2015-11-10T12:44:28-06:00 2014-12-31 351178661 BLUE & CO LLC 8800 LYRA DRIVE SUITE 450 COLUMBUS OH 43240 990 2014-01-01 237374256 MCCULLOUGH-HYDE MEMORIAL HOSPITAL ENDOWMENT FUND MCCU 5135245310 110 NORTH POPLAR OXFORD OH 45056 BRYAN HEHEMANN CEO 5135245310 2015-11-09 1 NANCY KIRCHNER P00386751 6148852583 2015-11-09 2014 2016-03-07 17:11:31Z BRYAN HEHEMANN 110 NORTH POPLAR STREET OXFORD OH 45056 1380739 0 X WWW.MHMH.ORG X 1942 OH TO SUPPORT HEALTH, EDUCATIONAL, AND BUILDING PROGRAMS OF MCCULLOUGH-HYDE MEMORIAL HOSPITAL 10 10 0 0 0 0 265525 224452 0 0 580076 1058707 83383 -13285 928984 1269874 410379 425838 0 0 0 0 0 0 0 73166 56711 483545 482549 445439 787325 13035000 11005233 2290270 144257 10744730 10860976 X SUPPORT THE HOSPITAL WITH HEALTH PROGRAMS, EDUCATION ASSISTANCE, BUILDING AND EQUIPMENT NEEDS 0 0 173351 173351 DEVELOPMENT OFFICE SUPPORT:THE TRUST PROVIDES SUPPORT FOR THE HOSPITAL DEVELOPMENT DEPARTMENT THAT ACTS AS A LIASON BETWEEN THE HOSPITAL AND THE DONOR COMMUNITY. EFFORTS OF THIS OFFICE OVER THE YEARS HAS PRODUCED AN ENDOWMENT OF $8.3 MILLION IN UNRESTRICTED CONTRIBUTIONS AND $2.5 MILLION IN DESIGNATED GIFTS. 148796 148796 SUPPORT FOR BLDG & EQUIPMENT NEEDS:FUNDED ALL OR PART OF 6 EQUIPMENT PURCHASES INCLUDING A CRITICAL CARE BED FOR ICU, BIRTHING BED FOR OB, LAB EQUIPMENT AND PHYSICAL THERAPY EQUIPMENT. IN ADDITION, BUILDING IMPROVEMENTS FOR THE ONCOLOGY PROGRAM WERE SUPPORTED. 67323 67323 SUPPORT FOR HEALTH PROGRAMS:PROVIDED SUPPORT FOR NEEDY PATIENTS REQUIRING TRANSPORTATION, ONCOLOGY MEDS AND TEMPORARY ASSISTANCE DURING MEDICAL EMERGENCIES AND SUPPORT FOR THE OXFORD FREE CLINIC. 36368 36368 SUPPORT FOR EDUCATIONAL NEEDS:FUNDED HEALTH CAREER SCHOLARSHIPS, EARLY CHILDHOOD DEVELOPMENT, STAFF CONTINUING EDUCATION AND STAFF CAREER DEVELOPMENT PROGRAMS. 36368 36368 425838 1 1 0 0 0 1 0 0 0 1 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 1 0 0 0 0 1 1 0 0 0 1 8 0 1 0 0 0 0 0 0 0 0 0 0 0 X 10 10 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 0 0 0 OH X JAMES MILLER CONTROLLER 5135245310 110 NORTH POPLAR STREET OXFORD OH 45056 JOHN HARLAN MD VICE CHAIRMAN 1.00 1.00 X X 0 0 0 ERIKA DARKS DIRECTOR 1.00 1.00 X 0 0 0 RICHARD M NORMAN CHAIRMAN 1.00 1.00 X X 0 0 0 ALAN OAK SECRETARY-TREASURER 1.00 1.00 X X 0 0 0 STEPHEN FLEE DIRECTOR 1.00 1.00 X 0 0 0 SUSAN LIPNICKEY DIRECTOR 1.00 1.00 X 0 0 0 THOMAS W SPEH DIRECTOR 1.00 1.00 X 0 0 0 RALPH GUTOWSKI DIRECTOR 1.00 1.00 X 0 0 0 HILLARY EVANS MD DIRECTOR 1.00 1.00 X 0 0 0 JAMES FORMAL DIRECTOR 1.00 1.00 X 0 0 0 BRYAN HEHEMANN PRESIDENT AND CEO 40.00 40.00 X 0 213624 19295 JOHN CLEMENTS VICE PRESIDENT AND CFO 40.00 40.00 X 0 146434 8908 0 360058 28203 0 0 1 0 0 224452 51449 224452 289540 289540 97580 110865 -13285 -13285 -13285 769167 0 769167 769167 769167 1269874 0 0 1045422 425838 425838 400 400 51127 51127 5000 5000 BANK FEES 184 184 482549 425838 56711 0 859639 974453 2500 59091 17709 1086792 553631 565128 533161 11548642 9479910 13035000 11005233 24775 19796 2265495 124461 2290270 144257 X 8240600 8332932 460960 388373 2043170 2139671 10744730 10860976 13035000 11005233 X 787325 -671079 X 0 1 X 1 0 X X 1 MCCULLOUGH-HYDE MEMORIAL HOSPITAL INC 310650283 509(A)(3)(A) 0 420313 0 1 420313 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 10 19743 151686 51701 1 1 11548642 184959 427284 164936 2516039 9479910 10045352 384066 1270951 151727 11548642 9014757 97325 1099844 166574 10045352 9551600 296717 -706525 127035 9014757 8626691 137514 970829 183434 9551600 0.95900 0.04100 1 0 