PIKE HEALTH SERVICES INC: Form 990, tax year 2015
View the entire original 990 at ProPublica ↗
- Organization
- PIKE HEALTH SERVICES INC (EIN 31-1072406)
- Tax period
- 2015-01-01 to 2015-12-31
- Filed
- 2016-11-14
- IRS object ID
- 201613199349305121
- Schema version
- 2015v2.1
- 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 I
- Schedule J
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2016-11-14T11:57:57-06:00 | ReturnTs |
| Tax Period End | 2015-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 381357951 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | PLANTE & MORAN PLLC | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 250 S High St Suite 100 | AddressLine1Txt |
| City | Columbus | CityNm |
| State Abbreviation | OH | StateAbbreviationCd |
| ZIP | 43215 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2015-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 311072406 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | PIKE HEALTH SERVICES INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | PIKE | BusinessNameControlTxt |
| Phone | 7409472186 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 100 DAWN LANE | AddressLine1Txt |
| City | WAVERLY | CityNm |
| State Abbreviation | OH | StateAbbreviationCd |
| ZIP | 45690 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | LISA CARLSON | PersonNm |
| Person Title | CFO | PersonTitleTxt |
| Phone | 7409472186 | PhoneNum |
| Signature | 2016-11-14 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | Bernie Ostrowski | PreparerPersonNm |
| PTIN | P00366367 | PTIN |
| Phone | 6148493000 | PhoneNum |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2015 | TaxYr |
| Build TS | 2017-02-10 21:41:12Z | BuildTS |
Form 990 IRS990
Doing Business As Name DoingBusinessAsName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ADENA PIKE MEDICAL CENTER | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | MARK SHUTER | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 100 DAWN LANE | AddressLine1Txt |
| City | WAVERLY | CityNm |
| State Abbreviation | OH | StateAbbreviationCd |
| ZIP | 45690 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $19,946,410 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | ADENA.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1983 | FormationYr |
| Legal Domicile State | OH | LegalDomicileStateCd |
| Activity Or Mission | PIKE HEALTH SERVICES, INC. IS HIGH QUALITY; COMPASSIONATE HEALTHCARE; ACCESSIBLE TO THE COMMUNITY; COMMITTED TO EXCELLENCE; RESPECTFUL OF EACH INDIVIDUAL; AND FOUNDED ON SERVICE TO OTHERS. | ActivityOrMissionDesc |
| Voting Members Governing Body | 8 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 7 | VotingMembersIndependentCnt |
| Total Employee | 153 | TotalEmployeeCnt |
| Total Volunteers | 23 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $10,000 | PYContributionsGrantsAmt |
| CY Contributions Grants | $9,399 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $18,223,759 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $19,507,221 | CYProgramServiceRevenueAmt |
| PY Investment Income | $42,399 | PYInvestmentIncomeAmt |
| CY Investment Income | $64,001 | CYInvestmentIncomeAmt |
| PY Other Revenue | $1,307,943 | PYOtherRevenueAmt |
| CY Other Revenue | $164,165 | CYOtherRevenueAmt |
| PY Total Revenue | $19,584,101 | PYTotalRevenueAmt |
| CY Total Revenue | $19,744,786 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $11,000 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $20,000 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $9,523,382 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $9,320,481 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $12,184,613 | PYOtherExpensesAmt |
| CY Other Expenses | $10,034,321 | CYOtherExpensesAmt |
| PY Total Expenses | $21,718,995 | PYTotalExpensesAmt |
| CY Total Expenses | $19,374,802 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$2,134,894 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $369,984 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $15,899,206 | TotalAssetsBOYAmt |
| Total Assets EOY | $12,946,176 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $1,153,571 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $908,805 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $14,745,635 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $12,037,371 | NetAssetsOrFundBalancesEOYAmt |
| Mission | PIKE HEALTH SERVICES, INC. IS HIGH QUALITY; COMPASSIONATE HEALTHCARE; ACCESSIBLE TO THE COMMUNITY; COMMITTED TO EXCELLENCE; RESPECTFUL OF EACH INDIVIDUAL; AND FOUNDED ON SERVICE TO OTHERS. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $18,021,936 | ExpenseAmt |
| Grant | $20,000 | GrantAmt |
| Revenue | $19,507,221 | RevenueAmt |
| Desc | PIKE HEALTH SERVICES, INC. IS A 25- BED CRITICAL ACCESS HOSPITAL AND PHYSICIAN PRACTICE LOCATED IN THE STATE OF OHIO IN PIKE COUNTY. INCLUDED IN THE BED COUNT ARE 21 ACUTE BEDS AND 4 INTENSIVE CARE BEDS WITH AUTHORIZATION FOR SWING BEDS ON AN AS NEEDED BASIS. IN 2015, PIKE HEALTH SERVICES, INC. HAD 527 INPATIENT ADMISSIONS, 75,749 OUTPATIENT VISITS, INCLUDING VISITS TO THE EMERGENCY DEPARTMENT. ADENA PIKE COMMUNITY HOSPITAL PROVIDED CHARITY CARE TO THE COMMUNITY IN THE AMOUNT OF $959,469. DURING THE YEAR, PIKE HEALTH SERVICES, INC PARTICIPATED IN HEALTH FAIRS OFFERING SCREENING AND EDUCATION FOR DIABETES, CHOLESTEROL AND ARTHRITIS FOR BOTH ADULTS AND CHILDREN. | Desc |
| Total Program Service Expenses | $18,021,936 | 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 | 0 | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | Yes (1) | ReportOtherAssetsInd |
| Report Other Liabilities | 0 | 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 | Yes (1) | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| 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 | 0 | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | 0 | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 0 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Employee | 153 | 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 | 8 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 7 | 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 | 0 | CompensationProcessCEOInd |
| Compensation Process Other | 0 | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SHARON WISECUP DIRECTOR OF FINANCIAL REPORTING | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 7407794478 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 272 HOSPITAL ROAD | AddressLine1Txt |
| City | CHILLICOTHE | CityNm |
| State Abbreviation | OH | StateAbbreviationCd |
| ZIP | 456019031 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (17 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Highest Compensated EmployeeHighestCompensatedEmployeeInd | Former Ofcr Director TrusteeFormerOfcrDirectorTrusteeInd |
|---|---|---|---|---|---|---|---|---|---|
