SHELBY COUNTY MEMORIAL HOSPITAL ASSOCIATION INC: Form 990, tax year 2014
View the entire original 990 at ProPublica ↗
- Organization
- SHELBY COUNTY MEMORIAL HOSPITAL ASSOCIATION INC (EIN 34-4427944)
- Tax period
- 2014-01-01 to 2014-12-31
- Filed
- 2015-11-13
- IRS object ID
- 201523179349302022
- 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 L
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2015-11-13T08:59:21-06:00 | ReturnTs |
| Tax Period End | 2014-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 351178661 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BLUE & CO LLC | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 8800 LYRA DRIVE SUITE 450 | AddressLine1Txt |
| City | COLUMBUS | CityNm |
| State Abbreviation | OH | StateAbbreviationCd |
| ZIP | 43240 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2014-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 344427944 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | THE SHELBY COUNTY MEMORIAL HOSPITAL ASSOCIATION | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | SHEL | BusinessNameControlTxt |
| Phone | 9374982311 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 915 WEST MICHIGAN STREET | AddressLine1Txt |
| City | SIDNEY | CityNm |
| State Abbreviation | OH | StateAbbreviationCd |
| ZIP | 453652491 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | JULIE COVAULT | PersonNm |
| Person Title | VP - FINANCE | PersonTitleTxt |
| Phone | 9374982311 | PhoneNum |
| Signature | 2015-11-12 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | STEPHEN A SHERIDAN | PreparerPersonNm |
| PTIN | P00028551 | PTIN |
| Phone | 6148852583 | PhoneNum |
| Preparation | 2015-11-12 | PreparationDt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2014 | TaxYr |
| Build TS | 2016-02-25 16:41:14Z | BuildTS |
Form 990 IRS990
Doing Business As Name DoingBusinessAsName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | WILSON MEMORIAL HOSPITAL | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | JULIE COVAULT | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 915 WEST MICHIGAN STREET | AddressLine1Txt |
| City | SIDNEY | CityNm |
| State Abbreviation | OH | StateAbbreviationCd |
| ZIP | 453652491 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $97,844,326 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.WILSONHOSPITAL.COM | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1920 | FormationYr |
| Legal Domicile State | OH | LegalDomicileStateCd |
| Activity Or Mission | TO MAINTAIN A PATIENT-CENTERED ENVIRONMENT THAT ENCOURAGES AND SUPPORTS INNOVATION AND TEAMWORK IN ACHIEVING EXCELLENCE. TO MAXIMIZE CUSTOMER SATISFACTION BY MEETING THE HIGHEST STANDARDS OF VALUE, SERVICE, AND PERFORMANCE. TO PROVIDE COMMUNITY LEADERSHIP BY ASSURING ACCESS TO THE HIGHEST QUALITY, COMPREHENSIVE HEALTH CARE SERVICES. | ActivityOrMissionDesc |
| Voting Members Governing Body | 15 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 14 | VotingMembersIndependentCnt |
| Total Employee | 846 | TotalEmployeeCnt |
| Total Volunteers | 189 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $74,874 | PYContributionsGrantsAmt |
| CY Contributions Grants | $1,031,734 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $85,664,451 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $93,706,234 | CYProgramServiceRevenueAmt |
| PY Investment Income | $2,143,211 | PYInvestmentIncomeAmt |
| CY Investment Income | $1,023,275 | CYInvestmentIncomeAmt |
| PY Other Revenue | $3,410,256 | PYOtherRevenueAmt |
| CY Other Revenue | $1,888,083 | CYOtherRevenueAmt |
| PY Total Revenue | $91,292,792 | PYTotalRevenueAmt |
| CY Total Revenue | $97,649,326 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $44,217,830 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $47,029,900 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $40,406,036 | PYOtherExpensesAmt |
| CY Other Expenses | $41,831,434 | CYOtherExpensesAmt |
| PY Total Expenses | $84,623,866 | PYTotalExpensesAmt |
| CY Total Expenses | $88,861,334 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $6,668,926 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $8,787,992 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $103,903,853 | TotalAssetsBOYAmt |
| Total Assets EOY | $110,640,475 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $12,907,178 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $10,478,284 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $90,996,675 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $100,162,191 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | TO MAINTAIN A PATIENT-CENTERED ENVIRONMENT THAT ENCOURAGES AND SUPPORTS INNOVATION AND TEAMWORK IN ACHIEVING EXCELLENCE. TO MAXIMIZE CUSTOMER SATISFACTION BY MEETING THE HIGHEST STANDARDS OF VALUE, SERVICE, AND PERFORMANCE. TO PROVIDE COMMUNITY LEADERSHIP BY ASSURING ACCESS TO THE HIGHEST QUALITY, COMPREHENSIVE HEALTH CARE SERVICES. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $26,675,038 | ExpenseAmt |
| Revenue | $26,717,846 | RevenueAmt |
| Desc | INPATIENT HEALTHCARE SERVICES - THERE WERE 3,478 ADMISSIONS TO THE HOSPITAL IN 2014, REPRESENTING 12,569 PATIENT DAYS OF CARE. THERE WERE 513 INPATIENT SURGERIES PERFORMED DURING 2014. | Desc |
Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $17,217,827 | ExpenseAmt |
| Revenue | $20,067,360 | RevenueAmt |
| Desc | OUTPATIENT HEALTHCARE SERVICES - THERE WERE 75,519 OUTPATIENT REGISTRATIONS RECORDED IN 2014. | Desc |
Prog Srvc Accom Acty3 ProgSrvcAccomActy3Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $11,830,428 | ExpenseAmt |
| Revenue | $13,239,783 | RevenueAmt |
| Desc | SAME DAY SURGERY - THERE WERE 3,126 OUTPATIENT SURGERIES PERFORMED AT THE HOSPITAL IN 2014. | Desc |
Prog Srvc Accom Acty Other ProgSrvcAccomActyOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $22,270,300 | ExpenseAmt |
| Revenue | $27,581,159 | RevenueAmt |
