2015-11-13T13:07:19-07:00 2014-12-31 990 2014-01-01 340714771 THE UNION HOSPITAL ASSOCIATION UNIO 3303433311 659 Boulevard Dover OH 44622 Eugene A Thorn III Vice President - Finance 3303640805 2015-10-20 2014 2016-03-07 17:11:31Z Union Hospital Eugene A Thorn III 659 Boulevard Dover OH 44622 116680675 0 X www.unionhospital.org X 1906 OH To provide excellent quality health care to the community at a competitive price through highly competent people and an integrated provider network. 17 16 1218 135 157779 33699 79070 218286 84113424 89078567 5060457 2686500 13569380 13644317 102822331 105627670 0 0 0 0 52654862 54506895 0 0 1214042 42421668 42835671 95076530 97342566 7745801 8285104 163042892 190897665 41831406 63285352 121211486 127612313 Patient Care: The Union Hospital Association provides quality medical health care regardless of race, creed, sex, national origin, handicap, age or ability to pay. 0 0 66533163 0 88947544 The Union Hospital Association provided quality medical health care regardless of race, creed, age, sex, national origin, handicap, or the ability to pay. Hospital medical services provided 5,196 inpatients a total of 19617patient days and 250,787 outpatient visits a total of 317,982 procedures. 346367 0 52824 Patient and family support programs, general and other: During 2014 Union Hospital provided 53,319 meals for residents who were unable to prepare meals for themselves due to medical limitations. These meals are provided at cost and are delivered by a volunteer group, Mobile Meals. The Hospital had 135 volunteers donate 19,955 hours toward the common purpose of serving the health care needs of the community. The value of these hours is $189573 which is returned to the community through lower cost of patient services. The Hospital co sponsors annual events that provides laboratory tests and blood pressure checks for the residents of the community; these services are provided at or below cost. Medicare and Medicaid made up 55% of patient care provided. The Hospital also participates in a local program called Rainbow Connection, a non profit charity that is dedicated to emitting the needs of disadvantaged and disabled resident of Tuscarawas County; we write off 50% of all charges for those patients while the program pays the remaining 50%. We also provided to the local Hospice agency a write off specified charges for individuals under this program (105 patients, $93,059). We sponsor a Helpline program that enabled 750 elderly and disabled consumers the opportunity to remain in their homes and feel safe in that setting. Since the Hospital does not provide mental health services as part of its normal operations, we lease building space to Community Professional Services, a mental health non profit organization at $2.04 per square foot, well below the average rate of $11.75 per square foot. Thus the rental rate and related in kind support provided by the Hospital are justified as a continuance of our mission. We operate a 35ft mobile medical vehicle that provides screenings to the areas that would have been underserved. An outreach sports medicine program provides training to various school to promote healthy athletes and physicals at a fraction of the cost. The Hospital supports and hosts various groups such as Down Syndrome, RSD, pain management, cancer supports,etc. We also provide babysitting and AARP driving courses to the community and sent out 55,000 biannual healthy newsletters to the community. 0 0 0 66879530 1 1 0 0 0 0 0 0 0 0 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 108 0 1218 1 1 1 0 0 0 0 0 X 17 16 0 0 0 0 1 0 0 1 1 0 0 1 1 1 1 1 1 1 1 1 1 OH X Eugene A Thorn III 3303640805 659 Boulevard Dover OH 44622 John R Herzig Board Member 2 0 X 0 0 0 James J Pringle Board Member 2 0 X 0 0 0 Anne E Geib Board Member 2 0 X 0 0 0 Agnes K Swigart Board member 2 0 X 0 0 0 Mark N Kubina Medical Staff President 2 0 X 0 0 0 Robert A Horn Vice Chairman 2 0 X 0 0 0 Craig B Laughlin Treasurer 2 0 X 0 0 0 Lois E Andreas Board Member 2 0 X 0 0 0 Robert E Moore Jr Board member 2 0 X 0 0 0 C Jason Deeds Board member 2 0 X 0 0 0 John E Dooling Board Member 2 0 X 0 0 0 Perry L Hershberger Board Member 2 0 X 0 0 0 Andrew J Wherley Medical Staff Past President 2 0 X 0 0 0 James E Knisely Chairman 2 0 X 0 0 0 William V Swoger Medical Staff Vice President 2 0 X 0 0 0 Kevin Gray board member 2 0 X 0 0 0 Darwin K Smith Vice President 40 0 X 145930 0 14168 Thomas J Kelly