CHMC COMMUNITY HEALTH SERVICES NETWORK: Form 990, tax year 2012
View the entire original 990 at ProPublica ↗
- Organization
- CHMC COMMUNITY HEALTH SERVICES NETWORK (EIN 31-1459815)
- Tax period
- 2012-07-01 to 2013-06-30
- Filed
- 2014-05-12
- IRS object ID
- 201421329349300632
- Schema version
- 2012v2.1
- 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 ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2014-05-12T09:07:33-05:00 | Timestamp |
| Tax Period End Date | 2013-06-30 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 861065772 | EIN |
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | DELOITTE TAX LLP | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 250 EAST FIFTH STREET SUITE 1900 | AddressLine1 |
| City | CINCINNATI | City |
| State | OH | State |
| ZIP Code | 45202 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2012-07-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 311459815 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CHMC COMMUNITY HEALTH SERVICES NETWORK | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | CHMC | NameControl |
| Phone | 5136368778 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 3333 BURNET AVENUE | AddressLine1 |
| City | CINCINNATI | City |
| State | OH | State |
| ZIP Code | 452293039 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | SCOTT J HAMLIN | Name |
| Title | DIRECTOR/TREASURER/SECRETARY | Title |
| Phone | 5136368778 | Phone |
| Date Signed | 2014-05-12 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | JAMES SOWAR | Name |
| PTIN | P00529407 | PTIN |
| Phone | 5137847100 | Phone |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2012 | TaxYear |
| Build TS | 2015-11-30 17:44:51Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | DEE ELLINGWOOD | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 3333 BURNET AVENUE | AddressLine1 |
| City | CINCINNATI | City |
| State | OH | State |
| ZIP Code | 452293039 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 3318912 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | N/A | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1995 | YearFormation |
| State Legal Domicile | OH | StateLegalDomicile |
| Activity Or Mission Description | PROVIDE MEDICAL SERVICES TO CHILDREN IN THE COMMUNITY | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 5 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 0 | NbrIndependentVotingMembers |
| Total Nbr Employees | 0 | TotalNbrEmployees |
| Total Nbr Volunteers | 0 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 0 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 0 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 2862546 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 3284561 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 0 | InvestmentIncomePriorYear |
| Investment Income Current Year | 0 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 227926 | OtherRevenuePriorYear |
| Other Revenue Current Year | 34351 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 3090472 | TotalRevenuePriorYear |
| Total Revenue Current Year | 3318912 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 0 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 0 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 1869617 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 1930057 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 0 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 839115 | OtherExpensePriorYear |
| Other Expenses Current Year | 1122083 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 2708732 | TotalExpensesPriorYear |