| ANTHONY FISH | |||||||||
| CHAIRMAN | 2.00 | 0.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| MARGARET FOILL | |||||||||
| TREASURER (JAN-SEPT) | 2.00 | 0.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| VAL FRANCIS | |||||||||
| VICE CHAIRMAN | 2.00 | 0.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| LINDA SHOEMAKER | |||||||||
| SECRETARY | 2.00 | 0.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| PAUL ADKINS | |||||||||
| TRUSTEE | 2.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |||
| TODD BURKITT | |||||||||
| TRUSTEE | 2.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |||
| DAVID KESSLER | |||||||||
| CHIEF OF MEDICAL STAFF | 2.00 | 0.00 | Yes (X) | $308,555 | $0 | $2,016 | |||
| CONNIE SHELLEY | |||||||||
| TRUSTEE | 2.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |||
| TONY DIXON | |||||||||
| TRUSTEE | 2.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |||
| DAVE ZANNI | |||||||||
| CEO | 50.00 | 0.00 | Yes (X) | $136,530 | $0 | $33,728 | |||
| DAN RASE | |||||||||
| EMPLOYEE | 40.00 | 0.00 | $101,995 | $0 | $21,161 | Yes (X) | |||
| JOHN CRAWFORD | |||||||||
| PHYSICIAN | 40.00 | 0.00 | $133,315 | $0 | $24,367 | Yes (X) | |||
| ELLIS FRAZIER | |||||||||
| PHYSICIAN | 40.00 | 0.00 | $189,047 | $0 | $14,078 | Yes (X) | |||
| CHERYL SMITH | |||||||||
| PHARMACIST | 40.00 | 0.00 | $148,094 | $0 | $14,080 | Yes (X) | |||
| MIKE DIENER | |||||||||
| EMPLOYEE | 40.00 | 0.00 | $148,716 | $0 | $43,446 | Yes (X) | |||
| CATHERINE FARINET | |||||||||
| FORMER CHIEF OF MEDICAL STAFF | 50.00 | 0.00 | $238,958 | $0 | $20,879 | Yes (X) | |||
| CRAIG SOLLE | |||||||||
| FORMER PRESIDENT AND CEO | 50.00 | 0.00 | $146,515 | $0 | $0 | Yes (X) | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $1,551,725 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $173,755 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 10 | 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 (2 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| PREMIER HEALTH CARE SERVICES INC | |||||
| 332 CONGRESS PARK DRIVE | DAYTON | OH | 45459 | ER COVERAGE | $612,691 |
| PRECYSE SOLUTIONS LLC | |||||
| DEPT 1736 PO BOX 11407 | BIRMINGHAM | AL | 35246 | TRANSCRIPTION & CODING | $444,830 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 2 | CntrctRcvdGreaterThan100KCnt |
| Related Organizations | $9,399 | RelatedOrganizationsAmt |
| Total Contributions | $9,399 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | NET PATIENT SVC REV | Desc |
| Business | 622110 | BusinessCd |
| Total Revenue Column | $19,507,221 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $19,507,221 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $19,507,221 | TotalProgramServiceRevenueAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $9,176 | 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 | $9,176 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $9,176 | TotalRevenueColumnAmt |
| Exclusion | $9,176 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $254,597 | SecuritiesAmt |
| Other | $1,300 | OtherAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $190,346 | SecuritiesAmt |
| Other | $1,550 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $64,251 | SecuritiesAmt |
| Other | -$250 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $64,001 | TotalRevenueColumnAmt |
| Exclusion | $64,001 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Fundraising Gross Income | $21,175 | FundraisingGrossIncomeAmt |
| Fundraising Direct Expenses | $9,728 | FundraisingDirectExpensesAmt |
Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $11,447 | TotalRevenueColumnAmt |
| Exclusion | $11,447 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp (2 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | ExclusionExclusionAmt |
|---|---|---|---|
| EHR IMPLEMENTATION | 622110 | $81,600 | $81,600 |
| CAFETERIA REVENUE | 722514 | $18,284 | $18,284 |
Miscellaneous Revenue MiscellaneousRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $43,658 | TotalRevenueColumnAmt |
| Exclusion | $43,658 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $143,542 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $19,744,786 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $19,507,221 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $228,166 | ExclusionAmt |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $15,500 | TotalAmt |
| Program Services | $15,500 | ProgramServicesAmt |
Grants To Domestic Individuals GrantsToDomesticIndividualsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,500 | TotalAmt |
| Program Services | $4,500 | ProgramServicesAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $480,829 | TotalAmt |
| Program Services | $310,571 | ProgramServicesAmt |
| Management And General | $170,258 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $6,549,021 | TotalAmt |
| Program Services | $6,345,399 | ProgramServicesAmt |
| Management And General | $203,622 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,802,144 | TotalAmt |
| Program Services | $1,734,565 | ProgramServicesAmt |
| Management And General | $67,579 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $488,487 | TotalAmt |
| Program Services | $473,299 | ProgramServicesAmt |
| Management And General | $15,188 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,791,330 | TotalAmt |
| Program Services | $1,815,407 | ProgramServicesAmt |
| Management And General | -$24,077 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $278,292 | TotalAmt |
| Program Services | $262,561 | ProgramServicesAmt |
| Management And General | $15,731 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $375,804 | TotalAmt |
| Program Services | $14,651 | ProgramServicesAmt |
| Management And General | $361,153 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $78,371 | TotalAmt |
| Program Services | $56,455 | ProgramServicesAmt |
| Management And General | $21,916 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $775,096 | TotalAmt |
| Program Services | $431,420 | ProgramServicesAmt |
| Management And General | $343,676 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $64,052 | TotalAmt |
| Program Services | $64,052 | ProgramServicesAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| CORPORATE OVERHEAD ALLO | $3,303,360 | $3,139,025 | $164,335 |
| BAD DEBT EXPENSE | $1,555,093 | $1,555,093 | |
| MEDICAL SUPPLIES | $1,480,679 | $1,467,194 | $13,485 |
| FRANCHISE FEES | $332,244 | $332,244 |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $19,374,802 | TotalAmt |
| Program Services | $18,021,936 | ProgramServicesAmt |
| Management And General | $1,352,866 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,006,208 | BOYAmt |
| EOY | $1,130,134 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $45,815 | BOYAmt |