Jr Vice President 40 0 X 176371 0 2056 Eugene A Thorn III Vice President 40 0 X 213916 0 8908 Robert J Craig Vice President 40 0 X 168245 0 0 Jody Stoldt Vice President 40 0 X 139996 0 12216 R Bruce James President and CEO 40 0 X 366520 0 15000 Diana L Boyd Vice President 40 0 X 158015 0 8238 Todd Meyerhoefer Vice President Medical Affairs 40 0 X 237878 0 9920 Mathew Noyes Physician 40 0 X 617288 0 15000 James McQuillan Physician 40 0 X 703629 0 15000 Robert Levitt Physician 40 0 X 731176 0 13940 Thomas Teater Physician 40 0 X 590515 0 15000 Joseph Zemis Physician 40 0 X 1010500 0 15000 5259979 0 144446 59 0 1 0 Emergimed Inc 659 Boulevard Dover OH 44622 Emergency services 5297246 Seneca Medical PO BOX 712361 Cincinnati OH 45271 Seller of medical equipment 2926520 Cardinal Health 5490 Collections Center Drive Chicago IL 60693 Seller of medical drugs 4968791 Anesthesia Care of Union Hospital 659 Boulevard Dover OH 44622 Anesthesia and pain care associates 1702537 Milestone Healthcare L 3452 Columbus OH 43260 Management and subcontract labor 900470 89 0 0 0 0 0 218286 0 218286 Net patient revenue 622000 89000368 89000368 0 0 Laboratory services 621500 78199 0 78199 0 0 0 0 0 89078567 2678281 2598701 79580 0 0 0 0 0 0 0 0 0 892271 0 457303 0 434968 0 434968 0 0 434968 0 8219 0 0 0 8219 8219 0 0 8219 0 21352507 10595702 10756805 10756805 0 0 Health promotion 900099 50503 50503 0 0 Helpline program 900099 133257 133257 0 0 Athletic training 900099 83804 83804 0 0 2184980 2184980 0 0 2452544 105627670 104808418 157779 443187 X 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 43106863 35428483 7207515 470865 2220059 0 2220059 0 5513088 0 5513088 0 3666885 3193671 437975 35239 0 0 0 0 160760 0 160760 0 68632 0 68632 0 0 0 0 0 0 0 0 0 0 0 18154935 14715930 3331321 107684 555815 56745 499070 10004958 8796612 1187431 20915 1633006 0 1633006 0 0 0 0 0 2092286 1182680 909003 603 179617 81427 93101 5089 0 0 0 0 18603 6693 11740 170 1201012 719166 481846 0 0 0 0 0 5188662 2681355 2498072 9235 890188 0 890188 0 Miscellanous 2341365 0 2278804 62561 Dues 210131 10894 196659 2578 Meals 50201 2465 47703 33 Education expense 85500 3409 82091 0 97342566 66879530 29248994 1214042 6277449 6660440 0 0 0 0 12523158 13255729 0 0 0 0 2274694 2257544 1448405 1507979 135072741 87093213 48338771 47979528 49841503 49306250 2057398 1457386 2009690 769511 38271824 67703298 163042892 190897665 7979720 8665394 25685000 45060000 3247308 2370000 4919378 7189958 41831406 63285352 X 108244235 113542503 399983 1515397 12567268 12554413 121211486 127612313 163042892 190897665 X 8285104 -139807 0 0 0 -1744470 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1105252 1105252 0 56501481 26517730 29983751 0 2616769 2296902 319867 0 73835106 58278581 15556525 0 1014133 0 1014133 47979528 Asset whose use is limited by donor specification 139129 Assets Held by trustees under bond indenture 18433795 Trust agreeements 12554413 Other receivables 33258544 Interest in TVRCC 1532365 Contribution receivable 1370687 Deferred financing costs 414365 67703298 0 Interest payable 43618 Workers compensation payable 232381 Interest rate swap agreements 4322948 Accrued payroll withholdings 2234360 Other payables 356651 7189958 X Schedule D, Part X, Line 2 The Hospital is a not for profit corporation exempt from federal income taxes under Section 501c3 of the Internal Revenue Code; therefore no revision has been made for federal income taxes in the accompanying financial statements. In addition the IRS has determined taht the Hospital is not a "private foundation" within the meaning of section 509(a) of the code. 1 1 X 1 X 1 X 1 1 1 0 1 1 3426863 0 3426863 13098190 10993650 204540 0 0 16525053 10993650 3631403 0 40 42548 346367 52824 293543 13 2700 0 2700 53 42548 349067 52824 296243 0 53 42548 16874120 11046474 3927646 0 1 5660411 24550 29386657 20804048 8582609 X 1 1 Tuscarawas Ambulatory Surgery Center ambulatory surgery center 0.7 0 0.3 1 1 The Union Hospital Association 659 Boulevard Dover OH 44622 www.unionhospital.org X X X The Union Hospital Association 1 0 0 1 X X X X X X X X X 12 1 0 0 1 X www.unionhospital.org 1 13 1 www.unionhospital.org 0 0 1 X 100 300 X 1 1 X X 1 X X 1 X X 0 X X X X 1 X 0 0 Schedule H, Part V, Section B, Line 5-The Union Hospital Association The Hospital's panel included area physicians and medical leaders from all aspects of patient care including mental health care, senior citizen care.They ranged from