THE CITY HOSPITAL ASSOCIATION: Form 990, tax year 2014
View the entire original 990 at ProPublica ↗
- Organization
- THE CITY HOSPITAL ASSOCIATION (EIN 34-0714583)
- Tax period
- 2014-01-01 to 2014-12-31
- Filed
- 2016-04-18
- IRS object ID
- 201601099349300915
- Schema version
- 2014v6.0
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
- Return header
- Form 990
- Schedule A
- Schedule C
- Schedule D
- Schedule H
- Schedule I
- Schedule J
- Schedule K
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2016-04-18T14:35:25-05:00 | ReturnTs |
| Tax Period End | 2014-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 351178661 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BLUE & CO LLC | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 8800 LYRA DRIVE SUITE 450 | AddressLine1Txt |
| City | COLUMBUS | CityNm |
| State Abbreviation | OH | StateAbbreviationCd |
| ZIP | 43240 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2014-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 340714583 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CITY HOSPITAL ASSOCIATION | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | CITY | BusinessNameControlTxt |
| Phone | 3303862000 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 425 WEST FIFTH STREET | AddressLine1Txt |
| City | EAST LIVERPOOL | CityNm |
| State Abbreviation | OH | StateAbbreviationCd |
| ZIP | 43920 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | KYLE JOHNSON | PersonNm |
| Person Title | CFO | PersonTitleTxt |
| Phone | 3303862000 | PhoneNum |
| Signature | 2016-02-29 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | MATTHEW DASTA | PreparerPersonNm |
| PTIN | P00544683 | PTIN |
| Phone | 6148852583 | PhoneNum |
| Preparation | 2016-02-29 | PreparationDt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2014 | TaxYr |
| Build TS | 2016-08-17 19:52:53Z | BuildTS |
Form 990 IRS990
Doing Business As Name DoingBusinessAsName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | EAST LIVERPOOL CITY HOSPITAL | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | MIKE BRUNTON | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 425 WEST FIFTH STREET | AddressLine1Txt |
| City | EAST LIVERPOOL | CityNm |
| State Abbreviation | OH | StateAbbreviationCd |
| ZIP | 43920 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $65,473,599 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.ELCH.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1905 | FormationYr |
| Legal Domicile State | OH | LegalDomicileStateCd |
| Activity Or Mission | THE ORGANIZATION IS ORGANIZED AND OPERATED TO PROVIDE THE PEOPLE OF THE TRI-STATE AREA HIGH QUALITY HEALTH CARE SERVICES, REGARDLESS OF THE PERSON'S ABILITY TO PAY. THESE SERVICES INCLUDE THE PREVENTION OF ILLNESS, RELIEF OF SUFFERING, HEALTH RESTORATION, AND HEALTH CARE EDUCATION. | ActivityOrMissionDesc |
| Voting Members Governing Body | 17 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 16 | VotingMembersIndependentCnt |
| Total Employee | 0 | TotalEmployeeCnt |
| Total Volunteers | 17 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $24,000 | PYContributionsGrantsAmt |
| CY Contributions Grants | $3,490 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $64,437,682 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $60,262,469 | CYProgramServiceRevenueAmt |
| PY Investment Income | $2,816,337 | PYInvestmentIncomeAmt |
| CY Investment Income | $1,117,908 | CYInvestmentIncomeAmt |
| PY Other Revenue | $1,601,954 | PYOtherRevenueAmt |
| CY Other Revenue | $4,089,732 | CYOtherRevenueAmt |
| PY Total Revenue | $68,879,973 | PYTotalRevenueAmt |
| CY Total Revenue | $65,473,599 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $150,000 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $106,067 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $33,404,712 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $28,800,867 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $36,106,043 | PYOtherExpensesAmt |
| CY Other Expenses | $43,600,914 | CYOtherExpensesAmt |
| PY Total Expenses | $69,660,755 | PYTotalExpensesAmt |
| CY Total Expenses | $72,507,848 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$780,782 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$7,034,249 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $100,749,210 | TotalAssetsBOYAmt |
| Total Assets EOY | $92,365,159 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $39,331,984 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $41,678,880 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $61,417,226 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $50,686,279 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | WE WILL PROVIDE HIGH QUALITY, COMPASSIONATE HEALTH CARE SERVICES WITHIN THE AVAILABLE RESOURCES. HEALTHCARE SERVICES WILL BE PROVIDED TO PREVENT ILLNESS, RELIEVE SUFFERING, AID IN HEALTH RESTORATION AND TO PROMOTE WELLNESS. WE WILL PROVIDE SERVICES TO ANY PERSON, WITHOUT DISCRIMINATION. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $51,323,780 | ExpenseAmt |
| Grant | $106,067 | GrantAmt |
| Revenue | $64,104,414 | RevenueAmt |
