2016-05-16T15:39:31-05:00 2015-06-30 381357951 PLANTE & MORAN PLLC 65 EAST STATE ST STE 600 COLUMBUS OH 43215 990 2014-07-01 274385692 AVITA HEALTH SYSTEM AVIT 4194681244 269 PORTLAND WAY SOUTH GALION OH 44833 D ERIC DRAIME CFO 4194681244 2016-05-13 1 BERNIE OSTROWSKI P00366367 6148493000 2014 2016-08-17 19:52:53Z JERRY MORASKO 269 PORTLAND WAY SOUTH GALION OH 44833 22969710 0 X N/A X 2010 OH TO IMPROVE THE HEALTH AND WELL-BEING OF THOSE WE SERVE. 18 18 231 18 0 0 0 0 39443847 21667058 0 0 1316970 1302652 40760817 22969710 3000 0 0 0 24894969 12072452 0 0 0 15862848 10897258 40760817 22969710 0 0 0 0 0 0 0 0 TO IMPROVE THE HEALTH AND WELL-BEING OF THOSE WE SERVE. 0 0 22969710 0 25103369 AVITA PROVIDES MANAGEMENT AND ADMINISTRATIVE SERVICES TO THE VARIOUS TAX EXEMPT ENTITIES WITHIN ITS HEALTH SYSTEM. AVITA PROVIDES SENIOR EXECUTIVE MANAGEMENT AND ADMINISTRATIVE STAFF TO ITS AFFILIATES AND THE FOLLOWING SERVICES: BILLING AND COLLECTION, INFORMATION TECHNOLOGY, HUMAN RESOURCES, ACCOUNTING AND FINANCE, FACILITIES MANAGEMENT (INCLUDING MAINTENANCE) AND OTHER SUPPORT SERVICES NECESSARY FOR THE ADMINISTRATIVE FUNCTIONS OF THE SYSTEM. 22969710 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 0 0 231 1 0 0 0 0 0 0 0 0 0 0 X 18 18 0 0 0 0 0 0 0 1 0 0 0 1 1 1 1 1 1 1 1 0 OH X D ERIC DRAIME 4194685501 269 PORTLAND WAY SOUTH GALION OH 44833 DOUGLAS SCHILLING CHAIR 0.10 0.30 X X 0 0 0 JOSEPH SHADEED VICE CHAIR 0.10 0.10 X X 0 0 0 REX CRAMER TREASURER 0.10 0.10 X X 0 0 0 LINDA CHAMBERS SECRETARY 0.10 0.10 X X 0 0 0 MARK SCHNEIDER DIRECTOR 0.10 0.10 X 0 0 0 KYMBERLY FOX DIRECTOR 0.10 0.10 X 0 0 0 DONALD BARR DIRECTOR 0.10 0.10 X 0 0 0 ALAN BASINGER DIRECTOR 0.10 0.10 X 0 0 0 PHILLIP BROWN DIRECTOR 0.10 0.10 X 0 0 0 SHERRI CLEVENGER DIRECTOR 0.10 0.10 X 0 0 0 JASON MCMULLEN DIRECTOR 0.10 0.10 X 0 0 0 ERIC GEYER DIRECTOR 0.10 0.30 X 0 0 0 JANET HERMAN DIRECTOR 0.10 0.10 X 0 0 0 KAY MCDONALD DIRECTOR 0.10 0.10 X 0 0 0 CHARLES WALKER DIRECTOR 0.10 0.10 X 0 0 0 DONALD L PLOTTS DIRECTOR 0.10 0.10 X 0 0 0 LINDA H SMITH DIRECTOR 0.10 0.10 X 0 0 0 JEFFERY A UNDERWOOD DIRECTOR 0.10 0.10 X 0 0 0 JERRY MORASKO EX-OFFICIO PRESIDENT/CEO 0.10 40.60 X 425801 0 52344 D ERIC DRAIME CFO 0.10 40.60 X 214744 0 0 ANDREW DANIELS COO 40.00 0.40 X 183240 0 9654 SHIRLEY FITZ VP PATIENT CARE 40.00 0.00 X 146223 0 4503 TRACI OSWALD VP HUMAN RESOURCES 40.00 0.00 X 144092 0 4357 THOMAS KELLY CONTROLLER 40.00 0.00 X 140214 0 7462 MYLES CREED DIRECTOR OF PHYSICIAN RECRUITMENT 40.00 