| EOY | $61,182 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,107,401 | BOYAmt |
| EOY | $2,523,004 | EOYAmt |
Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $170,716 | BOYAmt |
| EOY | $439,438 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $306,807 | BOYAmt |
| EOY | $275,830 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,012,285 | BOYAmt |
| EOY | $1,591,513 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $9,962,769 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $3,934,229 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,254,195 | BOYAmt |
| EOY | $6,028,540 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $995,779 | BOYAmt |
| EOY | $896,535 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $15,899,206 | BOYAmt |
| EOY | $12,946,176 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,153,571 | BOYAmt |
| EOY | $908,805 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,153,571 | BOYAmt |
| EOY | $908,805 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $14,745,635 | BOYAmt |
| EOY | $12,037,371 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $14,745,635 | BOYAmt |
| EOY | $12,037,371 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $15,899,206 | BOYAmt |
| EOY | $12,946,176 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | $369,984 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | $73,894 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | -$3,152,142 | OtherChangesInNetAssetsAmt |
| Info In Schedule O Part XII | Yes (X) | InfoInScheduleOPartXIIInd |
| 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 | $481 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $481 | 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 | THE OHIO HOSPITAL ASSOCIATION DOES LOBBYING ON BEHALF OF HOSPITAL RELATED CAUSES. THIS ACTIVITY IS PAID FOR THROUGH DUES PAID TO THE OHIO HOSPITAL ASSOCIATION. | ExplanationTxt |
Schedule D IRS990ScheduleD
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $350,000 | OtherCostOrOtherBasisAmt |
| Book Value | $350,000 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $5,461,813 | OtherCostOrOtherBasisAmt |
| Depreciation | $838,063 | DepreciationAmt |
| Book Value | $4,623,750 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $3,892,002 | OtherCostOrOtherBasisAmt |
| Depreciation | $2,996,900 | DepreciationAmt |
| Book Value | $895,102 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $258,954 | OtherCostOrOtherBasisAmt |
| Depreciation | $99,266 | DepreciationAmt |
| Book Value | $159,688 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $6,028,540 | TotalBookValueLandBuildingsAmt |
Other Assets Org OtherAssetsOrgGrp (2 entries)
| DescDesc | Book ValueBookValueAmt |
|---|---|
| GROUND LEASE | $1,939,000 |
| COST REPORT SETTLEMENT RECEIVABLE/(PAYABLE) | -$1,042,465 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $896,535 | TotalBookValueOtherAssetsAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Part X, Line 2: | FormAndLineReferenceDesc |
| Explanation | ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA REQUIRE MANAGEMENT TO EVALUATE TAX POSITIONS TAKEN BY THE SYSTEM AND RECOGNIZE A TAX LIABILITY IF THE SYSTEM HAS TAKEN AN UNCERTAIN POSITION THAT MORE LIKELY THAN NOT WOULD NOT BE SUSTAINED UPON EXAMINATION BY THE IRS OR OTHER APPLICABLE TAXING AUTHORITIES. MANAGEMENT HAS ANALYZED THE TAX POSITIONS TAKEN BY THE SYSTEM AND HAS CONCLUDED AS OF DECEMBER 31, 2015 AND 2014, THERE ARE NO UNCERTAIN POSITIONS TAKEN OR EXPECTED TO BE TAKEN THAT WOULD REQUIRE RECOGNITION OF A LIABILITY OR DISCLOSURE IN THE CONSOLIDATED FINANCIAL STATEMENTS. THE SYSTEM IS SUBJECT TO ROUTINE AUDITS BY TAXING JURISDICTIONS; HOWEVER, THERE ARE CURRENTLY NO AUDITS FOR ANY TAX PERIODS IN PROGRESS. MANAGEMENT BELIEVES THAT IT IS NO LONGER SUBJECT TO INCOME TAX EXAMINATIONS FOR YEARS PRIOR TO DECEMBER 31, 2012. | ExplanationTxt |
Schedule G IRS990ScheduleG
Fundraising Event Information FundraisingEventInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Event1 | FESTIVAL OF TREES | Event1Nm |
| Gross Receipts Event1 | $21,175 | GrossReceiptsEvent1Amt |
| Gross Revenue Event1 | $21,175 | GrossRevenueEvent1Amt |
| Food And Beverage Event1 | $5,783 | FoodAndBeverageEvent1Amt |
| Other Direct Expenses Event1 | $3,945 | OtherDirectExpensesEvent1Amt |
| Gross Receipts Total | $21,175 | GrossReceiptsTotalAmt |
| Gross Revenue Total Events | $21,175 | GrossRevenueTotalEventsAmt |
| Food And Beverage Total Events | $5,783 | FoodAndBeverageTotalEventsAmt |
| Oth Direct Expnss Total Events | $3,945 | OthDirectExpnssTotalEventsAmt |
| Direct Expense Summary Events | $9,728 | DirectExpenseSummaryEventsAmt |
| Net Income Summary | $11,447 | NetIncomeSummaryAmt |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (1) | FinancialAssistancePolicyInd |
| Written Policy | Yes (1) | WrittenPolicyInd |
| All Hospitals Policy | Yes (X) | AllHospitalsPolicyInd |
| FPG Reference Free Care | Yes (1) | FPGReferenceFreeCareInd |
| Percent200 | Yes (X) | Percent200Ind |
| FPG Reference Discounted Care | Yes (1) | FPGReferenceDiscountedCareInd |
| Percent400 | Yes (X) | Percent400Ind |
| Free Care Medically Indigent | Yes (1) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (1) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | Yes (1) | ExpensesExceedBudgetInd |
| Unable To Provide Care | 0 | UnableToProvideCareInd |
| 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) |
|---|---|---|
| Total Community Benefit Expns | $968,698 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,760,010 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | -$791,312 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00000 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $5,848,956 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $3,228,933 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $2,620,023 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.14700 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $6,817,654 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $4,988,943 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,828,711 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.14700 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $27,073 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $27,073 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00150 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $27,073 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $27,073 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00150 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $6,844,727 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $4,988,943 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,855,784 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.14850 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 0 | BadDebtExpenseReportedInd |