| Desc | CITY HOSPITAL ASSOCIATION DBA EAST LIVERPOOL CITY HOSPITAL PROVIDES QUALITY MEDICAL HEALTHCARE REGARDLESS OF RACE, CREED, SEX, NATIONAL ORIGIN, HANDICAP, AGE, OR ABILITY TO PAY. ALTHOUGH REIMBURSEMENT FOR SERVICES RENDERED IS CRITICAL TO THE OPERATION AND STABILITY OF THE HOSPITAL, IT IS RECOGNIZED THAT NOT ALL INDIVIDUALS POSSESS THE ABILITY TO AFFORD ESSENTIAL MEDICAL SERVICES AND HEALTHCARE EDUCATION. THEREFORE, IN KEEPING WITH THE HOSPITAL'S COMMITMENT TO SERVE ALL MEMBERS OF OUR COMMUNITY WITH FREE CARE AND OR SUBSIDIZED CARE, CARE PROVIDED TO PERSONS COVERED BY GOVERNMENTAL PROGRAMS BELOW COSTS, AND HEALTH ACTIVITIES AND PROGRAMS TO SUPPORT THE COMMUNITY HAVE BEEN CONSIDERED WHERE THE NEED AND AN INDIVIDUAL'S INABILITY TO PAY EXIST. THESE ACTIVITIES INCLUDE WELLNESS PROGRAMS, COMMUNITY EDUCATION PROGRAMS, AND A VARIETY OF BROAD COMMUNITY SUPPORT ACTIVITIES. THE HOSPITAL PROVIDES CARE TO PERSONS COVERED BY GOVERNMENTAL PROGRAMS BELOW COST. RECOGNIZING ITS MISSION TO THE COMMUNITY, SERVICES ARE PROVIDED TO BOTH MEDICARE AND MEDICAID PATIENTS. TO THE EXTENT REIMBURSEMENT IS BELOW COST, THE HOSPITAL CONSIDERS THESE AMOUNTS AS UNCOMPENSATED CARE IN MEETING ITS MISSION TO THE ENTIRE COMMUNITY. THE HOSPITAL IS LOCATED IN EAST LIVERPOOL, OHIO AND SERVICES THE SURROUNDING COMMUNITIES; STAFFING 158 BEDS FOR ACUTE CARE, INTENSIVE CARE, NURSERY, AND SKILLED NURSING IN THIS MEDICALLY UNDERSERVED AREA.DURING 2014, THE HOSPITAL PROVIDED NUMEROUS BENEFITS TO THE SURROUNDING COMMUNITY, INCLUDING FINANCIAL SUPPORT THROUGH THE COMMUNITY BENEFIT INITIATIVE PROGRAM.COMMUNITY BENEFIT INITIATIVE - THE HOSPITAL PROVIDED FINANCIAL SUPPORT TOTALING $106,067 TO LOCAL PROGRAMS.COMMUNITY EDUCATION AND WELLNESS PROGRAMS - THE HOSPITAL OFFERED THE FOLLOWING TO THE COMMUNITY FREE OR AT A NOMINAL CHARGE:HEALTH FAIRSCPR CLASSESCHILDBIRTH CLASSESGARFIELD ELEMENTARY WELLNESS PROGRAMCOVER THE UNINSURED PROGRAMHEARTSAVER FIRST AID CLASSESADVANCE CARDIAC LIFE SUPPORTHEALTHCARE PROVIDE RECERTIFICATIONBREAST FEEDING SUPPORTPASTORAL OUTREACH PROGRAMSDIABETES EDUCATIONARTHRITIS AQUATICS CLASSESSMOKING CESSATION CLASSESBASICS IN BABYSITTING CLASSESAUTISM SUPPORT GROUPCONDUCTED HOSPITAL TOURS FOR AREA SCHOOLS AND COMMUNITY GROUPS. SERVED AS AN OBSERVATION SITE FOR THE HIGH SCHOOL FOR HEALTH PROFESSIONS DEVELOPED BY THE PUBLIC SCHOOLS. HOSTED SEVERAL SHADOW STUDENTS FROM AREA SCHOOLS. SERVED AS HOST SITE FOR OHIO HIGHER EDUCATION TELECOMMUNICATION SYSTEM.OPERATED A PHYSICIAN REFERRAL LINE FREE TO THE COMMUNITY.SPENT $45,972 TO RECRUIT PHYSICIANS TO THE UNDERSERVED COMMUNITY;HOSTED PROGRAMS FOR STUDENT NURSES AND RADIOLOGY TECHNICIANS IN TRAINING.SALVATION ARMY: PROVIDED FOOD TO NEEDY FAMILIES FOR THANKSGIVING, AND GIFTS TO NEEDY CHILDREN FOR CHRISTMAS.DAY OF CARING, DAY OF GIVING PROGRAM - MONEY AND FOOD DRIVE. | Desc |
| Total Program Service Expenses | $51,323,780 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | 0 | 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 | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | Yes (1) | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | 0 | 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 | 0 | 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 | Yes (1) | TaxExemptBondsInd |
| Invest Tax Exempt Bonds | 0 | InvestTaxExemptBondsInd |
| Escrow Account | 0 | EscrowAccountInd |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuerInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | 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 | 0 | EmployeeCnt |
| 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 | 17 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 16 | 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 | 0 | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | 0 | 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 | 0 | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (1) | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | OH | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ANTHONY PUORRO | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 3303862633 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 425 W FIFTH STREET | AddressLine1Txt |
| City | EAST LIVERPOOL | CityNm |
| State Abbreviation | OH | StateAbbreviationCd |
| ZIP | 43920 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (20 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Highest Compensated EmployeeHighestCompensatedEmployeeInd | Former Ofcr Director TrusteeFormerOfcrDirectorTrusteeInd |
|---|---|---|---|---|---|---|---|---|
| KENNETH COCHRAN | ||||||||
| CEO | 40.00 | Yes (X) | Yes (X) | $332,717 | $0 | $0 | ||
| STEVE LATULIPPE MD | ||||||||
| TRUSTEE | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| DR DONALD WILLIAMS | ||||||||
| TRUSTEE | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| JOSPEH LUDOVICI | ||||||||
| TRUSTEE | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| JERYL SCHREINER | ||||||||
| TRUSTEE | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| JD GAURON | ||||||||
| TRUSTEE | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| PETE WICKS | ||||||||
| SECRETARY/TREASURER | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| ROB OHARA | ||||||||
| TRUSTEE | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| TAMMIE MCINTOSH | ||||||||
| TRUSTEE | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| WILLIAM MILLER | ||||||||
| VICE CHAIRMAN OF THE BOARD | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| MICHAEL SIGLER | ||||||||
| TRUSTEE | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| MARY LOU VISNIC | ||||||||
| TRUSTEE | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| JOSEPH SHEMASEK | ||||||||
| TRUSTEE | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| DAVID HAMILTON | ||||||||
| TRUSTEE | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| JAY B VOTAW DVM | ||||||||
| TRUSTEE | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| GRETCHEN NICKELL DO | ||||||||
| TRUSTEE | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| FRANK MADER | ||||||||
| INFORMATION SERVICES DIRECTOR | 40.00 | $109,368 | $0 | $41,655 | Yes (X) | |||
| CHARLES PARRY | ||||||||
| ADMINISTRATOR | 40.00 | $105,467 | $0 | $18,723 | Yes (X) | |||
| TINA ROBINSON | ||||||||
| REGISTERED NURSE | 40.00 | $100,227 | $0 | $21,869 | Yes (X) | |||
| KYLE JOHNSON FORMER CFO | ||||||||
| FORMER CFO | 40.00 | $205,058 | $0 | $20,272 | Yes (X) | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $852,837 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $102,519 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 5 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | Yes (1) | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| CARDINAL HEALTH | |||||
