2014-10-31T15:02:43-05:00 2013-12-31 351178661 BLUE & CO LLC 8800 LYRA DRIVE SUITE 450 COLUMBUS OH 43240 990 2013-01-01 310650283 MCCULLOUGH-HYDE MEMORIAL HOSPITAL MCCU 5135245310 110 NORTH POPLAR STREET OXFORD OH 45056 JOHN CLEMENTS VICE PRESIDENT/CFO 5135245310 2014-10-31 1 NANCY KIRCHNER P00386751 6148852583 2014-10-31 2013 2015-11-30 17:44:51Z JOHN CLEMENTS 110 NORTH POPLAR STREET OXFORD OH 45056 62833898 0 X WWW.MHMH.ORG X 1953 OH ACUTE CARE HOSPITAL FACILITY DELIVERING QUALITY SERVICES TO OUR PATIENTS AND THE COMMUNITIES WE SERVE. 10 10 624 225 -119185 -67172 1369732 319340 59762684 60187052 27436 32371 671777 2075373 61831629 62614136 18650 17800 0 0 28007913 28295900 0 0 0 33654733 34089514 61681296 62403214 150333 210922 45799306 43437362 21957803 19401702 23841503 24035660 X ACUTE CARE HOSPITAL FACILITY DELIVERING QUALITY SERVICES TO OUR PATIENTS AND THE COMMUNITIES WE SERVE. 0 0 7350842 9497899 PHARMACY-CONSISTING OF CARE PROVIDED TO INPATIENTS (19%) AND OUTPATIENTS (81%). OUTPATIENT CARE INCLUDES A MAJOR PROGRAM FOR ONCOLOGY TREATMENT. 7307763 9442516 SURGERY-IS COMPRISED OF SURGERY, ENDO/MINOR PROCEURES, SAME DAY SURGERY AND ANESTHESIA. TOTAL VOLUME IS 9,615 CONSISTING OF IP CARE (23%) AND OUTPATIENT CARE (77%). 7155442 0 9245698 INPATIENT CARE INPATIENT VOLUME CONSISTED OF 2,237 DISCHARGES AND 7,721 PATIENT DAYS WITH AN AVERAGE LENGTH OF STAY OF 3.5 DAYS. BIRTHS TOTALED 409 WITH A TOTAL OF 713 OBSERVATION DAYS OF SERVICE. 24767359 17800 32000938 OVERALL, INPATIENT AND OUTPATIENT CARE REPRESENT 26% AND 74% OF GROSS PATIENT REVENUE, RESPECTIVELY. 24767359 17800 32000938 46581406 1 1 0 1 0 0 0 0 0 0 1 0 0 1 1 1 1 1 0 0 0 0 0 0 0 0 1 1 1 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 55 0 1 624 1 1 1 0 0 0 0 0 0 0 0 0 X 10 10 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 IN OH X JAMES MILLER 5135245310 110 NORTH POPLAR STREET OXFORD OH 450561292 JOHN HARLAND MD VICE CHAIRMAN 1.00 X 0 0 0 SUSAN CROSS LIPNICKEY TRUSTEE 1.00 X 0 0 0 JACK MANN TRUSTEE 1.00 X 0 0 0 RICHARD M NORMAN CHAIRMAN 1.00 X 0 0 0 ALAN OAK SECRETARY-TREASURER 1.00 X 0 0 0 WILLIAM DOUGLAS ROSS DO TRUSTEE 1.00 X 0 0 0 THOMAS W SPEH TRUSTEE 1.00 X 0 0 0 PAIGE WOOD TRUSTEE 1.00 X 0 0 0 STEPHEN FLEE TRUSTEE 1.00 X 0 0 0 RALPH R GUTOWSKI TRUSTEE 1.00 X 0 0 0 BRYAN HEHEMANN CEO 40.00 40.00 X 206702 0 25126 JOHN CLEMENTS VP & CFO 40.00 40.00 X 141240 0 12499 PAMELA COLLINS VP & CPSO 40.00 40.00 