| Total Expenses Current Year | 3052140 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 381740 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 266772 | RevenuesLessExpensesCY |
| Total Assets BOY | 1348998 | TotalAssetsBOY |
| Total Assets EOY | 1613400 | TotalAssetsEOY |
| Total Liabilities BOY | 25172 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 22802 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 1323826 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 1590598 | NetAssetsOrFundBalancesEOY |
| Info In Schedule O Part III | X | InfoInScheduleOPartIII |
| Mission Description | CHMC COMMUNITY HEALTH SERVICES NETWORK ("CHSN") IS ORGANIZED AND OPERATED EXCLUSIVELY TO SUPPORT CINCINNATI CHILDREN'S HOSPITAL MEDICAL CENTER ("CCHMC") IN CCHMC'S EFFORTS TO PROVIDE MEDICAL SERVICES TO ALL OF THE CHILDREN IN THE COMMUNITY. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 3052140 | Expense |
| Revenue | 3318912 | Revenue |
| Description | CINCINNATI CHILDREN'S HOSPITAL MEDICAL CENTER ("CCHMC") IS DEVOTED TO PROVIDING MEDICAL SERVICES TO ALL OF THE CHILDREN IN THE COMMUNITY. CHMC COMMUNITY HEALTH SERVICES NETWORK ("CHSN") IS ORGANIZED AND OPERATED EXCLUSIVELY TO SUPPORT CHMC IN THIS EFFORT BY REACHING OUT TO THE MEDICALLY UNDERSERVED AND ECONOMICALLY DISADVANTAGED NEIGHBORHOODS OF OUR COMMUNITY.CHSN SERVES AS THE STRUCTURE FOR BRINGING MEDICAL PROFESSIONALS WHO SHARE THE VISION OF PROVIDING QUALITY MEDICAL CARE TO THE UNDERPRIVILEGED AND UNDERSERVED. CHSN CARRIES OUT ITS CHARITABLE PURPOSES BY SEEKING AND HIRING SUCH "MISSION" ORIENTED PHYSICIANS. IN ADDITION, CHSN WILL MAKE MEDICAL PROFESSIONALS AN INTEGRAL PART OF THESE UNDERPRIVILEGED NEIGHBORHOODS BY ESTABLISHING SITES WITHIN THESE COMMUNITIES WHERE RESIDENT PHYSICIANS WILL WORK. THE RESIDENT PHYSICIANS WILL BE ABLE TO LEARN MORE ABOUT THE PATIENTS THEY SEEK TO SERVE AND THEREBY PROVIDE BETTER SERVICE TO THEM. FURTHERMORE, IN ORDER TO ENSURE ITS GOALS ARE MET, CHSN WILL ACT AS A LIASON BETWEEN THE NEIGHBORHOODS AND CCHMC AND WILL FOCUS ON HOW TO BEST MEET THE DIFFICULT AND UNIQUE NEEDS OF THE UNDERPRIVILEGED NEIGHBORHOODS OF OUR COMMUNITY. | Description |
| Total Program Service Expense | 3052140 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 0 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 0 | LobbyingActivities |
| Subject To Proxy Tax | 0 | SubjectToProxyTax |
| Donor Advised Funds | 0 | DonorAdvisedFunds |
| Conservation Easements | 0 | ConservationEasements |
| Collections Of Art | 0 | CollectionsOfArt |
| Credit Counseling | 0 | CreditCounseling |
| Term Or Permanent Endowments | 0 | TermOrPermanentEndowments |
| Report Land Bldg Equip | 1 | ReportLandBldgEquip |
| Report Invest Oth Securities | 0 | ReportInvestOthSecurities |
| Report Prog Rel Invest | 0 | ReportProgRelInvest |
| Report Other Assets | 1 | ReportOtherAssets |
| Report Other Liabilities | 0 | ReportOtherLiabilities |
| Report Fin48 Footnote | 0 | ReportFin48Footnote |
| Independent Audit Financial Stmt | 0 | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | 1 | ConsolidatedAuditFinancialStmt |
| School | 0 | School |
| Foreign Office | 0 | ForeignOffice |
| Foreign Activities | 0 | ForeignActivities |
| More Than5000 K To Organizations | 0 | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividuals |
| Professional Fundraising | 0 | ProfessionalFundraising |
| Fundraising Activities | 0 | FundraisingActivities |
| Gaming | 0 | Gaming |
| Hospital | 0 | Hospital |
| Grants To Organizations | 0 | GrantsToOrganizations |
| Grants To Individuals | 0 | GrantsToIndividuals |
| Schedule J Required | 1 | ScheduleJRequired |
| Tax Exempt Bonds | 0 | TaxExemptBonds |