| 21377 NETWORK PL | CHICAGO | IL | 60673 | PHARMACY SERVICES | $3,161,796 |
| AVI FOODSYSTEMS INC | |||||
| 2590 ELM ROAD NE | WARREN | OH | 44483 | FOOD/SUPPLIES/PROFESSIONAL SERVICES | $2,562,667 |
| MEDLINE INDUSTRIES INC | |||||
| PO BOX 382075 | PITTSBURGH | PA | 15251 | HOSPITAL MED-SURG SUPPLY | $1,086,828 |
| INPATIENT MANAGEMENT INC | |||||
| 1 MCBRIDE SON CENTER DRIVE | ST LOUIS | MO | 63005 | PROFESSIONAL FEES | $967,852 |
| PSYCHIATRIC RESOURCE PARTNERS | |||||
| 6100 TOWER CIRCLE DRIVE STE 1000 | FRANLKIN | TN | 37067 | BEHAVIORAL HEALTH PROFESSIONAL FEES | $879,504 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 5 | CntrctRcvdGreaterThan100KCnt |
| All Other Contributions | $3,490 | AllOtherContributionsAmt |
| Total Contributions | $3,490 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | NET PATIENT REVENUE | Desc |
| Business | 900099 | BusinessCd |
| Total Revenue Column | $60,262,469 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $60,262,469 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $60,262,469 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $1,065,538 | TotalRevenueColumnAmt |
| Exclusion | $1,065,538 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $89,424 | 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 | $89,424 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $89,424 | TotalRevenueColumnAmt |
| Exclusion | $89,424 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $52,370 | SecuritiesAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $0 | SecuritiesAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $52,370 | SecuritiesAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $52,370 | TotalRevenueColumnAmt |
| Exclusion | $52,370 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt | ExclusionExclusionAmt |
|---|---|---|---|---|
| HCAP | 900099 | $2,378,746 | $2,378,746 | |
| MEDICAID SUBSIDY | 900099 | $1,357,812 | $1,357,812 | |
| CAFETERIA INCOME | 900099 | $158,363 | $158,363 |
Miscellaneous Revenue MiscellaneousRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $105,387 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $105,387 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $4,000,308 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $65,473,599 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $64,104,414 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $1,365,695 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $106,067 | TotalAmt |
| Program Services | $106,067 | ProgramServicesAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $332,717 | TotalAmt |
| Program Services | $199,630 | ProgramServicesAmt |
| Management And General | $133,087 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $19,601,520 | TotalAmt |
| Program Services | $11,760,912 | ProgramServicesAmt |
| Management And General | $7,840,608 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $910,548 | TotalAmt |
| Program Services | $910,548 | ProgramServicesAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $6,237,850 | TotalAmt |
| Program Services | $6,237,850 | ProgramServicesAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,718,232 | TotalAmt |
| Program Services | $1,254,309 | ProgramServicesAmt |
| Management And General | $463,923 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $563,894 | TotalAmt |
| Management And General | $563,894 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $62,413 | TotalAmt |
| Management And General | $62,413 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $12,292,939 | TotalAmt |
| Program Services | $7,447,277 | ProgramServicesAmt |
| Management And General | $4,845,662 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $271,655 | TotalAmt |
| Management And General | $271,655 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $122,011 | TotalAmt |
| Program Services | $73,207 | ProgramServicesAmt |
| Management And General | $48,804 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,177,684 | TotalAmt |
| Program Services | $2,506,610 | ProgramServicesAmt |
| Management And General | $1,671,074 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $59,254 | TotalAmt |
| Program Services | $35,552 | ProgramServicesAmt |
| Management And General | $23,702 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $69,094 | TotalAmt |
| Program Services | $69,094 | ProgramServicesAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,417,547 | TotalAmt |
| Program Services | $2,417,547 | ProgramServicesAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,074,632 | TotalAmt |
| Management And General | $4,074,632 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $561,321 | TotalAmt |
| Program Services | $561,321 | ProgramServicesAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| BAD DEBTS | $8,967,735 | $8,967,735 | |
| SUPPLIES | $7,887,766 | $7,098,989 | $788,777 |
| MISCELLANEOUS | $1,979,184 | $1,583,347 | $395,837 |
| RECRUITMENT | $93,785 | $93,785 |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $72,507,848 | TotalAmt |
| Program Services | $51,323,780 | ProgramServicesAmt |
| Management And General | $21,184,068 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $800 | BOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $514,685 | BOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $12,694,318 | BOYAmt |
| EOY | $11,476,879 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $80,753 | BOYAmt |
| EOY | $59,940 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $995,681 | BOYAmt |
| EOY | $987,191 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $95,615,000 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $68,207,965 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $29,881,382 | BOYAmt |