X 126237 0 12674 TAMMY LANGDON VP & CAO 40.00 40.00 X 66822 0 9 KENNETH KELLER PHYSICIAN 40.00 X 155470 0 13437 BRYAN MCCULLOUGH PHYSICIAN 40.00 X 143979 0 10181 MARK CRISTELL PT DIRECTOR 40.00 X 128655 0 26502 MATTHEW DAGGY PHYSICIAN 40.00 X 238514 0 23652 DONALD WATSON PHARMACY DIRECTOR 40.00 X 128956 0 26509 1336575 0 150589 15 0 1 0 CPSI 6600 WALL STREET MOBILE AL 36695 COMPUTER SYSTEMS 620971 CHRIST HOSPITAL 2139 AUBURN AVE CINCINNATI OH 45219 PHYSICIAN SERVICES 540957 COUSIN CONSTRUCTION CO 2930 HIGHLAND AVE CINCINNATI OH 45212 CONSTRUCTION 472315 NEACE LUKENS-COLUMBUS 400 SMITH ROAD CINCINNATI OH 45209 INSURANCE 377727 GE HEALTHCARE PO BOX 96483 CHICAGO IL 60693 MEDICAL EQUIPMENT REPAIR 369979 24 319340 319340 PATIENT SERVICES 900099 60187052 60187052 60187052 29686 29686 207062 219762 -12700 -12700 -119185 106485 2685 0 2685 2685 2685 EHR PAYMENTS 900099 1138844 1138844 MANAGEMENT INCOME 900099 424838 424838 DIETARY 722210 235495 235495 288896 288896 2088073 62614136 60187052 -119185 2226929 X 17800 17800 554407 399173 155234 21597701 15550345 6047356 321784 231684 90100 4232751 3047581 1185170 1589257 1144265 444992 206884 206884 106200 106200 3466 2426 1040 6247914 4373540 1874374 372100 7442 364658 1003938 953741 50197 1571448 1021441 550007 2358320 282998 2075322 52348 25127 27221 71881 30190 41691 580083 417660 162423 3952582 2845859 1106723 MEDICAL SUPPLIES 9314886 9314886 BAD DEBT 6884054 6815213 68841 MISCELLANEOUS 1039519 93557 945962 PROF/GL INS 323891 6478 317413 62403214 46581406 15821808 0 X 2325 4863 4925984 3839824 8518246 8266724 1120098 1104485 1479791 1399254 76637687 52108825 26135207 24528862 3617655 4293350 45799306 43437362 4156380 3547365 15101425 13450826 2699998 2403511 21957803 19401702 X 23841503 24035660 23841503 24035660 45799306 43437362 210922 -16765 0 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 6031 6031 0 PART II-B, LINE 1: SUPPORT PROVIDED THRU DUES PAID TO OHA AND AHA FOR DIRECT COMMUNICATION WITH CERTAIN MEMBERS OF FEDERAL, STATE, OR LOCAL GOVERNMENT. 548616 548616 28614581 15744304 12870277 4319745 1559106 2760639 42696190 34805415 7890775 458555 458555 24528862 UNAMORTIZED FINANCE COSTS 124727 DOCTORS' LOANS RECEIVABLE 635453 CASH SURRENDER VALUE 280132 DUE FROM RELATED PARTY 2265495 ACCRUED INVESTMENT INCOME 1290 BOARD DESIGNATED INVESTMENTS 986253 4293350 ESTIMATED THIRD PARTY SETTLEMENTS 701323 A/R CREDIT BALANCE - UNCLAIMED