2014-11-14T11:33:47-06:00 2013-12-31 341827159 GILMORE JASION MAHLER LTD 1715 INDIAN WOOD CIRCLE STE 100 MAUMEE OH 43537 990 2013-01-01 341116795 HOSPITAL COUNCIL OF NORTHWEST OHIO HOSP 4198420800 3231 CENTRAL PARK WEST NO 200 TOLEDO OH 43617 W SCOTT FRY PRESIDENT & CEO 4198420800 2014-11-14 1 HEIDI FERGUSON P00410007 4197942000 2014-11-13 2013 2015-11-30 17:44:51Z W SCOTT FRY 3231 CENTRAL PARK WEST NO 200 TOLEDO OH 43617 4212238 0 X WWW.HCNO.ORG X 1973 OH SEE BELOW.THE HOSPITAL COUNCIL OF NORTHWEST OHIO IS A MEMBER DRIVEN ORGANIZATION THAT REPRESENTS AND ADVOCATES ON BEHALF OF ITS MEMBER HOSPITALS AND HEALTH SYSTEMS AND PROVIDES COLLABORATIVE OPPORTUNITIES TO ENHANCE THE HEALTH STATUS OF THE CITIZENS OF NORTHWEST OHIO. THE HOSPITAL COUNCIL IS DEDICATED TO: -BRINGING TOGETHER NORTHWEST OHIO'S HEALTH CARE LEADERS. -PROVIDING COLLABORATIVE OPPORTUNITIES TO ADDRESS HEALTHCARE PROVIDERS' SHARED CONCERNS. -DEVELOPING CREATIVE HEALTH-RELATED INITIATIVES TO IMPROVE THE REGION'S HEALTH STATUS. -PROVIDING EDUCATIONAL PROGRAMS FOR THE HEALTHCARE SECTOR. 22 21 27 48 0 0 1846679 1756767 2141688 2402613 1882 1565 21906 29224 4012155 4190169 1905276 1584782 0 0 1478150 1641812 0 0 0 1201683 970522 4585109 4197116 -572954 -6947 3374968 3767064 557990 957033 2816978 2810031 X THE HOSPITAL COUNCIL OF NORTHWEST OHIO IS A MEMBER DRIVEN ORGANIZATION THAT REPRESENTS AND ADVOCATES ON BEHALF OF ITS MEMBER HOSPITALS AND HEALTH SYSTEMS AND PROVIDES COLLABORATIVE OPPORTUNITIES TO ENHANCE THE HEALTH STATUS OF THE CITIZENS OF NORTHWEST OHIO. SEE SCHEDULE O THE HOSPITAL COUNCIL IS DEDICATED TO: -BRINGING TOGETHER NORTHWEST OHIO'S HEALTH CARE LEADERS. -PROVIDING COLLABORATIVE OPPORTUNITIES TO ADDRESS HEALTHCARE PROVIDERS' SHARED CONCERNS. -DEVELOPING CREATIVE HEALTH-RELATED INITIATIVES TO IMPROVE THE REGION'S HEALTH STATUS. -PROVIDING EDUCATIONAL PROGRAMS FOR THE HEALTHCARE SECTOR. 0 0 3910204 1584782 2439581 -PROVIDING COLLABORATIVE OPPORTUNITIES TO ADDRESS HEALTHCARE PROVIDERS' SHARED CONCERNS.-DEVELOPING, IMPLEMENTING, AND SECURING FUNDING FOR CREATIVE HEALTH-RELATED INITIATIVES TO IMPROVE THE REGION'S HEALTH STATUS.-PROVIDING EDUCATIONAL PROGRAMS FOR THE HEALTHCARE SECTOR. 3910204 1 1 0 1 0 0 0 0 1 0 1 0 0 0 0 1 1 0 0 0 0 0 0 0 1 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 39 0 1 27 1 0 0 0 0 0 0 0 0 0 0 X 22 21 0 0 0 0 1 1 1 1 1 0 0 0 1 1 1 1 1 1 1 0 OH X W SCOTT FRY 4198420800 3231 CENTRAL PARK WEST TOLEDO OH 43617 ALAN SATTLER TRUSTEE 4.00 X 0 0 0 BRADLEY BERTKE TRUSTEE 4.00 X 0 0 0 DALE THORNTON FORMER TRUSTEE 4.00 X 0 0 0 DANIEL L WAKEMAN TREASURER 4.00 X X 0 0 0 DANIEL SCHWANKE FORMER TRUSTEE 4.00 X 