| EOY | $27,407,035 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $51,361,210 | BOYAmt |
| EOY | $42,148,838 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,220,381 | BOYAmt |
| EOY | $10,285,276 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $100,749,210 | BOYAmt |
| EOY | $92,365,159 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,598,968 | BOYAmt |
| EOY | $7,415,460 | EOYAmt |
Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $29,222,102 | BOYAmt |
| EOY | $26,501,239 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $1,747,538 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,510,914 | BOYAmt |
| EOY | $6,014,643 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $39,331,984 | BOYAmt |
| EOY | $41,678,880 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $61,283,754 | BOYAmt |
| EOY | $50,548,456 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $75,034 | BOYAmt |
| EOY | $79,385 | EOYAmt |
Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $58,438 | BOYAmt |
| EOY | $58,438 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $61,417,226 | BOYAmt |
| EOY | $50,686,279 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $100,749,210 | BOYAmt |
| EOY | $92,365,159 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | -$7,034,249 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | $679,130 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | -$4,375,828 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Separate Basis Fincl Stmt | Yes (X) | SeparateBasisFinclStmtInd |
| 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 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 | $6,105 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $6,105 | 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 | A PERCENTAGE OF AHA AND OHA DUES ARE USED FOR LOBBYING PURPOSES. | ExplanationTxt |
Schedule D IRS990ScheduleD
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $1,434,347 | OtherCostOrOtherBasisAmt |
| Book Value | $1,434,347 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $44,568,504 | OtherCostOrOtherBasisAmt |
| Depreciation | $27,323,581 | DepreciationAmt |
| Book Value | $17,244,923 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $49,021,814 | OtherCostOrOtherBasisAmt |
| Depreciation | $40,884,384 | DepreciationAmt |
| Book Value | $8,137,430 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $590,335 | OtherCostOrOtherBasisAmt |
| Book Value | $590,335 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $27,407,035 | TotalBookValueLandBuildingsAmt |
Other Assets Org OtherAssetsOrgGrp (4 entries)
| DescDesc | Book ValueBookValueAmt |
|---|---|
| DEFERRED BOND FINANCING COSTS | $347,106 |
| DUE FROM AFFILIATES | $166,451 |
| GUARANTEES | $5,494,443 |
| ESTIMATED THIRD PARTY SETTLEMENTS | $4,277,276 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $10,285,276 | TotalBookValueOtherAssetsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (3 entries)
| DescDesc | AmtAmt |
|---|---|
| INTEREST RATE SWAP | $2,984,843 |
| GUARANTEES | $2,930,011 |
| BANK OVERDRAFT | $99,789 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $6,014,643 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $55,302,296 | TotalRevEtcAuditedFinclStmtAmt |
| Revenue Not Reported | $0 | RevenueNotReportedAmt |
| Revenue Subtotal | $55,302,296 | RevenueSubtotalAmt |
| Other Revenues Not Included | $10,171,303 | OtherRevenuesNotIncludedAmt |
| Revenue Not Reported Fincl Stmt | $10,171,303 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $65,473,599 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $62,336,545 | TotExpnsEtcAuditedFinclStmtAmt |
| Expenses Not Reported | $0 | ExpensesNotReportedAmt |
| Expenses Subtotal | $62,336,545 | ExpensesSubtotalAmt |
| Other Expenses Not Included | $10,171,303 | OtherExpensesNotIncludedAmt |
| Expenses Not Rpt Fincl Stmt | $10,171,303 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $72,507,848 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART X, LINE 2: | ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA REQUIRE MANAGEMENT TO EVALUATE TAX POSITIONS TAKEN BY THE HOSPITAL AND RECOGNIZE A TAX LIABILITY IF THE HOSPITAL HAS TAKEN AN UNCERTAIN POSITION THAT MORE LIKELY THAN NOT WOULD NOT BE SUSTAINED UPON EXAMINATION BY VARIOUS FEDERAL AND STATE TAXING AUTHORITIES. MANAGEMENT HAS ANALYZED THE TAX POSITIONS TAKEN BY THE HOSPITAL, AND HAS CONCLUDED THAT AS OF DECEMBER 31, 2014 AND 2013, THERE ARE NO UNCERTAIN POSITIONS TAKEN OR EXPECTED TO BE TAKEN THAT WOULD REQUIRE RECOGNITION OF A LIABILITY OR DISCLOSURE IN THE ACCOMPANYING FINANCIAL STATEMENTS. THE HOSPITAL IS SUBJECT TO ROUTINE AUDITS BY TAXING JURISDICTIONS; HOWEVER, THERE ARE CURRENTLY NO AUDITS FOR ANY TAX PERIODS IN PROGRESS. |
| PART XI, LINE 4B - OTHER ADJUSTMENTS: | BAD DEBT EXPENSE INCLUDED IN INCOME 8,967,735. CHANGE IN INTEREST RATE SWAP 1,203,568. |
| PART XII, LINE 4B - OTHER ADJUSTMENTS: | BAD DEBT EXPENSE INCLUDED IN INCOME 8,967,735. CHANGE IN INTEREST RATE SWAP 1,203,568. |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (1) | FinancialAssistancePolicyInd |
| Written Policy | Yes (1) | WrittenPolicyInd |
| FPG Reference Free Care | Yes (1) | FPGReferenceFreeCareInd |
| Percent100 | Yes (X) | Percent100Ind |
| FPG Reference Discounted Care | Yes (1) | FPGReferenceDiscountedCareInd |
| Percent200 D | Yes (X) | Percent200DInd |
| Free Care Medically Indigent | Yes (1) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (1) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | 0 | ExpensesExceedBudgetInd |