| Excess Benefit Transaction | 0 | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | 0 | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | 0 | LoanToOfficerOrDQP |
| Grant To Related Person | 0 | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | 0 | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | 0 | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | 0 | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | 0 | DeductibleNonCashContributions |
| Deductible Contributions Of Art | 0 | DeductibleContributionsOfArt |
| Terminated | 0 | Terminated |
| Partial Liquidation | 0 | PartialLiquidation |
| Disregarded Entity | 0 | DisregardedEntity |
| Related Entity | 1 | RelatedEntity |
| Related Org Controlled Entity | 0 | RelatedOrgControlledEntity |
| Transfers To Exempt Non Chrtbl Org | 0 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 0 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Number Of Employees | 0 | NumberOfEmployees |
| Unrelated Business Income | 0 | UnrelatedBusinessIncome |
| Foreign Financial Account | 0 | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTrans |
| Taxable Party Notification | 0 | TaxablePartyNotification |
| Non Deductible Contributions | 0 | NonDeductibleContributions |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributions |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | 0 | FundsToPayPremiums |
| Premiums Paid | 0 | PremiumsPaid |
| Indoor Tanning Services | 0 | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 5 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 0 | NumberIndependentVotingMembers |
| Family Or Business Relationship | 0 | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | 0 | DelegationOfManagementDuties |
| Changes To Organizing Docs | 0 | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuse |
| Members Or Stockholders | 1 | MembersOrStockholders |
| Election Of Board Members | 1 | ElectionOfBoardMembers |
| Decisions Subject To Approval | 0 | DecisionsSubjectToApproval |
| Minutes Of Governing Body | 1 | MinutesOfGoverningBody |
| Minutes Of Committees | 1 | MinutesOfCommittees |
| Officer Mailing Address | 0 | OfficerMailingAddress |
| Local Chapters | 0 | LocalChapters |
| Form990 Provided To Governing Body | 1 | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | 1 | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | 1 | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | 1 | RegularMonitoringEnforcement |
| Whistleblower Policy | 0 | WhistleblowerPolicy |
| Document Retention Policy | 0 | DocumentRetentionPolicy |
| Compensation Process CEO | 1 | CompensationProcessCEO |
| Compensation Process Other | 1 | CompensationProcessOther |
| Investment In Joint Venture | 0 | InvestmentInJointVenture |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MICHAEL BAUER | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 5136368778 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 3333 BURNET AVENUE | AddressLine1 |
| City | CINCINNATI | City |
| State | OH | State |
| ZIP Code | 452293039 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionA (5 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Average Hours Per Week RelatedAverageHoursPerWeekRelated | Individual Trustee Or DirectorIndividualTrusteeOrDirector | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | OfficerOfficer |
|---|---|---|---|---|---|---|---|
| MICHAEL FISHER | |||||||
| DIRECTOR | 1.00 | 49.00 | X | 0 | 907237 | 231616 | |
| DEE ELLINGWOOD | |||||||
| DIRECTOR/PRESIDENT | 1.00 | 49.00 | X | 0 | 549317 | 105530 | X |
| SCOTT J HAMLIN | |||||||
| DIR/TREAS/SECRETARY | 1.00 | 49.00 | X | 0 | 948827 | 166062 | X |
