ELEMENT OF CONTROL TO BE CONSIDERED A RELATED ORGANIZATION AND ARE THEREFORE NOT REPORTED ON SCHEDULE R. ACCORDINGLY, THERE IS NO COMPENSATION REPORTED FOR THE BOARD MEMBERS SINCE THEY ARE NOT COMPENSATED BY THE ORGANIZATION OR A RELATED ORGANIZATION. AS A RESULT, ALL FOUR BOARD MEMBERS HAVE BEEN LISTED ON FORM 990, PART VI, AND LINE B AS NOT LACKING INDEPENDENCE. 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