| Desc | THERE WERE 26,567 EMERGENCY VISITS AT THE HOSPITAL IN 2014THERE WERE 16,989 OCCUPATIONAL HEALTH VISITS RECORDED FOR 2014THERE WERE 100,177 OFFICE VISITS IN THE WILSON CARE, LLC OFFICES IN 2014THERE WERE 18,740 HOME HEALTH AND 4,719 HOSPICE VISITS IN 2014 | Desc |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Prog Srvc Expense | $22,270,300 | TotalOtherProgSrvcExpenseAmt |
| Total Other Prog Srvc Revenue | $27,581,159 | TotalOtherProgSrvcRevenueAmt |
| Total Program Service Expenses | $77,993,593 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | 0 | 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 | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (1) | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 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 | Yes (1) | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | Yes (1) | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | Yes (1) | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | Yes (1) | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | 0 | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 134 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 846 | EmployeeCnt |
| Employment Tax Returns Filed | 0 | 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 | 15 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 14 | 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 | 0 | MembersOrStockholdersInd |
| Election Of Board Members | 0 | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | 0 | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | 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 | JULIE COVAULT | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 9374982311 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 915 WEST MICHIGAN STREET | AddressLine1Txt |
| City | SIDNEY | CityNm |
| State Abbreviation | OH | StateAbbreviationCd |
| ZIP | 45365 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (24 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | OfficerOfficerInd | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Key EmployeeKeyEmployeeInd | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|---|
| DAN BENSMAN | |||||||||
| TRUSTEE | 1.00 | Yes (X) | $0 | $0 | $0 | ||||
| STAN CROSLEY | |||||||||
| VICE-CHAIR | 1.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | |||
| GERALD DOERGER | |||||||||
| TRUSTEE | 1.00 | Yes (X) | $0 | $0 | $0 | ||||
| FRED HAUSSMAN MD | |||||||||
| TRUSTEE | 1.00 | Yes (X) | $0 | $0 | $0 | 1.00 | |||
| RUDY KEISTER | |||||||||
| SECRETARY | 1.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | |||
| DAVE MONNIER | |||||||||
| TREASURER | 1.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | |||
| KENNETH MONNIER | |||||||||
| CHAIRMAN | 1.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | 1.00 | ||
| JEFF RAIBLE | |||||||||
| TRUSTEE | 1.00 | Yes (X) | $0 | $0 | $0 | ||||
| TOM SHEEHAN | |||||||||
| TRUSTEE | 1.00 | Yes (X) | $0 | $0 | $0 | ||||
| JOHN SPOLTMAN | |||||||||
| TRUSTEE | 1.00 | Yes (X) | $0 | $0 | $0 | ||||
| TONYA THIEMAN | |||||||||
| TRUSTEE | 1.00 | Yes (X) | $0 | $0 | $0 | ||||
| BOB WHEELER | |||||||||
| TRUSTEE | 1.00 | Yes (X) | $0 | $0 | $0 | ||||
| ANDY COUNTS | |||||||||
| TRUSTEE | 1.00 | Yes (X) | $0 | $0 | $0 | ||||
| MARK DOOLEY | |||||||||
| PRESIDENT AND CEO | 40.00 | Yes (X) | $178,854 | $0 | $17,070 | Yes (X) | |||
| PATTI ROSS | |||||||||
| TRUSTEE | 1.00 | Yes (X) | $0 | $0 | $0 | ||||
| THOMAS BOECKER | |||||||||
| CEO | 40.00 | $507,044 | $0 | $109,394 | Yes (X) | ||||
| JULIE COVAULT | |||||||||
| VP-FINANCE | 40.00 | $170,920 | $0 | $46,652 | Yes (X) | ||||
| CRAIG LANNOYE | |||||||||
| VP-OPERATIONS | 40.00 | $196,065 | $0 | $68,486 | Yes (X) | ||||
| LINDA MAURER | |||||||||
| VP-NURSING & PATIENT CARE | 40.00 | $160,100 | $0 | $46,828 | Yes (X) | ||||
| VALERIE SCHULTTE | |||||||||
| PHYSICIAN | 40.00 | $461,517 | $0 | $53,193 | Yes (X) | ||||
| CECILIA BANGA | |||||||||
| PHYSICIAN | 40.00 | $282,218 | $0 | $15,429 | Yes (X) | ||||
| FREDERICK SIMPSON | |||||||||
| PHYSICIAN | 40.00 | $294,448 | $0 | $66,919 | Yes (X) | ||||
| KAREN SMITH | |||||||||
| PHYSICIAN | 40.00 | $294,582 | $0 | $40,449 | Yes (X) | ||||
| RUDY BOHINE | |||||||||
| PHYSICIAN | 40.00 | $289,363 | $0 | $13,893 | Yes (X) | ||||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $2,835,111 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $478,313 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 10 | 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 |
|---|---|---|---|---|---|
| KETTERING ANESTHESIA ASSOCIATES INC | |||||
| 300 PENTAGON | BEAVERCREEK | OH | 45431 | ANESTHESIOLOGISTS | $823,090 |
| WILSON SLEEP LLC | |||||
| 915 WEST MICHIGAN STREET | SIDNEY | OH | 45365 | SLEEP LAB STUDIES | $631,070 |
| LABORATORY CORPORATON OF AMERICAN HOLDIN | |||||
| P O BOX 12140 | BURLINGTON | NC | 27216 | LABORATORY SERVICES | $471,869 |
| PREMIER HEALTH CARE SERVICES INC | |||||
| P O BOX 634485 | CINCINNATI | OH | 452634850 | ER PHYSICIANS | $463,464 |
| PREMIER PHYSICIAN SERVICES | |||||
| P O BOX 637682 | CINCINNATI | OH | 452637682 | OCC MED PHYSICIANS | $338,581 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 11 | CntrctRcvdGreaterThan100KCnt |
| Government Grants | $904,965 | GovernmentGrantsAmt |
| All Other Contributions | $126,769 | AllOtherContributionsAmt |
| Total Contributions | $1,031,734 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | NET PATIENT SERVICE REVENUE | Desc |
| Business | 900099 | BusinessCd |
| Total Revenue Column | $93,706,234 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $93,706,234 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $93,706,234 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $1,153,637 | TotalRevenueColumnAmt |
| Exclusion | $1,153,637 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $489,563 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $0 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $489,563 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $489,563 | TotalRevenueColumnAmt |