| STEVE MUETHING MD | |||||||
| DIRECTOR | 1.00 | 49.00 | X | 0 | 320310 | 27090 | |
| TOM DEWITT MD | |||||||
| DIRECTOR | 1.00 | 49.00 | X | 0 | 299680 | 48807 | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 0 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 3025371 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 579105 | TotalOtherCompensation |
| Number Individuals GT100 K | 0 | NumberIndividualsGT100K |
| Formers Listed | 0 | FormersListed |
| Total Comp GT150 K | 1 | TotalCompGT150K |
| Compensation From Other Sources | 0 | CompensationFromOtherSources |
| Number Of Contractors GT100 K | 0 | NumberOfContractorsGT100K |
Program Service Revenue ProgramServiceRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | NET PATIENT REVENUES | Description |
| Business Code | 621990 | BusinessCode |
| Total Revenue Column | 3284561 | TotalRevenueColumn |
| Related Or Exempt Function Income | 3284561 | RelatedOrExemptFunctionIncome |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 3284561 | TotalProgramServiceRevenue |
Miscellaneous Revenue MiscellaneousRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 34351 | TotalRevenueColumn |
| Related Or Exempt Function Income | 34351 | RelatedOrExemptFunctionIncome |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 34351 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 3318912 | TotalRevenueColumn |
| Related Or Exempt Function Income | 3318912 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $0 | ExclusionAmount |
Comp Disqual Persons CompDisqualPersons
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1669429 | Total |
| Program Services | 1669429 | ProgramServices |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 260628 | Total |
| Program Services | 260628 | ProgramServices |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 30379 | Total |
| Program Services | 30379 | ProgramServices |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 380307 | Total |
| Program Services | 380307 | ProgramServices |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 160926 | Total |
| Program Services | 160926 | ProgramServices |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 17337 | Total |
| Program Services | 17337 | ProgramServices |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 13862 | Total |
| Program Services | 13862 | ProgramServices |
Other Expenses OtherExpenses (4 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices |
|---|---|---|
| COLLECTION FEES | 348202 | 348202 |
| PURCHASED SERVICES | 67893 | 67893 |
| TELEPHONE | 49888 | 49888 |
| DUES | 28796 | 28796 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 24493 | Total |
| Program Services | 24493 | ProgramServices |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3052140 | Total |
| Program Services | 3052140 | ProgramServices |
| Management And General | 0 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 163489 | BOY |
| EOY | 73738 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 173447 | BOY |
| EOY | 235082 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 273140 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 119100 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 9362 | BOY |
| EOY | 154040 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1002700 | BOY |
| EOY | 1150540 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1348998 | BOY |
| EOY | 1613400 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 25172 | BOY |
| EOY | 22802 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 25172 | BOY |
| EOY | 22802 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1323826 | BOY |