0 0 0 GARY ADKINS CHAIR- ELECT 4.00 X X 0 0 0 GARY CATES TRUSTEE 4.00 X 0 0 0 HOLLY BRISTOLL TRUSTEE 4.00 X 0 0 0 JTODD ALMENDINGER TRUSTEE 4.00 X 0 0 0 JACALYN LIEBOWITZ TRUSTEE 4.00 X 0 0 0 KEVIN COOK FORMER TRUSTEE 4.00 X 0 0 0 KEVIN WEBB PHD TRUSTEE 4.00 X 0 0 0 KIM BORDENKIRCHER TRUSTEE 4.00 X 0 0 0 LYNN DETTERMAN CHAIRMAN 4.00 X X 0 0 0 MICHAEL WINTHROP TRUSTEE 4.00 X 0 0 0 NORMA TOMLINSON TRUSTEE 4.00 X 0 0 0 PAM JENSEN TRUSTEE 4.00 X 0 0 0 PATRICK MARTIN IMMEDIATE PAST CHAIR 4.00 X X 0 0 0 PATTI FINN SECRETARY 4.00 X X 0 0 0 PHIL ENNEN TRUSTEE 4.00 X 0 0 0 ROBERT E GOSPODAREK FORMER CHAIRMAN 4.00 X X 0 0 0 ROSS MATLACK TRUSTEE 4.00 X 0 0 0 SCOTT C MALANEY TRUSTEE 4.00 X 0 0 0 SONYA SELHORST TRUSTEE 4.00 X 0 0 0 STANLEY KORDUCKI TRUSTEE 4.00 X 0 0 0 THOMAS ARQUILLA TRUSTEE 4.00 X 0 0 0 TRISH MCDANIEL INTERIM TRUSTEE 4.00 X 0 0 0 W SCOTT FRY PRESIDENT & CEO 20.70 19.30 X X 107657 100576 69463 JAN RUMA VICE PRESIDENT 44.10 X 156900 0 48991 264557 100576 118454 2 0 1 0 0 7000 3282 1204245 542240 1756767 CONTRACT INCOME 900099 1910552 1910552 MEMBERSHIP DUES 900099 492061 492061 2402613 1565 1565 14325 3282 22069 -7744 -7744 36968 36968 36968 4190169 2439581 0 -6179 1584782 1584782 277696 172171 105525 971202 922642 48560 93310 93069 241 213927 199127 14800 85677 76252 9425 20650 20650 8268 8268 332216 315313 16903 7100 100 7000 149151 122521 26630 34570 27752 6818 88070 80134 7936 47717 43761 3956 22235 13875 8360 2869 2381 488 15796 14846 950 PROGRAM EXPENSE 236747 236747 ORG DUES AND MEMBERSHIP 3490 3132 358 TRAINING 1041 1007 34 SUBSCRIPTIONS 602 592 10 4197116 3910204 286912 0 1098602 1989501 1985673 1000307 12000 144729 263639 606964 4987 18365 95193 87995 10067 7198 3374968 3767064 202440 157261 348656 799772 6894 0 557990 957033 X 1913057 1925302 903921 884729 2816978 2810031 3374968 3767064 -6947 0 X X 0 1 X 1 1 1 X 3633414 2370103 2952844 1846679 1756767 12559807 3633414 2370103 2952844 1846679 1756767 12559807 12559807 14229 3652 3038 1882 1565 24366 27087 27487 51153 42653 51293 199673 12783846 8344889 0.98250 0.98290 X SCHEDULE A, PART II, LINE 10, EXPLANATION OF OTHER INCOME: REIMBURSEMENT INCOME SPECIAL EVENT INCOME RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 0 1 716 0 0 1 994 0 0 1710 0 0 1 X 36269 32306 3963 58924 55689 3235 7198 X 4285632 73394 73394 4212238 -22069 -22069 4190169 4292579 95463 95463 4197116 0 4197116 PART IV, LINE 2B: HOSPITAL COUNCIL WAS A FISCAL AGENT AT THE BEGINNING OF THE YEAR FOR THE LUCAS COUNTY SUICIDE PREVENTION COALITION. THEY WERE NO LONGER AN AGENT AT THE END OF THE YEAR. PART X, LINE 2: MANAGEMENT OF THE ORGANIZATION IS REQUIRED