| Bad Debt Expense | $625,950 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $0 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $5,958,225 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $6,191,244 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$233,019 | 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 |
| 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 | PIKE HEALTH SERVICES INC | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 100 DAWN LANE | AddressLine1Txt |
| City | WAVERLY | CityNm |
| State Abbreviation | OH | StateAbbreviationCd |
| ZIP | 45690 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | WWW.ADENA.ORG | WebsiteAddressTxt |
| State License | ST. REG. NUM. 1299 | StateLicenseNum |
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Critical Access Hospital | Yes (X) | CriticalAccessHospitalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | PIKE HEALTH SERVICES INC | 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 |
| Information Gaps | Yes (X) | InformationGapsInd |
| CHNA Conducted | 13 | CHNAConductedYr |
| Take Into Account Others Input | Yes (1) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | Yes (1) | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | 0 | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (1) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | adena.org/inside/page.dT/chna | OwnWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Rpt Available Thru Other Method | Yes (X) | RptAvailableThruOtherMethodInd |
| Implementation Strategy Adopt | Yes (1) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 13 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (1) | StrategyPostedWebsiteInd |
| Strategy Website URL | http://www.adena.org/files/resources/pike-chna-is-final.pdf | StrategyWebsiteURLTxt |
| Strategy Attached | 0 | StrategyAttachedInd |
| 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 | 200.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 400.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Medical Indigency Criteria | Yes (X) | MedicalIndigencyCriteriaInd |
| Insurance Status Criteria | Yes (X) | InsuranceStatusCriteriaInd |
| Underinsurance Stat Criteria | Yes (X) | UnderinsuranceStatCriteriaInd |
| Explained Basis | Yes (1) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (1) | AppFinancialAsstExplnInd |
| Described Info | Yes (X) | DescribedInfoInd |
| Described Suprt Doc | Yes (X) | DescribedSuprtDocInd |
| Provided Hospital Contact | Yes (X) | ProvidedHospitalContactInd |
| Provided Nonprofit Contact | Yes (X) | ProvidedNonprofitContactInd |
| Includes Publicity Measures | Yes (1) | IncludesPublicityMeasuresInd |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | www.adena.org/files/resources/adenafinaidformfinal.pdf | FAPAppAvailableOnWebsiteURLTxt |
| FAP Avlbl On Request No Charge | Yes (X) | FAPAvlblOnRequestNoChargeInd |
| FAP App Avlbl On Request No Chrg | Yes (X) | FAPAppAvlblOnRequestNoChrgInd |
| FAP Actions On Nonpayment | Yes (1) | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | 0 | CollectionActivitiesInd |
| FAP Notified All Patients | Yes (X) | FAPNotifiedAllPatientsInd |
| Documented Elig Determination | Yes (X) | DocumentedEligDeterminationInd |
| Other Actions Taken | Yes (X) | OtherActionsTakenInd |
| Nondis Emergency Care Policy | Yes (1) | NondisEmergencyCarePolicyInd |
| Other Method Used | Yes (X) | OtherMethodUsedInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | 0 | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (6 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PIKE HEALTH SERVICES, INC. | Part V, Section B, Line 5: ADENA PIKE MEDICAL CENTER CAPTURED THE BROAD INTERESTS OF THE COMMUNITY FOR THE CHNA THROUGH TWO METHODS: SURVEY AND INTERVIEWS. A HEALTH NEEDS SURVEY WAS WIDELY DISTRIBUTED TO THE PIKE COUNTY COMMUNITY THROUGH PAPER AND WEB FORM. IN ADDITION TO THE SURVEYS, INTERVIEWS WITH LOCAL COMMUNITY LEADERS, INCLUDING CIVIC, PUBLIC HEALTH AND EMERGENCY RESPONSE WERE REQUESTED AND/OR CONDUCTED TO GAIN FURTHER KNOWLEDGE OF SURVEY TOPICS. |
| PIKE HEALTH SERVICES, INC. | Part V, Section B, Line 6a: THE CHNA FOR ADENA PIKE MEDICAL CENTER WAS CONDUCTED IN COLLABORATION WITH WITH TWO OTHER HOSPITAL FACILITIES THAT ARE PART OF THE ADENA HEALTH SYSTEM: ADENA REGIONAL MEDICAL CENTER AND ADENA GREENFIELD MEDICAL CENTER. |
| PIKE HEALTH SERVICES, INC. | Part V, Section B, Line 7d: HARD COPIES OF THE CHNA REPORT WERE PRINTED AND SENT TO COMMUNITY LEADERS AND AGENCIES. |
| PIKE HEALTH SERVICES, INC. | Part V, Section B, Line 11: OBESITY-EMPLOYEE HEALTH INITIATIVES:IN 2015, AHS CONTINUED ITS INTERNAL EFFORTS AROUND EMPLOYEE HEALTH AND WELLNESS (INCLUDING PIKE EMPLOYEES) BY EXPANDING AND IMPLEMENTING EVIDENCE-BASED HEALTH AND WELLNESS PROGRAMMING BUILT ON THREE DIFFERENT PILLARS MOVEMENT, NUTRITION AND WELL-BEING. SOME PROGRAMMING WAS ALSO EXPANDED INTO THE GREATER ROSS COUNTY COMMUNITY.THE TEAM CONTINUED THE CAMPUS BASED WALKING PROGRAM, WEIGHT WATCHERS AT WORK, ADENA FIT, AND STRESS MANAGEMENT CLASSES. THE COMMUNICATION PLAN DEVELOPED IN 2014 WAS EXPANDED INTO SOCIAL MEDIA, REPRESENTATIVES FROM THE ORGANIZATION'S HEALTH & WELLNESS COMMITTEE ROUNDED TO DEPARTMENTAL MEETINGS, OFFSITE LOCATIONS AND COORDINATED A HEALTH & WELLNESS FAIR TO ENSURE EFFECTIVE COMMUNICATION TO EMPLOYEES. THE MOVE MORE CHALLENGE WAS KICKED OFF AGAIN IN MAY OF 2015 WITH MORE THAN 700 ADENA EMPLOYEES PARTICIPATING, INCLUDING WAVERLY AND PIKETON EMPLOYEES. ALL OF THE HEALTH & WELLNESS PROGRAMMING AGAIN ENGAGED MORE THAN 35% OF THE TOTAL EMPLOYEE POPULATION THROUGH THESE INITIATIVES IN 2015.OBESITY-COMMUNITY PROGRAMMING:AHS COMMUNITY HEALTH ADVANCEMENT COLLABORATED WITH A VARIETY OF COMMUNITY PARTNERS TO COORDINATE AND DELIVER COMMUNITY PROGRAMS AIMED AT PROMOTING MOVEMENT AND NUTRITION. PROGRAMS BASED OR FACILITATED THROUGH THE PIKE MEDICAL CENTER INCLUDED:SPONSORSHIP AND PARTICIPATION IN THE HEALTHY KIDS' EVENT AT THE PIKE COUNTY YMCA.THE CYCLEMANIA EVENT AT THE 2015 PIKE COUNTY FAIR, WHICH IS AN ANNUAL BIKE RACE. THE MOVE MORE CHALLENGE WAS EXPANDED INTO THE COMMUNITY. PARTICIPATION OVERALL WITH COMMUNITY INVOLVEMENT WAS INCREASED BY 22% FROM THE PREVIOUS YEAR. SPONSORSHIP OF THE PIKE COUNTY PUBLIC LIBRARY'S HEALTHY KIDS PORTION OF THE BOOKWORM PROGRAM. OBESITY-REGIONAL INITIATIVES:THE COMMUNITY HEALTH FOCUS AND MESSAGE, "MOVE MORE, EAT WELL" WAS FINALIZED AND IMPLEMENTED IN 2015. BANNERS FOR APPROXIMATELY 15 COMMUNITY EVENTS (COUNTY FAIRS, FESTIVALS, SENIOR HEALTH FAIRS, EMPLOYEE HEALTH FAIRS AND HEALTH EXPOS) WERE DISPLAYED THROUGHOUT SIX COUNTIES (FAYETTE, ROSS, HIGHLAND, PIKE, JACKSON, AND PICKAWAY) AS WELL BROCHURES AND EDUCATIONAL INFORMATION ON PHYSICAL ACTIVITY AND NUTRITION WERE DISTRIBUTED. SOCIAL MEDIA POSTS ON BENEFITS TO PROPER NUTRITION AND FITNESS WERE ALSO POSTED ON FACEBOOK THROUGHOUT THE YEAR. THERE WERE ALSO TWO ONE HOUR RADIO PROGRAMS FEATURING ADENA PHYSICIANS