| Exclusion | $489,563 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $64,638 | SecuritiesAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $0 | SecuritiesAmt |
| Other | $195,000 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $64,638 | SecuritiesAmt |
| Other | -$195,000 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$130,362 | TotalRevenueColumnAmt |
| Exclusion | -$130,362 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt | ExclusionExclusionAmt |
|---|---|---|---|---|
| REBATES | 900099 | $347,804 | $347,804 | |
| DIETARY | 722210 | $337,315 | $337,315 | |
| INVESTMENT IN JOINT VENTURES | 900099 | $337,001 | $337,001 |
Miscellaneous Revenue MiscellaneousRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $376,400 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $62,991 | RelatedOrExemptFuncIncomeAmt |
| Exclusion | $313,409 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $1,398,520 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $97,649,326 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $94,454,030 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $2,163,562 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $34,647,844 | TotalAmt |
| Program Services | $30,410,413 | ProgramServicesAmt |
| Management And General | $4,237,431 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,611,444 | TotalAmt |
| Program Services | $1,414,364 | ProgramServicesAmt |
| Management And General | $197,080 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $8,358,173 | TotalAmt |
| Program Services | $7,335,968 | ProgramServicesAmt |
| Management And General | $1,022,205 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,412,439 | TotalAmt |
| Program Services | $2,117,398 | ProgramServicesAmt |
| Management And General | $295,041 | ManagementAndGeneralAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $150,000 | TotalAmt |
| Program Services | $131,655 | ProgramServicesAmt |
| Management And General | $18,345 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $106,939 | TotalAmt |
| Program Services | $93,860 | ProgramServicesAmt |
| Management And General | $13,079 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $37,803 | TotalAmt |
| Program Services | $33,180 | ProgramServicesAmt |
| Management And General | $4,623 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $14,044,495 | TotalAmt |
| Program Services | $12,326,854 | ProgramServicesAmt |
| Management And General | $1,717,641 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $126,227 | TotalAmt |
| Program Services | $110,789 | ProgramServicesAmt |
| Management And General | $15,438 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $220,984 | TotalAmt |
| Program Services | $193,958 | ProgramServicesAmt |
| Management And General | $27,026 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,502,084 | TotalAmt |
| Program Services | $2,196,079 | ProgramServicesAmt |
| Management And General | $306,005 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $125,853 | TotalAmt |
| Program Services | $110,461 | ProgramServicesAmt |
| Management And General | $15,392 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $275,259 | TotalAmt |
| Program Services | $241,595 | ProgramServicesAmt |
| Management And General | $33,664 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $145,620 | TotalAmt |
| Program Services | $127,811 | ProgramServicesAmt |
| Management And General | $17,809 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,574,866 | TotalAmt |
| Program Services | $4,893,060 | ProgramServicesAmt |
| Management And General | $681,806 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $893,441 | TotalAmt |
| Program Services | $784,173 | ProgramServicesAmt |
| Management And General | $109,268 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (3 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| MEDICAL AND OTHER SUPPL | $10,585,257 | $9,290,680 | $1,294,577 |
| BAD DEBTS | $5,940,357 | $5,213,851 | $726,506 |
| MISCELLANEOUS | $1,102,249 | $967,444 | $134,805 |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $88,861,334 | TotalAmt |
| Program Services | $77,993,593 | ProgramServicesAmt |
| Management And General | $10,867,741 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,600 | BOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $11,394,665 | BOYAmt |
| EOY | $12,594,418 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $9,719,459 | BOYAmt |
| EOY | $10,372,679 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,034,554 | BOYAmt |
| EOY | $1,109,845 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,200,773 | BOYAmt |
| EOY | $1,545,286 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $97,798,526 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $61,306,896 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $37,528,835 | BOYAmt |
| EOY | $36,491,630 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $32,776,661 | BOYAmt |
| EOY | $36,651,105 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $441,107 | BOYAmt |
| EOY | $494,454 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $9,804,199 | BOYAmt |
| EOY | $11,381,058 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $103,903,853 | BOYAmt |
| EOY | $110,640,475 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,171,150 | BOYAmt |
| EOY | $2,515,974 | EOYAmt |
Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,852,483 | BOYAmt |
| EOY | $3,727,476 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $100,000 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,883,545 | BOYAmt |
| EOY | $4,134,834 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $12,907,178 | BOYAmt |
| EOY | $10,478,284 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $83,126,084 | BOYAmt |
| EOY | $91,741,849 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,870,591 | BOYAmt |
| EOY | $8,420,342 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $90,996,675 | BOYAmt |
