LODI COMMUNITY HOSPITAL: Form 990, tax year 2014
View the entire original 990 at ProPublica ↗
- Organization
- LODI COMMUNITY HOSPITAL (EIN 34-0718390)
- Tax period
- 2014-01-01 to 2014-12-31
- Filed
- 2015-11-12
- IRS object ID
- 201503169349304350
- Schema version
- 2014v5.0
- 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 B
- Schedule C
- Schedule D
- Schedule H
- Schedule J
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2015-11-12T14:11:10-06:00 | ReturnTs |
| Tax Period End | 2014-12-31 | TaxPeriodEndDt |
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2014-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 340718390 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | LODI COMMUNITY HOSPITAL | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | LODI | BusinessNameControlTxt |
| Phone | 3309485501 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 225 ELYRIA STREET | AddressLine1Txt |
| City | LODI | CityNm |
| State Abbreviation | OH | StateAbbreviationCd |
| ZIP | 44254 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | DEBORAH GORBACH | PersonNm |
| Person Title | INTERIM CFO | PersonTitleTxt |
| Phone | 3303446603 | PhoneNum |
| Signature | 2015-11-12 | SignatureDt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2014 | TaxYr |
| Build TS | 2016-02-25 16:41:14Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | ALAN PAPA | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 225 ELYRIA STREET | AddressLine1Txt |
| City | LODI | CityNm |
| State Abbreviation | OH | StateAbbreviationCd |
| ZIP | 44254 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $17,492,115 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.LODIHOSPITAL.COM | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1920 | FormationYr |
| Legal Domicile State | OH | LegalDomicileStateCd |
| Activity Or Mission | TO IMPROVE THE HEALTH AND LIVES OF THE PEOPLE AND COMMUNITIES WE SERVE. | ActivityOrMissionDesc |
| Voting Members Governing Body | 9 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 8 | VotingMembersIndependentCnt |
| Total Employee | 162 | TotalEmployeeCnt |
| Total Volunteers | 42 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $22,000 | PYContributionsGrantsAmt |
| CY Contributions Grants | $10,000 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $17,280,092 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $17,195,707 | CYProgramServiceRevenueAmt |
| PY Investment Income | $581 | PYInvestmentIncomeAmt |
| CY Investment Income | -$24,640 | CYInvestmentIncomeAmt |
| PY Other Revenue | $17,328 | PYOtherRevenueAmt |
| CY Other Revenue | $215,168 | CYOtherRevenueAmt |
| PY Total Revenue | $17,320,001 | PYTotalRevenueAmt |
| CY Total Revenue | $17,396,235 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $4,648 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $10,289 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $7,363,998 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $7,538,906 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $8,110,652 | PYOtherExpensesAmt |
| CY Other Expenses | $7,767,572 | CYOtherExpensesAmt |
| PY Total Expenses | $15,479,298 | PYTotalExpensesAmt |
| CY Total Expenses | $15,316,767 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $1,840,703 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $2,079,468 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $11,413,182 | TotalAssetsBOYAmt |
| Total Assets EOY | $11,712,071 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $3,132,331 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $1,880,306 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $8,280,851 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $9,831,765 | NetAssetsOrFundBalancesEOYAmt |
| Mission | LODI COMMUNITY HOSPITAL'S MISSION IS TO IMPROVE THE HEALTH AND LIVES OF THE PEOPLE AND COMMUNITIES WE SERVE. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $2,271,969 | ExpenseAmt |
| Revenue | $3,132,347 | RevenueAmt |
| Desc | LODI COMMUNITY HOSPITAL IS A 25 BED HOSPITAL OFFERING INPATIENT SERVICES FOR MEDICAL AND SURGICAL PATIENTS. | Desc |
Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $10,190,214 | ExpenseAmt |
| Revenue | $14,057,645 | RevenueAmt |
| Desc | LODI COMMUNITY HOSPITAL OFFERS A VARIETY OF OUTPATIENT SERVICES. OUTPATIENT SERVICES OFFERED TO PATIENTS INCLUDE RADIOLOGY, PHYSICAL THERAPY, CARDIAC, SURGERY, MAMMOGRAPHY, SLEEP CENTER, LAB SERVICES AND EMERGENCY SERVICES. | Desc |
Prog Srvc Accom Acty3 ProgSrvcAccomActy3Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $10,289 | ExpenseAmt |
| Grant | $10,289 | GrantAmt |
| Revenue | $5,715 | RevenueAmt |
| Desc | LODI COMMUNITY HOSPITAL OFFERS COMMUNITY HEALTH AND EDUCATIONAL SERVICES TO THE LOCAL AND SURROUNDING COMMUNITIES. | Desc |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Expenses | $12,472,472 | 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 | Yes (1) | 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 | 0 | 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 | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | Yes (1) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (1) | AuditedFinancialStmtAttInd |
| Grants To Organizations | 0 | 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 | Yes (1) | RelatedOrganizationCtrlEntInd |
| Transaction With Control Ent | Yes (1) | TransactionWithControlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 10 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 162 | 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 | 9 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 8 | 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 | Yes (1) | LocalChaptersInd |
| Policies Reference Chapters | Yes (1) | PoliciesReferenceChaptersInd |
| 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 | 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 | DEBORAH GORBACH | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 3303446603 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1 AKRON GENERAL AVENUE | AddressLine1Txt |
| City | AKRON | CityNm |
| State Abbreviation | OH | StateAbbreviationCd |
| ZIP | 44307 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part VII | Yes (X) | InfoInScheduleOPartVIIInd |
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 | Key EmployeeKeyEmployeeInd | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|---|
| ALAN PAPA | |||||||||
| PRESIDENT, COO, DIRECTOR | 5.00 | 63.00 | Yes (X) | Yes (X) | $0 | $437,259 | $102,423 | ||
| THOMAS STOVER MD | |||||||||
| DIRECTOR | 0.40 | 71.40 | Yes (X) | $0 | $818,485 | $134,689 | |||
| TODD BREAUX MD | |||||||||
| DIRECTOR | 0.40 | 0.00 | Yes (X) | $0 | $0 | $0 | |||
| WILLIAM FRANTZ | |||||||||