| EOY | 1590598 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1323826 | BOY |
| EOY | 1590598 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1348998 | BOY |
| EOY | 1613400 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expenses | 266772 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | 0 | ReconcilationOtherChanges |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | 0 | AccountantCompileOrReview |
| FS Audited | 1 | FSAudited |
FS Audited Basis FSAuditedBasis
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Statement Consolidated | X | FinancialStatementConsolidated |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | 1 | AuditCommittee |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Publicly Supported Org509a2 | X | PubliclySupportedOrg509a2 |
Gross Receipts From Admissions GrossReceiptsFromAdmissions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 2455249 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 2702574 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 2871766 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 2862546 | CurrentTaxYearMinus1Year |
| Current Tax Year | 3284561 | CurrentTaxYear |
| Total | 14176696 | Total |
Total509 Total509
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 2455249 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 2702574 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 2871766 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 2862546 | CurrentTaxYearMinus1Year |
| Current Tax Year | 3284561 | CurrentTaxYear |
| Total | 14176696 | Total |
Amts Recd From Disqual Persons AmtsRecdFromDisqualPersons
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Amts From Subst Contributors AmtsFromSubstContributors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Support From DQ Ps Etc SupportFromDQPsEtc
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support Total509 | 14176696 | PublicSupportTotal509 |
Other Income509 OtherIncome509
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 56312 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 64829 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 63565 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 227926 | CurrentTaxYearMinus1Year |
| Current Tax Year | 34351 | CurrentTaxYear |
| Total | 446983 | Total |
Total Support Total TotalSupportTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 2511561 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 2767403 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 2935331 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 3090472 | CurrentTaxYearMinus1Year |
| Current Tax Year | 3318912 | CurrentTaxYear |
| Total | 14623679 | Total |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support Percentage509 | 0.96940 | PublicSupportPercentage509 |
| Prior Year Support Percentage | 0.96480 | PriorYearSupportPercentage |
| Investment Income Percentage | 0.00000 | InvestmentIncomePercentage |
| Thirty Three Percnt Tests CY509 | X | ThirtyThreePercntTestsCY509 |
Schedule D IRS990ScheduleD
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 273140 | OtherCostOrOtherBasis |
| Depreciation | 119100 | Depreciation |
| Book Value | 154040 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 154040 | TotalOfBookValueLandBuildings |
Other Assets OtherAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | RECEIVABLE FROM CCHMC | Description |
| Book Value | 1150540 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | 1150540 | TotalBookValueOtherAssets |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Severance Payment | 0 | SeverancePayment |