| Annual Community Bnft Report | 0 | AnnualCommunityBnftReportInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $754,126 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $754,126 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01190 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $17,310,696 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $11,706,538 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $5,604,158 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.08820 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $18,064,822 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $11,706,538 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $6,358,284 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.10010 | TotalExpensePct |
Health Professions Education HealthProfessionsEducationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,876,342 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $721,445 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,154,897 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01820 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,876,342 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $721,445 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,154,897 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01820 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $19,941,164 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $12,427,983 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $7,513,181 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.11830 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 0 | BadDebtExpenseReportedInd |
| Reimbursed By Medicare | $16,535,891 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $17,081,765 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$545,874 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | Yes (X) | OtherInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | Yes (1) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (1) | FinancialAssistancePrvsnInd |
| Hospital Facilities | 2 | HospitalFacilitiesCnt |
Hospital Facilities HospitalFacilitiesGrp (2 entries)
| FacilityFacilityNum | Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | OtherOtherDesc | Licensed HospitalLicensedHospitalInd | General Medical And SurgicalGeneralMedicalAndSurgicalInd |
|---|---|---|---|---|---|---|---|
| ELCH REHAB | |||||||
| 1 | 15655 ST RTE 170 | EAST LIVERPOOL | OH | 43920 | PT, OT, SPEECH SERVICES | ||
| ELCH | |||||||
| 2 | 5TH STREET | EAST LIVERPOOL | OH | 43920 | DSH | Yes (X) | Yes (X) |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | EAST LIVERPOOL CITY HOSPITAL | 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 | HTTP://WWW.ELCH.ORG/COMMUNITYHEALTH/ | OwnWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Implementation Strategy Adopt | Yes (1) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 13 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (1) | StrategyPostedWebsiteInd |
| Strategy Website URL | HTTP://WWW.ELCH.ORG/COMMUNITYHEALTH/ | 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 | 100.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 100.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Income Level Criteria | Yes (X) | IncomeLevelCriteriaInd |
| Insurance Status Criteria | Yes (X) | InsuranceStatusCriteriaInd |
| Explained Basis | Yes (1) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (1) | AppFinancialAsstExplnInd |
| Includes Publicity Measures | Yes (1) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | HTTP://WWW.ELCH.ORG/PATIENT/BILLING/FINANCIAL-AID-FOR-PATIENTS/593/ | FAPAvailableOnWebsiteURLTxt |
| FAP Avlbl On Request No Charge | Yes (X) | FAPAvlblOnRequestNoChargeInd |
| FAP Actions On Nonpayment | Yes (1) | FAPActionsOnNonpaymentInd |
| Permit Report To Credit Agency | Yes (X) | PermitReportToCreditAgencyInd |
| Collection Activities | Yes (1) | CollectionActivitiesInd |
| Reporting To Credit Agency | Yes (X) | ReportingToCreditAgencyInd |
| FAP Notified Upon Admission | Yes (X) | FAPNotifiedUponAdmissionInd |
| FAP Notified Before Discharge | Yes (X) | FAPNotifiedBeforeDischargeInd |
| FAP Notified All Patients | Yes (X) | FAPNotifiedAllPatientsInd |
| Documented Elig Determination | Yes (X) | DocumentedEligDeterminationInd |
| Nondis Emergency Care Policy | Yes (1) | NondisEmergencyCarePolicyInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | Yes (1) | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (4 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| EAST LIVERPOOL CITY HOSPITAL | PART V, SECTION B, LINE 6A: SALEM COMMUNITY HOSPITAL |
| EAST LIVERPOOL CITY HOSPITAL | PART V, SECTION B, LINE 24: ALL PATIENTS ARE BILLED THE SAME GROSS CHARGE. DISCOUNTS ARE APPLIED AT THE TIME OF PAYMENT. |
| PART V, SECTION B, LINE 16 | FINANCIAL ASSISTANCE POLICY WEBSITE AVAILABILITY |
| EAST LIVERPOOL CITY HOSPITAL PART V, SECTION B, LINE 16A WEBSITE: | HTTP://WWW.ELCH.ORG/PATIENT/BILLING/FINANCIAL-AID-FOR-PATIENTS/593/ |
Supplemental Information Detail SupplementalInformationDetail (10 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 7, COLUMN (F): | THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $ 8,967,735. |
| PART II, COMMUNITY BUILDING ACTIVITIES: | ONGOING EFFORTS AND EVALUATION OF MANAGEMENT, STAFF, PHYSICIANS WITH FEEDBACK FROM PATIENTS AND COMMUNITY. DEMOGRAPHIC RESEARCH AND STUDIES ALSO UTILIZED TO DETERMINE TYPE AND QUANTITY OF SERVICES NEEDED BY SPECIALTY TO BEST SERVE OUR COMMUNITY. |