| DIRECTOR, CHAIR THRU 12/2014 | 2.90 | 2.90 | Yes (X) | $0 | $0 | $0 | |||
| MARY BETH C CARROLL | |||||||||
| DIRECTOR | 1.40 | 3.00 | Yes (X) | $0 | $0 | $0 | |||
| SONIA ALEMAGNO PHD | |||||||||
| SEE SCHEDULE O | 1.30 | 0.00 | Yes (X) | $0 | $0 | $0 | |||
| THERESA CARTER | |||||||||
| SEE SCHEDULE O | 0.20 | 0.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| BRET TREIER | |||||||||
| DIRECTOR | 0.20 | 0.00 | Yes (X) | $0 | $0 | $0 | |||
| MARLENE BARKHEIMER | |||||||||
| DIRECTOR | 0.40 | 0.00 | Yes (X) | $0 | $0 | $0 | |||
| JAMES RICE | |||||||||
| DIRECTOR | 0.20 | 0.00 | Yes (X) | $0 | $0 | $0 | |||
| HAROLD YOUNG | |||||||||
| DIRECTOR | 0.20 | 0.00 | Yes (X) | $0 | $0 | $0 | |||
| ROBERT W KAMIENSKI | |||||||||
| DIRECTOR, THRU 12/2014 | 0.20 | 40.00 | Yes (X) | $0 | $453,911 | $41,571 | |||
| CRAIG M BABBITT | |||||||||
| SECRETARY | 0.30 | 63.70 | Yes (X) | $0 | $370,321 | $78,251 | |||
| DEBORAH GORBACH | |||||||||
| ASST TREASURER | 0.60 | 59.40 | Yes (X) | $0 | $221,862 | $92,586 | |||
| SUE MCCARTHY | |||||||||
| TREASURER | 0.80 | 52.80 | Yes (X) | $0 | $435,013 | $31,421 | |||
| THOMAS WHELAN | |||||||||
| PRES COMMUNITY/SPECIALTY HOSPITALS | 30.00 | 20.00 | $136,166 | $73,320 | $64,782 | Yes (X) | |||
| STEPHANIE D KOCSIS | |||||||||
| VP, NURSING & OPERATIONS | 40.00 | 0.00 | $134,539 | $0 | $43,642 | Yes (X) | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $270,705 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $2,810,171 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $589,365 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 2 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | 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 |
|---|---|---|---|---|---|
| SIMONSON CONSTRUCTION SERVICE INC | |||||
| 2112 TROY ROAD | ASHLAND | OH | 44805 | CONSTRUCTION SERVICES | $833,320 |
| EPMG OF OHIO INC PA | |||||
| 2000 GREEN RD SUITE 300 | ANN ARBOR | MI | 481051571 | ER PHYSICIANS | $582,921 |
| RESPIRATORY SUPPORT SERVICES | |||||
| 328 BOSTON MILLS ROAD | HUDSON | OH | 44236 | CARDIOPULMONARY SERVICES | $400,037 |
| ALLIANCE HEALTHCARE SERVICES | |||||
| PO BOX 96485 | CHICAGO | IL | 606936485 | MRI SERVICES | $147,005 |
| ARAMARK | |||||
| 115 NORTH FIRST STREET | BURBANK | CA | 91502 | LINEN SERVICES | $116,338 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 5 | CntrctRcvdGreaterThan100KCnt |
| Government Grants | $10,000 | GovernmentGrantsAmt |
| Total Contributions | $10,000 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| NET PATIENT REVENUE | 622110 | $14,762,427 | $14,762,427 |
| MEDICARE/MEDICAID PAYM | 622110 | $2,427,565 | $2,427,565 |
| COMMUNITY HEALTH/EDUCA | 621990 | $5,715 | $5,715 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $17,195,707 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $292 | TotalRevenueColumnAmt |
| Exclusion | $292 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $41,021 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $70,948 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | -$29,927 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$29,927 | TotalRevenueColumnAmt |
| Exclusion | -$29,927 | ExclusionAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $24,932 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | -$24,932 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$24,932 | TotalRevenueColumnAmt |
| Exclusion | -$24,932 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp (2 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | ExclusionExclusionAmt |
|---|---|---|---|
| CHANGE IN INTEREST-FOU | 900099 | $47,975 | $47,975 |
| CAFETERIA | 900099 | $44,372 | $44,372 |
Miscellaneous Revenue MiscellaneousRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $152,748 | TotalRevenueColumnAmt |
| Exclusion | $152,748 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $245,095 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $17,396,235 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $17,195,707 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $190,528 | 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 | $6,289 | TotalAmt |
| Program Services | $6,289 | ProgramServicesAmt |
Grants To Domestic Individuals GrantsToDomesticIndividualsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,000 | TotalAmt |
| Program Services | $4,000 | ProgramServicesAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $178,274 | TotalAmt |
| Program Services | $178,274 | ProgramServicesAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,978,901 | TotalAmt |
| Program Services | $5,127,378 | ProgramServicesAmt |
| Management And General | $851,523 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $118,354 | TotalAmt |
| Program Services | $101,873 | ProgramServicesAmt |
| Management And General | $16,481 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $861,725 | TotalAmt |
| Program Services | $735,866 | ProgramServicesAmt |
| Management And General | $125,859 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $401,652 | TotalAmt |
| Program Services | $363,558 | ProgramServicesAmt |
| Management And General | $38,094 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $500 | TotalAmt |
| Management And General | $500 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $35,108 | TotalAmt |
| Management And General | $35,108 | ManagementAndGeneralAmt |
Fees For Services Lobbying FeesForServicesLobbyingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $461 | TotalAmt |
| Management And General | $461 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,244,119 | TotalAmt |
| Program Services | $1,886,478 | ProgramServicesAmt |
| Management And General | $357,641 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $77,125 | TotalAmt |
| Program Services | $77,125 | ProgramServicesAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $452,596 | TotalAmt |
| Program Services | $271,094 | ProgramServicesAmt |
| Management And General | $181,502 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $65,769 | TotalAmt |
| Program Services | $56,611 | ProgramServicesAmt |
| Management And General | $9,158 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $842,393 | TotalAmt |
| Program Services | $725,090 | ProgramServicesAmt |
| Management And General | $117,303 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $35,238 | TotalAmt |
| Program Services | $16,926 | ProgramServicesAmt |
| Management And General | $18,312 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,119 | TotalAmt |
| Management And General | $5,119 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $9,026 | TotalAmt |
| Program Services | $7,769 | ProgramServicesAmt |