| Supplemental Nonqual Retire Plan | 1 | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | 0 | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | 0 | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | 0 | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | 0 | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | 0 | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | 0 | AnyNonFixedPayments |
| Initial Contract Exception | 0 | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (5 entries)
| TitleTitle | Base Compensation Filing OrgBaseCompensationFilingOrg | Comp Based On Related OrgsCompBasedOnRelatedOrgs | Bonus Filing OrgBonusFilingOrg | Bonus Related OrgsBonusRelatedOrgs | Other Compensation Filing OrgOtherCompensationFilingOrg | Other Compensation Related OrgsOtherCompensationRelatedOrgs | Deferred Comp Filing OrgDeferredCompFilingOrg | Deferred Comp Related OrgsDeferredCompRelatedOrgs | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg | Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs | Total Compensation Filing OrgTotalCompensationFilingOrg | Total Compensation Related OrgsTotalCompensationRelatedOrgs | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrg | Comp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| MICHAEL FISHER | ||||||||||||||
| DIRECTOR | 0 | 767047 | 0 | 100000 | 0 | 40190 | 0 | 168859 | 0 | 62757 | 0 | 1138853 | 0 | 0 |
| DEE ELLINGWOOD | ||||||||||||||
| DIRECTOR/PRESIDENT | 0 | 365889 | 0 | 141828 | 0 | 41600 | 0 | 77773 | 0 | 27757 | 0 | 654847 | 0 | 0 |
| SCOTT J HAMLIN | ||||||||||||||
| DIR/TREAS/SECRETARY | 0 | 615636 | 0 | 208567 | 0 | 124624 | 0 | 144809 | 0 | 21253 | 0 | 1114889 | 0 | 84434 |
| STEVE MUETHING MD | ||||||||||||||
| DIRECTOR | 0 | 259193 | 0 | 46127 | 0 | 14990 | 0 | 25000 | 0 | 2090 | 0 | 347400 | 0 | 0 |
| TOM DEWITT MD | ||||||||||||||
| DIRECTOR | 0 | 268910 | 0 | 425 | 0 | 30345 | 0 | 25000 | 0 | 23807 | 0 | 348487 | 0 | 0 |
Form990 Schedule J Part III Form990ScheduleJPartIII (2 entries)
| Return ReferenceReturnReference | ExplanationExplanation | IdentifierIdentifier |
|---|---|---|
| PART I, LINE 4B | CERTAIN OFFICERS AND KEY EMPLOYEES OF CINCINNATI CHILDREN'S HOSPITAL MEDICAL CENTER ("CCHMC"), A RELATED ORGANIZATION TO CHSN, HAVE ARRANGEMENTS WHICH PROVIDE FOR SUPPLEMENTAL RETIREMENT BENEFITS AS DESCRIBED IN IRC SEC. 457(F). DUE TO THE SUBSTANTIAL RISK OF FORFEITURE PROVISION, THESE ARRANGEMENTS ARE NON-VESTED AND THERE IS NO GUARANTEE THAT THESE OFFICERS AND FACULTY MEMBERS WILL EVER RECEIVE THESE BENEFITS. THE FOLLOWING IS A LISTING OF OFFICERS AND KEY EMPLOYEES THAT RECEIVED A DEFERRAL, SUBJECT TO THE SUBSTANTIAL RISK OF FORFEITURE PROVISION, UNDER CCHMC'S IRC SEC. 457(F) PLAN DURING THE YEAR (THESE AMOUNTS ARE INCLUDED IN THE TOTALS FOR SCHEDULE J, PART II, COLUMN C, DEFERRED COMPENSATION): 1. DEE ELLINGWOOD - $52,773 2. SCOTT HAMLIN - $119,809 3. MICHAEL FISHER - $143,859 THE FOLLOWING IS A LISTING OF OFFICERS AND KEY EMPLOYEES THAT RECEIVED A PAYMENT UNDER CCHMC'S IRC SEC. 457(F) PLAN DURING THE YEAR: 1. SCOTT HAMLIN - $84,434 | |
| PART III | CHMC COMMUNITY HEALTH SERVICES NETWORK RELIED ON CINCINNATI CHILDREN'S HOSPITAL MEDICAL CENTER ("CCHMC"), A RELATED ORGANIZATION, TO ESTABLISH THE COMPENSATION OF INDIVIDUALS LISTED ON FORM 990, PART VII. CCHMC USED ONE OR MORE OF THE METHODS DESCRIBED BELOW TO ESTABLISH AN APPROPRIATE LEVEL OF COMPENSATION: COMPENSATION COMMITTEE INDEPENDENT COMPENSATION CONSULTANT FORM 990 OF OTHER ORGANIZATIONS COMPENSATION SURVEY OR STUDY APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE EXPLANATION OF BENEFITS: ALL COMPENSATION AND BENEFITS REPORTED ON FORM 990, PART VII AND SCHEDULE J, PART