AND REPRESENTATIVES AIRED DURING 2015.MENTAL & BEHAVIORAL HEALTH-ADVOCACY:AHS CONTINUED ITS SUPPORT OF MULTIPLE COMMUNITY PARTNERS IN 2015 TO ADVOCATE FOR EXPANDED ACCESS TO MENTAL AND BEHAVIORAL HEALTH SERVICES. AHS CONTINUED DELIVERY OF PRENATAL CARE TO HIGH-RISK PREGNANT WOMEN, INCLUDING THOSE WITH ADDICTION ISSUES USING A CENTERINGPREGNANCY MODEL AT THE ADENA REGIONAL MEDICAL CENTER CAMPUS. A TOTAL OF 200 WOMEN (APPROXIMATELY 10% FROM PIKE COUNTY) WERE SERVED IN 2015 WITH THOSE PARTICIPATING IN THE PROGRAM ACHIEVING BETTER BIRTH OUTCOMES OVERALL THAN THOSE OPTED NOT TO PARTICIPATE. THIS PROJECT PROVIDED A MONTHLY OPPORTUNITY TO INFORM THE STATE OF OHIO ABOUT BARRIERS TO ACHIEVING POSITIVE BIRTH OUTCOMES, INCLUDING ACCESS TO LONGER-TERM ADDICTION TREATMENT IN SOUTHERN OHIO AND WILL BE REIMBURSED FOR IN 2016.THE AHS DIRECTOR OF COMMUNITY HEALTH ADVANCEMENT CONTINUED PARTICIPATING IN THE SOUTHEAST OHIO MEDICAID EXPANSION COMMITTEE, AROUND EFFORTS TO EXPAND MEDICAID COVERAGE TO THE REGION'S RESIDENTS. THIS GROUP ALSO INFORMS STATE GOVERNMENT ON THE NEED AND BENEFIT OF AFFORDABLE HEALTH CARE IN SOUTHERN OHIO.MENTAL & BEHAVIORAL HEALTH-REFERRAL SOURCES:AHS CONTINUED TO OPERATE THE REGION'S ONLY ACUTE INPATIENT, PSYCHIATRIC UNIT FOR INSURED, UNINSURED AND UNDER INSURED PATIENTS IN 2015 AT THE ADENA REGIONAL MEDICAL CENTER (INCLUDING PATIENTS FROM PIKE COUNTY). AHS WOMEN'S & CHILDREN'S, PRIMARY CARE AND PAIN MANAGEMENT SERVICE LINES MADE REFERRALS FOR PATIENTS NEEDING MENTAL AND BEHAVIORAL HEALTH SERVICES IN PIKE COUNTY TO THE ADENA COUNSELING CENTER, PIKE COUNTY COMMUNITY ACTION, PIKE COUNTY RECOVERY COUNCIL, PAINT VALLEY MENTAL HEALTH CENTER, ADENA WOMEN'S AND CHILDREN'S CENTERINGPREGNANCY PROGRAM, THE PIKE COUNTY HEALTH DEPARTMENT'S VIVITROL PROGRAM.MENTAL & BEHAVIORAL HEALTH-CESSATION RESOURCES:AHS SERVED A TOTAL OF 114 WOMEN ADDICTED TO OPIATES AS PART OF ITS CENTERINGPREGNANCY PROGRAM IN 2015 (INCLUDING PATIENTS FROM PIKE COUNTY). THE WORK TEAM CONVENED TO REVIEW COMMUNITY NEED, DEMAND AND OPPORTUNITIES FOR EXPANSION OF CURRENT AHS MENTAL AND BEHAVIORAL HEALTH OPPORTUNITIES ALSO DEVELOPED RELATIONSHIPS WITH MARYHAVEN AND COMPASS COMMUNITY HEALTH TO ASSIST WITH EXPANDING DRUG ADDICTION SUPPORT SERVICES, INCLUDING HOUSING, IN ROSS COUNTY.MENTAL & BEHAVIORAL HEALTH-SCREENING:IN 2015, AHS CONTINUED ITS SCREENING POLICY TO IDENTIFY POSSIBLE MENTAL AND BEHAVIORAL ISSUES WITH PATIENTS PRESENTING IN THE EMERGENCY ROOMS OF ADENA HEALTH SYSTEM HOSPITALS, INCLUDING THE ADENA PIKE MEDICAL CENTER.SMOKING-CESSATION RESOURCES:THE ADENA QUIT CLINIC WAS PILOTED AT THE PACCAR/KENWORTH TRUCKING COMPANY IN 2015. A TOTAL OF 45 PARTICIPANTS WERE SERVED AS PART OF THE PROGRAM THAT UTILIZES PHARMACISTS, TRAINED IN THE US PUBLIC HEALTH SERVICES' 5 A'S METHODOLOGY, TO ASSIST TOBACCO USERS IN CESSATION. THE PROGRAM WILL BE EXPANDED TO ADENA EMPLOYEES, INCLUDING THOSE WHO LIVE IN PIKE COUNTY, IN 2016SMOKING-SCREENING:AHS CANCER CENTER PROVIDED 662 PATIENTS WITH FREE LUNG SCREENINGS IN 2015 (INCLUDING PATIENTS FROM PIKE COUNTY), WITH 16 PATIENTS WHO WERE IDENTIFIED WITH EARLY STAGE LUNG CANCER.NEEDS THAT CANNOT BE ADDRESSED:UNINTENTIONAL INJURIES, IN GENERAL, WERE NOT ADDRESSED AS PART OF THE IMPLEMENTATION PLAN. THE PRIMARY CAUSE OF UNINTENTIONAL INJURIES IN PIKE COUNTY IS AUTOMOTIVE ACCIDENTS AND DRUG OVERDOSE DEATHS. AHS/APMC DOES NOT HAVE THE CAPABILITIES OR RESOURCES, AT THIS TIME TO DELIVER A DRIVER SAFETY CAMPAIGN, BUT IS EQUIPPED TO DELIVER NARCAN TO THOSE PRESENTING WITH A DRUG OVERDOSE IN ITS EMERGENCY ROOM. A PROGRAM FOR TRAFFIC SAFETY IS CURRENTLY COORDINATED BY THE OHIO STATE HIGHWAY PATROL AND LOCAL LAW ENFORCEMENT IN PARTNERSHIP WITH THE PIKE COUNTY HEALTH DEPARTMENT.ADDITIONAL INITIATIVES AND RESOURCES:ADENA FAMILY MEDICINE- RESIDENCY CLINIC:THE ADENA FAMILY MEDICINE - RESIDENCY CLINIC OPERATED A HOSPITAL CLINIC IN 2015 PROVIDING AFFORDABLE, QUALITY HEALTH CARE. THE CLINIC PAIRED ACCESSIBLE PRIMARY CARE MEDICAL SERVICES PROVIDED BY PHYSICIAN INTERNS AND RESIDENTS OF ADENA'S GRADUATE MEDICAL EDUCATION PROGRAM, FAMILY AND INTERNAL MEDICINE PRECEPTORS AND A CERTIFIED NURSE PRACTITIONER ALSO PROVIDING SERVICES TO PATIENTS IN THE CLINIC. A TOTAL OF 1,437 PATIENTS, MOSTLY FROM SEVEN COUNTIES (ROSS, FAYETTE, VINTON, PICKAWAY, PIKE, HIGHLAND AND JACKSON) MADE A TOTAL OF 4,022 VISITS TO THE RESIDENCY CLINIC IN 2015.ADENA SPORTS MEDICINE-ATHLETIC TRAINING PROGRAM:THE ADENA HEALTH SYSTEM PROVIDED MORE THAN $400,000 IN ATHLETIC INJURY PREVENTION, DIAGNOSIS, AND EVALUATION SERVICES TO 10 LOCAL PUBLIC HIGH SCHOOLS WITHIN THE SERVICE REGION. A TOTAL OF 8 ATHLETIC TRAINERS WORK WITHIN THE SCHOOL'S ATHLETIC DEPARTMENTS AND FOCUS ON EDUCATING STUDENTS, PARENTS AND COACHES ON SPORTS MEDICINE TOPICS, INCLUDING CONCUSSION IDENTIFICATION AND TREATMENT. THE STAFF IS ALSO READILY AVAILABLE AT ATHLETIC EVENTS AND PROVIDES YEARLY SPORTS PHYSICALS TO MORE THAN 1,200 STUDENTS IN PIKE, ROSS, AND JACKSON COUNTIES IN 2015. COMMUNITY HEALTH EVENTS: AHS COORDINATED AND FACILITATED THE HEAD TO TOE EXPO AT THE CHILLICOTHE MIDDLE SCHOOL IN 2015 WHICH ENGAGED MORE THAN 200 COMMUNITY MEMBERS ON ORTHOPEDIC AND NEUROLOGIC HEALTH ISSUES. THE EVENT, ATTENDED BY MEMBERS OF THE PIKE COUNTY COMMUNITY, INCLUDED A VENDOR EXPO THAT SHOWCASED COMMUNITY HEALTH PARTNERS AND ADENA HEALTH SYSTEM SERVICES, PROVIDED BLOOD PRESSURE CHECKS, DIABETES INFORMATION, AND BONE DENSITY SCREENINGS (THERE WAS NO INVASIVE TESTING ), AS WELL AS OFFERED SIX CONCURRENT EDUCATION SESSIONS AND FEATURED A CELEBRITY GUEST SPEAKER. COMMUNITY COLLABORATIONS:PIKE COUNTY HEALTH COALITIONADENA HEALTH SYSTEM HAS THREE EMPLOYEES WHO PARTICIPATE AS PART OF THE PIKE COUNTY HEALTH COALITION. THIS COALITION MEETS QUARTERLY AND HAS MORE THAN 10 AGENCIES WHO PARTICIPATE AS PART OF THE COALITION. HOPE CLINICTHE DIRECTOR OF THE ADENA CANCER CENTER VOLUNTEERS AS THE EXECUTIVE DIRECTOR OF THE HOPE CLINIC OF ROSS COUNTY, AS WELL AS FOUR AHS CLINICIANS. THIS CLINIC PROVIDES FREE MEDICAL CARE TO THOSE WITHOUT HEALTH INSURANCE COVERAGE, INCLUDING MEDICAL, DENTAL AND VISION CARE. THE CLINIC IS OPEN ONE DAY PER WEEK. AHS PROVIDES MORE THAN $3,000 IN MONETARY SUPPORT FROM ITS COMMUNITY HEALTH BUDGET EVERY YEAR TO THE HOPE CLINIC FOR MEDICAL SUPPLIES AND RESOURCES. |
| PIKE HEALTH SERVICES, INC. | Part V, Section B, Line 20e: PATIENTS HAVE 120 DAYS FROM THE TIME THEIR ACCOUNT GOES TO "SELF-PAY" TO PAY IN FULL OR MAKE PAYMENT ARRANGEMENTS. ON THE 121ST DAY, THEY ARE SENT TO A COLLECTION AGENCY WHO WILL DO CREDIT REPORTING. COLLECTION AGENCIES REQUIRE ADENA MANAGEMENT APPROVAL TO PURSUE LEGAL ACTION. |