| Management And General | $1,257 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $758,011 | TotalAmt |
| Program Services | $368,018 | ProgramServicesAmt |
| Management And General | $389,993 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $409,528 | TotalAmt |
| Program Services | $352,501 | ProgramServicesAmt |
| Management And General | $57,027 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| PROVISION FOR BAD DEBTS | $1,540,438 | $1,540,438 | |
| MEDICAL SUPPLIES | $647,303 | $647,303 | |
| MGMT FEE TO AGHS | $340,970 | $340,970 | |
| OHIO FRANCHISE FEE | $276,491 | $276,491 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $27,377 | TotalAmt |
| Program Services | $5,881 | ProgramServicesAmt |
| Management And General | $21,496 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $15,316,767 | TotalAmt |
| Program Services | $12,472,472 | ProgramServicesAmt |
| Management And General | $2,844,295 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,216,076 | BOYAmt |
| EOY | $359,604 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,235,896 | BOYAmt |
| EOY | $2,975,983 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $47,159 | BOYAmt |
| EOY | $45,265 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $110,798 | BOYAmt |
| EOY | $119,203 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $16,311,299 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $9,161,287 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,770,531 | BOYAmt |
| EOY | $7,150,012 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,032,722 | BOYAmt |
| EOY | $1,062,004 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $11,413,182 | BOYAmt |
| EOY | $11,712,071 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,048,664 | BOYAmt |
| EOY | $1,021,521 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,083,667 | BOYAmt |
| EOY | $858,785 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,132,331 | BOYAmt |
| EOY | $1,880,306 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,575,058 | BOYAmt |
| EOY | $9,143,413 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $705,793 | BOYAmt |
| EOY | $688,352 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $8,280,851 | BOYAmt |
| EOY | $9,831,765 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $11,413,182 | BOYAmt |
| EOY | $11,712,071 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | $2,079,468 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | -$528,554 | 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) |
|---|---|---|
| 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 | Yes (1) | GrantsOtherOrganizationsInd |
| Grants Other Organizations | $461 | GrantsOtherOrganizationsAmt |
| Direct Contact Legislators | 0 | DirectContactLegislatorsInd |
| Rallies Demonstrations | 0 | RalliesDemonstrationsInd |
| Other Activities | 0 | OtherActivitiesInd |
| Total Lobbying Expenditures | $461 | 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 | PART II-B, LINE 1 (F), GRANTS TO OTHER ORGANIZATIONS FOR LOBBYING PURPOSES: LODI COMMUNITY HOSPITAL IS A DUES PAYING MEMBER OF THE OHIO HOSPITAL ASSOCIATION (OHA). A PORTION OF OUR DUES ($461) IS USED BY OHA FOR LOBBYING ACTIVITIES. | ExplanationTxt |
Schedule D IRS990ScheduleD
CY Endwmt Fund CYEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $705,793 | BeginningYearBalanceAmt |
| Contributions | $291 | ContributionsAmt |
| Investment Earnings Or Losses | $36,620 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $54,352 | OtherExpendituresAmt |
| End Year Balance | $688,352 | EndYearBalanceAmt |
CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $779,774 | BeginningYearBalanceAmt |
| Contributions | $8,901 | ContributionsAmt |
| Investment Earnings Or Losses | $81,322 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $164,204 | OtherExpendituresAmt |
| End Year Balance | $705,793 | EndYearBalanceAmt |
CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $683,304 | BeginningYearBalanceAmt |
| Contributions | $34,659 | ContributionsAmt |
| Investment Earnings Or Losses | $70,646 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | -$8,835 | OtherExpendituresAmt |
| End Year Balance | $779,774 | EndYearBalanceAmt |
CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $336,802 | BeginningYearBalanceAmt |
| Contributions | $343,021 | ContributionsAmt |
| Investment Earnings Or Losses | $3,481 | InvestmentEarningsOrLossesAmt |
| End Year Balance | $683,304 | EndYearBalanceAmt |
CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $132,986 | BeginningYearBalanceAmt |
| Contributions | $200,000 | ContributionsAmt |
| Investment Earnings Or Losses | $3,816 | InvestmentEarningsOrLossesAmt |
| End Year Balance | $336,802 | EndYearBalanceAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Prmnnt Endowment Balance EOY | 1.00000 | PrmnntEndowmentBalanceEOYPct |
| Endowments Held Unrelated Org | 0 | EndowmentsHeldUnrelatedOrgInd |
| Endowments Held Related Org | Yes (1) | EndowmentsHeldRelatedOrgInd |
| Related Org List Sch R | Yes (1) | RelatedOrgListSchRInd |
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | $98,793 | InvestmentCostOrOtherBasisAmt |
| Book Value | $98,793 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | $10,759,025 | InvestmentCostOrOtherBasisAmt |
| Depreciation | $5,036,130 | DepreciationAmt |
| Book Value | $5,722,895 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | $5,453,481 | InvestmentCostOrOtherBasisAmt |
| Depreciation | $4,125,157 | DepreciationAmt |
| Book Value | $1,328,324 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $7,150,012 | TotalBookValueLandBuildingsAmt |
Other Assets Org OtherAssetsOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | INTEREST IN FOUNDATION NET ASSETS | Desc |
| Book Value | $1,062,004 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $1,062,004 | TotalBookValueOtherAssetsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (5 entries)
| DescDesc | AmtAmt |
|---|---|
| ESTIMATED MEDICARE SETTLEMENT DUE | $299,383 |
| ACCRUED SELF INSURANCE CLAIMS PAYABLE | $475,708 |
| ASSET RETIREMENT OBLIGATION | $20,000 |
| PAYABLE TO AFFILIATES | $35,863 |
| OHIO FRANCHISE FEE PAYABLE | $27,831 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $858,785 | TotalLiabilityAmt |
| Total Rev Etc Audited Fincl Stmt | $15,592,713 | TotalRevEtcAuditedFinclStmtAmt |
| Other Revenue | -$1,874,470 | OtherRevenueAmt |
| Revenue Not Reported | -$1,874,470 | RevenueNotReportedAmt |
| Revenue Subtotal | $17,467,183 | RevenueSubtotalAmt |
| Other Revenues Not Included | -$70,948 | OtherRevenuesNotIncludedAmt |
| Revenue Not Reported Fincl Stmt | -$70,948 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $17,396,235 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $13,513,245 | TotExpnsEtcAuditedFinclStmtAmt |