II ARE PROVIDED BY CCHMC, A RELATED ENTITY TO CHSN. THE EMPLOYEE BENEFIT PLAN CONTRIBUTION AMOUNTS LISTED ON SCHEDULE J, PART II MAY INCLUDE ONE OR MORE OF THE FOLLOWING BENEFITS: 1. ELECTIVE EMPLOYEE DEFERRALS UNDER IRC SEC. 403(B) 2. DISCRETIONARY EMPLOYER CONTRIBUTIONS UNDER IRC SEC. 403(B) 3. ELECTIVE EMPLOYEE DEFERRALS UNDER IRC SEC. 457(B) 4. ELECTIVE EMPLOYEE DEFERRALS UNDER IRC SEC. 457(F) IN ADDITION TO THE RETIREMENT PLAN CONTRIBUTIONS DISCLOSED ON FORM 990, PART VII AND SCHEDULE J, PART II, THE FOLLOWING NON-TAXABLE EMPLOYEE WELFARE BENEFITS WERE MADE AVAILABLE TO THE EMPLOYED, COMPENSATED OFFICERS AND KEY EMPLOYEES LISTED ON FORM 990, PART VII AND SCHEDULE J, PART II: 1. HEALTH AND DENTAL INSURANCE BENEFITS 2. GROUP LIFE INSURANCE (PORTIONS OF WHICH ARE TAXED) 3. UNEMPLOYMENT BENEFITS 4. DISABILITY BENEFITS THE OFFICERS AND KEY EMPLOYEES LISTED ON FORM 990, PART VII AND SCHEDULE J, PART II ARE ALSO ELIGIBLE FOR ANY OTHER AVAILABLE EMPLOYEE BENEFITS. | SUPPLEMENTAL INFORMATION |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (11 entries)
| Return ReferenceReturnReference | ExplanationExplanation | IdentifierIdentifier |
|---|---|---|
| FORM 990, PART VI, SECTION A, LINE 6 | ARTICLE III OF CHSN'S CODE OF REGULATIONS PROVIDES THAT CHILDREN'S HOSPITAL MEDICAL CENTER, A RELATED ORGANIZATION, POSSESSES THE AUTHORITY TO APPOINT, ELECT, AND REMOVE MEMBERS OF CHSN'S BOARD OF TRUSTEES. | |
| FORM 990, PART VI, SECTION A, LINE 7A | ARTICLE III OF CHSN'S CODE OF REGULATIONS PROVIDES THAT CHILDREN'S HOSPITAL MEDICAL CENTER, A RELATED ORGANIZATION, POSSESSES THE AUTHORITY TO APPOINT, ELECT, AND REMOVE MEMBERS OF CHSN'S BOARD OF TRUSTEES. | |
| FORM 990, PART VI, SECTION B, LINE 11 | THE CHMC COMMUNITY HEALTH SERVICES NETWORK ("CHSN") FORM 990 IS PREPARED BY SENIOR MANAGEMENT FROM CINCINNATI CHILDREN'S HOSPITAL MEDICAL CENTER ("CCHMC"), A RELATED ORGANIZATION. EXTERNAL TAX CONSULTANTS THEN REVIEW THE FORM 990 FOR COMPLETENESS AND ACCURACY. THE FORM 990 IS THEN MADE AVAILABLE TO ALL CHSN BOARD MEMBERS IN ADVANCE OF FILING. | |
| FORM 990, PART VI, SECTION B, LINE 12C | ALL OF CHSN'S BOARD MEMBERS RECEIVE AN ANNUAL QUESTIONNAIRE REQUESTING INFORMATION REGARDING FAMILY AND BUSINESS RELATIONSHIPS THAT COULD POTENTIALLY RESULT IN A CONFLICT OF INTEREST UNDER CHSN'S CONFLICT OF INTEREST POLICY. ONCE THE QUESTIONNAIRES HAVE BEEN COMPLETED BY ALL OF CHSN'S BOARD MEMBERS, THE QUESTIONNAIRES ARE REVIEWED AND IF CHSN DETERMINES THAT A RELATIONSHIP EXISTS THAT PRESENTS A CONFLICT OF INTEREST, CHSN FOLLOWS THE PROVISIONS SET FORTH IN CHSN'S CONFLICT OF INTEREST POLICY TO RESOLVE THE CONFLICT AND DETERMINES THE APPROPRIATE REPORTING TO THE BOARD AND, IF REQUIRED, FORM 990 DISCLOSURE. | |
| FORM 990, PART VI, SECTION B, LINE 15 | CHSN'S BOARD MEMBERS ARE EMPLOYED BY CINCINNATI CHILDREN'S HOSPITAL MEDICAL CENTER ("CCHMC"), A RELATED ORGANIZATION. CCHMC HAS A COMPENSATION COMMITTEE THAT ANNUALLY REVIEWS THE RECOMMENDATIONS OF CCHMC MANAGEMENT REGARDING EMPLOYEE PERFORMANCE EVALUATION AND COMPENSATION ADJUSTMENTS FOR DISQUALIFIED PERSONS TO ENSURE THAT CCHMC HAS COMPLIED WITH THE PROVISIONS OF THE REBUTTABLE PRESUMPTION OF REASONABLENESS UNDER IRC SEC. 4958. | |
| FORM 990, PART VI, SECTION C, LINE 19 | CHSN'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE MAINTAINED ON FILE BY CCHMC SENIOR MANAGEMENT AND ARE AVAILABLE TO THE PUBLIC UPON REQUEST EITHER IN-PERSON, BY TELEPHONE, OR BY WRITTEN REQUEST. | |
| FORM 990, PART VI, SECTION B, QUESTION 13 | CHSN'S BOARD OF TRUSTEES HAS NOT FORMALLY ADOPTED A WRITTEN WHISTLEBLOWER POLICY. HOWEVER, CHSN IS A RELATED ORGANIZATION OF CINCINNATI CHILDREN'S HOSPITAL MEDICAL CENTER ("CCHMC"). CCHMC HAS A WRITTEN WHISTLEBLOWER POLICY AND CHSN ABIDES BY THE PROVISIONS OF THIS POLICY. | WRITTEN WHISTLEBLOWER POLICY |