| EOY | $100,162,191 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $103,903,853 | BOYAmt |
| EOY | $110,640,475 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | $8,787,992 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | -$21,665 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | $399,189 | OtherChangesInNetAssetsAmt |
| Info In Schedule O Part XII | Yes (X) | InfoInScheduleOPartXIIInd |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule C IRS990ScheduleC
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART II-B, LINE 1: | FormAndLineReferenceDesc |
| Explanation | PERCENTAGE OF OHA DUES USED IN LOBBYING IS 3.4% | ExplanationTxt |
Schedule D IRS990ScheduleD
CY Endwmt Fund CYEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $179,168 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $10,809 | InvestmentEarningsOrLossesAmt |
| End Year Balance | $189,977 | EndYearBalanceAmt |
CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $173,542 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $5,626 | InvestmentEarningsOrLossesAmt |
| End Year Balance | $179,168 | EndYearBalanceAmt |
CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $162,670 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $10,872 | InvestmentEarningsOrLossesAmt |
| End Year Balance | $173,542 | EndYearBalanceAmt |
CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $163,551 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $2,915 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $3,796 | OtherExpendituresAmt |
| End Year Balance | $162,670 | EndYearBalanceAmt |
CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $157,308 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $6,243 | InvestmentEarningsOrLossesAmt |
| End Year Balance | $163,551 | EndYearBalanceAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Prmnnt Endowment Balance EOY | 0.55000 | PrmnntEndowmentBalanceEOYPct |
| Term Endowment Balance EOY | 0.45000 | TermEndowmentBalanceEOYPct |
| Endowments Held Unrelated Org | 0 | EndowmentsHeldUnrelatedOrgInd |
| Endowments Held Related Org | 0 | EndowmentsHeldRelatedOrgInd |
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $589,676 | OtherCostOrOtherBasisAmt |
| Book Value | $589,676 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $52,507,062 | OtherCostOrOtherBasisAmt |
| Depreciation | $29,904,295 | DepreciationAmt |
| Book Value | $22,602,767 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $43,351,323 | OtherCostOrOtherBasisAmt |
| Depreciation | $31,402,601 | DepreciationAmt |
| Book Value | $11,948,722 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $1,350,465 | OtherCostOrOtherBasisAmt |
| Book Value | $1,350,465 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $36,491,630 | TotalBookValueLandBuildingsAmt |
Other Assets Org OtherAssetsOrgGrp (8 entries)
| DescDesc | Book ValueBookValueAmt |
|---|---|
| ACCRUED INTEREST | $15,302 |
| DEFERRED FINANCING COSTS | $21,850 |
| INTEREST IN FOUNDATION'S ASSET | $8,420,342 |
| OTHER A/R | $457,544 |
| INSURANCE DEPOSIT | $1,000 |
| ESTIMATED THIRD-PARTY SETTLEMENTS | $1,603,883 |
| MEANINGFUL USE | $861,027 |
| OTHER ASSETS | $110 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $11,381,058 | TotalBookValueOtherAssetsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (2 entries)
| DescDesc | AmtAmt |
|---|---|
| ACCRUED EMPLOYEE COMPENSATION AND RELATED TAXES | $3,663,104 |
| DEFERRED COMPENSATION PAYABLE | $471,730 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $4,134,834 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART V, LINE 4: | THE ENDOWMENT FUNDS WERE ESTABLISHED FOR A VARIETY OF PURPOSES. THE ENDOWMENT FUNDS CONSIST OF FOUR SEPARATE FUNDS, INCLUDING THE MARY KEISER HOSPICE FUND, THE RUTH HEALTH AND EQUIPMENT FUND, THE ROSS HOME HEALTH CARE AND HOSPICE FUND, AND THE CRIMM FUND FOR SURGICAL EQUIPMENT. |
| PART X, LINE 2: | SCHEDULE D, PART X LINE 2: ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA REQUIRE MANAGEMENT TO EVALUATE TAX POSITIONS TAKEN AND RECOGNIZE A TAX LIABILITY IF AN UNCERTAIN POSITION HAS BEEN TAKEN THAT MORE LIKELY THAN NOT WOULD NOT BE SUSTAINED UPON EXAMINATION BY VARIOUS FEDERAL AND STATE TAXING AUTHORITIES. MANAGEMENT HAS ANALYZED THE TAX POSITIONS TAKEN BY THESE ENTITIES 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 ENTITIES ARE SUBJECT TO ROUTINE AUDITS BY TAXING JURISDICTIONS; HOWEVER, THERE ARE CURRENTLY NO AUDITS FOR ANY TAX PERIODS IN PROGRESS. |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (1) | FinancialAssistancePolicyInd |
| Written Policy | Yes (1) | WrittenPolicyInd |
| FPG Reference Free Care | Yes (1) | FPGReferenceFreeCareInd |
| Percent100 | Yes (X) | Percent100Ind |
| FPG Reference Discounted Care | Yes (1) | FPGReferenceDiscountedCareInd |
| Percent200 D | Yes (X) | Percent200DInd |
| Free Care Medically Indigent | Yes (1) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (1) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | 0 | ExpensesExceedBudgetInd |
| Annual Community Bnft Report | Yes (1) | AnnualCommunityBnftReportInd |
| Report Publically Available | Yes (1) | ReportPublicallyAvailableInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,066,377 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $1,066,377 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01500 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $13,073,257 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $10,505,831 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $2,567,426 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.03610 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $14,139,634 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $10,505,831 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $3,633,803 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.05110 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $66,623 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $66,623 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00000 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $66,623 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $66,623 | NetCommunityBenefitExpnsAmt |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $14,206,257 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $10,505,831 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $3,700,426 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.05110 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (1) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $5,940,357 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $150,592 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $15,010,757 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $18,314,622 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$3,303,865 | 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 |