| Other Expenses Included | $70,948 | OtherExpensesIncludedAmt |
| Expenses Not Reported | $70,948 | ExpensesNotReportedAmt |
| Expenses Subtotal | $13,442,297 | ExpensesSubtotalAmt |
| Other Expenses Not Included | $1,874,470 | OtherExpensesNotIncludedAmt |
| Expenses Not Rpt Fincl Stmt | $1,874,470 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $15,316,767 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (4 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART XI, LINE 2D - OTHER ADJUSTMENTS: | MANAGEMENT FEE -340,970. EXPENSES RECORDED IN REVENUE 6,938. BAD DEBT -1,540,438. |
| PART XI, LINE 4B - OTHER ADJUSTMENTS: | RENTAL EXPENSES -70,948. |
| PART XII, LINE 2D - OTHER ADJUSTMENTS: | RENTAL EXPENSES 70,948. |
| PART XII, LINE 4B - OTHER ADJUSTMENTS: | MANAGEMENT FEE 340,970. EXPENSES RECORDED IN REVENUE -6,938. BAD DEBT 1,540,438. |
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 | 0 | AnnualCommunityBnftReportInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $205,908 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $205,908 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01490 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $3,091,825 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,989,314 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,102,511 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.08000 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $3,297,733 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,989,314 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,308,419 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.09490 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $146,026 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $11,524 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $134,502 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00980 | TotalExpensePct |
Health Professions Education HealthProfessionsEducationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $21,751 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $21,751 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00160 | TotalExpensePct |
Cash And In Kind Contributions CashAndInKindContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $28,657 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $28,657 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00210 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $196,434 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $11,524 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $184,910 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01350 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $3,494,167 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $2,000,838 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,493,329 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.10840 | TotalExpensePct |
Other Communtity Building Acty OtherCommuntityBuildingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $23,458 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $23,458 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00150 | TotalExpensePct |
Total Communtity Building Acty TotalCommuntityBuildingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $23,458 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $23,458 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00150 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (1) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $565,537 | BadDebtExpenseAmt |
| Reimbursed By Medicare | $3,200,782 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $3,028,536 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | $172,246 | 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 | LODI COMMUNITY HOSPITAL | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 225 ELYRIA ST | AddressLine1Txt |
| City | LODI | CityNm |
| State Abbreviation | OH | StateAbbreviationCd |
| ZIP | 44254 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | WWW.AKRONGENERAL.ORG | WebsiteAddressTxt |
| 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 | LODI COMMMUNITY 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 | WWW.AKRONGENERAL.ORG | OwnWebsiteURLTxt |
| Implementation Strategy Adopt | Yes (1) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 13 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (1) | StrategyPostedWebsiteInd |
| Strategy Website URL | WWW.AKRONGENERAL.ORG | 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 |
| Income Level Criteria | Yes (X) | IncomeLevelCriteriaInd |
| Other Criteria | Yes (X) | OtherCriteriaInd |
| 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 |
| Includes Publicity Measures | Yes (1) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Avlbl On Request No Charge | Yes (X) | FAPAvlblOnRequestNoChargeInd |
| FAP App Avlbl On Request No Chrg | Yes (X) | FAPAppAvlblOnRequestNoChrgInd |
| FAP Sum Avlbl On Request No Chrg | Yes (X) | FAPSumAvlblOnRequestNoChrgInd |
| Other Publicity | Yes (X) | OtherPublicityInd |
| FAP Actions On Nonpayment | Yes (1) | FAPActionsOnNonpaymentInd |
| Collection Activities | 0 | CollectionActivitiesInd |
| 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 |
| Medicare Rates | Yes (X) | MedicareRatesInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | 0 | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (8 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| LODI COMMMUNITY HOSPITAL | PART V, SECTION B, LINE 5: IN CONDUCTING ITS 2013 COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA), THE FACILITY TOOK INTO ACCOUNT INPUT FROM PERSONS WHO REPRESENT THE COMMUNITY BY INTERVIEWING COMMUNITY LEADERS, INCLUDING THOSE WITH SPECIALIZED KNOWLEDGE IN THE AREA OF PUBLIC HEALTH, AND BY CONDUCTING FOCUS GROUPS WITH RESIDENTS IN THE COMMUNITY TO SOLICIT THEIR VIEWS OF THE SIGNIFICANT HEALTH NEEDS OF THE COMMUNITY. A LIST OF THE COMMUNITY LEADERS INTERVIEWED - IDENTIFIED BY ORGANIZATION AND TITLE - CAN BE FOUND ON PAGE 7 OF THE CHNA REPORT, AVAILABLE ON OUR WEBSITE, WWW.AKRONGENERAL.ORG. |
| LODI COMMMUNITY HOSPITAL | PART V, SECTION B, LINE 6A: IN PREPARING ITS OWN COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA), LODI COMMUNITY HOSPITAL PARTICIPATED IN A COMMUNITY WIDE COLLABORATIVE THAT INCLUDED MEDINA HOSPITAL AND WADSWORTH RITTMAN HOSPITAL. |
| LODI COMMMUNITY HOSPITAL | PART V, SECTION B, LINE 11: LODI COMMUNITY HOSPITAL (LCH) ADDRESSES EACH CATEGORY OF SIGNIFICANT NEED IDENTIFIED IN ITS COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA). IN ITS CHNA, LCH DOES IDENTIFY AS "NEEDS NOT ADDRESSED" SEVERAL TYPES OF HEALTH SCREENINGS. THOSE SCREENINGS ARE:HIV SCREENINGSCHILD ANEMIACHILD ELEVATED LEAD THE REASON LCH DOES NOT ADDRESS THESE PARTICULAR SCREENING IS BECAUSE THE MEDINA COUNTY HEALTH DEPARTMENT IS ADDRESSING THESE SCREENINGS. |