Emergency room physicians to family care doctors practicing in the area to Alcohol and drug counselors. The information obtained was used to address and discover the community's health needs. Schedule H, Part V, Section B, Line 11-The Union Hospital Association The Hospital has taken all the needs that were brought up into consideration and then analyzed the ones that the Hospital could help meet. A committee was organized to determine which ones the Hospital could make an impact and which ones the Hospital couldn't address by itself but could assist in a collaberation of efforts with other health leaders. Schedule H, Part V, Section B, Line 13h-The Union Hospital Association The policy lists criteria for charges 6 Tuscarawas Ambulatory Surgery Center 320 Oxford Street Dover OH 44622 Ambulatory surgery center Tuscarawas Valley Regional Cancer Center 659 Boulevard Dover OH 44622 Physician oncology center Union Physician Services LLC 300 Medical Park Drive Suite 101 C Dover OH 44622 Physician offices DASCO UH Home Medical Equipment LLC 375 North West Street Westerville OH 43082 Home medical equipment sales UHMS LLC 659 Boulevard Dover OH 44622 Physician offices Union Pharmacy Care 659 Boulevard Dover OH 44622 Pharmaceutical Schedule H, Part I, Line 7 Used the ratio of patient cost to charge from worksheet 2 to calculate charity care. Schedule H, Part III, Section A, Line 4 Patient accounts are due in full when billed. Accounts are considered delinquent and subsequently writteon off as bad debt based on individual credit evaluation and cirmcumstances of the account. Line 2 represetn 3% if gross patient revenue as seen as being uncollectible by self pay patients based on historical trending valuations. A bad debt expense footnote is not presented in the notes to the financial statements. Schedule H, Part III, Section B, Line 8 Amounts are generated by the Medicare cost report which utilizes a department cost to charge methodology. Schedule H, Part III, Section C, Line 9b The Hospital will refund any monies paid on an account deemed charity or that qualifies for financial assistance once that assessment has been determined. The account is then written off to such classification and any or all collections will cease after determination has been made. Schedule H, Part VI, Line 2 Our community wellness department is committed to addressign teh health assessments and concerns of our community. The department compiled the data gathered by utilizing secondary sources such as teh CDC adn Ohio Obesity prevention. We had identified six areas taht are of high concern in our community; they are cancer, diabetes, heart disease and strokes, physical activity, tobacco use, and the overall education in the community. In response to the areas of concern the Hospital offers blood pressure and cholesterol screenings, fasting blood sugar tests, vascular screenings at a reduced cost. WE also have a cancer prevention day and sponsors many marathon training sessions, supports youth fit iniative and maintains a walking trail Schedule H, Part VI, Line 3 Patients are given an informational booklet upon admission to the Hospital, this booklet contains information regardng contact with patient account representatives, accepted insurances and other payment options for insured and underinsured. The Hospital also employees a patient financial specialist who meets with the patient and or family to discuss factors of qualifying information. Financial assistance is provided with the first billing. Schedule H, Part VI, Line 4 Tuscarawas county is one of the 88 counties of the State of Ohio. The county has a population of approximately 91,000 residents with 25% under teh age of 25 and 25% between 45-62. It is predominately caucasian and is set in a rural setting with 7.2% families being below the poverty level. Schedule H, Part VI, Line 5 Hospital provides low cost clinics for blood pressure, cholesterol screenings, cancer screenings, and diabetes clinics to the area to help the community stay healthy and prevent diseases. We offer health fairs and promote health speakers on various health and safety issues at no cost to the person. Schedule H, Part VI, Line 7 Not filed with any state. X X 0 0 0 0 0 0 0 0 0 R Bruce James President and CEO 318463 0 53577 0 0 0 15000 0 15283 0 402323 0 0 0 Darwin K Smith Vice President 132150 0 13780 0 0 0 7929 0 14168 0 168027 0 0 0 Diana L Boyd Vice President 142838 0 15177 0 0 0 8238 0 6495 