Management Co And Jnt Ventures ManagementCoAndJntVenturesGrp (2 entries)
| Primary ActivitiesPrimaryActivitiesTxt | Org Profit Or OwnershipOrgProfitOrOwnershipPct | Ofcr Etc Profit Or OwnershipOfcrEtcProfitOrOwnershipPct | Physicians Profit Or OwnershipPhysiciansProfitOrOwnershipPct |
|---|---|---|---|
| 1 WILSON SLEEP LLC | |||
| SLEEP STUDIES | 0.60000 | 0.00000 | 0.40000 |
| 2 HONDA HEALTH PARTNERS | |||
| PROVIDING OCCUPATIONAL HEALTH SERVICES TO HONDA | 0.33330 | 0.00000 | 0.00000 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| 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 | SHELBY COUNTY MEMORIAL HOSPITAL ASSOC | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 915 W MICHIGAN STREET | AddressLine1Txt |
| City | SIDNEY | CityNm |
| State Abbreviation | OH | StateAbbreviationCd |
| ZIP | 45365 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | THE SHELBY COUNTY MEMORIAL 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 | 0 | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | 0 | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (1) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | HTTP://WWW.WILSONHEALTH.ORG/COMMUNITY-HEALTH-NEEDS-ASSESSMENT | OwnWebsiteURLTxt |
| Other Website | Yes (X) | OtherWebsiteInd |
| Other Website URL | HTTP://SHELBYCOUNTYHEALTHDEPT.ORG | OtherWebsiteURLTxt |
| Implementation Strategy Adopt | Yes (1) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 13 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (1) | StrategyPostedWebsiteInd |
| Strategy Website URL | HTTP://WWW.WILSONHEALTH.ORG/COMMUNITY-HEALTH-NEEDS-ASSESSMENT | StrategyWebsiteURLTxt |
| Strategy Attached | 0 | StrategyAttachedInd |
| Organization Incur Excise Tax | 0 | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (1) | EligCriteriaExplainedInd |
| FPG Family Incm Lmt Free Dscnt | Yes (X) | FPGFamilyIncmLmtFreeDscntInd |
| FPG Family Incm Lmt Free Care | 100.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 200.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Income Level Criteria | Yes (X) | IncomeLevelCriteriaInd |
| Medical Indigency Criteria | Yes (X) | MedicalIndigencyCriteriaInd |
| Explained Basis | Yes (1) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (1) | AppFinancialAsstExplnInd |
| Described Info | Yes (X) | DescribedInfoInd |
| Described Suprt Doc | Yes (X) | DescribedSuprtDocInd |
| Includes Publicity Measures | Yes (1) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP Avlbl On Request No Charge | Yes (X) | FAPAvlblOnRequestNoChargeInd |
| FAP App Avlbl On Request No Chrg | Yes (X) | FAPAppAvlblOnRequestNoChrgInd |
| FAP Notice Displayed | Yes (X) | FAPNoticeDisplayedInd |
| FAP Actions On Nonpayment | Yes (1) | FAPActionsOnNonpaymentInd |
| Collection Activities | 0 | CollectionActivitiesInd |
| FAP Notified All Patients | Yes (X) | FAPNotifiedAllPatientsInd |
| Documented Elig Determination | Yes (X) | DocumentedEligDeterminationInd |
| Nondis Emergency Care Policy | Yes (1) | NondisEmergencyCarePolicyInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | Yes (1) | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (6 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| THE SHELBY COUNTY MEMORIAL HOSPITAL | PART V, SECTION B, LINE 5: THE 2013 CHNA RESEARCH EFFORTS INCLUDED: INTERVIEWS WITH 30 COMMUNITY LEADERS; A DEMOGRAPHIC ANALYSIS; A SURVEY OF NEARLY 2,000 MIDDLE AND HIGH SCHOOL STUDENTS; AND A SURVEY OF 400 ADULT RESIDENTS. BEYOND THAT, WILSON MEMORIAL COLLABORATED WITH THE GREATER DAYTON AREA HOSPITAL ASSOCIATION AND WRIGHT STATE UNIVERSITY TO STUDY SECONDARY DATA SUCH AS VITAL STATISTICS, CANCER TRENDS, AND HOSPITAL AND EMERGENCY DEPARTMENT DISCHARGE DATA. THE STEERING COMMITTEE MET 10 TIMES TO ANALYZE THE RESULTS AND IDENTIFY HEALTH PRIORITIES. COMMUNITY FORUMS WERE HELD TO PRESENT KEY FINDINGS, RECOGNIZING THAT AN INFORMED COMMUNITY WILL ENHANCE THE PARTNERSHIP THAT COMMUNITY IMPROVEMENT REQUIRES. |
| THE SHELBY COUNTY MEMORIAL HOSPITAL | PART V, SECTION B, LINE 22D: ALL PATIENTS ARE CHARGED THE SAME GROSS CHARGE REGARDLESS OF PAYOR SOURCE. FAP ELIGIBLE INDIVIDUALS WILL QUALIFY FOR A MINIMUM OF A 30% DISCOUNT. |
| THE SHELBY COUNTY MEMORIAL HOSPITAL | PART V, SECTION B, LINE 24: ALL PATIENTS ARE CHARGED THE SAME GROSS CHARGE REGARDLESS OF PAYOR SOURCE. FAP ELIGIBLE INDIVIDUALS WILL QUALIFY FOR A MINIMUM OF A 30% DISCOUNT. |
| PART V, SECTION B, LINE 16 | FINANCIAL ASSISTANCE POLICY WEBSITE AVAILABILITY |
| THE SHELBY COUNTY MEMORIAL HOSPITAL PART V, SECTION B, LINE 16A WEBSITE: | HTTP://WWW.WILSONHEALTH.ORG |
| THE SHELBY COUNTY MEMORIAL HOSPITAL PART V, SECTION B, LINE 16B WEBSITE: | HTTP://WWW.WILSONHEALTH.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 |
|---|---|---|---|---|
| WILSON HOME HEALTH AND HOSPICE | ||||
| 1081 FAIRINGTON STREET | SIDNEY | OH | 45365 | HOME HEALTH |
| WILSON SLEEP LLC | ||||
| 915 WEST MICHIGAN STREET | SIDNEY | OH | 45365 | SLEEP SERVICES |
Supplemental Information Detail SupplementalInformationDetail (9 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART II, COMMUNITY BUILDING ACTIVITIES: | N/A |