FUNDS 959235 OTHER LIABILITIES 742953 2403511 X 62817134 -16764 -16764 62833898 -219762 -219762 62614136 62622976 219762 219762 62403214 0 62403214 PART X, LINE 2: ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA REQUIRE MANAGEMENT TO EVALUATE TAX POSITIONS TAKEN BY THE HOSPITAL AND RECOGNIZE A TAX LIABILITY IF THE HOSPITAL HAS TAKEN AN UNCERTAIN POSITION THAT MORE LIKELY THAN NOT WOULD NOT BE SUSTAINED UPON EXAMINATION BY VARIOUS FEDERAL AND STATE TAXING AUTHORITIES. MANAGEMENT HAS ANALYZED THE TAX POSITIONS TAKEN BY THE HOSPITAL, AND HAS CONCLUDED THAT AS OF DECEMBER 31, 2013 AND 2012, 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 HOSPITAL IS SUBJECT TO ROUTINE AUDITS BY TAXING JURISDICTIONS; HOWEVER, THERE ARE CURRENTLY NO AUDITS FOR ANY TAX PERIODS IN PROGRESS. PART XI, LINE 4B - OTHER ADJUSTMENTS: RENTAL EXPENSE RECLASS -219,762. PART XII, LINE 2D - OTHER ADJUSTMENTS: RENTAL EXPENSE RECLASS 219,762. 1 1 1 X 1 X 1 1 0 1 1 1085181 396886 688295 0.01240 5446312 3348276 2098036 0.03780 6531493 3745162 2786331 0.05020 137844 137844 0.00220 137844 137844 0.00220 6669337 3745162 2924175 0.05240 1 6884053 1754931 8637909 10594090 -1956181 X 1 1 1 1 MCCULLOUGH HYDE MEMORIAL HOSPITAL 110 N POPLAR ST OXFORD OH 45056 X X X MCCULLOUGH-HYDE MEMORIAL HOSPITAL 1 1 X X X X X X X X 13 1 1 1 X HTTP://MHMH.ORG/ABOUT-ANNUAL.ASPX X X X X 1 0 1 1 100.000000000000 1 300.000000000000 1 X 1 1 X X X X 1 X X 1 X X X X 1 X 0 0 MCCULLOUGH-HYDE MEMORIAL HOSPITAL PART V, SECTION B, LINE 4: REGIONAL HEALTH NEEDS ASSESSEMENT CONDUCTED BY GREATER CINCINNATI HEALTH COUNCIL MCCULLOUGH-HYDE MEMORIAL HOSPITAL PART V, SECTION B, LINE 5D: COMMUNITY FORUMS MCCULLOUGH-HYDE MEMORIAL HOSPITAL PART V, SECTION B, LINE 11: $34,470 BASE + 4,020/ADD'L FAMILY MEMBER MCCULLOUGH-HYDE MEMORIAL HOSPITAL PART V, SECTION B, LINE 20D: APPLIED 30% DISCOUNT PART II, COMMUNITY BUILDING ACTIVITIES: MCCULLOUGH-HYDE MEMORIAL HOSPITAL PROMOTES HEALTH AND WELLBEING IN OUR COMMUNITY IN NUMEROUS WAYS NOT LISTED IN THE COMMUNITY EVENTS AND PROGRAMS SECTION OF THE 990. EXAMPLES INCLUDE: 1. MHMH HELPED PROMOTE WELLNESS BY PROVIDING MEETING SPACE TO THE INFANT/CHILD LOSS BEREAVEMENT SUPPORT GROUP AND FIBROMYALGIA SUPPORT GROUP. 