149670 149670 876186 514073 362113 29955 18703 11252 30981 20855 10126 533161 DUE TO RELATED MCCULLOUGH-HYDE MEMORIAL HOSPITAL 124461 124461 X PART V, LINE 4: HEALTH EDUCATION, HOSPITAL EQUIPMENT, COMMUNITY HEALTH PART X, LINE 2: ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA REQUIRE MANAGEMENT TO EVALUATE TAX POSITIONS TAKEN BY THE TRUST AND THE HOSPITAL AND RECOGNIZE A TAX LIABILITY IF THEY HAVE 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, 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 TRUST AND THE HOSPITAL ARE SUBJECT TO ROUTINE AUDITS BY TAXING JURISDICTIONS; HOWEVER, THERE ARE CURRENTLY NO AUDITS FOR ANY TAX PERIODS IN PROGRESS. 1 OXFORD FREE CLINIC PO BOX 18818 FAIRFIELD OH 45018 204253386 501(C)(3) 5525 HEALTH CLINIC MCCULLOUGH-HYDE MEMORIAL HOSPITAL 110 NORTH POPLAR STREET OXFORD OH 45056 310650283 501(C)(3) 420313 PATIENT SUPPORT 2 0 PART I, LINE 2: THE ORGANIZATION HAS REPRESENTATION ON THE BOARD THAT OVERSEES OPERATIONS. 1 1 0 0 0 0 0 0 0 BRYAN HEHEMANN PRESIDENT AND CEO 0 213624 0 0 0 0 0 938 0 18357 0 232919 0 0 JOHN CLEMENTS VICE PRESIDENT AND CFO 0 146434 0 0 0 0 0 938 0 7970 0 155342 0 0 PART I, LINES 4A-B BRYAN HEHEMANN - LIFE INSURANCE POLICY - PAID UP POLICY AT 65. FACE AMOUNT IS $100K WITH CASH SURRENDER VALUE. THERE IS AN ANNUAL PREMIUM OF $8,874 WITH THE VALUE AT 12/31/14 AT $54,377. X EQUIPMENT 1 51449 FMV 0 1 0 FORM 990, PART VI, SECTION B, LINE 11 THE 990 IS REVIEWED BY THE CFO AND FINANCE COMMITTEE OF THE BOARD PRIOR TO SUBMISSION. ALL BOARD MEMBERS ARE INVITED ATTEND. THE FINANCE COMMITTEE REVIEWS WITH THE FULL BOARD AT THE NEXT SCHEDULED MEETING. FORM 990, PART VI, SECTION B, LINE 12C ALL MEMBERS OF ADMINISTRATION, DEPARTMENT DIRECTORS, MANAGERS, SUPERVISORS AND OTHER INDIVIDUALS WHO ARE, OR MAY BE, RESPONSIBLE FOR THE DIRECT PURCHASE OF GOODS AND/OR SERVICES ON BEHALF OF THE HOSPITAL SHALL BE REQUIRED TO REVIEW THIS POLICY AND COMPLETE A CONFLICT OF INTEREST FORM FOR SUBMISSION TO THE CORPORATE COMPLIANCE OFFICER ANNUALLY. WHEN A CONFLICT OF INTEREST ARISES OR A POTENTIAL CONFLICT OF INTEREST DEVELOPS, THE PERSON WHO IS OR MAY BE IN A CONFLICT OF INTEREST SITUATION IS REQUIRED TO MAKE A FULL WRITTEN DISCLOSURE OF THE SITUATION OR POTENTIAL SITUATION BY COMPLETING AND SIGNING A CONFLICT OF INTEREST QUESTIONNAIRE AND RETURNING IT TO HIS/HER DEPARTMENT DIRECTOR AND/OR APPROPRIATE ADMINISTRATOR, WHO WILL FORWARD THE CONFLICT OF INTEREST FORM TO THE CORPORATE COMPLIANCE OFFICER FOR REVIEW AND APPROPRIATE ACTION. THE CORPORATE COMPLIANCE COMMITTEE SHALL CONDUCT A FULL REVIEW AND ASSESSMENT OF THE POTENTIAL CONFLICT AND WILL PROVIDE ONE OF THE FOLLOWING WRITTEN RECOMMENDATIONS/CONCLUSIONS: 1. THE CIRCUMSTANCES REPORTED DO NOT PRESENT A PROBLEM. 2. ALTERNATE ARRANGEMENTS MADE BY/WITH THE EMPLOYEE ARE ACCEPTABLE AND PRESENT NO PROBLEM. 3. ALTERNATE ARRANGEMENTS ARE NOT ACCEPTABLE AND THE CONFLICT WILL BE DEALT WITH ON AN INDIVIDUAL BASIS. FORM 990, PART VI, SECTION C, LINE 19 THE DOCUMENTS ARE MADE AVAILABLE UPON REQUEST. FORM 990, PART XI, LINE 9: CHANGE IN TEMPORARILY RESTRICTED NET ASSETS -72,587. CHANGE IN PERMANENTLY RESTRICTED NET ASSETS 96,501. NET UNREALIZED LOSSED ON INVESTMENTS -694,993. MCCULLOUGH-HYDE MEMORIAL HOSPITAL INC 110 N POPLAR STREET OXFORD OH 45056 310650283 HOSPITAL OH 501(C)(3) LINE 3 MCCULLOUGH-HYDE MEMORIAL HOSPITAL ENDOWMENT TRUST 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 MCCULLOUGH HYDE MEMORIAL HOSPITAL B 136175 COST MCCULLOUGH HYDE MEMORIAL HOSPITAL P 284138 COST