| PIKE HEALTH SERVICES, INC. | Part V, Section B, Line 22d: THE PATIENT IS INITIALLY CHARGED REGULAR HOSPITAL RATES FOR SERVICES PERFORMED. THE PATIENT THEN COMPLETES AN APPLICATION FOR FINANCIAL AID FORM AND RETURNS IT TO THE FINANCIAL COUNSELORS, EMPLOYED BY AN OUTSIDE AGENCY. HCAP/CHARITY ADJUSTMENTS ARE ADMINISTERED BASED ON PROOF OF INCOME AND THE TABLES OF THE FEDERAL POVERTY LIMITS (FPL) AND THE MAXIMUM AMOUNT CHARGED IS CALCULATED IN THE FOLLOWING MANNER: 1. 100% WRITE-OFF AND HCAP ELIGIBLE - LESS THAN OR EQUAL TO 200% FPL 2. 60% WRITE-OFF - BETWEEN 201% - 400% OF FPL. MANAGEMENT DECIDED TO LIMIT THE DISCOUNT TO THOSE UNDER THE 400% FPL, BASED ON MANAGEMENT'S EXPERIENCE AT OTHER INSTITUTIONS ALONG WITH A CURSORY REVIEW OF HOSPITALS IN THE LOCAL MARKET. |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | 1 - ADENA FAMILY MEDICINE - PIKETON | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 100 INDIAN RIDGE DRIVE | AddressLine1Txt |
| City | PIKETON | CityNm |
| State Abbreviation | OH | StateAbbreviationCd |
| ZIP | 45661 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | PHYSICIAN OFFICES | FacilityTxt |
Supplemental Information Detail SupplementalInformationDetail (13 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part I, Line 6a: | ADENA HEALTH SYSTEM EIN: 31-4379443 |
| Part I, Line 7: | THE COST-TO-CHARGE RATIO DERIVED FROM WORKSHEET 2 WAS USED TO CONVERT CHARGES TO COSTS IN LINE 7A AND 7B. ACTUAL COSTS WERE USED IN LINE 7E. |
| Part I, Ln 7 Col(f): | BAD DEBT EXPENSE OF $1,555,093 WAS DEDUCTED FROM TOTAL OPERATING EXPENSES WHEN CALCULATING THE PERCENTAGES IN THIS COLUMN. |
| Part III, Line 2: | THE BAD DEBT EXPENSE LISTED ON PART III, LINE 2 IS DERIVED FROM THE FINANCIAL STATEMENTS MINUS THE PRESUMPTIVE CHARITY AMOUNT THAT WAS RECLASSED TO SCHEDULE H, PART I, LINE 7A. |
| Part III, Line 3: | IN 2015, THE HOSPITAL DEVELOPED, WITH THE HELP OF AN OUTSIDE VENDOR, A NEW PRESUMPTIVE CHARITY POLICY. THE HOSPITAL SENDS A QUARTERLY FILE OF ALL SELF-PAY BALANCES TO THE VENDOR. AFTER THE VENDOR PERFORMS THE CREDIT ANALYSIS, THE VENDOR CATEGORIZES THE CLAIMS INTO THREE CATEGORIES, A CATEGORY THAT WOULD NOT BE ELIGIBLE FOR CHARITY BASED ON THE HOSPITALS CHARITY POLICY, A GROUP THAT WOULD BE ELIGIBLE FOR A 60% CHARITY WRITEOFF, AND A THIRD CATEGORY THAT WOULD BE ELIGIBLE FOR A 100% WRITE OFF. AFTER THE VENDOR RETURNS THIS DATA, A REPORT OF RECEIPTS ON THESE SELF PAY BALANCES IS RUN; THE PAYMENTS RECEIVED SINCE THE FILE WAS SENT TO THE VENDOR IS USED TO REDUCE THE POTENTIAL PRESUMPTIVE CHARITY. THE REMAINING AMOUNT IS USED AS OUR PRESUMPTIVE CHARITY FOR SCHEDULE H, PART III, LINE 3. |
| Part III, Line 4: | WE DO NOT HAVE SEPARATE FINANCIAL STATEMENTS FOR ADENA PIKE MEDICAL CENTER. IT IS INCLUDED IN THE CONSOLIDATED STATEMENTS OF ADENA HEALTH SYSTEM. THE FOOTNOTE IN OUR FINANCIAL STATEMENTS INCLUDES THE FOLLOWING ABOUT OUR BAD DEBT EXPENSE AND ALLOWANCE FOR UNCOLLECTIBLES. "AN ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS IS ESTABLISHED ON AN AGGREGATE BASIS BY USING HISTORICAL WRITE-OFF FACTORS APPLIED TO UNPAID ACCOUNTS BASED ON AGING. LOSS RATE FACTORS ARE BASED ON HISTORICAL LOSS EXPERIENCE AND ADJUSTED FOR ECONOMIC CONDITIONS AND OTHER TRENDS AFFECTING THE SYSTEM'S ABILITY TO COLLECT OUTSTANDING AMOUNTS. UNCOLLECTIBLE ACCOUNTS ARE WRITTEN OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS IN THE PERIOD THEY ARE DETERMINED TO BE UNCOLLECTIBLE. AN ALLOWANCE FOR CONTRACTUAL ADJUSTMENTS AND INTERIM PAYMENT ADVANCES IS ESTABLISHED BASED ON EXPECTED PAYMENT RATES FROM PAYORS UTILIZING CURRENT REIMBURSEMENT METHODOLOGIES AND PAYMENT RATES. THIS AMOUNT ALSO INCLUDES AMOUNTS RECEIVED AS INTERIM PAYMENTS AGAINST UNPAID CLAIMS BY CERTAIN PAYORS. FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS (WHICH INCLUDES BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND COPAYMENT BALANCES DUE FOR WHICH THIRDPARTY COVERAGE EXISTS FOR PART OF THE BILL), THE SYSTEM RECORDS A SIGNIFICANT PROVISION FOR BAD DEBTS IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST EXPERIENCE, WHICH INDICATES THAT MANY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. THE DIFFERENCE BETWEEN THE STANDARD RATES (OR THE DISCOUNTED RATES, IF NEGOTIATED) AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS IN THE PERIOD THEY ARE DETERMINED TO BE UNCOLLECTIBLE." |
| Part III, Line 8: | OUR SERVICE AREA IS A RURAL 13 COUNTY AREA IN SOUTHERN OHIO. THE POPULATION IS AN AGING POPULATION WHICH RESULTS IN MEDICARE AS OUR LARGEST PAYOR GROUP. IN ADDITION, THE ECONOMIC CONDITIONS THAT RESULT FROM APPALACHIAN DESIGNATION CREATE A RECRUITING ISSUE. TO COMBAT THE ISSUE, WE ARE FORCED TO NOT ONLY EMPLOY PHYSICIANS BUT MUST PAY A PREMIUM TO GET THEM TO AGREE TO SERVE THE AREA'S RESIDENTS. BASED ON THESE ISSUES, WE BELIEVE SERVICE TO OUR MEDICARE POPULATION, THAT RESULTED IN A MEDICARE SHORTFALL OF $233,019, IS A COMMUNITY BENEFIT. ALSO, THE HOSPITAL USED THE METHODOLOGY REQUIRED FOR COMPLETING THE MEDICARE COST REPORT WHEN DETERMINING THE AMOUNT ON PART III - LINE 6. |
| Part III, Line 9b: | THERE ARE TWO TIERS: 100% CHARITY FOR UP TO OR EQUAL TO 200% OF FEDERAL POVERTY LEVELS AND 60% FOR 201%-400% OF FEDERAL POVERTY LEVELS. |
| Part VI, Line 2: | IN 2015, AHS'S COMMUNITY BUILDING ACTIVITIES PROMOTED ECONOMIC DEVELOPMENT IN DOWNTOWN CHILLICOTHE. THE HEALTH SYSTEM IS HELPING FUND A HISTORIC BUILDING REHABILITATION PROJECT WHICH WILL IN TURN HELP REVITALIZE THE DOWNTOWN CHILLICOTHE BUSINESS DISTRICT AS WELL AS PROMOTE JOB GROWTH. THE BUILDING WILL ALSO PROVIDE HOUSING FOR ADENA PHYSICIAN RESIDENTS AND MEDICAL STUDENTS WHICH ENABLES THE HEALTH SYSTEM TO INCREASE PROVIDER ACCESS WITHIN THE REGION. |
| Part VI, Line 3: | THE AVAILABILITY OF FINANCIAL ASSISTANCE IS COMMUNICATED IN THE FOLLOWING MANNER: 1. STATEMENTS FROM ADENA AS WELL AS COLLECTION VENDORS EXPLAIN AND LIST THE 100% AND 60% ASSISTANCE GUIDELINES ON THE BACKSIDE OF THE STATEMENT. 2. THERE IS SIGNAGE EXPLAINING THE PROGRAM AT ALL THE REGISTRATION AREAS. 3. A CONTRACTED VENDOR SUPPLIES STAFF AT THE CASHIER AREA TO EXPLAIN OPTIONS AVAILABLE TO THE PATIENT. 4. WE SEND AN APPLICATION WITH THE SELF-PAY DISCOUNT LETTERS IN CASE THE PATIENT/GUARANTOR CAN'T SET UP A PAYMENT PLAN. 5. THE CUSTOMER SERVICE STAFF IS EDUCATED ON ALL THE OPTIONS AND CAN EXPLAIN THE PROGRAMS WHEN PATIENTS CALL. 6. OUR PHYSICIAN OFFICES, AS WELL AS COLLECTION VENDORS HAVE FINANCIAL AID APPLICATIONS AVAILABLE. 7. LASTLY, WE UTILIZE A "HINDSIGHT" VENDOR THAT SCREENS ALL BAD DEBT ACCOUNTS, AFTER THE YEAR-END, AGAINST THE STATE MEDICAID ELIGIBILITY AND FEDERAL POVERTY GUIDELINES TO ATTEMPT ONE LAST EFFORT TO OBTAIN FINANCIAL ASSISTANCE FOR INDIVIDUALS. |