TO DETERMINE WHETHER A TAX POSITION OF THE ORGANIZATION IS MORE LIKELY THAN NOT TO BE SUSTAINED UPON EXAMINATION BY THE APPLICABLE TAXING AUTHORITY, INCLUDING RESOLUTION OF ANY RELATED APPEALS OR LITIGATION PROCESSES, BASED ON THE TECHNICAL MERITS OF THE POSITION. MANAGEMENT OF THE ORGANIZATION IS NOT AWARE OF ANY TAX POSITIONS FOR WHICH IT IS REASONABLY POSSIBLE THAT THE TOTAL AMOUNTS OF UNRECOGNIZED TAX BENEFITS WILL SIGNIFICANTLY CHANGE IN THE NEXT TWELVE MONTHS. HOWEVER, MANAGEMENT'S CONCLUSIONS MAY BE SUBJECT TO REVIEW AND ADJUSTMENT AT A LATER DATE BASED ON FACTORS INCLUDING, BUT NOT LIMITED TO, NEW TAX LAWS, REGULATIONS, AND ADMINISTRATIVE INTERPRETATIONS (INCLUDING RELEVANT COURT DECISIONS). THE ORGANIZATION'S FEDERAL TAX RETURNS FOR THE PRIOR THREE YEARS REMAIN SUBJECT TO EXAMINATION BY THE INTERNAL REVENUE SERVICE. NO INTEREST OR PENALTIES WERE INCURRED OR RECOGNIZED IN 2013 OR 2012. PART XI, LINE 2D - OTHER ADJUSTMENTS: INTERCOMPANY TRANSACTIONS 73,394. PART XI, LINE 4B - OTHER ADJUSTMENTS: SPECIAL EVENT EXPENSE -22,069. PART XII, LINE 2D - OTHER ADJUSTMENTS: INTERCOMPANY TRANSACTIONS 73,394. SPECIAL EVENT EXPENSE 22,069. BLACK SWAMP GOLF 17607 3282 14325 3696 3195 2043 13135 17607 3282 14325 3696 3195 2043 13135 22069 -7744 1 BLANCHARD VALLEY HEALTH SYSTEM 1900 SOUTH MAIN STREET FINDLAY OH 45840 341369963 77869 SUPPORT BLUFFTON HOSPITAL 139 GARAU STREET BLUFFTON OH 45817 341369963 15520 SUPPORT COMMUNITY AND RURAL HEALTH SERVICES 410 BIRCHARD AVE FREMONT OH 43420 341120194 19500 SUPPORT COMMUNITY HOSPITALS AND WELLNESS CENTERSBRYAN 433 W HIGH STREET BRYAN OH 43506 341048666 16705 SUPPORT COMMUNITY HOSPITALS AND WELLNESS CENTERSMONTPELIER 909 SNYDER MONTPELIER OH 43543 341048666 5851 SUPPORT COMMUNITY MEMORIAL HOSPITAL 208 N COLUMBUS STREET HICKSVILLE OH 43526 346401873 29867 SUPPORT EAST TOLEDO FAMILY CENTER 1020 VARLAND AVENUE TOLEDO OH 43605 344429427 10000 SUPPORT FIRELANDS PHYSICIAN GROUP 1031 PIERCE STREET SUITE D SANDUSKY OH 44870 341608091 33000 SUPPORT FIRELANDS REGIONAL MEDICAL CENTER 1101 DECATUR STREET SANDUSKY OH 44870 344428218 24376 SUPPORT FISHER-TITUS MEDICAL CENTER 272 BENEDICT AVE NORWALK OH 44857 344430716 32943 SUPPORT FULTON COUNTY HEALTH CENTER 725 SOUTH SHOOP AVENUE WAUSEON OH 43567 344428214 18852 SUPPORT HENRY COUNTY HOSPITAL 1600 EAST RIVERVIEW AVENUE NAPOLEON OH 43545 344477047 17261 SUPPORT ISTHMUS LTD 240 BRYANT AVE WORTHINGTON OH 43085 010730930 118500 SUPPORT JOINT TOWNSHIP DISTRICT MEMORIAL HOSPITAL 200 ST CLAIR STREET ST MARYS OH 45885 341623770 17368 SUPPORT LIMA MEMORIAL HOSPITAL 1001 BELLEFONTAINE AVE LIMA OH 43504 341883284 8433 SUPPORT LUCAS