| PART III, LINE 4: | NET PATIENT SERVICE REVENUE IS RECOGNIZED AS SERVICES ARE PERFORMED AND IS REPORTED BASED ON CHARGES, NET OF CERTAIN DEDUCTIONS FROM THOSE CHARGES. DEDUCTIONS ARE BASED ON THE DIFFERENCE BETWEEN CHARGES AT ESTABLISHED RATES AND AMOUNTS ESTIMATED BY MANAGEMENT TO BE REIMBURSABLE BY THIRD-PARTY PAYORS. REIMBURSABLE AMOUNTS ARE GENERALLY LESS THAN THE ESTABLISHED CHARGES. FINAL DETERMINATION OF AMOUNTS EARNED FOR PATIENTS IS SUBJECT TO REVIEW BY PROGRAM REPRESENTATIVES. SUBSEQUENT ADJUSTMENTS, IF ANY, ARISING FROM SUCH REVIEW ARE RECORDED IN THE YEAR THEY BECOME KNOWN.THE HOSPITAL HAS A DETAILED FINANCIAL ASSISTANCE POLICY WHICH STATES THAT TO PARTICIPATE IN CHARITY CARE CANDIDATES MUST COOPERATE FULLY. IN ADDITION THE HOSPITAL EDUCATES PATIENTS WILL LIMITED ABILITY TO PAY REGARDING FINANCIAL ASSISTANCE. FOR THIS REASON THE ORGANIZATION BELIEVES THAT IT ACCURATELY CAPTURES ALL CHARITY CARE DEDUCTIONS PROVIDED ACCORDING TO THE FINANCIAL ASSISTANCE POLICY AND THE AMOUNT OF BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S CHARITY CARE POLICY IS NEGLIGIBLE. |
| PART III, LINE 8: | THE ELDERLY ARE OFTEN AN UNDERSERVED POPULATION THAT EXPERIENCE ISSUES REGARDING ACCESS TO HEALTHCARE SERVICES. MEDICARE IS OUR LARGEST PAYER, AND HOSPITALS MUST ACCEPT MEDICARE PATIENTS REGARDLESS OF WHETHER THEY HAVE A SURPLUS OR DEFICIT FROM PROVIDING THESE SERVICES. PROVIDING MEDICARE SERVICES PROMOTES ACCESS TO HEALTHCARE SERVICES WHICH IS A COMMUNITY BENEFIT. IF TAX EXEMPT HOSPITALS DID NOT PROVIDE MEDICARE SERVICES, THE FEDERAL GOVERNMENT WOULD BEAR THE BURDEN OF DIRECTLY PROVIDING SERVICES TO THE MEDICARE ELIGIBLE. |
| PART III, LINE 9B: | IN ORDER FOR THE HOSPITAL TO CONTINUE OPERATING EFFICIENTLY, THE FOLLOWING COLLECTION POLICY HAS BEEN ADOPTED.A. EACH PATIENT/GUARANTOR IS INDIVIDUALLY RESPONSIBLE FOR PAYMENT OF ALL CHARGES UNLESS HIS/HER THIRD-PARTY PAYER HAS A CONTRACT WITH THE HOSPITAL.B. THE HOSPITAL WILL ACCEPT ASSIGNMENT OF HEALTH INSURANCE BENEFITS FOR MEDICARE, MEDICAID, TRICARE, AND OTHERS PER INDIVIDUAL CONTRACT.1. DEDUCTIBLE, CO-INSURANCE, OR NON-COVERED SERVICES ARE PAYABLE AT THE TIME OF SERVICE UNLESS FINANCIAL ARRANGEMENTS HAVE BEEN MADE WITH THE FINANCIAL ADVISOR.2. ANY BALANCE AFTER THE APPLICATION OF HEALTH INSURANCE PAYMENTS TO THE PATIENT'S ACCOUNT IS TO BE PAID WITHIN THIRTY (30) DAYS FOLLOWING NOTIFICATION. IF PAID WITHIN 30 DAYS OF RECEIPT OF FIRST STATEMENT, PATIENT IS ELIGIBLE FOR A 10% DISCOUNT ON THE BALANCE OF THE BILL.3. THE HOSPITAL WILL ACCEPT MASTER CARD, VISA, AND DISCOVER CHARGE CARDS FOR PAYMENTS ON PATIENT ACCOUNTS.4. PAYMENTS OR ARRANGEMENT FOR PAYMENT PLANS ARE TO COMMENCE WITHIN THIRTY (30) DAYS OF BILL DATE. 5. PATIENTS ARE ASKED TO "PAY IN FULL" HOWEVER, IF THE PATIENT/GUARANTOR INDICATES AN INABILITY TO MAKE PAYMENT IN FULL, THE PATIENT/GUARANTOR WILL BE GIVEN THE OPTION TO ESTABLISH A CONTRACT ACCOUNT WITH WILSON MEMORIAL HOSPITAL.A MONTHLY CONTRACT ACCOUNT CAN BE ESTABLISHED. THE MONTHLY AGREEMENT MUST BE SET UP SO THAT THE ENTIRE AMOUNT WILL BE PAID OFF IN TWELVE MONTHS, UNLESS OTHERWISE APPROVED BY DIRECTOR OF PATIENT FINANCIAL SERVICES. NO MONTHLY PAYMENT WILL BE LESS THAN $25.00IF THE PATIENT OR ANY FAMILY MEMBER OF THE RESPONSIBLE PARTY OR GUARANTOR'S FAMILY IS CURRENTLY PAYING ON A BILL AND HAS NEED OF THE HOSPITAL'S SERVICES AGAIN, THE PAYMENT MUST THEN BE ADJUSTED UPWARDS TO REFLECT THE NEXT BALANCE DUE.WILSON MEMORIAL HOSPITAL EMPLOYEES, ALONG WITH THEIR SPOUSE AND CHILDREN UNDER THE AGE OF EIGHTEEN, WHO INDICATE DIFFICULTY IN MEETING PAYMENT OBLIGATIONS ON THEIR ACCOUNT ARE GIVEN THE OPTION TO MAKE MONTHLY PAYMENTS, OR HAVE PAYMENTS DEDUCTED FROM THEIR PAY CHECK. (PAYROLL DEDUCTION PROGRAM)PAYMENT ON THE ACCOUNTS NOT RECEIVED ACCORDING TO THE ABOVE PROVISION WILL BE SUBJECT TO BECOMING A "DELINQUENT ACCOUNT". ACTIONS TAKEN BY THE HOSPITAL TOWARD SUCH ACCOUNTS WILL BE AT THE HOSPITAL'S DISCRETION.THE HOSPITAL RETAINS THE RIGHT TO REFER THE PATIENT'S DELINQUENT ACCOUNTS TO A PROFESSIONAL COLLECTION AGENCY.THE FIRST STATEMENT A PATIENT RECEIVES WILL BE SENT OUT BY WILSON HOSPITAL. IF WITHIN 30 DAYS THERE HAS BEEN NO PAYMENT ON THE ACCOUNT, IT WILL BE SENT TO OUR EARLY OUT PROGRAM. THEY WILL ACT AS A WILSON MEMORIAL FINANCIAL ADVISOR AND RECEIVE A PERCENTAGE OF THE ACCOUNT IF ANY PAYMENT IS MADE TO THEM. IF THE EARLY OUT AGENCY CANNOT COLLECT ON THE ACCOUNTS, THEY ARE SENT BACK TO THE HOSPITAL TO BE SENT TO ONE OF 3 COLLECTION AGENCIES.DIRECTOR OF PATIENT FINANCIAL SERVICES MUST APPROVE ALL ACCOUNTS SENT TO THE COLLECTION AGENCY AND MUST APPROVE ANY LEGAL ACTION THAT IS SUGGESTED BY THE COLLECTION AGENCY.WILSON MEMORIAL HOSPITAL IS REQUIRED BY LAW TO GIVE "FREE CARE"TO THOSE PERSONS WHO ARE ELIGIBLE BASED ON STATE STATUTES.WILSON MEMORIAL HOSPITAL HAS A CHARITY CARE POLICY FOR THOSE ELIGIBLE WHO CANNOT AFFORD TO PAY FOR CARE. THE CURRENT FEDERAL POVERTY INCOME GUIDELINES WILL BE USED TO DETERMINE ELIGIBILITY OF THE PATIENT.ANY HOSPITAL SERVICES RESULTING FROM AN ACCIDENT OR OTHER CAUSES INVOLVING A DISPUTE AS TO LIABILITY BETWEEN THE PATIENT AND OTHERS, DOES NOT INVOLVE THE HOSPITAL. THE HOSPITAL WILL EXPECT PAYMENT IN THE SAME MANNER AS ALL OTHER SERVICES. THE HOSPITAL WILL ACCEPT A LETTER OF PROTECTION FOR A DURATION OF 90 DAYS. AFTER 90 DAYS THE HOSPITAL WILL ACTIVELY PURSUE THE PATIENT OR GUARANTOR FOR PAYMENT OF RENDERED SERVICES.EXCEPTIONS TO THE ABOVE ITEMS CAN BE MADE WITH THE APPROVAL OF THE DIRECTOR OF PATIENT FINANCIAL SERVICES. ALL UNUSUAL ARRANGEMENTS AND CIRCUMSTANCES ARE REVIEWED AND APPROVED BY THE VICE PRESIDENT OF FINANCE. |