| LODI COMMMUNITY HOSPITAL | PART V, SECTION B, LINE 16I: FOR UNINSURED AND UNDERINSURED PATIENTS, OUR FINANCIAL COUNSELORS OR ELIGIBILITY VENDOR STAFF REACH OUT UPON ADMISSION, OR AS SOON AS POSSIBLE THEREAFTER, TO EXPLAIN THE PROGRAMS FOR FREE OR DISCOUNTED CARE AND TO ASSESS ELIGIBILITY FOR MEDICAID AND OTHER VARIOUS PROGRAMS (VETERAN'S ADMINISTRATION, COBRA, OTHER LOCAL PROGRAMS, ETC.).FOR SCHEDULED OUTPATIENT SERVICES, FINANCIAL COUNSELORS ATTEMPT TO CONTACT THE PATIENT PRIOR TO SERVICE TO SCREEN UNINSURED PATIENTS FOR POSSIBLE ASSISTANCE/PAYMENT SOLUTIONS. IF UNABLE TO CONTACT PATIENT PRIOR TO THE SERVICE, WE ATTEMPT TO SCREEN ON THE DAY OF SERVICE OR AS SOON THEREAFTER AS POSSIBLE.FOR UNSCHEDULED EMERGENCY SERVICES, SCREENING MAY BE COMPLETED DURING THE VISIT WHEN PATIENT IS ABLE. OTHERWISE, ATTEMPTS TO CONTACT THE PATIENT ARE MADE BY THE FINANCIAL COUNSELING STAFF.IN EITHER CASE, IF WE ARE UNABLE TO CONTACT THE PATIENT, THE FINANCIAL ASSISTANCE INFORMATION IS ON EACH BILLING STATEMENT SENT TO THE PATIENT.IF THE PATIENT IS DETERMINED TO BE LIKELY ELIGIBLE FOR MEDICAID, THE ELIGIBILITY VENDOR STAFF ASSIST AND REPRESENT THE PATIENT THROUGHOUT THE APPLICATION PROCESS (UPON APPROVAL FROM THE PATIENT). IN ADDITION TO SIGNAGE, BROCHURES EXPLAINING OUR PROGRAMS ARE IN ALL OF OUR REGISTRATION AREAS. OUR WELCOME PACKETS ALSO INCLUDE INFORMATION AS DOES OUR WEBSITE. ALL STATEMENTS MAILED TO PATIENTS INCLUDE A NOTICE THAT OUR FINANCIAL ASSISTANCE APPLICATIONS ARE ON THE BACK OF THE STATEMENT. PHONE NUMBERS ARE PROVIDED FOR ASSISTANCE. |
| PART V, SECTION B, LINE 16 | FINANCIAL ASSISTANCE POLICY WEBSITE AVAILABILITY |
| LODI COMMMUNITY HOSPITAL PART V, SECTION B, LINE 16A WEBSITE: | WWW.AKRONGENERAL.ORG |
| LODI COMMMUNITY HOSPITAL PART V, SECTION B, LINE 16B WEBSITE: | WWW.AKRONGENERAL.ORG |
| LODI COMMMUNITY HOSPITAL PART V, SECTION B, LINE 16C WEBSITE: | WWW.AKRONGENERAL.ORG |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 2 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp (2 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | FacilityFacilityTxt |
|---|---|---|---|---|
| LODI COMMUNITY CARE CENTER | ||||
| 402 HIGHLAND DRIVE | LODI | OH | 44254 | PHYSICIANS OFFICE |
| LODI COMMUNITY CARE CENTER | ||||
| 221 ELYRIA ST SUITE 102 | LODI | OH | 44254 | PHYSICIANS OFFICE |
Supplemental Information Detail SupplementalInformationDetail (10 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 7: | COSTING METHODOLOGY. THE ORGANIZATION USED A COST TO CHARGE RATIO. THE COST TO CHARGE RATIO USED WAS DERIVED USING WORKSHEET 2 OF THE SCHEDULE H INSTRUCTIONS.PART I, LINE 7(F):COLUMN (F): IN CALCULATING THE PERCENTAGE OF TOTAL EXPENSE REPORTED IN COLUMN (F), TOTAL EXPENSES AS REPORTED ON FORM 990, PART IX, LINE 25, COLUMN (A) WERE REDUCED BY $1,540,438 - THE AMOUNT OF BAD DEBT EXPENSE INCLUDED ON THAT LINE. |
| PART II, COMMUNITY BUILDING ACTIVITIES: | PART III, SECTION A, LINES 2 AND 3: COSTING METHODOLOGY. BAD DEBTS AS REPORTED ON LINE 2 ARE DERIVED FROM THE GROSS CHARGES WRITTEN OFF AS UNCOLLECTIBLE FOR FINANCIAL REPORTING PURPOSES. THE COST-CHARGE RATIO DERIVED FROM SCHEDULE H, WORKSHEET 2 - RATIO OF PATIENT CARE COST TO CHARGES, WAS APPLIED IN CALCULATING LINE 2. |
| PART III, LINE 4: | THE PROVISION FOR BAD DEBTS IS BASED UPON MANAGEMENT'S ASSESSMENT OF HISTORICAL AND EXPECTED NET COLLECTIONS CONSIDERING HISTORICAL BUSINESS AND ECONOMIC CONDITIONS, TRENDS IN HEALTH CARE COVERAGE AND OTHER COLLECTION INDICATORS. PERIODICALLY THROUGHOUT THE YEAR, MANAGEMENT ASSESSES THE ADEQUACY OF THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS BASED UPON HISTORICAL WRITE-OFF EXPERIENCE BY PAYOR CATEGORY. THE RESULTS OF THIS REVIEW ARE THEN USED TO MAKE ANY MODIFICATIONS TO THE PROVISION FOR BAD DEBTS TO ESTABLISH AN APPROPRIATE ALLOWANCE FOR UNCOLLECTIBLE RECEIVABLES.AFTER SATISFACTION OF AMOUNTS DUE FROM INSURANCE, LODI COMMUNITY HOSPITAL FOLLOWS ESTABLISHED GUIDELINES FOR PLACING CERTAIN PAST-DUE PATIENT BALANCES WITH COLLECTION AGENCIES, SUBJECT TO VARIOUS RESTRICTIONS INCLUDING A PROHIBITION AGAINST ENGAGING IN EXTRAORDINARY COLLECTION PROCEDURES AGAINST AN INDIVIDUAL WITHOUT HAVING FIRST MADE REASONABLE EFFORTS TO DETERMINE THAT INDIVIDUALS ELIGIBILITY UNDER THE FINANCIAL ASSISTANCE POLICY. |
| PART III, LINE 8: | LODI COMMUNITY HOSPITAL PROVIDES AN IMPORTANT COMMUNITY BENEFIT THROUGH ITS PARTICIPATION IN THE MEDICARE PROGRAM. BY ABSORBING THIS SHORTFALL, LODI COMMUNITY HOSPITAL PROMOTES THE HEALTH OF THOSE MEMBERS OF THE COMMUNITY RELYING ON MEDICARE AND LESSENS THE BURDEN OF GOVERNMENT BY DOING SO.THE COSTING METHODOLOGY USED TO DETERMINE THE AMOUNT OF MEDICARE ALLOWABLE COSTS IS THE COST TO CHARGE RATIO DEVELOPED IN ACCORDANCE WITH THE MEDICARE COST REPORT INSTRUCTIONS. |
| PART III, LINE 9B: | LODI COMMUNITY HOSPITAL'S BAD DEBT COLLECTION POLICY ADDRESSES HOW TO IDENTIFY AND PROCESS PATIENTS' ACCOUNTS FOR QUALIFICATION AS CHARITY CARE OR OTHER FINANCIAL ASSISTANCE. AT REGISTRATION/ADMISSION A SCREENING PROCESS IDENTIFIES THOSE PATIENTS WITHOUT INSURANCE. THOSE PATIENT ACCOUNTS ARE AUTOMATICALLY CHECKED FOR POSSIBLE MEDICAID OR OTHER FINANCIAL ASSISTANCE ELIGIBILITY. WHERE ELEGIBILITY IS ESTABLISHED, THE PATIENT RECEIVES ASSISTANCE AFTER COMPLETING ANY REQUIRED APPLICATIONS. PATIENTS WHO QUALIFY FOR 100% CHARITY CARE WILL HAVE THEIR CHARGES WRITTEN OFF AS SUCH AND NO COLLECTION EFFORTS WILL FOLLOW. PATIENTS THAT QUALIFY FOR A SLIDING SCALE DISCOUNT THROUGH CHARITY CARE WILL HAVE THEIR STATEMENT ADJUSTED ACCORDINGLY. IF THE ADJUSTED BALANCE IS UNPAID, THE ADJUSTED BALANCE GOES TO COLLECTIONS IN ACCORDANCE WITH POLICY FOR ALL BAD DEBT ACCOUNTS. |
| PART VI, LINE 2: | THERE ARE A VARIETY OF NEEDS ASSESSMENT METHODS EMPLOYED BY LODI COMMUNITY HOSPITAL IN DETERMINING THE HEALTH NEEDS OF THE COMMUNITY IT SERVES. FOR MEDICAL STAFFING AND SERVICES, A COMBINATION OF FACTORS INCLUDING THE COMMUNITY'S DEMOGRAPHICS AND HEALTH NEEDS, THE DEMOGRAPHICS OF MEDICAL STAFF (PHYSICIAN AGE, SPECIALTY, ETC...) ARE WEIGHED TO DETERMINE WHERE RESOURCES SHOULD BE CONCENTRATED IN ORDER TO MEET CURRENT AND FUTURE HEALTHCARE NEEDS OF THE COMMUNITY. LODI COMMUNITY HOSPITAL PARTICIPATES IN HEALTHCARE INITIATIVES OF STATE AND LOCAL HEALTH DEPARTMENTS, EITHER SOLELY OR IN CONCERT WITH OTHER HEALTHCARE PROVIDERS, DEPENDING ON THE INITIATIVE. LODI COMMUNITY HOSPITAL HAS WORKED WITH LOCAL CHURCHES AND SOCIAL WELFARE ORGANIZATIONS TO IDENTIFY AND SERVICE HEALTHCARE NEEDS OF PERSONS WHO ARE UNDERSERVED BY GOVERNMENT PROGRAMS OR WHO HAVE FALLEN COMPLETELY THROUGH GOVERNMENT SAFETY NETS. |