COUNTY REGIONAL HEALTH DEPARTMENT 635 N ERIE STREET TOLEDO OH 43604 346400806 13500 SUPPORT MAGRUDER HOSPITAL 615 FULTON STREET PORT CLINTON OH 43452 344441792 14343 SUPPORT MEMORIAL HOSPITAL 715 SOUTH TAFT AVENUE FREMONT OH 43420 344430849 20575 SUPPORT MERCER COUNTY HEALTH DEPARTMENT 220 WEST LIVINGSTON ST B252 CELINA OH 45822 346400877 5640 SUPPORT MERCER COUNTY JT TWP COMMUNITY HOSPITAL 800 WEST MAIN STREET COLDWATER OH 45828 341101385 15571 SUPPORT MERCY HEALTH PARTNERS 2600 NAVARRE AVENUE OREGON OH 43616 341344482 7500 SUPPORT MERCY HOSPITAL OF DEFIANCE 1404 E SECOND STREET DEFIANCE OH 43512 020701635 9558 SUPPORT MERCY HOSPITAL OF TIFFIN 485 W MARKET STREET TIFFIN OH 44883 344431174 11240 SUPPORT MERCY HOSPITAL OF WILLARD 110 EAST HOWARD STREET WILLARD OH 44890 341577110 12491 SUPPORT MERCY PHYSICIAN ENTERPRISE 2200 JEFFERSON AVE TOLEDO OH 43624 264779623 15000 SUPPORT MERCY ST VINCENT MEDICAL CENTER 2224 CHERRY STREET TOLEDO OH 43608 344428250 42840 SUPPORT MERCY ST ANNE HOSPITAL 3404 SYLVANIA AVENUE TOLEDO OH 43623 311556404 21016 SUPPORT MERCY ST CHARLES HOSPITAL 2600 NAVARRE AVENUE OREGON OH 43616 344445373 25836 SUPPORT NORTHERN OHIO MEDICAL SPECIALISTS LLC 3004 HAYES AVE SANDUSKY OH 44870 341933718 10500 SUPPORT PAULDING COUNTY HOSPITAL 1035 W WAYNE STREET PAULDING OH 45879 346405718 40699 SUPPORT PERRY TOWNSHIP FIRE AND RESCUE 2408 E BREESE RD LIMA OH 45806 346401065 13515 SUPPORT PROMEDICA BAY PARK HOSPITAL 2801 BAY PARK DRIVE OREGON OH 43616 341883132 31559 SUPPORT PROMEDICA DEFIANCE REGIONAL HOSPITAL 1200 RALSTON AVE DEFIANCE OH 43512 344446484 17568 SUPPORT PROMEDICA FLOWER HOSPITAL 5200 HARROUN ROAD SYLVANIA OH 43560 344428794 26080 SUPPORT PROMEDICA FOSTORIA COMMUNITY HOSPITAL 501 VAN BUREN STREET FOSTORIA OH 44830 340898745 11862 SUPPORT PROMEDICA PHYSICIANS 5855 MONROE STREET SYLVANIA OH 43560 341880767 127500 SUPPORT PROMEDICA ST LUKES HOSPITAL 5901 MONCLOVA RD MAUMEE OH 43537 344428232 35304 SUPPORT PROMEDICA TOLEDO HOSPITAL 2142 NORTH COVE BLVD TOLEDO OH 43606 344428256 55578 SUPPORT SHEALY GROUP LTD 68 PARK AVENUE WEST MANSFIELD OH 44902 010724512 10500 SUPPORT ST RITA'S MEDICAL CENTER 730 W MARKET STREET LIMA OH 45801 341105619 50458 SUPPORT THE BELLEVUE HOSPITAL 1400 WEST MAIN BELLVUE OH 44811 344428205 26465 SUPPORT TREASURER STATE OF OHIOOHIO DEPARTMENT OF TRANSPORTATION 317 EAST POE BOWLING GREEN OH 43402 311334820 5000 SUPPORT UNITED WAY OF GREATER TOLEDO 424 JACKSON STREET TOLEDO OH 43604 344427947 50000 SUPPORT UNIVERSITY OF TOLEDO 3000 ARLINGTON TOLEDO OH 43614 346401483 93830 SUPPORT VAN WERT COUNTY HOSPITAL 1250 SOUTH WASHINGTON STREET VAN WERT OH 45891 