| FORM 990, PART VI, SECTION B, QUESTION 14 | CHSN'S BOARD OF TRUSTEES HAS NOT FORMALLY ADOPTED A WRITTEN DOCUMENT RETENTION AND DESTRUCTION POLICY. HOWEVER, CHSN IS A RELATED ORGANIZATION OF CINCINNATI CHILDREN'S HOSPITAL MEDICAL CENTER ("CCHMC"). CCHMC HAS A WRITTEN DOCUMENT RETENTION AND DESTRUCTION POLICY AND CHSN ABIDES BY THE PROVISIONS OF THIS POLICY. | WRITTEN DOCUMENT RETENTION & DESTRUCTION POLICY |
| FORM 990, PART VII | ALL INDIVIDUALS LISTED ON FORM 990, PART VII ARE EMPLOYED BY CINCINNATI CHILDREN'S HOSPITAL MEDICAL CENTER ("CCHMC"), A RELATED ORAGNIZATION. EACH INDIVIDUAL DEVOTES AN AVERAGE OF 50 HOURS/WEEK FOR THEIR DUTIES TO CCHMC AND AFFILATED ENTITIES. | NUMBER OF HOURS WORKED |
| FORM 990, PART IX, LINE 2B | CHSN'S FINANCIAL STATEMENTS ARE INCLUDED AS PART OF THE CINCINNATI CHILDREN'S HOSPITAL MEDICAL CENTER & AFFILIATES FINANCIAL STATEMENT AUDIT. | AUDITED FINANCIAL STATEMENTS |
| FORM 990, SCHEDULE R | DURING THE TIME PERIOD COVERED BY THIS RETURN, CHMC COMMUNITY HEALTH SERVICES NETWORK RECEIVED CERTAIN ACCOUNTING AND ADMINISTRATIVE SERVICES FROM CINCINNATI CHILDREN'S HOSPITAL MEDICAL CENTER AT NO COST. THE VALUE OF THESE SERVICES IS AN UNSPECIFIED AMOUNT. | TRANSACTIONS WITH RELATED ORGANIZATIONS |
Schedule R IRS990ScheduleR
Form990 Schedule R Part II Form990ScheduleRPartII
Name Of Disregarded Entity NameOfDisregardedEntity
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CHILDREN'S HOSPITAL MEDICAL CENTER | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 3333 BURNET AVE | AddressLine1 |
| City | CINCINNATI | City |
| State | OH | State |
| ZIP Code | 45229 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 310833936 | EIN |
| Primary Activities | PEDIATRIC HEALTHCARE | PrimaryActivities |
| Legal Domicile State | OH | LegalDomicileState |
| Exempt Code Section | 501(C)(3) | ExemptCodeSection |
| Public Charity Status | 3 | PublicCharityStatus |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | TCH | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Controlled Org | 0 | ControlledOrg |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | 0 | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | 0 | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | 0 | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | 0 | LoansOrGuaranteesFromOtherOrg |
| Dividends Related Organization | 0 | DividendsRelatedOrganization |
| Sale Of Assets To Other Org | 0 | SaleOfAssetsToOtherOrg |
| Purchase Of Assets From Other Org | 0 | PurchaseOfAssetsFromOtherOrg |
| Exchange Of Assets | 0 | ExchangeOfAssets |
| Rental Of Facilities To Other Orgs | 0 | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | 0 | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | 0 | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | 0 | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | 1 | SharingOfFacilities |
| Sharing Of Paid Employees | 1 | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | 1 | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | 1 | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | 1 | OtherTransferToOtherOrg |
| Other Transfer From Other Org | 1 | OtherTransferFromOtherOrg |
Transactions Related Orgs Table TransactionsRelatedOrgsTable (2 entries)
| Transaction TypeTransactionType | Amount InvolvedAmountInvolved | Method Of Amt DeterminationMethodOfAmtDetermination |
|---|---|---|
| CHILDREN'S HOSPITAL MEDICAL CENTER | ||
| R | 298638 | CASH |
| CHILDREN'S HOSPITAL MEDICAL CENTER | ||
| S | 4608302 | CASH |