| PART VI, LINE 3: | FOR UNINSURED AND UNDERINSURED PATIENTS, OUR FINANCIAL COUNSELORS OR ON-SITE ELIGIBILITY VENDOR STAFF REACH OUT UPON ADMISSION OR PRIOR TO DISCHARGE TO EXPLAIN THE PROGRAMS FOR FREE OR DISCOUNTED CARE AND TO ASSESS ELIGIBILITY FOR MEDICAID AND OTHER VARIOUS PROGRAMS (VETERAN'S ADMINISTRATION, COBRA, OTHER LOCAL PROGRAMS, ETC.).IF THE PATIENT IS DETERMINED TO BE LIKELY ELIGIBLE FOR MEDICAID, THE ELIGIBILITY VENDOR STAFF ASSIST AND REPRESENT THE PATIENT THROUGHOUT THE APPLICATION PROCESS (UPON APPROVAL FROM THE PATIENT). IN ADDITION TO SIGNAGE, BROCHURES EXPLAINING OUR PROGRAMS ARE IN ALL OF OUR REGISTRATION AREAS. OUR WELCOME PACKETS ALSO INCLUDE INFORMATION AS DOES OUR WEBSITE. ALL STATEMENTS MAILED TO PATIENTS INCLUDE A NOTICE THAT OUR FINANCIAL ASSISTANCE APPLICATIONS ARE ON THE BACK OF THE STATEMENT. PHONE NUMBERS ARE PROVIDED FOR ASSISTANCE. FINANCIAL ASSISTANCE APPLICATIONS ARE ON THE BACK OF EVERY PATIENT STATEMENT AS WELL AS MESSAGES INFORMING PATIENTS THAT ASSISTANCE IS AVAILABLE - VIA WEBSITE, AUTOMATED ATTENDANT OR CUSTOMER SERVICE LINE. SUCH MESSAGES ALSO ARE CONSPICUOUSLY POSTED IN PATIENT AREAS AND THROUGHOUT OUR FACILITIES. WE ALSO HAVE FINANCIAL ASSISTANCE INFORMATION SUCH AS CUSTOMER SERVICE PHONE NUMBERS POSTED THROUGHOUT OUR FACILITIES AT PATIENT INTAKE AREAS. IN ADDITION, FINANCIAL COUNSELORS ARE AVAILABLE AT OUR MAIN CAMPUS TO DISCUSS PAYMENT OPTIONS AND FINANCIAL ASSISTANCE WITH PATIENTS AS THEY DISCHARGE. |
| PART VI, LINE 4: | LODI COMMUNITY HOSPITAL IS LOCATED IN SOUTHERN MEDINA COUNTY AND SERVES THE POPULATION OF 174,915 PEOPLE IN MEDINA. THE MEDIAN AGE OF RESIDENTS IN MEDINA IS 41.3 AND THE MEDIAN HOUSEHOLD INCOME IS AROUND $50,000. THE DOMINANT INDUSTRIES IN THE AREA ARE AGRICULTURE, MANUFACTURING, RETAIL AND GOVERNMENT. LODI COMMUNITY HOSPITAL ALSO SERVES A LARGE AMISH POPULATION. WHILE MEDINA COUNTY'S CURRENT UNEMPLOYMENT RATE IS AT 4.6% THE SURROUNDING COUNTIES' RATES ARE HIGHER; LORAIN IS 6.2% AND CUYAHOGA IS 5.8% WITH THE STATE OF OHIO AT 5%. |
| PART VI, LINE 5: | IN ORDER TO ENSURE THE FURTHERANCE OF LODI COMMUNITY HOSPITAL'S EXEMPT PURPOSE, ITS BOARD OF DIRECTORS CONSISTS OF COMMUNITY MEMBERS - THE MAJORITY OF WHOM ARE INDEPENDENT. THE SIZE OF THE BOARD IS DESIGNED TO BE LARGE ENOUGH TO PROVIDE SUFFICIENT EXPERTISE AND DIVERSITY FOR AN ORGANIZATION OF THIS SIZE WITHOUT BEING TOO LARGE TO MANAGE ITSELF. THE BOARD, AS WELL AS SENIOR MANAGEMENT AND MEDICAL STAFF LEADERS, ARE CHARGED BY POLICY WITH THE EXPECTATION THAT PERSONS IN SUCH POSITIONS WILL ADVOCATE STRONG TIES BETWEEN THE ORGANIZATION AND THE COMMUNITY IT SERVES. AMONG OTHER THINGS THE POLICY CITES THE ASSUMPTION OF BOARD POSITIONS WITH SERVICE ORGANIZATIONS AND COMMUNITY AGENCIES AS WAYS TO PROMOTE SUCH TIES. THROUGH THE HEALTH SYSTEM'S COMMUNITY HEALTH COMMITTEE, LODI COMMUNITY HOSPITAL RECEIVES CONSIDERABLE SUPPORT IN MAINTAINING CONTACTS WITH A DIVERSE CROSS SECTION OF ITS COMMUNITY. THE COMMUNITY HEALTH COMMITTEE SUPPORTS INITIATIVES DESIGNED TO MEET THE NEEDS OF VULNERABLE, DISADVANTAGED POPULATIONS AND THOSE WHO LACK ACCESS TO QUALITY HEALTH CARE. THE MAJORITY OF THE COMMUNITY MEMBERS ARE INDEPENDENT MEMBERS WHOSE FOCUSED MISSION PROVIDES AN IMPORTANT ACCESS POINT FOR GROUPS WITHIN THE COMMUNITY.LODI COMMUNITY HOSPITAL ALSO MAINTAINS AN OPEN MEDICAL STAFF.LODI COMMUNITY HOSPITAL IS BOUND BY LAW TO REINVEST ANY SURPLUS FROM OPERATIONS INTO ITS FACILITIES AND PROGRAMS IN FURTHERANCE OF ITS EXEMPT PURPOSE, PROMOTING THE HEALTH OF THE COMMUNITY IT SERVES. |
| PART VI, LINE 6: | AKRON GENERAL HEALTH SYSTEM IS A NOT-FOR-PROFIT HEALTHCARE ORGANIZATION WITH THE MISSION OF IMPROVING THE HEALTH AND LIVES OF PATIENTS AND THE COMMUNITY, AKRON GENERAL HEALTH SYSTEM INCLUDES: AKRON GENERAL MEDICAL CENTER, A 537-BED TEACHING AND RESEARCH MEDICAL CENTER, EDWIN SHAW REHAB, THE AREA'S LARGEST PROVIDER OF REHABILITATION SERVICES, PARTNERS PHYSICIAN GROUP AND LODI COMMUNITY HOSPITAL; AKRON GENERAL PARTNERS, WHICH INCLUDES THE AKRON GENERAL HEALTH & WELLNESS CENTERS, COMMUNITY HEALTH CENTERS AND OTHER COMPANIES, VISITING NURSE SERVICE AND AFFILIATES, THE LARGEST AND MOST COMPREHENSIVE PROVIDER OF HOME HEALTHCARE AND HOSPICE SERVICES IN OHIO, AND THE AKRON GENERAL FOUNDATION.AKRON GENERAL HEALTH SYSTEM BRINGS TOGETHER A NETWORK OF HEALTH CARE FACILITIES AND STAFF WITH A RICH HERITAGE OF EXCEPTIONAL CARE. IT IS AN INTEGRATED HEALTH SYSTEM THAT PROVIDES HIGH-QUALITY HEALTHCARE FOR PATIENTS AND COMMUNITY THROUGHOUT THEIR ENTIRE LIFE - BIRTHS, INPATIENT AND OUTPATIENT SERVICES FOR ADULTS, EMERGENCY CARE, HOME CARE, WELLNESS, DURABLE MEDICAL EQUIPMENT AND HOSPICE SERVICES. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Idemnification Gross Up Pmts | Yes (X) | IdemnificationGrossUpPmtsInd |
| Discretionary Spending Acct | Yes (X) | DiscretionarySpendingAcctInd |
| Written Policy Ref T And E Expnss | Yes (1) | WrittenPolicyRefTAndEExpnssInd |
| Substantiation Required | Yes (1) | SubstantiationRequiredInd |
| Compensation Committee | Yes (X) | CompensationCommitteeInd |
| Independent Consultant | Yes (X) | IndependentConsultantInd |
| Form990 Of Other Organizations | Yes (X) | Form990OfOtherOrganizationsInd |
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | Yes (1) | 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| ALAN PAPA | ||||||||||||||
| PRESIDENT, COO, DIRECTOR | $0 | $373,712 | $0 | $25,000 | $0 | $38,547 | $0 | $83,183 | $0 | $19,240 | $0 | $539,682 | $0 | $0 |
| THOMAS STOVER MD | ||||||||||||||
| DIRECTOR | $0 | $674,511 | $0 | $100,000 | $0 | $43,974 | $0 | $111,194 | $0 | $23,495 | $0 | $953,174 | $0 | $0 |
| ROBERT W KAMIENSKI | ||||||||||||||
| DIRECTOR, THRU 12/2014 | $0 | $394,057 | $0 | $44,718 | $0 | $15,136 | $0 | $24,835 | $0 | $16,736 | $0 | $495,482 | $0 | $0 |
| CRAIG M BABBITT | ||||||||||||||
| SECRETARY | $0 | $313,656 | $0 | $25,000 | $0 | $31,665 | $0 | $53,257 | $0 | $24,994 | $0 | $448,572 | $0 | $0 |
| DEBORAH GORBACH | ||||||||||||||
| ASST TREASURER | $0 | $185,102 | $0 | $25,000 | $0 | $11,760 | $0 | $76,243 | $0 | $16,343 | $0 | $314,448 | $0 | $0 |
| SUE MCCARTHY | ||||||||||||||
| TREASURER | $0 | $394,224 | $0 | $25,000 | $0 | $15,789 | $0 | $14,685 | $0 | $16,736 | $0 | $466,434 | $0 | $0 |
| THOMAS WHELAN | ||||||||||||||
| PRES COMMUNITY/SPECIALTY HOSPITALS | $125,573 | $67,616 | $0 | $0 | $10,593 | $5,704 | $30,421 | $16,381 | $11,687 | $6,293 | $178,274 | $95,994 | $0 | $0 |
| STEPHANIE D KOCSIS | ||||||||||||||