| Part VI, Line 4: | PIKE COUNTY, HOME OF THE ADENA PIKE MEDICAL CENTER (APMC), IS LOCATED IN SOUTH CENTRAL OHIO IN THE 2ND CONGRESSIONAL DISTRICT AND IS ONE OF OHIO'S 32 APPALACHIAN COUNTIES. IT CONTAINS THE POPULATION PATTERNS AND DISTINCT ECONOMIC CONDITIONS INHERENT OF THIS REGION OF THE U.S AND FACES SIMILAR CHALLENGES IN DIVERSIFYING ITS ECONOMY TO IMPROVE THE LIVES OF ITS 26,066 RESIDENTS.THE TOTAL POPULATION OF PIKE COUNTY OHIO IS 28,685. IT REPRESENTS 5.6% OF THE TOTAL POPULATION OF THE TOTAL ADENA HEALTH SYSTEM SERVICE REGION. THE COUNTY, AS WELL AS THE REMAINDER OF THE 12 COUNTY SERVICE REGION, HAS SIMILAR DEMOGRAPHICS AS THE STATE OF OHIO AND U.S. OVER 57% OF THE POPULATION IS BETWEEN THE AGES OF 20 AND 64 AND 14.5% OF THE POPULATION IS OVER THE AGE OF 65. LESS THAN 4% OF THE POPULATION IS A RACE OR ETHNICITY OTHER THAN WHITE.THERE ARE 10,816 HOUSEHOLDS IN PIKE COUNTY. THE AVERAGE HOUSEHOLD SIZE IS 2.61 PEOPLE, COMPARABLE WITH THE REST OF THE 12 COUNTY SERVICE REGION AND OHIO. THE AVERAGE FAMILY SIZE IS AS WELL WITH 3.11 PEOPLE.APPROXIMATELY 22% OF THE ADULTS IN PIKE COUNTY HAVE NOT GRADUATED FROM HIGH SCHOOL. THIS PERCENTAGE IS HIGHER THAN THE AVERAGES FOR THE REGION (18.9%), OHIO (12.2%) AND THE NATION (14.6%). MORE THAN 11% OF THE POPULATION OF PIKE COUNTY IS ESTIMATED TO BE FUNCTIONALLY ILLITERATE, OR LACKING THE READING AND WRITING SKILLS SUFFICIENT FOR ORDINARY PRACTICAL NEEDS. THE UNEMPLOYMENT RATE IN PIKE COUNTY (10.7%) IS CONSIDERABLY HIGHER THAN THE REGIONAL (6.8%), STATE (6%) AND U.S. (7.7%) AVERAGES. IN ADDITION, MORE THAN 44.5% OF THE POPULATION IS NOT IN THE WORKFORCE. THIS IS HIGHER THAN THE STATE (35.4%) AND NATIONAL AVERAGES (35.2%). THE TOP FIVE EMPLOYMENT INDUSTRIES IN PIKE COUNTY ARE MANAGEMENT/BUSINESS/SCIENCE (28.9%), SERVICE (21.5%) SALES (23%), PRODUCTION/TRANSPORTATION SERVICES (19.2%), SALES (18.2%), AND NATURAL RESOURCES/CONSTRUCTION/MAINTENANCE. PIKE COUNTY HAS A GREATER PERCENTAGE OF PEOPLE EMPLOYED IN PRODUCTION, TRANSPORTATION AND MATERIAL MOVING OCCUPATIONS (19.2%) THAN THE REGIONAL, STATE AND NATIONAL AVERAGES. THE PER CAPITA MEDIAN AND MEAN HOUSEHOLD INCOMES IN PIKE COUNTY OHIO ARE MUCH LOWER THAN THE STATE AND U.S. AVERAGES. POVERTY RATES ARE ALSO HIGHER THAN REGIONAL, STATE AND NATIONAL AVERAGES. ACCESS TO EMPLOYMENT IN PIKE COUNTY IS ALSO LOWER THAN OTHER COUNTIES IN THE REGION.THERE ARE 7,697 CIVILIAN VETERANS LIVING IN PIKE COUNTY, ACCOUNTING FOR ALMOST 10% OF THE REGION'S POPULATION. THE TOTAL CIVILIAN VETERANS WITHIN THE ADENA HEALTH SYSTEM 12-COUNTY SERVICE REGION REPRESENT 5% OF OHIO'S TOTAL CIVILIAN VETERAN POPULATION.PIKE COUNTY AND ITS ENTIRE SURROUNDING SERVICE REGION HAVE A HIGHER PREVALENCE OF DISABILITY THAN THE REST OF OHIO. SEVEN OF THE 12 COUNTIES IN THE SERVICE REGION, INCLUDING PIKE COUNTY, HAVE DISABILITY PREVALENCE RATES OF 16.7% - 22%. |
| Part VI, Line 5: | ADENA PIKE MEDICAL CENTER WORKS TO PROMOTE THE HEALTH OF ITS COMMUNITY THROUGH A VARIETY OF MEANS, INCLUDING BOARD MEMBERS, ADMINISTRATIONS, EMPLOYEES AND VOLUNTEERS. THE 2015 BOARD OF TRUSTEES OF ADENA PIKE MEDICAL CENTER WAS COMPRISED OF EIGHT MEMBERS. NONE OF THE BOARD MEMBERS ARE EMPLOYEES OF ADENA HEALTH SYSTEM. ALL OR 100% OF THE BOARD MEMBERS RESIDE IN PIKE COUNTY OHIO. |
| Part VI, Line 6: | FOUNDED IN 1895, ADENA HEALTH SYSTEM IS AN INDEPENDENT, NOT-FOR-PROFIT HEALTHCARE ORGANIZATION BASED IN CHILLICOTHE, OH. THE HEALTH SYSTEM INCLUDES THREE HOSPITALS AND SIX REGIONAL CLINICS, WITH A TOTAL OF 311 BEDS. ADENA SERVES THE NEEDS OF NEARLY 500,000 PEOPLE IN 13 COUNTIES, LIVING IN OHIO'S APPALACHIAN REGION. OUR FACILITIES INCLUDE: ADENA REGIONAL MEDICAL CENTER: A 261-BED INPATIENT HOSPITAL IN CHILLICOTHE, OH FEATURING AN EMERGENCY DEPARTMENT, DIAGNOSTIC AND TREATMENT SERVICES, ADVANCED SURGICAL SUITES, INTENSIVE/CARDIAC CARE, MEDICAL OFFICE BUILDING AND THE ADENA HEALTH PAVILION, WHICH INCLUDES OUTPATIENT SURGERY, PHYSICIAN OFFICES AND THE ADENA SLEEP CENTER. IN 2011, ADENA INVESTED $21 MILLION IN THE CONSTRUCTION OF A 35,000 SQUARE-FOOT CANCER CENTER TO PROVIDE PATIENTS WITH ACCESS TO CANCER DIAGNOSIS AND TREATMENT AT A FACILITY NEAR THEIR HOMES. THE CANCER CENTER OPENED IN JANUARY 2012. GREENFIELD AREA MEDICAL CENTER AND PIKE HEALTH SERVICES, INC.: BOTH ARE CRITICAL ACCESS HOSPITALS, EACH WITH A 25-BED INPATIENT FACILITY IN GREENFIELD, OH AND WAVERLY, OH, RESPECTIVELY. EACH FEATURES AN EMERGENCY DEPARTMENT, INPATIENT CARE INCLUDING REHABILITATION AND MEDICAL/SURGICAL, DIAGNOSTIC AND TREATMENT SERVICES, AS WELL AS FAMILY PRACTICE AND SPECIALTY PHYSICIANS. THESE TWO HOSPITALS DIRECTLY BENEFIT HIGHLAND COUNTY (GREENFIELD AREA MEDICAL CENTER) AND PIKE COUNTY (PIKE HEALTH SERVICES, INC.) AS WELL AS SURROUNDING COMMUNITIES. ADENA HEALTH CENTERS: LOCATED IN CHILLICOTHE AND WITH REGIONAL SITES IN CIRCLEVILLE, JACKSON, OAK HILL, WASHINGTON COURT HOUSE AND WAVERLY, OH. OUR HEALTH CENTERS INCLUDE PHYSICIAN OFFICES, DIAGNOSTIC AND TREATMENT SERVICES, PHYSICAL, OCCUPATION AND SPEECH THERAPIES. URGENT CARE SERVICES ARE OFFERED IN CHILLICOTHE AND WAVERLY. ADENA HOME CARE AND HOSPICE: PROVIDES HIGHLY PERSONALIZED, QUALITY CARE TO PATIENTS OF FOUR SERVICE LINES -- HOME HEALTH, HOSPICE, HOME RESPIRATORY AND HOME INFUSION. ADENA REHABILITATION AND WELLNESS CENTER: PROVIDES PHYSICAL, OCCUPATIONAL, MASSAGE AND INDUSTRIAL REHABILITATION, AS WELL AS ORTHOPEDICS, SPORTS MEDICINE, WOMEN'S HEALTH, VESTIBULAR, FIBROMYALGIA AND CHRONIC PAIN PROGRAMS, AS WELL AS INDUSTRIAL AND SPECIALIZED HAND PROGRAMS. ADENA COUNSELING CENTER: PROVIDES A WIDE RANGE OF OUTPATIENT COUNSELING SERVICES, INCLUDING GROUP, INDIVIDUAL AND FAMILY COUNSELING. A VARIETY OF SUPPORT GROUPS ALSO MEET AT THE CENTER. OFF-CAMPUS PHYSICIAN OFFICES: A NUMBER OF PHYSICIAN OFFICES ARE LOCATED THROUGHOUT THE REGION SERVED BY ADENA. THESE INCLUDE OFFICES FOR FAMILY PHYSICIANS, ENDOCRINOLOGISTS, GERONTOLOGISTS AND UROLOGISTS. TELEMEDICINE: IN 2011, THE HEALTH SYSTEM CONTINUED ITS AFFILIATION WITH THE SOUTHERN OHIO HEALTH CARE NETWORK (SOHCN), A PARTNERSHIP OF THE REGION'S THREE LARGEST HEALTHCARE PROVIDERS -- ADENA, O'BLENESS HEALTH SYSTEM AND HOLZER CONSOLIDATED HEALTH SYSTEMS. THIS PARTNERSHIP HAS RESULTED IN THE CONSTRUCTION OF AN EXPANSIVE FIBER OPTIC BROADBAND TELECOMMUNICATIONS NETWORK TO SERVE THE HEALTHCARE AND EDUCATIONAL NEEDS OF PEOPLE LIVING IN OHIO'S APPALACHIAN REGION. THROUGH THIS TECHNOLOGY, TELEMEDICINE IS ENABLING PATIENTS TO BE ON ADENA'S CAMPUS, BUT TREATED BY PHYSICIANS OUTSIDE THE REGION. ADENA HAS TELEMEDICINE RELATIONSHIPS WITH OHIO STATE UNIVERSITY MEDICAL CENTER, RIVERSIDE METHODIST HOSPITAL, AND NATIONWIDE CHILDREN'S HOSPITAL IN COLUMBUS. |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Records Maintained | 0 | GrantRecordsMaintainedInd |
Recipient Table RecipientTable (2 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | Recipient EINRecipientEIN | IRC SectionIRCSectionDesc | Cash GrantCashGrantAmt | Purpose Of GrantPurposeOfGrantTxt |
|---|---|---|---|---|---|---|---|
| HOPE CLINIC OF PIKE COUNTY | |||||||
| PO BOX 101 | WAVERLY | OH | 45690 | 263193098 | 501(C)(3) | $10,000 | PROVIDE MEDICAL CARE |
| GARNET WILSON LIBRARY | |||||||
| 207 N MARKET ST | WAVERLY | OH | 45690 | 316401620 | 501(C)(4) | $5,000 | CAPITAL CAMPAIGN FOR NEW LIBRARY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total501c3 Org | 1 | Total501c3OrgCnt |