| SCH H PT V, LINE 22 | IN FULFILLING WILSON MEMORIAL HOSPITAL'S MISSION, WE RECOGNIZE THAT WE WILL NOT RECEIVE PAYMENT FROM CERTAIN INDIVIDUALS FOR CARE THAT HAS BEEN RENDERED, AND A CERTAIN DEGREE OF JUDGMENT WILL BE REQUIRED IN DETERMINING CHARITY CARE LEVELS OF THE PATIENTS.POLICYWILSON MEMORIAL HOSPITAL IS A NOT-FOR-PROFIT ENTITY ESTABLISHED TO MEET THE HEALTH CARE NEEDS OF ALL CITIZENS OF SIDNEY AND SURROUNDING COMMUNITIES. WILSON MEMORIAL HOSPITAL WILL PROVIDE CHARITABLE CARE FOR THOSE INDIVIDUALS WHO CAN DEMONSTRATE THE INABILITY TO PAY BASED ON THEIR FINANCIAL STATUS AS IT RELATES TO HOSPITAL AND FEDERAL POVERTY LEVEL GUIDELINES.RESPONSBILITYTHE HOSPITAL HAS A LEGAL AND MORAL OBLIGATION TO PROVIDE EMERGENCY, TRAUMA AND OBSTETRICAL CARE BEFORE DETERMINING THE SOURCE OF PAYMENT.ELIGIBILITY REQUIREMENTSI. ALL WILSON MEMORIAL HOSPITAL PATIENTS WHO ARE UNABLE TO PAY FOR HOSPITAL SERVICES WILL BE ELIGIBLE TO APPLY FOR CHARITY ASSISTANCE.II. CHARITY ASSISTANCE MAY BE APPROVED ON TOTAL OR PARTIAL PATIENT RESPONSIBILITY. DOLLAR AMOUNTS ARE BASED ON FINANCIAL INFORMATION SUPPLIED BY THE PATIENT.III. PATIENTS WILL BE ELIGIBLE FOR TOTAL CHARITY ASSISTANCE IF:A. THE PATIENT IS INELIGIBLE FOR PUBLIC ASSISTANCE (MEDICAID, GENERAL ASSISTANCE, ETC.).B. THE PATIENT COMPLETES A FINANCIAL STATEMENT INDICATING CURRENT EARNINGS, EXPENSES AND PERSONAL/FAMILY INFORMATION. WE WILL ACCEPT THE PATIENT'S DECLARATION OF INCOME.C. THE PATIENTS AND/OR FAMILY INCOME DOES NOT EXCEED THE POVERTY GUIDELINES AS ESTABLISHED BY THE U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES.IV. PATIENTS WILL BE ELIGIBLE FOR PARTIAL CHARITY ASSISTANCE IF:A. THE PATIENT IS INELIGIBLE FOR PUBLIC ASSISTANCE (MEDICAID, GENERAL ASSISTANCE, ETC.) EITHER OR PARTIAL COVERAGE.B. THE PATIENT COMPLETES A FINANCIAL STATEMENT INDICATING CURRENT EARNINGS, EXPENSES AND PERSONAL/FAMILY INFORMATION. WE WILL ACCEPT THE PATIENT'S DECLARATION OF INCOME.C. THE PATIENTS AND/OR FAMILY INCOME DOES NOT EXCEED TWO TIMES THE POVERTY GUIDELINES AS ESTABLISHED BY THE U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES.D. THE PATIENT AND/OR FAMILY INCOME EXCEEDS TWO TIMES THE INCOME POVERTY/GUIDELINES, DETERMINATION OF ELIGIBILITY AND AMOUNT OF CHARITY CARE WILL BE BASED ON FINANCIAL STATEMENT FROM PATIENT ON AN ACCOUNT BY ACCOUNT BASIS.V. PATIENTS MAY NOT BE ELIGIBLE FOR CHARITY CARE ASSISTANCE IF THE PROCEDURE PROVIDED IS ELECTIVE. EACH INSTANCE WILL BE REVIEWED ON A CASE BY CASE BASIS WITH MEDICAL STAFF AND MANAGEMENT INPUT. |
| PART VI, LINE 2: | THE ANNUAL STRATEGIC PLANNING PROCESS UTILIZES MARKET DATA WHICH SHOWS SERVICES THAT SHELBY COUNTY RESIDENTS LEAVE TO OBTAIN ELSEWHERE. INPUT IS PROVIDED BY COMMUNITY MEMBERS WHO SIT ON HOSPITAL BOARD. |
| PART VI, LINE 3: | INCOME ELIGIBLITY GUIDELINES ARE CONSPICUOUSLY POSTED AT ALL REGISTRATION POINTS. IN ADDITION, THE GUIDELINES ARE PRINTED ON PATIENT STATEMENTS AND BILLS. THE HOSPITAL EMPLOYS FINANCIAL COUNSELORS WHO MEET PERSONALLY AND BY PHONE WITH PATIENTS TO ASSIST THEM IN COMPLETING FORMS TO DETERMINE THE EXTENT OF THEIR ELIGIBLITY FOR ANY FINANCIAL ASSISTANCE. |
| PART VI, LINE 4: | THE PRIMARY SERVICE AREA IS SHELBY AND SURROUNDING COUNTIES. WITH THE EXCEPTION OF MIAMI COUNTY TO THE SOUTH ALL OF THE SERVICE AREA IS CONSIDERED RURAL. |
| PART VI, LINE 5: | THE SHELBY COUNTY MEMORIAL HOSPITAL ASSOCIATION'S BOARD OF TRUSTEES IS COMPRISED OF VOLUNTEERS FROM OUR COMMUNITY. THE MAJORITY OF OUR BOARD MEMBERS LIVE AND WORK WITHIN THE COMMUNITY AND ARE ACTIVELY INVOLVED WITH OTHER NON-PROFIT AGENCIES. THE MAJORITY OF OUR SENIOR MANAGERS AND STAFF ALSO LIVE IN OUR PRIMARY SERVICE AREA AND MANY SIT ON OTHER COMMUNITY BASED GOVERNANCE BOARDS. THE "SPIRIT" OF COMMUNITY BASED HEALTHCARE RESIDES IN OUR BOARD OF TRUSTEES AND HOSPITAL STAFF AND IS FURTHER EVIDENCED BY OUR OPEN MEDICAL STAFF. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Club Dues Or Fees | Yes (X) | ClubDuesOrFeesInd |
| Written Policy Ref T And E Expnss | Yes (1) | WrittenPolicyRefTAndEExpnssInd |
| Substantiation Required | Yes (1) | SubstantiationRequiredInd |
| Compensation Committee | Yes (X) | CompensationCommitteeInd |
| Written Employment Contract | Yes (X) | WrittenEmploymentContractInd |
| 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 (10 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| MARK DOOLEY | ||||||||||||||
| PRESIDENT AND CEO | $149,714 | $0 | $0 | $0 | $29,140 | $0 | $0 | $0 | $17,070 | $0 | $195,924 | $0 | $0 | $0 |
| THOMAS BOECKER | ||||||||||||||
| CEO | $409,450 | $0 | $76,970 | $0 | $20,624 | $0 | $86,481 | $0 | $22,913 | $0 | $616,438 | $0 | $0 | $0 |
| JULIE COVAULT | ||||||||||||||
| VP-FINANCE | $161,256 | $0 | $0 | $0 | $9,664 | $0 | $14,584 | $0 | $32,068 | $0 | $217,572 | $0 | $0 | $0 |
| CRAIG LANNOYE | ||||||||||||||
| VP-OPERATIONS | $183,468 | $0 | $0 | $0 | $12,597 | $0 | $34,578 | $0 | $33,908 | $0 | $264,551 | $0 | $0 | $0 |
| LINDA MAURER | ||||||||||||||
| VP-NURSING & PATIENT CARE | $150,248 | $0 | $0 | $0 | $9,852 | $0 | $13,605 | $0 | $33,223 | $0 | $206,928 | $0 | $0 | $0 |
| VALERIE SCHULTTE | ||||||||||||||
| PHYSICIAN | $403,357 | $0 | $0 | $0 | $58,160 | $0 | $11,025 | $0 | $42,168 | $0 | $514,710 | $0 | $0 | $0 |
| CECILIA BANGA | ||||||||||||||
| PHYSICIAN | $261,734 | $0 | $0 | $0 | $20,484 | $0 | $11,025 | $0 | $4,404 | $0 | $297,647 | $0 | $0 | $0 |
| FREDERICK SIMPSON | ||||||||||||||
| PHYSICIAN | $253,650 | $0 | $0 | $0 | $40,798 | $0 | $33,750 | $0 | $33,169 | $0 | $361,367 | $0 | $0 | $0 |
| KAREN SMITH | ||||||||||||||
| PHYSICIAN | $161,403 | $0 | $0 | $0 | $133,179 | $0 | $7,289 | $0 | $33,160 | $0 | $335,031 | $0 | $0 | $0 |
| RUDY BOHINE | ||||||||||||||
| PHYSICIAN | $183,754 | $0 | $0 | $0 | $105,609 | $0 | $0 | $0 | $13,893 | $0 | $303,256 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 1A | THE HOSPITAL PAYS THE DUES FOR MR. BOECKER, THE PRESIDENT/CEO FOR THE PIQUA COUNTRY CLUB EACH YEAR. THE AMOUNT IS INCLUDED IN HIS TAXABLE SALARY. |
| PART I, LINE 4B | PAST CEO THOMAS BOECKER HAD ADDITIONAL W2 COMPENSATION OF $250,433 FOR 2014.THIS INCOME IS COMPENSATION THOMAS BOECKER HAD PRIOR REPORTED AS W2 INCOME AND INVESTED INTO A COMPANY SPONSORED 457(F) PLAN. BOARD RESOLUTION TERMINATED THE PLAN WHICH RESULTED IN PAYOUT OF INVESTMENT IN 2014 AND REPORTED AS 2014 INCOME. |
Schedule L IRS990ScheduleL
Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp (3 entries)