0.00 X 141704 0 5662 DR JAMES HEDDLESON PHYSICIAN 40.00 0.00 X 824718 0 2451 2220736 0 86433 12 0 1 0 0 MANAGEMENT FUNCTION 561000 21667058 21667058 21667058 EHR TECHNOLOGY INCOME 900099 1302652 1302652 1302652 22969710 22969710 0 0 897493 897493 7567304 7567304 524695 524695 2168611 2168611 914349 914349 415736 415736 526474 526474 1627992 1627992 455543 455543 4734008 4734008 2457107 2457107 444056 444056 79520 79520 32211 32211 5441 5441 RECRUITMENT 119170 119170 22969710 22969710 0 0 0 0 0 0 X 0 0 0 0 0 0 X X 0 1 X 1 0 X X 1 GALION COMMUNITY HOSPITAL 344451872 3 1 0 0 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 PART IV: AVITA PROVIDES MANAGEMENT AND ADMINISTRATIVE SERVICES TO THE VARIOUS TAX EXEMPT ENTITIES WITHIN ITS HEALTH SYSTEM. AVITA PROVIDES SENIOR EXECUTIVE MANAGEMENT AND ADMINISTRATIVE STAFF TO ITS AFFILIATES AND THE FOLLOWING SERVICES: BILLING AND COLLECTION, INFORMATION TECHNOLOGY, HUMAN RESOURCES, ACCOUNTING AND FINANCE, FACILITIES MANAGEMENT (INCLUDING MAINTENANCE) AND OTHER SUPPORT SERVICES NECESSARY FOR THE ADMINISTRATIVE FUNCTIONS OF THE SYSTEM. 0 X PART X, LINE 2: 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 THAT AS OF JUNE 30, 2015, 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 IT IS NO LONGER SUBJECT TO INCOME TAX EXAMINATIONS FOR YEARS PRIOR TO JUNE 30, 2012. X 1 1 X X X 0 1 0 0 0 0 0 0 0 JERRY MORASKO EX-OFFICIO PRESIDENT/CEO 425801 0 0 0 0 0 50000 0 2344 0 478145 0 0 0 D ERIC DRAIME CFO 187990 0 26754 0 0 0 0 0 0 0 214744 0 0 0 ANDREW DANIELS COO 158856 0 24384 0 0 0 0 0 9654 0 192894 0 0 0 SHIRLEY FITZ VP PATIENT CARE 128387 0 17836 0 0 0 0 0 4503 0 150726 0 0 0 DR JAMES HEDDLESON PHYSICIAN 439654 0 385064 0 0 0 0 0 2451 0 827169 0 0 0 PART I, LINE 1A A MEMBERSHIP AT THE LOCAL COUNTRY CLUB IS PAID FOR THE CEO, JERRY MORASKO. THIS BENEFIT HAS NOT BEEN TREATED AS TAXABLE COMPENSATION. PART I, LINE 4B 457(F)- SUBJECT TO SUBSTANTIAL RISK OF FORFEITURE JERRY MORASKO- $80,000 FORM 990, PART VI, SECTION A, LINE 8B THE ORGANIZATION DOES NOT HAVE SUB-COMMITTEES WITH THE AUTHORITY TO ACT ON BEHALF OF THE GOVERNING BODY. FORM 990, PART VI, SECTION B, LINE 11 THE FORM 990 IS PROVIDED TO THE BOARD OF DIRECTORS AND SENT TO THE EXECUTIVE COMMITTEE OF FOR THEIR REVIEW PRIOR TO FILING. THE BOARD EXECUTIVE COMMITTEE APPROVES THE FORM 990 FOLLOWING REVIEW, AS AUTHORIZED BY THE FULL GOVERNING BODY. FORM 990, PART VI, SECTION B, LINE 12C THE CONFLICT OF INTEREST POLICY COVERS ALL BOARD OF DIRECTORS AND OFFICERS