2. MHMH ASSISTED OUR LOCAL SCHOOL DISTRICT WITH IDENTIFIEDHEALTH/WELLNESS NEEDS. EXAMPLES INCLUDE: A. DEVELOPED AND PROVIDED CRISIS CARDS FOR ALL 8TH GRADERS AND ALL COUNSELORS IN THE SCHOOL DISTRICT B. DEVELOPED CURRICULUM THAT COMBINED TRADITIONAL LEARNING WITH EXERCISE TO HELP FIGHT OBESITY IN OUR ELEMENTARY STUDENTS C. DEVELOPED AND HELD MINI HEALTH SEMINARS FOR 6TH GRADE STUDENTS ON SLEEP, NUTRITION, EXERCISE AND MENTAL HEALTH 3. MHMH PROVIDED OFFICE SPACE AND MEETING SPACE FOR THE OXFORD COLLEGE CORNER CLINIC, WHICH IS A CLINIC THAT PROVIDES FREE HEALTH CARE TO THE UNINSURED AND UNDERINSURED ADULTS IN OUR COMMUNITY 4. MHMH IMPROVED THEIR EMPLOYEE WELLNESS PROGRAM BY: A. IMPLEMENTING A HEALTH RISK ASSESSMENT FOR THEIR EMPLOYEES TO IDENTIFY HEALTH NEEDS/CONCERNS IN OUR EMPLOYEE POPULATION B. OFFERING MAMMOGRAMS AND PROSTATE SCREENING TO APPROPRIATE EMPLOYEES FREE OF CHARGE C. INCENTIVIZING EMPLOYEES TO ADOPT HEALTHIER BEHAVIOR PART III, LINE 4: 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 WITH 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 SOURCE USED TO DETERMINE THE AMOUNT OF MEDICARE ALLOWABLE COSTS REPORTED FOR PART III, SECTION B, MEDICARE HAS BEEN PROVIDED FROM THE YEAR ENDED DECEMBER 31, 2012 REPORT: HOSPITAL STATEMENT OF REIMBURSABLE COST. PART III, LINE 9B: ONCE IT HAS BEEN DETERMINED THAT A PATIENT QUALIFIES FOR CHARITY CARE/FINANCIAL ASSISTANCE, COLLECTION PRACTICES ARE STOPPED. PART VI, LINE 2: MCCULLOUGH-HYDE USES A PROCESS OF ASSESSMENT TO GAUGE THE HEALTHCARE NEEDS OF THE COMMUNITY WE SERVE. THE COMPONENTS OF THAT PROCESS FOR 2011 WERE:1. A NINE-MONTH STRATEGIC PLANNING PROCESS WITH INPUT FROM VARIOUS STAKEHOLDER GROUPS INCLUDING THE MEDICAL STAFF, THE LOCAL COMMUNITY FOUNDATION, THE LOCAL FREE MEDICAL CLINIC (OXFORD COLLEGE CORNER CLINIC), THE LOCAL SOCIAL NEEDS UMBRELLA ORGANIZATION (FAMILY RESOURCE CENTER), AND SEVERAL SMALLER FOCUS GROUPS OF PATIENTS, COMMUNITY LEADERS, AND NON-PATIENTS.2. ALL UNINSURED EMERGENCY DEPARTMENT PATIENTS ARE ASSESSED BY STAFF AND REFERRED TO THE LOCAL FREE MEDICAL CLINIC FOR FOLLOW-UP CARE AND ASSISTANCE, WHEN APPROPRIATE. THAT DATA INFORMS POTENTIAL EDUCATION AND SERVICE PROGRAMS THAT THE HOSPITAL OFFERS TO THE COMMUNITY.3. ON-GOING PARTNERSHIPS WITH MIAMI UNIVERSITY, THE CITY OF OXFORD, AND THE LOCAL SCHOOL DISTRICT TO JOINTLY ADDRESS SPECIFIC HEALTH CARE NEEDS OF THEIR RESPECTIVE POPULATIONS.4. AN ON-GOING, LESS FORMAL PROGRAM, GATHERS INPUT FROM MINISTERS IN OUR CHAPLAIN PROGRAM AND FROM OUR MANY VOLUNTEERS. PART VI, LINE 3: FINANCIAL COUNSELORS ARE LOCATED IN THE PATIENT ACCESS AREAS AND PATIENTS ARE OFTEN