| PART III, LINE 4: | ALTHOUGH NOT DESCRIBED IN THE FOOTNOTES TO THE HOSPITAL'S FINANCIAL STATEMENTS, THE PRACTICE OF THE HOSPITAL IS TO RECORD BAD DEBT EXPENSE AT THE UNPAID BALANCES AFTER CONTRACTUAL DISCOUNTS FOR PATIENT'S WITH INSURANCE AND AT THE FULL OR DISCOUNTED CHARGE LEVEL FOR THOSE WHO DO NOT HAVE INSURANCE. THE HOSPITAL NEGOTIATES WITH PAYERS TO COME UP WITH A FAIR DISCOUNTED RATE TO BE PAID FOR SERVICES RENDERED. THESE DISCOUNTS ARE NOT RECORDED AS BAD DEBT EXPENSES. SIMILARLY FOR PATIENTS WITHOUT ANY INSURANCE, THE HOSPITAL OFFERS SEVERAL DIFFERENT DISCOUNT PROGRAMS, BASED UPON FINANCIAL NEED, TO THESE PATIENTS AND ONCE AGAIN THESE DISCOUNTS ARE NOT RECORDED AS BAD DEBTS. FOR PATIENTS WHO DO NOT MEET OR DO NOT FOLLOW-THROUGH TO DEMONSTRATE FINANCIAL HARDSHIP, THE HOSPITAL DOES EXPECT TO BE REIMBURSED AT OUR FULL CHARGE LEVEL. ALL OF THE REMAINING BALANCES THAT ARE NOT PAID ARE RECORDED AS BAD DEBTS.THE HOSPITAL HAS COSTED THE BAD DEBT EXPENSE IN LINE 2 OF THIS SECTION AT THE FULL UNPAID CONTRACTED RATE FOR PATIENTS WITH INSURANCE AS THIS REPRESENTS THE "CONTRACTED COST" FOR THE SERVICE AND THUS NOT APPLICABLE TO AN OVERALL COST-TO-CHARGE RATION. FOR PATIENTS WITH NO INSURANCE, THE COSTS ON LINE 2 REPRESENT THE FULL CHARGE LEVELS MULTIPLIED BY THE OVERALL COST-TO-CHARGE RATIO FROM THE AUDITED FINANCIAL STATEMENTS.THE CRITERIA THE HOSPITAL USES FOR DISTINGUISHING BETWEEN CHARITY CARE AND BAD DEBT IS THAT IN ORDER FOR A PATIENT TO QUALIFY AS CHARITY CARE, THEY MUST SHARE THEIR FINANCIAL INFORMATION AND SHOW THAT THEY FALL WITHIN THE FEDERAL POVERTY GUIDELINES. THUS THE HOSPITAL BELIEVES THAT 23% OF THE FIGURE RECORDED AS BAD DEBT EXPENSE ON LINE 2 WOULD QUALIFY FOR CHARITY CARE IF THE PATIENTS HAD SHARED THEIR FINANCIAL INFORMATION. THIS PERCENTAGE WAS DERIVED FROM DEMOGRAPHIC STUDIES OF THE COMMUNITY FOR FAMILIES FALLING BELOW THE FEDERAL POVERTY GUIDELINES IN OUR MARKET AREA. THUS THIS AMOUNT SHOULD BE INCLUDED IN THE TOTAL COMMUNITY BENEFIT PROVIDED BY THE HOSPITAL. |
| PART III, LINE 8: | THE HOSPITAL CONTENDS THAT THE ENTIRE AMOUNT OF THE MEDICARE SHORTFALL SHOULD ALSO BE CONSIDERED AS A COMMUNITY BENEFIT. THE REASON FOR THIS IS THAT THE MEDICARE RATES ARE SET UNILATERALLY BY THE FEDERAL GOVERNMENT AND THE HOSPITAL AGREES TO SERVICE THESE PATIENTS AT THESE RATES AS PART OF OUR MISSION AND SERVICE TO THE COMMUNITY.THE COST INCLUDED ON LINE 6 COMES FROM THE MEDICARE COST REPORT WHICH THE FEDERAL GOVERNMENT HAS SET UP AS THEIR WAY TO CAPTURE AND SEGREGATE THE COSTS OF SERVICES PROVIDED TO MEDICARE PATIENTS. |
| PART III, LINE 9B: | THE HOSPITAL PRACTICE IS THAT UPON VERIFICATION THAT A PATIENT QUALIFIES FOR CHARITY OR FINANCIAL ASSISTANCE, THE HOSPITAL DISCONTINUES COLLECTION EFFORTS AND MAKES THE APPROPRIATE ADJUSTMENT TO THE PATIENT'S ACCOUNT BASED UPON THE PATIENT'S INDIVIDUAL CIRCUMSTANCES. |
| PART VI, LINE 2: | ONGOING EFFORTS AND EVALUATION OF MANAGEMENT, STAFF, PHYSICIANS WITH FEEDBACK FROM PATIENTS AND COMMUNITY. DEMOGRAPHIC RESEARCH AND STUDIES ALSO UTILIZED TO DETERMINE TYPE AND QUANTITY OF SERVICES NEEDED BY SPECIALTY TO BEST SERVE OUR COMMUNITY. |
| PART VI, LINE 3: | INFORMATION REGARDING FINANCIAL ASSISTANCE AND CHARITY CARE IS MADE AVAILABLE AT TIME OF REGISTRATION, ON THE HOSPITAL'S WEBSITE, AND ON PATIENT STATEMENTS. APPLICATIONS ARE ALSO MADE AVAILABLE TO PATIENTS AT TIME OF REGISTRATION IF APPROPRIATE. |
| PART VI, LINE 4: | EAST LIVERPOOL CITY HOSPITAL IS THE ONLY HOSPITAL WITHIN 20 MILES OF THE CITY. THE HOSPITAL SERVES PATIENTS WITHIN A 10-15 MILE RADIUS INCLUDING PATIENTS FROM NEIGHBORING PENNSYLVANIA AND WEST VIRGINIA. MOST RESIDENTS HAVE LIVED HERE ALL THEIR LIVES AND THE COMMUNITY SERVED IS COMPRISED OF A SIGNIFICANT BIAS OF SENIOR CITIZENS. |
| PART VI, LINE 5: | EAST LIVERPOOL CITY HOSPITAL HAS AN OPEN MEDICAL STAFF, A COMMUNITY BOARD OF TRUSTEES AND IS EXTREMELY GENEROUS WITH FUNDING COMMUNITY CHARITIES AND DONATING EMPLOYEE TIME TO SERVE THE GENERAL POPULATION OF THE AREA SERVED. |
| PART VI, LINE 6: | NOT APPLICABLE |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Records Maintained | Yes (1) | GrantRecordsMaintainedInd |
Recipient Table RecipientTable (5 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | IRC SectionIRCSectionDesc | Cash GrantCashGrantAmt | Purpose Of GrantPurposeOfGrantTxt |
|---|---|---|---|---|---|---|
| COMMUNITY RESOURCE CENTER | ||||||
| 940 PENNSYLVANIA AVE | EAST LIVERPOOL | OH | 43920 | 501C3 | $7,000 | MEALS OR FOOD TO COMMUNITY |
| ELHS JOB TRAINING PROGRAM | ||||||
| 500 MARYLAND AVENUE | EAST LIVERPOOL | OH | 43920 | 501C3 | $5,500 | FUNDING TO ASSIST WITH PLACEMENT OF HIGH SCHOOL KIDS WITH DISABILITIES |
| RSVP (RX PROGRAM) | ||||||
| 966 1/2 NORTH MARKET STREET | LISBON | OH | 44432 | 501C3 | $9,994 | FUNDING OF MEDICATION SERVICES |
| CERAMIC CITY SENIOR CENTER | ||||||
| 600 E 4TH STREET | EAST LIVERPOOL | OH | 43920 | 501C3 | $5,000 | COMMUNITY SUPPORT |
| TEAM MOJO | ||||||
| PO BOX 44 | EAST LIVERPOOL | OH | 43920 | 501C3 | $7,000 | COMMUNITY SUPPORT |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total501c3 Org | 5 | Total501c3OrgCnt |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 2: | THE ORGANIZATION MAINTAINS RECORDS TO SUBSTANTIATE THE AMOUNT OF GRANTS OR ASSISTANCE, AND THE SELECTION CRITERIA USED TO AWARD THE GRANTS OR ASSISTANCE. |
| SCHEDULE I | DEAR COMMUNITY BENEFIT FUND APPLICANT: THE COMMUNITY BENEFIT INITIATIVE PROGRAM (CBI), WHICH IS ADMINISTERED BY EAST LIVERPOOL CITY HOSPITAL, INVITES YOUR APPLICATION TO RECEIVE FUNDING FOR YOUR PROGRAM, PROJECT, OR ACTIVITY. EACH YEAR, CBI SUPPORTS PROJECTS AND ACTIVITIES THAT IMPROVE LOCAL HEALTH STATUS, IMPROVE THE QUALITY OF LIFE, AND PROVIDE A BENEFIT TO OUR COMMUNITY AND RESIDENTS. WE ARE CONTINUALLY LOOKING FOR NEW AND INNOVATIVE PROJECTS THAT TARGET AN UNMET NEED OR UNDERSERVED SEGMENT OF OUR POPULATION. ELCH MAKES INVESTMENTS IN COMMUNITY ASSETS AND THOSE GRANTED FUNDING ARE NOT MERELY RECIPIENTS, BUT HAVE SHARED ACCOUNTABILITY FOR IMPROVING HEALTH AND QUALITY OF LIFE IN OUR COMMUNITY. OVER THE PAST SEVERAL YEARS, THE NUMBER OF REQUESTS FOR PROJECT FUNDING HAS INCREASED DRAMATICALLY. IN AN EFFORT TO REDUCE DUPLICATION OF SERVICES, EFFICIENTLY USE EXISTING RESOURCES, AND INSURE THE INTEGRITY OF THE PROGRAMS OFFERED, WE ARE REQUESTING THAT YOUR AGENCY OR ORGANIZATION PROVIDE THE FOLLOWING INFORMATION: A. GENERAL INFORMATION 1. LOCAL ORGANIZATION APPLYING _______________________________________________________________ (NAME OF ORGANIZATION