0 172748 0 0 0 Robert J Craig Vice President 152170 0 16075 0 0 0 9130 0 15889 0 193264 0 0 0 Eugene A Thorn III Vice President 194386 0 19530 0 0 0 8908 0 16153 0 238977 0 0 0 Thomas J Kelly Jr Vice President 150879 0 25492 0 0 0 2056 0 2342 0 180769 0 0 0 Jody Stoldt Vice President 128589 0 11407 0 0 0 12216 0 1258 0 153470 0 0 0 Todd Meyerhoefer Vice President Medical Affairs 237878 0 0 0 0 0 9920 0 15813 0 263611 0 0 0 Mathew Noyes Physician 617288 0 0 0 0 0 15000 0 19004 0 651292 0 0 0 James McQuillan Physician 703629 0 0 0 0 0 15000 0 17940 0 736569 0 0 0 Robert Levitt Physician 555501 0 175675 0 0 0 13940 0 19510 0 764626 0 0 0 Thomas Teater Physician 590515 0 0 0 0 0 15000 0 18510 0 624025 0 0 0 Joseph Zemis Physician 610500 0 400000 0 0 0 15000 0 20858 0 1046358 0 0 0 A Tuscarawas County Ohio 346002853 90069baa2 2009-10-15 27515000 Re issue of 1993 and 2001 bonds 1 1 0 A 0 0 0 0 0 0 484184 0 0 2969070 0 0 2009 1 1 1 1 A 0 0 0 0 0 0 0 1 0 1 A 0 0 0 0 1 1 RBS Citizens NA 20.5 0 0 0 0 1 A 1 Form 990, Part VI, Section A, Line 6 The Association has a 17 member board of trustees who oversee the management of the Hospital. All monthly financial reporting is presented to the board of trustees. The trustees also oversee hiring of any upper management and the approval of all capital and operating budgets Form 990, Part VI, Section B, Line 11b The 990 is prepared internally by the Manager of Accounting. The general ledger is reconciled to the appropriate schedules on the form and to the audited financial statements. It is then forwarded to the Chief Financial Officer who reviews it for completeness and accuracy. After his review it is then submitted to the finance committee made up of board of trustee members; after the review it is then forwarded to the Board of trustees for review and approval. The return is also reviewed by an independent accounting firm. Form 990, Part VI, Section B, Line 12c Officers and members are required annually to review the conflict of interest policy and make any known conflicts that may have or have arose or any other discloseable event. If any notable event is disclosed it is reported to the Hospital CEO and Chairman of the Board. Additionally all financial transactions are reviewed through the Hospital's accounting systems. Form 990, Part VI, Section B, Line 15 Compensations are established based on the appropriate healthcare industry standards and related surveys. Compensation amounts for the key management is reviewed by the Executive Committee of the Board of Trustees. Form 990, Part VI, Section C, Line 19 The public at anytime during normal business hours inquire at the administrative office in the main campus adn ask for a copy of the Form 990. The public may view on the Hospital's website the annual report and community benefit report. Form 990, Part IX, Line 11g professional fees, contract labor and purchased maintenance agreements Form 990, Part XI, Line 9 Swap valuation and loss on debt Union Hospital Medical Services 659 Boulevard Dover OH 44622 270273520 Physician offices OH -736952 184807 N/A Union Physician Services 659 Boulevard Dover OH 44622 264215547 Physician office OH -7496773 2435130 N/A Tuscarawas Valley Regional Cancer Center 659 Boulevard Dover OH 44622 340000100 Physician and Hospital Organization OH 501c3 3 N/A 0 Union Hospital Auxillary 659 Boulevard Dover OH 44622 341204928 Fundraising for the Hospital OH 501c3 11-III-FI N/A 0 Tuscarawas Ambulatory Surgery Center 320 Oxford St Dover OH 44622 311525875 Ambulatory surgery center OH N/A Related 592842 1357837 0 2513 0 0.7 Dasco Union Hospital Home Medical Equipment LLC 375 N West St Westerville OH 43082 270495743 Durable medical equipment sales OH N/A Unrelated 79580 192331 0 0 0.5 Valley Healthcare Inc 659 Boulevard Dover OH 44622 341654921 Inactive OH N/A C 0 0 1 Union Care Corporation 659 Boulevard Dover OH 44622 341556177 Inactive OH N/A C 0 0 1 Union Pharmaceutical Care 659 Boulevard Dover OH 44622 043588229 Retail pharmacy sales OH N/A C 4155 27405 1 0 1 0 0 0 0 1 0 0 0 1 0 0 0 0 0 0 1 0 0 Tuscarawas Valley Regional Cancer Center f 500000 Receives distributuions from TVRCC Union Hospital Auxillary c 205000 Annual donation Tuscarawas Ambulatory Surgery Center a-iv 400505 lease payments Tuscarawas Ambulatory Surgery Center j 400505 Lease payments received Dasco Union Hospital Home Medical Equipment LLC a-iv 13600 Fair market value of space rented Correct and accurate return