| VP, NURSING & OPERATIONS | $124,818 | $0 | $0 | $0 | $9,721 | $0 | $43,024 | $0 | $618 | $0 | $178,181 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 1A | THE EXPENSES INDICATED IN PART I, LINE 1 ARE TAXABLE BENEFITS. AS SUCH THEY ARE PART OF TOTAL COMPENSATION. TOTAL COMPENSATION IS TESTED FOR REASONABLENESS AS DESCRIBED IN SCHEDULE O FOR FORM 990, PART VI, SECTION B, LINES 15A AND B. DISCRETIONARY SPENDING ACCOUNT A PORTION OF THE EMPLOYEES' TAXABLE INCOME IS DESIGNATED AS A DISCRETIONARY SPENDING ACCOUNT BENEFIT. THE RECIPIENTS ARE TAXED ON THE ENTIRE VALUE OF THE BENEFIT. THE NET AMOUNT MAY THEN BE APPLIED TO ONE OR MORE OF A LIMITED NUMBER OF CHOICES AVAILABLE UNDER THIS BENEFIT. IF ANY OF THE NET AMOUNT REMAINS AFTER CHOOSING FROM SUCH OPTIONS, IT IS APPLIED TOWARD THE RECIPIENT'S NON-QUALIFIED RETIREMENT BENEFIT. THIS BENEFIT WAS OFFERED TO EMPLOYEES AT THE VICE PRESIDENT LEVEL AND ABOVE. IN 2014, 2 EMPLOYEES RECEIVED THIS BENEFIT FROM THE REPORTING ORGANIZATION. TAX INDEMNIFICATION AND GROSS-UP PAYMENTS SUPPLEMENTAL RETIREMENT IS GROSSED-UP FOR TAX PURPOSES. THE GROSS-UP AND THE BENEFIT BOTH ARE TAXED AND ARE INCLUDED IN TOTAL COMPENSATION. TOTAL COMPENSATION IS TESTED FOR REASONABLENESS AS DESCRIBED IN SCHEDULE O FOR FORM 990, PART VI, SECTION B, LINES 15A AND B. THIS BENEFIT WAS OFFERED TO EMPLOYEES AT THE VICE PRESIDENT LEVEL AND ABOVE. IN 2014, 2 EMPLOYEES RECEIVED THIS BENEFIT FROM THE REPORTING ORGANIZATION. NOTE THAT, TAX INDEMNIFICATION IS NOT OFFERED AS A BENEFIT. |
| PART I, LINE 4B | LINE 4B: THE FOLLOWING EMPLOYEES PARTICIPATED IN A NONQUALIFIED TAXABLE PLAN WHICH IS NOT FUNDED WITH EMPLOYER CONTRIBUTIONS. THOMAS WHELAN CRAIG BABBITT DEBORAH GORBACH SUE J. MCCARTHY TIM STOVER, M.D. ALAN PAPA DANA KOCSIS RELATED ORGANIZATION COMPENSATION AKRON GENERAL HEALTH SYSTEM (FEIN 34-1546466) IS THE SOLE MEMBER OF AKRON GENERAL MEDICAL CENTER (FEIN 34-0714478). AKRON GENERAL MEDICAL CENTER IS THE SOLE MEMBER OF LODI COMMUNITY HOSPITAL. THE INDIVIDUALS LISTED BELOW ARE FULL TIME EMPLOYEES OF AKRON GENERAL HEALTH SYSTEM. THE AMOUNTS SHOWN IN SCHEDULE J PART II LINE 2 REFLECT COMPENSATION FOR SERVICES TO THAT ORGANIZATION. CRAIG M. BABBITT TIM STOVER, M.D. SUE J. MCCARTHY ALAN PAPA DEBORAH GORBACH AKRON GENERAL HEALTH SYSTEM (FEIN 34-1546466) IS THE SOLE MEMBER OF AKRON GENERAL MEDICAL CENTER (FEIN 34-0714478). AKRON GENERAL MEDICAL CENTER IS THE SOLE MEMBER OF LODI COMMUNITY HOSPITAL. THOMAS WHELAN DIVIDES HIS DUTIES BETWEEN AKRON GENERAL MEDICAL CENTER AND LODI COMMUNITY HOSPITAL. THE AMOUNTS SHOWN IN SCHEDULE J PART II LINE 2 REFLECT COMPENSATION FOR SERVICES TO THAT ORGANIZATION. AKRON GENERAL HEALTH SYSTEM (FEIN 34-1546466) IS THE SOLE MEMBER OF AKRON GENERAL MEDICAL CENTER. IT IS ALSO THE SOLE MEMBER OF PARTNERS PHYSICIAN GROUP (FEIN 34-1843403). THE INDIVIDUAL LISTED BELOW IS PAID AS AN EMPLOYEE OF PARTNERS PHYSICIAN GROUP. THE AMOUNTS SHOWN IN SCHEDULE J PART II LINE 2 REFLECT COMPENSATION FOR SERVICES TO THAT ORGANIZATION. ROBERT KAMIENSKI, M.D. |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (10 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 6 | LODI COMMUNITY HOSPITAL HAS ONE MEMBER, AKRON GENERAL MEDICAL CENTER. AKRON GENERAL MEDICAL CENTER IS ORGANIZED IN OHIO AS A NON-PROFIT ORGANIZATION AND IS RECOGNIZED AS EXEMPT FROM FEDERAL INCOME TAX UNDER IRC 501(C)(3). AKRON GENERAL MEDICAL CENTER IS NOT A PRIVATE FOUNDATION. |
| FORM 990, PART VI, SECTION A, LINE 7A | AKRON GENERAL MEDICAL CENTER IS THE SOLE MEMBER OF LODI COMMUNITY HOSPITAL. AKRON GENERAL HEALTH SYSTEM IS THE SOLE MEMBER OF AKRON GENERAL MEDICAL CENTER. THE ORGANIZATION FOLLOWS THE PRACTICE UNDER WHICH LODI COMMUNITY HOSPITAL CURRENT BOARD SUGGESTS CANDIDATES FOR OPENINGS ON ITS BOARD, THAT ARE THEN REVIEWED FOR APPROVAL BY AKRON GENERAL HEALTH SYSTEM'S BOARD. |
| FORM 990, PART VI, SECTION A, LINE 7B | AKRON GENERAL MEDICAL CENTER IS THE SOLE MEMBER OF LODI COMMUNITY HOSPITAL. AKRON GENERAL HEALTH SYSTEM IS THE SOLE MEMBER OF AKRON GENERAL MEDICAL CENTER. AKRON GENERAL HEALTH SYSTEM'S RESPONSIBILITIES INCLUDE PROVIDING LONG TERM PLANNING, INTERNAL AUDIT, ESTABLISHING SYSTEM POLICIES AND PROCEDURES, FINANCIAL MANAGEMENT, AND ASSISTING ORGANIZATIONS WITHIN THE SYSTEM IN CARRYING OUT THIER EXEMPT PROGRAMS. GENERALLY, AKRON GENERAL HEALTH SYSTEM LIMITS ITS POWER OF APPROVAL OVER DECISIONS MADE BY THE BOARD OF LODI COMMUNITY HOSPITAL TO THOSE CONCERNING MEMBERSHIP OF THAT BOARD AND THAT ORGANIZATION'S ANNUAL BUDGET. |
| FORM 990, PART VI, SECTION B, LINE 11 | LODI COMMUNITY HOSPITAL IS A MEMBER OF THE AKRON GENERAL HEALTH SYSTEM. LODI COMMUNITY HOSPITAL PREPARES ITS FORM 990 INTERNALLY. THE RETURN IS SUBJECT TO AN OVERALL AND FINANCIAL REVIEW BY THE VICE PRESIDENT OF ACCOUNTING AND FINANCE/INTERIM CO-CHIEF FINANCIAL OFFICER OF AKRON GENERAL HEALTH SYSTEM AND REVIEWED FOR COMPLIANCE WITH THE REPORTING REQUIREMENTS OF FORM 990 BY THE DIRECTOR OF CORPORATE TAX FOR AKRON GENERAL HEALTH SYSTEM. AN OVERALL REVIEW IS PERFORMED BY THE GOVERNANCE COMMITTEE OF THE AKRON GENERAL HEALTH SYSTEM BOARD. |
| FORM 990, PART VI, SECTION B, LINE 12C | LODI COMMUNITY HOSPITAL IS A MEMBER OF THE AKRON GENERAL HEALTH SYSTEM (SYSTEM). AKRON GENERAL HEALTH SYSTEM IS THE PARENT ORGANIZATION OF THE SYSTEM AND AS SUCH IT DETERMINES CERTAIN POLICIES AND PROCEDURES APPLICABLE TO ALL MEMBER ORGANIZATIONS. IN THE CASE OF CONFLICT OF INTEREST REPORTING, AKRON GENERAL HEALTH SYSTEM NOT ONLY DETERMINES THE POLICY AND THE PROCEDURE, IT CARRIES OUT THE PROCEDURE FOR ALL SYSTEM ORGANIZATIONS. A CONFLICT OF INTEREST QUESTIONNAIRE IS DISTRIBUTED TO ALL BOARD MEMBERS, MANAGEMENT PERSONNEL, EMPLOYED PHYSICIANS AND ANY OTHER PERSONNEL THAT HAVE BEEN DESIGNATED BY MANAGEMENT. THE DISTRIBUTION COVERS ALL SYSTEM ORGANIZATIONS. ALL RESPONSES THAT INDICATE A PERCEIVED CONFLICT OF INTEREST ARE TURNED OVER TO THE GOVERNANCE COMMITTEE (THE COMMITTEE) OF AKRON GENERAL HEALTH SYSTEM FOR REVIEW. THE COMMITTEE MAKES A DETERMINATION AS TO WHETHER THE PERCEIVED CONFLICT IS LIKELY TO BE AN ACTUAL CONFLICT, THE MATERIALITY OF ANY ACTUAL CONFLICTS AND THE EXTENT OF SAFEGUARDS REQUIRED FOR ANY ACTUAL CONFLICTS. SAFEGUARDS INCLUDE, BUT ARE NOT LIMITED TO, REQUIRING, IN THE CASE OF A BOARD MEMBER, THAT THE PERSON RECUSE HIMSELF OR HERSELF FROM ANY DISCUSSIONS OR VOTING THAT MAY BE AFFECTED BY THE CONFLICT, REQUIRING THE PERSON TO DISENGAGE FROM THE CONDUCT CREATING THE CONFLICT OR REQUIRING THE PERSON TO RESIGN FROM THE POSITION AFFECTED BY THE CONFLICT. THIS PROCESS IS CONDUCTED BY AKRON GENERAL HEALTH SYSTEM'S LEGAL SERVICES DEPARTMENT ANNUALLY. THE CONFLICT OF INTEREST LETTER PUTS THE RECIPIENT ON NOTICE THAT HE OR SHE IS UNDER AN ONGOING DUTY TO REPORT ANY POTENTIAL CONFLICTS THAT MAY ARISE SUBSEQUENT TO THIS FORMAL PROCESS. SUBSEQUENT EVENT REPORTING IS MONITORED BY AKRON GENERAL HEALTH SYSTEM'S LEGAL SERVICES DEPARTMENT. ANY SUBSEQUENT REPORTED ITEMS ARE SUBJECT TO THE AFOREMENTIONED REVIEW PROCESS BY AKRON GENERAL HEALTH SYSTEM'S GOVERNANCE COMMITTEE. |