REFERRED TO THEM AFTER THE COMPLETION OF THE REGISTRATION PROCESS. IN THE EVENT THAT FINANCIAL COUNSELORS ARE NOT AVAILABLE PATIENT ACCESS STAFF IS EDUCATED ON THE CHARITY CARE/FINANCIAL ASSISTANCE POLICIES AND HAVE APPLICATIONS AVAILABLE. CHARITY CARE INFORMATION IS ALSO INCLUDED ON OUR PATIENT STATEMENTS. ALL CUSTOMER SERVICE REPRESENTATIVES ARE FAMILIAR WITH OUR POLICIES AND CAN SPEAK TO OUR CUSTOMERS ABOUT CHARITY CARE/FINANCIAL ASSISTANCE ELIGIBILITY. BROCHURES EXPLAINING CHARITY CARE/FINANCIAL ASSISTANCE ARE ALSO AVAILABLE IN VARIOUS LOCATIONS THROUGHOUT THE HOSPITAL. PART VI, LINE 4: MCCULLOUGH HYDE MEMORIAL HOSPITAL SERVES A DIVERSE DEMOGRAPHIC INCLUDING THE NORTHWESTERN CORNER OF BUTLER COUNTY, OHIO, THE SOUTHWESTERN CORNER OF PREBLE COUNTY, OHIO AND THE COUNTIES OF FRANKLIN, UNION AND FAYETTE IN INDIANA. THE MAIN CAMPUS IS LOCATED IN OXFORD, OHIO, THE HOME OF MIAMI UNIVERSITY WITH A POPULATION RANGING TO NEARLY 30,000 DURING THE SCHOOL YEAR TO HALF THAT NUMBER DURING THE SUMMER.MHMH COUNTS ITS PRIMARY SERVICE AREA AS THE FOLLOWING: OXFORD,OH - 45056 - POPULATION 29,739 BROOKVILLE, IN - 47012 - POPULATION 10,455 COLLEGE CORNER, OH - 45003 - POPULATION 971 EATON, OH - 45320 - POPULATION 15,354 SOMERSVILLE, OH - 45064 - 2,963 CAMDEN, OH - 45311 - 7,215 LIBERTY, IN - 47353 - 5,698 WEST COLLEGE CORNER, IN - 47003 - 834 TOTAL PRIMARY SERVICE AREA POPULATION = 73,229AND ITS PRIMARY AND ITS SECONDARY SERVICE AREAS ARE THE FOLLOWING: HAMILTON, OH - 45013 - 54,814 CONNERSVILLE, IN - 47331 - 23,438 METAMORA, IN - 47030 - 1,631 OKEANA, OH - 45053 - 3,712 TOTAL SECONDARY SERVICE AREA POPULATION = 83,595IN TERMS OF SOCIO-ECONOMIC DEMOGRAPHICS, THE EDUCATIONAL ATTAINMENT IS LOWER THAN COUNTY, STATE AND NATIONAL AVERAGES AND THE UNEMPLOYMENT HIGHER THAN COUNTY, STATE AND NATIONAL AVERAGES IN ALL OF THE UNINCORPORATED AND RURAL AREAS SERVED BY MHMH. ALL OF THE AREAS IN INDIANA AND THE RURAL AREAS IN PREBLE AND BUTLER COUNTIES (CAMDEN, SOMERVILLE) ARE DESIGNATED AS HEALTH PROFESSIONAL SHORTAGE AREAS BY THE NATIONAL HEALTH SERVICE CORPS.MCCULLOUGH HYDE HAS RECRUITED, SUPPORTED AND WILL CONTINUE TO RECRUIT AND SUPPORT BOTH PRIMARY CARE PHYSICIANS AND SPECIALISTS TO MEET THE NEEDS OF RESIDENTS OF THESE COMMUNITIES. 