344429514 16929 SUPPORT WGTE PUBLIC MEDIA 1270 S DETROIT AVE TOLEDO OH 43614 346554586 30900 SUPPORT WOOD COUNTY HOSPITAL 950 W WOOSTER STREET BOWLING GREEN OH 43402 344440884 55821 SUPPORT 35 12 PART I, LINE 2: THE PROGRAM STAFF WORK CLOSELY WITH EACH SUB GRANTEE REGARDING PAPER WORK NEEDED. ALL SUB GRANTEES MUST SUBMIT DOCUMENTATION FOR REIMBURSEMENT OF ALL EXPENDITURES. WHEN NECESSARY, THE ASSISTANT CONTROLLER TRACKS EXPENDITURES TO ENSURE ADHERENCE TO THE BUDGET; IN ADDITION, THE PROGRAM DIRECTOR WORKS WITH FINANCE TO OVERSEE THE GRANT AND MANTAIN COMPLIANCE WITH APPLICABLE MANDATES. X X X 0 0 0 0 0 0 0 0 0 W SCOTT FRY PRESIDENT & CEO 102507 95765 0 0 5150 4811 19193 17930 16720 15620 143570 134126 0 0 JAN RUMA VICE PRESIDENT 156289 0 0 0 611 0 19678 0 29313 0 205891 0 0 0 FORM 990, PART VI, SECTION A, LINE 6 AREA HOSPITALS COMPRISE THE MEMBERSHIP OF HOSPITAL COUNCIL OF NORTHWEST OHIO. FORM 990, PART VI, SECTION A, LINE 7A THESE MEMBER HOSPITALS MAY ELECT ONE OR MORE MEMBERS OF THE GOVERNING BODY. FORM 990, PART VI, SECTION A, LINE 7B THE GOVERNING DECISIONS OF THE FILING ENTITY ARE SUBJECT TO APPROVAL BY THE MEMBER HOSPITALS. FORM 990, PART VI, SECTION B, LINE 11 THE ORGANIZATION'S SIGNING OFFICER SCANS THE FORM 990 FOR COMPLETENESS PRIOR TO SIGNATURE, IN ADDITION TO RELYING UPON THE INDEPENDENT ACCOUNTANT FOR ACCURACY. FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION REGULARLY AND CONSISTENTLY MONITORS AND ENFORCES COMPLIANCE WITH THE CONFLICT OF INTEREST POLICY. FORM 990, PART VI, SECTION B, LINE 15 THE GOVERNING BODY USES A PROCESS FOR DETERMINING COMPENSATION OF THE ORGANIZATION'S CEO OR TOP MANAGEMENT OFFICIALS WHICH INCLUDES A COMPARISON TO OTHER ORGANIZATIONS, SALARY SURVEYS, AND CONTEMPORANEOUS SUBSTANTIATION OF THE DELIBERATION AND DECISION ON AN ANNUAL BASIS. THE ORGANIZATION USES A PROCESS FOR DETERMINING COMPENSATION OF THE ORGANIZATION'S OFFICERS OR KEY EMPLOYEES WHICH INCLUDES A REVIEW AND APPROVAL BY THE CEO, USE OF MANAGEMENT SURVEYS, AND CONTEMPORANEOUS SUBSTANTIATION OF THE DELIBERATION AND DECISION ON AN ANNUAL BASIS. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST. FORM 990, PART XII, LINE 2C: THE ORGANIZATION HAS A COMMITTEE THAT ASSUMES REPSONSIBILITY FOR OVERSIGHT OF THE AUDIT OF ITS FINANCIAL STATEMENTS AND SELECTION OF AN INDEPENDENT ACCOUNTANT. NORTHWEST OHIO SHARED SERVICES 3231 CENTRAL PARK WEST DR TOLEDO OH 43617 341388279 PURCHASE CORPORATION OH N/A C 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 1 0 1 0 0 NORTHWEST OHIO SHARED SERVICES INC L 121784 NORTHWEST OHIO SHARED SERVICES INC O 139216 NORTHWEST OHIO SHARED SERVICES INC Q 76806