OF THE CORPORATION. CONFLICT OF INTEREST SURVEYS ARE REVIEWED BY BOARD CHAIRMAN AND THE CEO TO ENSURE COMPLIANCE. VARIOUS RESTRICTIONS ARE IMPOSED ON INDIVIDUALS WITH POTENTIAL CONFLICTS OF INTEREST (I.E. INABILITY TO VOTE) UNTIL DECISION HAS BEEN MADE ON POTENTIAL CONFLICT. AVITA HEALTH SYSTEM HAS ADOPTED THIS POLICY. FORM 990, PART VI, SECTION B, LINE 15 THE PROCESS FOR DETERMINING COMPENSATION CONSISTED OF BOARD EXECUTIVE COMMITTEE REVIEW OF OHIO HOSPITAL ASSOCIATION COMPENSATION SURVEYS, AND THE COMMITTEE DETERMINES EXECUTIVE COMPENSATION BASED ON THIS COMPARABILITY DATA. CONTEMPORANEOUS MINUTES ARE KEPT OF MEETINGS HELD BY THE EXECUTIVE COMMITTEE REGARDING DECISIONS AND DELIBERATIONS OF THIS PROCESS. THIS PROCESS WAS LAST COMPLETED IN JUNE OF 2014 FOR 2015 COMPENSATION. FORM 990, PART VI, SECTION C, LINE 19 NO DOCUMENTS ARE AVAILABLE TO THE PUBLIC, OTHER THAN THE FINANCIAL STATEMENTS WHICH ARE ATTACHED TO GALION COMMUNITY HOSPITAL'S FORM 990. FORM 990, PART XI, LINE 2C: THE ORGANIZATION HAS A FINANCE COMMITTEE WHICH OVERSEES THE AUDIT OF THE FINANCIAL STATEMENTS. THIS PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. FORM 990, PART IX: AVITA HEALTH SYSTEM REPORTS EMPLOYEE BENEFIT AND RETIREMENT EXPENSES FOR COMMUNITY HEALTH ASSOCIATES, INC. AND GALION COMMUNITY HOSPITAL IN PART IX. GALION COMMUNITY HOSPITAL 269 PORTLAND WAY SOUTH GALION OH 44833 344451872 HOSPITAL SERVICES OH 501 (C)(3) LINE 3 AVITA HEALTH SYSTEM 1 COMMUNITY HEALTH ASSOCIATES INC 955 BUCYRUS ROAD GALION OH 44833 341784017 PHYSICIAN OFFICE OH 501 (C)(3) LINE 11A, I GALION COMMUNITY HOSPITAL 1 NORTH CENTRAL OHIO FAMILY CARE CENTER INC 269 PORTLAND WAY SOUTH GALION OH 44833 341807906 PHYSICIAN OFFICE OH 501 (C)(3) LINE 11A, I GALION COMMUNITY HOSPITAL 1 AVITA HEALTH FOUNDATION 269 PORTLAND WAY SOUTH GALION OH 44833 200934451 FOUNDATION OH 501 (C)(3) LINE 7 GALION COMMUNITY HOSPITAL 1 CRAWFORD COUNTY SHARED HEALTH SERVICES INC 1220 NORTH MARKET STREET GALION OH 44833 341484014 HOME HEALTH & HOSPICE OH 501 (C)(3) LINE 9 GALION COMMUNITY HOSPITAL 1 GALION COMMUNITY PAIN MANAGEMENT LLC 269 PORTLAND WAY SOUTH GALION OH 44833 300602607 HOSPITAL SUPPORT OH N/A GALION COMMUNITY VASCULAR SERVICES LLC 269 PORTLAND WAY SOUTH GALION OH 44833 611613817 HOSPITAL SUPPORT OH N/A 0 0 0 0 0 0 0 0 0 0 0 1 0 0 1 0 0 1 0 GALION COMMUNITY HOSPITAL L 21520554 MANAGEMENT FEE GALION COMMUNITY HOSPITAL R 2355937 FORGIVENESS OF PAYABLE GALION COMMUNITY HOSPITAL R 765405 FORGIVENESS OF PAYABLE