1 TALAWANDA SCHOOL DISTRICT 131 WEST CHESTER ST OXFORD OH 45056 316005340 10300 SCHOOL PROGRAMS SANE OF BUTLER COUNTY PO BOX 18818 FAIRFIELD OH 45018 311604036 7500 FORENSIC CARE 2 X X X X 1 1 0 0 0 0 0 0 0 BRYAN HEHEMANN CEO 203702 0 3000 0 0 0 0 0 25126 0 231828 0 0 0 JOHN CLEMENTS VP & CFO 141240 0 0 0 0 0 0 0 12499 0 153739 0 0 0 KENNETH KELLER PHYSICIAN 155470 0 0 0 0 0 0 0 13437 0 168907 0 0 0 BRYAN MCCULLOUGH PHYSICIAN 143979 0 0 0 0 0 0 0 10181 0 154160 0 0 0 MARK CRISTELL PT DIRECTOR 121098 0 7557 0 0 0 0 0 26502 0 155157 0 0 0 MATTHEW DAGGY PHYSICIAN 238514 0 0 0 0 0 0 0 23652 0 262166 0 0 0 DONALD WATSON PHARMACY DIRECTOR 128956 0 0 0 0 0 0 0 26509 0 155465 0 0 0 PART I, LINES 4A-B BRYAN HEHEMANN - LIFE INSURANCE POLICY - PAID UP POLICY AT 65. FACE AMOUNT IS 100K WITH CASH SURRENDER VALUE. THERE IS AN ANNUAL PREMIUM OF $8,874 WITH THE VALUE AT 12/31/13 AT $54,377. TAMMY LANGDON - SEVERANCE - POSITION ELIMINATION EFFECTIVE 1/11/13 - $60,916 A BUTLER COUNTY-SERIES 2009A 316000061 2013-09-19 10314685 REFUNDING OF 2009 SERIES 0 0 0 B BUTLER COUNTY-SERIES 2009B 316000061 2013-09-19 3131352 REFUNDING OF 2009 SERIES 0 0 0 A 10437650 10314685 64196 187162 2011 1 0 1 1 B 3158524 3131352 19490 46661 2011 1 0 1 1 A 0 0 0 0 0 0 1 B 0 0 0 0 0 0 1 A 0 0 0 0 0 0 0 0 0 B 0 0 0 0 0 0 0 0 0 A 0 B 0 FORM 990, PART VI, SECTION B, LINE 11 THE 990 IS PREPARED BY THE CPA FIRM, BLUE & CO LLC AND PRESENTED TO CFO AND FINANCE COMMITTEE FOR REVIEW. THE 990 IS THEN PRESENTED AT THE BOARD MEETING. FORM 990, PART VI, SECTION B, LINE 12C ANNUALLY THE CORPORATE COMPLIANCE OFFICER REQUIRES THE OFFICERS, TRUSTEES, DIRECTORS AND KEY EMPLOYEES TO DISCLOSE IN WRITING ANY INTEREST THAT COULD GIVE RISE TO CONFLICTS. FORM 990, PART VI, SECTION B, LINE 15 THE PROCESS FOR DETERMINING COMPENSATION INCLUDES INDEPENDENT CONSULTANT INPUT, WRITTEN EMPLOYMENT CONTRACT, COMPENSATION SURVEY STUDY AND APPROVAL BY THE BOARD. FORM 990, PART VI, SECTION C, LINE 19 UPON INDIVIDUAL REQUEST FORM 990, PART IX, LINE 11G OTHER: PROGRAM SERVICE EXPENSES 4,373,540. MANAGEMENT AND GENERAL EXPENSES 1,874,374. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 6,247,914. FORM 990 PAGE 10 PART X LINE 11G CONTRACTED WAGES = $2,305,387 PURCHASED SERVICES = $4,141,954 MCCULLOUGH-HYDE MEMORIAL HOSPITAL ENDOWMENT 110 NORTH POPLAR OXFORD OH 45056 237374256 OBTAIN CHARITABLE CONTRIBUTIONS, MANAGE THEM AND DISBURSE BY BOARD DIRECTION OH 501(C)(3) LINE 11A, I N/A 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 MCCULLOUGH-HYDE MEMORIAL HOSPITAL ENDOWMENT C 273152 MCCULLOUGH-HYDE MEMORIAL HOSPITAL ENDOWMENT Q