| FORM 990, PART VI, SECTION B, LINE 15 | THE REPORTING ORGANIZATION IS A MEMBER OF THE AKRON GENERAL HEALTH SYSTEM. THE EXEMPT PURPOSE OF THE SYSTEM PARENT, AKRON GENERAL HEALTH SYSTEM (AGHS), IS TO SUPPORT THE MEMBERS OF THAT SYSTEM. ONE OF THE SUPPORT SERVICES THAT AGHS PROVIDES IS DETERMINING THE COMPENSATION OF THE TOP MANAGEMENT PERSONNEL OF THE REPORTING ORGANIZATION. AGHS FOLLOWS A PROCESS FOR DETERMINING COMPENSATION OF THE ORGANIZATION'S CEO AND OTHER TOP MANAGEMENT PERSONNEL THAT IS MODELED AFTER THE REQUIREMENTS FOUND IN INTERNAL REVENUE CODE SECTION 4958 FOR ESTABLISHING THE PRESUMPTION OF REASONABLE COMPENSATION. THEREFORE, THE PROCESS CALLS FOR RECOMMENDATIONS - DEVELOPED BY AN INDEPENDENT COMPENSATION CONSULTANT, BASED ON COMPARABLE MARKET DATA FROM PUBLISHED SURVEYS AND THE FORMS 990 OF COMPARABLE ORGANIZATIONS - THAT ARE WITHIN THE RANGE OF THE COMPENSATION OF SIMILARLY SITUATED PERSONS AT SIMILARLY SITUATED ORGANIZATIONS. THESE RECOMMENDATIONS ARE REVIEWED BY THE COMPENSATION COMMITTEE OF AGHS. THE COMPENSATION COMMITTEE IS COMPRISED OF INDEPENDENT PERSONS AND THE DELIBERATIONS ARE DOCUMENTED, CONTEMPORANEOUSLY, IN THE COMMITTEE'S MINUTES OF ALL ORGANIZATIONS WITHIN THE HEALTH SYSTEM. THE COMPENSATION FOR THE REPORTING ORGANIZATION'S TOP MANAGEMENT WAS REVIEWED FOR REASONABLENESS USING THIS PROCESS IN 2012. |
| FORM 990, PART VI, SECTION C, LINE 19 | CURRENTLY, LODI COMMUNITY HOSPITAL DOES NOT MAKE ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, OR ITS FINANCIAL STATEMENTS GENERALLY AVAILABLE TO THE PUBLIC. LODI COMMUNITY HSOPITAL DOES MAKE THESE DOCUMENTS AVAILABLE ON A CASE BY CASE BASIS. |
| FORM 990, PART VII, COLUMN A, COMPENSATION OF DIRECTORS, NAME & TITLE | SONIA ALEMAGNO, PHD: DIRECTOR, VICE CHAIR BEGINNING 12/2014 THERESA CARTER: DIRECTOR, VICE CHAIR THRU 12/2014, CHAIR BEGINNING 12/2014 |
| FORM 990, PART IX, LINE 11G | PHYSICIAN PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 676,238. MANAGEMENT AND GENERAL EXPENSES 2,500. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 678,738. CLINICAL PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 837,206. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 837,206. BILLING & COLLECTION FEES: PROGRAM SERVICE EXPENSES 57,265. MANAGEMENT AND GENERAL EXPENSES 47,758. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 105,023. LICENSES & REGISTRATION: PROGRAM SERVICE EXPENSES 57,401. MANAGEMENT AND GENERAL EXPENSES 40,068. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 97,469. COURIER: PROGRAM SERVICE EXPENSES 71. MANAGEMENT AND GENERAL EXPENSES 52,880. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 52,951. TRANSCRIPTION: PROGRAM SERVICE EXPENSES 27,047. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 27,047. RECRUITING: PROGRAM SERVICE EXPENSES 5,000. MANAGEMENT AND GENERAL EXPENSES 33,000. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 38,000. MISCELLANEOUS: PROGRAM SERVICE EXPENSES 226,250. MANAGEMENT AND GENERAL EXPENSES 181,435. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 407,685. |
| FORM 990, PART XI, LINE 9: | CHANGE IN INTEREST IN FOUNDATION NET ASSETS -17,441. GRANT FUNDING FOR CAPITAL 24,659. TRANSFER TO/FROM AFFILIATES -535,772. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (9 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 |
|---|---|---|---|---|---|---|---|---|---|---|
| AKRON GENERAL HEALTH SYSTEM | ||||||||||
| 1 AKRON GENERAL AVENUE | AKRON | OH | 44307 | 341546466 | SUPPORTING ORGANIZATION | OH | IRC 501(C)(3) | 11C, FI | NONE | 0 |
| AKRON GENERAL PARTNERS INC | ||||||||||
| 1 AKRON GENERAL AVENUE | AKRON | OH | 44307 | 201801493 | SUPPORTING ORGANIZATION | OH | IRC 501(C)(3) | 11A | AKRON GENERAL HEALTH SYSTEM | Yes (1) |
| AKRON GENERAL FOUNDATION | ||||||||||
| 1 AKRON GENERAL AVENUE | AKRON | OH | 44307 | 341127047 | FUNDRAISING | OH | IRC 501(C)(3) | 7 | AKRON GENERAL HEALTH SYSTEM | Yes (1) |
| COMMUNITY HEALTH VENTURES INC | ||||||||||
| 1 HOME CARE PLACE | AKRON | OH | 44320 | 341478435 | SUPPORTING ORGANIZATION | OH | IRC 501(C)(3) | 11 TYPE 111 FI | AKRON GENERAL HEALTH SYSTEM | Yes (1) |
| AKRON GENERAL MEDICAL CENTER | ||||||||||
| 1 AKRON GENERAL AVENUE | AKRON | OH | 44307 | 340714478 | HOSPITAL | OH | IRC 501(C)(3) | 3 | AKRON GENERAL HEALTH SYSTEM | Yes (1) |
| PARTNERS PHYSICIAN GROUP | ||||||||||
| 1 AKRON GENERAL AVENUE | AKRON | OH | 44307 | 341843403 | COMMUNITY HEALTH SERVICES | OH | IRC 501(C)(3) | 9 | AKRON GENERAL MEDICAL CENTER | Yes (1) |
| AKRON GENERAL MEDICAL CENTER SELF INSURANCE TRUST FUND | ||||||||||
| 1 AKRON GENERAL AVENUE | AKRON | OH | 44307 | 341243687 | SUPPORTING ORGANIZATION | OH | IRC 501(C)(3) | 11A | AKRON GENERAL MEDICAL CENTER | Yes (1) |
| VISITING NURSE SERVICE INC | ||||||||||
| 1 HOME CARE PLACE | AKRON | OH | 44320 | 340714779 | HOME HEALTH CARE | OH | IRC 501(C)(3) | 9 | AKRON GENERAL HEALTH SYSTEM | Yes (1) |
| HOSPICE CARE OHIO INC | ||||||||||
| 1 HOME CARE PLACE | AKRON | OH | 44320 | 341771508 | HOSPICE SERVICES | OH | IRC 501(C)(3) | 9 | COMMUNITY HEALTH VENTURES INC | Yes (1) |
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp
Related Organization Name RelatedOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | AKRON GENERAL INNOVATIONS INC | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1 AKRON GENERAL AVENUE | AddressLine1Txt |
| City | AKRON | CityNm |
| State Abbreviation | OH | StateAbbreviationCd |
| ZIP | 44307 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 383928798 | EIN |
| Primary Activities | PARTNERSHIP INVESTMENTS | PrimaryActivitiesTxt |
| Legal Domicile State | OH | LegalDomicileStateCd |
| Entity Type | C | EntityTypeTxt |
| Controlled Organization | 0 | 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 | Yes (1) | 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 |
Transactions Related Org TransactionsRelatedOrgGrp (11 entries)
| Transaction TypeTransactionTypeTxt | InvolvedInvolvedAmt | Method Of Amount DeterminationMethodOfAmountDeterminationTxt |
|---|---|---|
| AKRON GENERAL HEALTH SYSTEM | ||
| O | $696,192 | FAIR MARKET VALUE |
| AKRON GENERAL HEALTH SYSTEM | ||
| P | $57,940 | FAIR MARKET VALUE |
| AKRON GENERAL MEDICAL CENTER | ||
| S | $233,560 | COST |
| AKRON GENERAL MEDICAL CENTER | ||
| R | $725,993 | COST |
| AKRON GENERAL MEDICAL CENTER | ||
| Q | $1,051,392 | COST |
| AKRON GENERAL MEDICAL CENTER | ||
| P | $327,282 | COST |
| PARTNERS PHYSICIAN GROUP | ||
| Q | $72,225 | COST |
| PARTNERS PHYSICIAN GROUP | ||
| P | $86,583 | COST |
| AKRON GENERAL PARTNERS INC | ||
| P | $110,905 | COST |
| AKRON GENERAL PARTNERS INC | ||
| Q | $151,231 | COST |
| AKRON GENERAL FOUNDATION | ||
| C | $50,291 | COST |