| Relationship DescriptionRelationshipDescriptionTxt | TransactionTransactionAmt | TransactionTransactionDesc | Sharing Of RevenuesSharingOfRevenuesInd |
|---|---|---|---|
| FRED HAUSSMAN MD FOR PREMIER HEALT | |||
| HOSPITAL TRUSTEE IS EMPLOYEE OF PREMIER HEALTHCARE | $463,464 | ER PHYSICIAN SERVICES | 0 |
| SONDRA BOECKER | |||
| MARRIED TO CEO | $22,784 | SALARY | 0 |
| DAN BENSMAN | |||
| HOSPITAL TRUSTEE IS PARTNER IN FAULKNER, GARMHAUSEN, KEISTER & SHENK | $35,610 | LEGAL SERVICES | 0 |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (7 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION B, LINE 11 | THE RETURN WILL BE REVIEWED BY THE BOARD OF TRUSTEES PRIOR TO SUBMISSION. |
| FORM 990, PART VI, SECTION B, LINE 12C | ANY DUALITY OF INTEREST OR POSSIBLE CONFLICT OF INTEREST ON THE PART OF ANY GOVERNING BOARD MEMBER SHOULD BE DISCLOSED TO THE OTHER MEMBERS OF THE BOARD AND MADE A MATTER OF RECORD, EITHER THROUGH THE ANNUAL PROCEDURE OR WHEN THE INTEREST BECOMES A MATTER OF BOARD ACTION. ANY GOVERNING BOARD MEMBER HAVING A DUALITY OF INTEREST OR POSSIBLE CONFLICT OF INTEREST ON ANY MATTER SHOULD NOT VOTE OR USE HIS PERSONAL INFLUENCE ON THE MATTER, AND THE PERSON SHALL NOT BE COUNTED IN DETERMINING THE QUORUM OF THE MEETING. THE MINUTES OF THE MEETING SHALL REFLECT THAT A DISCLOSURE WAS MADE, THE ABSTENTION FROM VOTING, AND THE QUORUM SITUATION. |
| FORM 990, PART VI, SECTION B, LINE 15 | THE HR COMMITTEE OF THE BOARD CONDUCTS AN ANNUAL EVALUATION PROCESS INVOLVING INPUT FROM BOARD MEMBER, SENIOR MANAGERS AND MEDICAL STAFF. COMPENSATION IS BENCHMARKED WITH SURVEYS FROM LIKE SIZED HEALTHCARE ORGANIZATIONS. THE BOARD OF TRUSTEES APPROVES THE CEO COMPENSATION PACKAGE ANNUALLY. |
| FORM 990, PART VI, SECTION C, LINE 19 | THE DOCUMENTS ARE MADE AVAILABLE UPON REQUEST. |
| FORM 990, PART IX, LINE 11G | PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 6,463,728. MANAGEMENT AND GENERAL EXPENSES 900,665. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 7,364,393. PHYSICIAN AND PROVIDER REMUNERATION: PROGRAM SERVICE EXPENSES 3,575,096. MANAGEMENT AND GENERAL EXPENSES 498,159. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 4,073,255. MAINTENANCE CONTRACTS: PROGRAM SERVICE EXPENSES 2,288,030. MANAGEMENT AND GENERAL EXPENSES 318,817. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,606,847. |
| FORM 990, PART XI, LINE 9: | TRANSFERS -150,562. NET ASSETS RELEASED FROM RESTRICTION 549,751. |
| FORM 990, PART XII, LINE 2C: | THE COMMITTEE THAT ASSUMES RESPONSIBLITY FOR OVERSIGHT OF THE AUDIT OF THE FINANCIAL STATEMENTS AND SELECTION OF THE INDEPENDENT ACCOUNTANT DID NOT CHANGE ITS OVERSIGHT PROCESS OR SELECTION PROCESS DURING THE CURRENT TAX YEAR. |
Schedule R IRS990ScheduleR
Id Disregarded Entities IdDisregardedEntitiesGrp
Disregarded Entity Name DisregardedEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | WILSON CARE LLC | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 915 W MICHIGAN STREET | AddressLine1Txt |
| City | SIDNEY | CityNm |
| State Abbreviation | OH | StateAbbreviationCd |
| ZIP | 45365 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 341734715 | EIN |
| Primary Activities | PHYSICIAN OFFICES | PrimaryActivitiesTxt |
| Legal Domicile State | OH | LegalDomicileStateCd |
| Total Income | -$1,549,006 | TotalIncomeAmt |
| End Of Year Assets | $3,933,120 | EndOfYearAssetsAmt |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | WILSON MEMORIAL HOSPITAL | BusinessNameLine1Txt |
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp
Disregarded Entity Name DisregardedEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | WILSON MEMORIAL HOSPITAL FOUNDATION | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 915 WEST MICHIGAN STREET | AddressLine1Txt |
| City | SIDNEY | CityNm |
| State Abbreviation | OH | StateAbbreviationCd |
| ZIP | 45365 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 521771615 | EIN |
| Primary Activities | SUPPORTING HOSPITAL ACTIVITIES | PrimaryActivitiesTxt |
| Legal Domicile State | OH | LegalDomicileStateCd |
| Exempt Code Section | 501(C)(3) | ExemptCodeSectionTxt |
| Public Charity Status | LINE 11A, I | PublicCharityStatusTxt |
| Direct Controlling NA | N/A | DirectControllingNACd |
| Controlled Organization | 0 | ControlledOrganizationInd |
Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp
Related Organization Name RelatedOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SLEEP LAB LLC | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 915 WEST MICHIGAN STREET | AddressLine1Txt |
| City | SIDNEY | CityNm |
| State Abbreviation | OH | StateAbbreviationCd |
| ZIP | 45365 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Legal Domicile State | OH | LegalDomicileStateCd |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SHELBY COUNTY MEMORIAL HOSPITAL | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Predominant Income Type | RELATED | PredominantIncomeTypeTxt |
| Share Of Total Income | $238,833 | ShareOfTotalIncomeAmt |
| Share Of EOY Assets | $178,913 | ShareOfEOYAssetsAmt |
| Disproportionate Allocations | 0 | DisproportionateAllocationsInd |
| General Or Managing Partner | 0 | GeneralOrManagingPartnerInd |
| Ownership | 0.60000 | OwnershipPct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | Yes (1) | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | Yes (1) | 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 | Yes (1) | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | 0 | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | 0 | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | Yes (1) | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | Yes (1) | 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
Other Organization Name OtherOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SLEEP LAB LLC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Transaction Type | J | TransactionTypeTxt |
| Involved | $23,327 | InvolvedAmt |
| Method Of Amount Determination | CASH | MethodOfAmountDeterminationTxt |