| Total Other Org | 1 | TotalOtherOrgCnt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Club Dues Or Fees | Yes (X) | ClubDuesOrFeesInd |
| Written Policy Ref T And E Expnss | Yes (1) | WrittenPolicyRefTAndEExpnssInd |
| Substantiation Required | Yes (1) | SubstantiationRequiredInd |
| Severance Payment | Yes (1) | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | 0 | 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 (8 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| DAVID KESSLER | ||||||||||||||
| CHIEF OF MEDICAL STAFF | $286,944 | $0 | $19,381 | $0 | $2,230 | $0 | $0 | $0 | $2,016 | $0 | $310,571 | $0 | $0 | $0 |
| DAVE ZANNI | ||||||||||||||
| CEO | $127,222 | $0 | $0 | $0 | $9,308 | $0 | $12,521 | $0 | $21,206 | $0 | $170,257 | $0 | $0 | $0 |
| JOHN CRAWFORD | ||||||||||||||
| PHYSICIAN | $132,357 | $0 | $1 | $0 | $957 | $0 | $0 | $0 | $24,367 | $0 | $157,682 | $0 | $0 | $0 |
| ELLIS FRAZIER | ||||||||||||||
| PHYSICIAN | $187,353 | $0 | $1 | $0 | $1,693 | $0 | $0 | $0 | $14,078 | $0 | $203,125 | $0 | $0 | $0 |
| CHERYL SMITH | ||||||||||||||
| PHARMACIST | $145,212 | $0 | $0 | $0 | $2,882 | $0 | $12,750 | $0 | $1,330 | $0 | $162,174 | $0 | $0 | $0 |
| MIKE DIENER | ||||||||||||||
| EMPLOYEE | $142,775 | $0 | $0 | $0 | $5,941 | $0 | $14,007 | $0 | $29,439 | $0 | $192,162 | $0 | $0 | $0 |
| CATHERINE FARINET | ||||||||||||||
| FORMER CHIEF OF MEDICAL STAFF | $237,880 | $0 | $76 | $0 | $1,002 | $0 | $0 | $0 | $20,879 | $0 | $259,837 | $0 | $0 | $0 |
| CRAIG SOLLE | ||||||||||||||
| FORMER PRESIDENT AND CEO | $0 | $0 | $0 | $0 | $146,515 | $0 | $0 | $0 | $0 | $0 | $146,515 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part I, Line 1a | DAVE ZANNI IS REIMBURSED FOR HIS ROTARY CLUB DUES. THIS IS NOT TREATED AS TAXABLE COMPENSATION. |
| Part I, Line 3 | THE TOP MANAGEMENT OFFICIAL AT ADENA PIKE MEDICAL CENTER HAS HIS COMPENSATION REVIEWED ANNUALLY BY ADENA HEALTH SYSTEM, A RELATED PARTY. THE SYSTEM UTILIZES A SEPARATE TPA MANAGEMENT COMPENSATION CONSULTING FIRM THAT USES SEVERAL AVAILABLE MARKET STUDIES FOR APPLICABLE POSITIONS IN COMPARABLE MARKETS. THIS PROCESS WAS LAST UNDERTAKEN IN 2014. |
| Part I, Line 4a | LINE 4A: ONE EMPLOYEE THAT WAS PREVIOUSLY LISTED IN PART VII, SECTION A, LINE 1A RECEIVED SEVERANCE IN 2015: - CRAIG SOLLE REPORTED SEVERANCE COMPENSATION OF $146,515. THEY ARE RECEIVING 12 MONTHS OF SEVERANCE AND THEN A 6 MONTH BRIDGE IF NOT EMPLOYED. AT ANY TIME AFTER THE INTIAL 12 MONTHS, AHS WOULD REDUCE PAY IF EMPLOYED AT A LESSER RATE. |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (9 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Form 990, Part VI, Section A, line 6 | THE SOLE MEMBER OF PIKE HEALTH SERVICES, INC. IS ADENA HEALTH SYSTEM. |
| Form 990, Part VI, Section A, line 7a | PIKE HEALTH SYSTEM, INC. ELECTS AND APPOINTS MEMBERS TO THE GOVERNING BODY SUBJECT TO THE APPROVAL OF ADENA HEALTH SYSTEM, THE SOLE MEMBER. |
| Form 990, Part VI, Section A, line 7b | CERTAIN GOVERNING DECISIONS ARE SUBJECT TO THE APPROVAL OF ADENA HEALTH SYSTEM, THE SOLE MEMBER OF PIKE HEALTH SERVICES, INC. |
| Form 990, Part VI, Section B, line 11 | THE 990 WAS REVIEWED AT A BOARD MEETING AND COPIES OF THE FORM 990 WERE PROVIDED TO THE BOD MEMBERS. |
| Form 990, Part VI, Section B, line 12c | THE CORPORATE COMPLIANCE OFFICE OF ADENA HEALTH SYSTEM, PIKE HEALTH SERVICES, INC.'S SOLE MEMBER, ANNUALLY COORDINATES THE DISTRIBUTION AND RETURN OF THE CONFLICT OF INTEREST STATEMENTS. THE CORPORATE COMPLIANCE OFFICE IS RESPONSIBLE FOR REVIEWING THE RESPONSES AND COMMUNICATING ANY EXTRA STEPS THAT NEED TO TAKE PLACE REGARDING ANY OF THE RESPONSES. AT EVERY BOARD MEETING AND COMMITTEE OF THE BOARD, THE AGENDA ITEM OF CONFLICT OF INTEREST IS INCLUDED AND CALLED OUT. CONFLICTED BOARD MEMBERS ABSTAIN FROM VOTING ON THE PARTICULAR ITEMS. ANY MEMBER ABSTAINING FROM VOTING IS DOCUMENTED IN THE MINUTES. ALL ADENA HEALTH SYSTEM WORKFORCE MEMBERS AND BOARD MEMBERS ARE SUBJECT TO THE CONFLICT OF INTEREST POLICY. |
| Form 990, Part VI, Section B, line 15 | THE TOP MANAGEMENT OFFICIAL AT ADENA PIKE MEDICAL CENTER HAS HIS COMPENSATION REVIEWED ANNUALLY BY ADENA HEALTH SYSTEM, A RELATED PARTY. THE SYSTEM UTILIZES A SEPARATE TPA MANAGEMENT COMPENSATION CONSULTING FIRM THAT USES SEVERAL AVAILABLE MARKET STUDIES FOR APPLICABLE POSITIONS IN COMPARABLE MARKETS. THIS PROCESS WAS LAST UNDERTAKEN IN 2015. |
| Form 990, Part VI, Section C, line 19 | THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST. |
| Form 990, Part XI, line 9: | TRANSFER (TO) FROM RELATED ORGANIZATION -3,152,142. |
| FORM 990, PART XII, LINE 2C: | ADENA HEALTH SYSTEM'S BOARD OF DIRECTORS OVERSEES THE AUDIT PROCESS AND APPROVES THE INDEPENDENT AUDIT FIRM. PIKE HEALTH SERVICES, INC. IS PART OF ADENA HEALTH SYSTEM'S CONSOLIDATED AUDIT. THIS PROCESS HAS NOT CHANGED FROM PRIOR YEAR. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (4 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Controlled OrganizationControlledOrganizationInd | Direct Controlling NADirectControllingNACd |
|---|---|---|---|---|---|---|---|---|---|---|---|
| GREENFIELD AREA MEDICAL CENTER | |||||||||||
| 550 MIRABEAU ST | GREENFIELD | OH | 45123 | 310993422 | HOSPITAL | OH | 501(c)(3) | 3 | ADENA HEALTH SYSTEM | Yes (1) | |
| ADENA HEALTH FOUNDATION | |||||||||||
| 242 HOSPITAL ROAD | CHILLICOTHE | OH | 45601 | 753008742 | FUNDRAISING | OH | 501(c)(3) | 11A | ADENA HEALTH SYSTEM | Yes (1) | |
| SOUTHERN OHIO HEALTHCARE NETWORK | |||||||||||
| 550 MIRABEAU ST | GREENFIELD | OH | 45123 | 261566590 | FIBEROPTIC NETWORK GRANTS | OH | 501(c)(3) | 11A | ADENA HEALTH SYSTEM | Yes (1) | |
| ADENA HEALTH SYSTEM | |||||||||||
| 242 HOSPITAL ROAD | CHILLICOTHE | OH | 45601 | 314379443 | HOSPITAL | OH | 501(c)(3) | 3 | 0 | N/A | |
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp
Related Organization Name RelatedOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ADENA CARE | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 272 HOSPITAL ROAD | AddressLine1Txt |
| City | CHILLICOTHE | CityNm |
| State Abbreviation | OH | StateAbbreviationCd |
| ZIP | 45601 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 453980850 | EIN |
| Primary Activities | PROVIDE EMPLOYEE HEALTH INSURANCE | PrimaryActivitiesTxt |
| Legal Domicile State | OH | LegalDomicileStateCd |
| Direct Controlling NA | N/A | DirectControllingNACd |
| Entity Type | C | EntityTypeTxt |
| Controlled Organization | Yes (1) | ControlledOrganizationInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | 0 | 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 | 0 | 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 | Yes (1) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | Yes (1) | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | Yes (1) | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | Yes (1) | TransferToOtherOrgInd |
| Transfer From Other Org | Yes (1) | TransferFromOtherOrgInd |