OR AGENCY) _______________________________________________________________ (LOCAL STREET ADDRESS) _______________________________________________________________ (CITY) (STATE) (ZIP) (COUNTY) 2. LOCAL DIRECTOR / LOCAL CONTACT PERSON OF ORGANIZATION OR AGENCY APPLYING _______________________________________________________________ (NAME/TITLE) (PHONE) _______________________________________________________________ (FAX) (EMAIL) 3. IF PROJECT IS APPROVED, LIST CONTACT NAME, TITLE, AND ADDRESS WHERE FUNDING SHOULD BE SENT: ____________________________________________________________ ____________________________________________________________ B. PROJECT INFORMATION FOR CALENDAR YEAR 2014 1. WHAT IS THE TOTAL BUDGET FOR THE PROJECT OR ACTIVITY? $___________ 2. AMOUNT OF FUNDING BEING REQUESTED FROM ELCH? $_________________ 3. WILL THERE BE ADDITIONAL FUNDING SOURCES? _____YES _____NO PLEASE LIST SOURCES: SOURCE __________________________AMOUNT $ __________________ SOURCE __________________________AMOUNT $ __________________ SOURCE __________________________AMOUNT $ __________________ 4. WHAT IS THE PROJECT / ACTIVITY TIME PERIOD? FROM: _______________________ TO: _______________________ 5. WHAT IS THE OVERALL MISSION OF YOUR AGENCY OR PROGRAM? 6. A. LIST TWO SPECIFIC COMMUNITY NEEDS, QUALITY OF LIFE, OR HEALTH CONCERNS AFFECTING OUR RESIDENTS: 1. ________________________________________________________ 2. ________________________________________________________ B. BRIEFLY SUMMARIZE YOUR PROJECT / ACTIVITY, 2014 GOALS, AND THE PURPOSE FOR THE REQUESTED FUNDING: C. EXPLAIN HOW THIS PROGRAM SPECIFICALLY ADDRESSES THE NEEDS LISTED IN QUESTION 6A: D. WHAT ARE THE GEOGRAPHIC LIMITS OF THIS PROGRAM OR AGENCY (EX: INDIVIDUALS RESIDE IN EAST LIVERPOOL, CHESTER, MIDLAND, ETC) AND DESCRIBE THE POPULATION SERVED: 7. HOW DO YOU TRACK THE EFFECTIVENESS OF YOUR PROJECT OR PROGRAM? (EX: DO YOU HAVE A DESIGNATED PERSON OR COMMITTEE THAT COMPILES DATA QUARTERLY, ANNUALLY, ETC? WHAT SYSTEM IS IN PLACE TO AVOID DUPLICATION OF EFFORTS?) 8. LIST COLLABORATING AGENCIES: (PRIORITY CONSIDERATION WILL BE GIVEN TO THOSE WHO SHOW COLLABORATIVE EFFORT WITH OTHER AGENCIES TO BUILD PARTNERSHIPS AND DECREASE DUPLICATION OF SERVICES) B. CERTIFICATION AS A CONDITION OF RECEIVING A GRANT, THE APPLICANT AGREES TO PROVIDE TO EAST LIVERPOOL CITY HOSPITAL: TWO EVALUATION REPORTS, ONE TO BE SUBMITTED BY APRIL 30, 2014 AND THE SECOND TO BE SUBMITTED BY AUGUST 31, 2014, DESCRIBING HOW FUNDS HAVE BEEN USED, MEASURABLE RESULTS (WHO WAS SERVED BY THE PROGRAM ACTIVITIES AND ACCOMPLISHMENTS), AND PLANS FOR CONTINUING THE PROGRAM AFTER THIS YEAR. THE APPLICANT ALSO AGREES TO CONTACT THE PLANNING DEPARTMENT AND OBTAIN PERMISSION TO CREDIT EAST LIVERPOOL CITY HOSPITAL IN PUBLIC RELEASES AND REFERENCES TO PROJECTS, EQUIPMENT/MATERIALS PURCHASED, AND ACTIVITIES MADE POSSIBLE THROUGH THIS GRANT. I CERTIFY THAT THE FOREGOING INFORMATION IS TRUE TO THE BEST OF MY KNOWLEDGE AND THE TERMS OF THE GRANT HAVE BEEN MET. NAME _______________________________________________________ TITLE _________________________________DATE ________________ ALL APPLICATIONS AND SUBSEQUENT REPORTS SHOULD BE SENT TO: ROBERT STEFFEN PLANNING DEPARTMENT - EAST LIVERPOOL CITY HOSPITAL 425 WEST FIFTH STREET EAST LIVERPOOL, OH 43920 IF YOU HAVE ANY QUESTIONS PERTAINING TO THIS APPLICATION, I CAN BE REACHED AT (330) 386-2086. APPLICATIONS MUST BE RETURNED BY AUGUST 31, 2014. NOTE: THE RECEIPT OF THESE MONIES CARRIES NO OBLIGATION TO REFER OR OTHERWISE DIRECT PATIENTS TO SERVICES PROVIDED BY EAST LIVERPOOL CITY HOSPITAL. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Travel For Companions | Yes (X) | TravelForCompanionsInd |
| Club Dues Or Fees | Yes (X) | ClubDuesOrFeesInd |
| Written Policy Ref T And E Expnss | Yes (1) | WrittenPolicyRefTAndEExpnssInd |
| Substantiation Required | Yes (1) | SubstantiationRequiredInd |
| Compensation Committee | Yes (X) | CompensationCommitteeInd |
| Written Employment Contract | Yes (X) | WrittenEmploymentContractInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | 0 | 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 (3 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| KENNETH COCHRAN | ||||||||||||||
| CEO | $280,678 | $0 | $48,539 | $0 | $3,500 | $0 | $0 | $0 | $0 | $0 | $332,717 | $0 | $0 | $0 |
| FRANK MADER | ||||||||||||||
| INFORMATION SERVICES DIRECTOR | $109,368 | $0 | $0 | $0 | $0 | $0 | $23,000 | $0 | $18,655 | $0 | $151,023 | $0 | $0 | $0 |
| KYLE JOHNSON FORMER CFO | ||||||||||||||
| FORMER CFO | $191,794 | $0 | $13,264 | $0 | $0 | $0 | $0 | $0 | $20,272 | $0 | $225,330 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART I, LINE 1A | FormAndLineReferenceDesc |
| Explanation | CITY HOSPITAL ASSOCIATION ALLOWS COMPANION TRAVEL BY EXECUTIVES ONLY WHEN IT SERVES A JUSTIFIED BUSINESS PURPOSE. IF IT IS LATER DETERMINED THAT THERE WAS NOT A JUSTIFIED BUSINESS PURPOSE, THIS WILL RESULT IN TAXABLE COMPENSATION TO THE EXECUTIVE IN QUESTION. CITY HOSPITAL PROVIDES A MEMBERSHIP TO AN AREA SOCIAL CLUB IN ORDER FOR EXECUTIVES TO CONDUCT HOSPITAL BUSINESS. ANY PERSONAL USE BY THE EXECUTIVES IN INCLUDED IN THAT EXECUTIVE'S TAXABLE WAGES. | ExplanationTxt |
Schedule K IRS990ScheduleK
Tax Exempt Bonds Issues TaxExemptBondsIssuesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
Issuer Name IssuerName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CITY OF EAST LIVERPOOL | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Issuer EIN | 346000900 | BondIssuerEIN |
| CUSIP | 2734505DU | CUSIPNum |
| Bond Issued | 2006-04-24 | BondIssuedDt |
| Issue Price | $17,165,000 | IssuePriceAmt |
| Purpose | FINANCE THE ACQUISITION, CONSTRUCTION, INSTALLATION, & EQUIPPING FACILITIES | PurposeDesc |
| Defeased | 0 | DefeasedInd |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuerInd |
| Pool Financing | 0 | PoolFinancingInd |
Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Total Proceeds | $17,165,000 | TotalProceedsAmt |
| Issuance Costs From Proceeds | $131,212 | IssuanceCostsFromProceedsAmt |
| Credit Enhancement | $33,788 | CreditEnhancementAmt |
| Current Refunding | 0 | CurrentRefundingInd |
| Advance Refunding | 0 | AdvanceRefundingInd |
| Final Allocation Made | 0 | FinalAllocationMadeInd |
| Adequate Books And Rec Maint | 0 | AdequateBooksAndRecMaintInd |
Tax Exempt Bonds Private Bus Use TaxExemptBondsPrivateBusUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Owning Bond Financed Property | 0 | OwningBondFinancedPropertyInd |
| Any Lease Arrangements | 0 | AnyLeaseArrangementsInd |
| Mgmt Contract Bond Fincd Prop | 0 | MgmtContractBondFincdPropInd |
| Any Research Agreements | 0 | AnyResearchAgreementsInd |
| Bond Iss Meet Prvt Sec Pymt Test | 0 | BondIssMeetPrvtSecPymtTestInd |
| Change In Use Bond Financed Prop | 0 | ChangeInUseBondFinancedPropInd |
| Procs Nonqualified Bond Remdtd | 0 | ProcsNonqualifiedBondRemdtdInd |
Tax Exempt Bonds Arbitrage TaxExemptBondsArbitrageGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Form8038 T Filed | 0 | Form8038TFiledInd |
| Rebate Not Due Yet | 0 | RebateNotDueYetInd |
| Exception To Rebate | 0 | ExceptionToRebateInd |
| No Rebate Due | 0 | NoRebateDueInd |
| Variable Rate Issue | Yes (1) | VariableRateIssueInd |
| Hedge Identified In Bks And Rec | 0 | HedgeIdentifiedInBksAndRecInd |
| Gross Proceeds Invested In GIC | 0 | GrossProceedsInvestedInGICInd |
| Gross Proceeds Invested | 0 | GrossProceedsInvestedInd |
| Written Proc To Monitor Reqs | 0 | WrittenProcToMonitorReqsInd |
Procedures Corrective Action ProceduresCorrectiveActionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Procedures Corrective Action | 0 | ProceduresCorrectiveActionInd |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (7 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 6 | TRI-COUNTY CARE SYSTEMS, INC. IS THE SOLE MEMBER |
| FORM 990, PART VI, SECTION B, LINE 11 | INFORMATION WAS COMPILED BY THE FINANCE DEPARTMENT AND REVIEWED BY A THIRD PARTY CPA FIRM. A FORMAL BOARD REVIEW DID NOT OCCUR THIS YEAR DUE TO TIME CONSTRAINTS. |
| FORM 990, PART VI, SECTION B, LINE 12C | ALL DUALITY OF INTEREST OR POSSIBLE CONFLICT OF INTEREST, ON THE PART OF ANY MEMBERS OF THE BOARD OF TRUSTEES, ON ANY ISSUE, SHOULD BE DISCLOSED TO THE OTHER MEMBERS OF THE BOARD OF TRUSTEES AND MADE A MATTER OF RECORD. ANY MEMBER OF THE BOARD OF TRUSTEES HAVING A DUALITY OF INTEREST OR POSSIBLE CONFLICT OF INTEREST, ON ANY MATTER SHOULD NOT VOTE OR USE HIS/HER PERSONAL INFLUENCE ON THE MATTER. THE MINUTES OF THE MEETING SHOULD REFLECT THAT A DISCLOSURE WAS MADE AND THE ABSTENTION FROM VOTING. |
| FORM 990, PART VI, SECTION B, LINE 15 | FOR THE CEO, EXECUTIVE DIRECTOR OR TOP MANAGEMENT: ESTABLISHED BY BOARD PERSONNEL COMPENSATION COMMITTEE AND REVIEWED AND APPROVED BY THE ENTIRE BOARD IN EXECUTIVE SESSION. FOR OTHER OFFICERS OR KEY EMPLOYEES: SUBMITTED AND REVIEWED BY BOARD CHAIRMAN AND THEN PRESENTED BY BOARD EXECUTIVE COMMITTEE FOR REVIEW AND APPROVAL. THE LAST REVIEW WAS COMPLETED IN NOVEMBER, 2012. |
| FORM 990, PART VI, SECTION C, LINE 19 | THE DOCUMENTS ARE AVAILABLE UPON REQUEST |
| FORM 990, PART IX, LINE 11G | COLLECTIONS: PROGRAM SERVICE EXPENSES 178,783. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 178,783. PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 7,268,494. MANAGEMENT AND GENERAL EXPENSES 4,845,662. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 12,114,156. |
| FORM 990, PART XI, LINE 9: | CHANGE IN RESTRICTED NET ASSETS 4,351. TRANSFER TO AFFILIATES -4,380,179. |
Schedule R IRS990ScheduleR
Id Disregarded Entities IdDisregardedEntitiesGrp
Disregarded Entity Name DisregardedEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | EAST LIVERPOOL PROFESSIONALS | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 425 W 5TH STREET | AddressLine1Txt |
| City | EAST LIVERPOOL | CityNm |
| State Abbreviation | OH | StateAbbreviationCd |
| ZIP | 43290 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Primary Activities | PROFESSIONAL MEDICAL SERVICES | PrimaryActivitiesTxt |
| Legal Domicile State | OH | LegalDomicileStateCd |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | TRI-COUNTY CARE | BusinessNameLine1Txt |
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (2 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 |
|---|---|---|---|---|---|---|---|---|---|---|
| TRI-COUNTY CARE SYSTEMS | ||||||||||
| 425 W FIFTH | EAST LIVERPOOL | OH | 43920 | 341552205 | PARENT HOLDING COMPANY | OH | 501(C)(3) | LINE 3 | NONE | 0 |
| OHIO VALLEY HOME HEALTH SERVICES | ||||||||||
| 15679 ST RTE 170 | EAST LIVERPOOL | OH | 43920 | 341014198 | HOME HEALTH SERVICES | OH | 501(C)(3) | LINE 9 | TRI-COUNTY CARE SYSTEMS | 0 |
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (2 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Entity TypeEntityTypeTxt | Controlled OrganizationControlledOrganizationInd |
|---|---|---|---|---|---|---|---|---|---|
| AMERICAN COMMUNITY SERVICES | |||||||||
| 422 W 6TH ST | EAST LIVERPOOL | OH | 43290 | 341522019 | MANAGEMENT SERVICES | OH | OHIO VALLEY HOME HEALTH SERVICES | C | 0 |
| MONROE HEALTH | |||||||||
| 422 W 6TH ST | EAST LIVERPOOL | OH | 43290 | 341562035 | PHYSICIAN SERVICES | OH | AMERICAN COMMUNITY SERVICES | C | 0 |
| 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 | 0 | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | Yes (1) | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |
Transactions Related Org TransactionsRelatedOrgGrp (2 entries)
| Transaction TypeTransactionTypeTxt | InvolvedInvolvedAmt | Method Of Amount DeterminationMethodOfAmountDeterminationTxt |
|---|---|---|
| OHIO VALLEY HOME HEALTH SERVICE | ||
| R | $3,246,000 | CASH |
| RIVER VALLEY PHYSICIANS | ||
| R | $1,017,015 | CASH |