MCCULLOUGH-HYDE MEMORIAL HOSPITAL ENDOWMENT FUND: Form 990, tax year 2013
View the entire original 990 at ProPublica ↗
- Organization
- MCCULLOUGH-HYDE MEMORIAL HOSPITAL ENDOWMENT FUND (EIN 23-7374256)
- Tax period
- 2013-01-01 to 2013-12-31
- Filed
- 2014-10-31
- IRS object ID
- 201423049349301302
- Schema version
- 2013v3.0
- 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 D
- Schedule G
- Schedule I
- Schedule J
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2014-10-31T15:02:43-05:00 | ReturnTs |
| Tax Period End | 2013-12-31 | 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 | BusinessNameLine1 |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 8800 LYRA DRIVE SUITE 450 | AddressLine1 |
| City | COLUMBUS | City |
| State | OH | State |
| ZIP Code | 43240 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2013-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 237374256 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MCCULLOUGH-HYDE MEMORIAL HOSPITAL ENDOWMENT FUND | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | MCCU | BusinessNameControlTxt |
| Phone | 5135245310 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 110 NORTH POPLAR | AddressLine1 |
| City | OXFORD | City |
| State | OH | State |
| ZIP Code | 45056 | ZIPCode |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | JOHN CLEMENTS | PersonNm |
| Person Title | CFO | PersonTitleTxt |
| Phone | 5135245310 | PhoneNum |
| Signature | 2014-10-31 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | NANCY KIRCHNER | PreparerPersonNm |
| PTIN | P00386751 | PTIN |
| Phone | 6148852583 | PhoneNum |
| Preparation | 2014-10-29 | PreparationDt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2013 | TaxYr |
| Build TS | 2015-11-30 17:44:51Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | JOHN CLEMENTS | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 110 NORTH POPLAR STREET | AddressLine1 |
| City | OXFORD | City |
| State | OH | State |
| ZIP Code | 45056 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $1,030,443 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.MHMH.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1942 | FormationYr |
| Legal Domicile State | OH | LegalDomicileStateCd |
| Activity Or Mission | TO SUPPORT HEALTH, EDUCATIONAL, AND BUILDING PROGRAMS OF MCCULLOUGH-HYDE MEMORIAL HOSPITAL | ActivityOrMissionDesc |
| Voting Members Governing Body | 10 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 10 | VotingMembersIndependentCnt |
| Total Employee | 0 | TotalEmployeeCnt |
| Total Volunteers | 10 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $185,162 | PYContributionsGrantsAmt |
| CY Contributions Grants | $265,525 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $0 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $0 | CYProgramServiceRevenueAmt |
| PY Investment Income | $351,847 | PYInvestmentIncomeAmt |
| CY Investment Income | $580,076 | CYInvestmentIncomeAmt |
| PY Other Revenue | $10,662 | PYOtherRevenueAmt |
| CY Other Revenue | $83,383 | CYOtherRevenueAmt |
| PY Total Revenue | $547,671 | PYTotalRevenueAmt |
| CY Total Revenue | $928,984 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $310,728 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $410,379 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $0 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $0 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $104,878 | PYOtherExpensesAmt |
| CY Other Expenses | $73,166 | CYOtherExpensesAmt |
| PY Total Expenses | $415,606 | PYTotalExpensesAmt |
| CY Total Expenses | $483,545 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $132,065 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $445,439 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $11,256,494 | TotalAssetsBOYAmt |
| Total Assets EOY | $13,035,000 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $1,936,390 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $2,290,270 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $9,320,104 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $10,744,730 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | SUPPORT THE HOSPITAL WITH HEALTH PROGRAMS, EDUCATION ASSISTANCE, BUILDING AND EQUIPMENT NEEDS | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $205,565 | ExpenseAmt |
| Grant | $205,565 | GrantAmt |
| Desc | DEVELOPMENT OFFICE SUPPORT:THE TRUST PROVIDES SUPPORT FOR THE HOSPITAL DEVELOPMENT DEPARTMENT THAT ACTS AS A LIASON BETWEEN THE HOSPITAL AND THE DONOR COMMUNITY. EFFORTS OF THIS OFFICE OVER THE YEARS HAS PRODUCED AN ENDOWMENT OF $7.2 MILLION IN UNRESTRICTED CONTRIBUTIONS AND $2 MILLION IN DESIGNATED GIFTS. | Desc |
Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $84,271 | ExpenseAmt |
| Grant | $84,271 | GrantAmt |
| Desc | EDUCATIONAL SUPPORT:FUNDED ALL OR PART OF 32 EDUCATIONAL ACTIVITIES INCLUDING 6 FOR HEALTH CAREERS, 17 RELATED TO CLINICAL SKILLS DEVELOPMENT AND 15 RELATED TO ADMINISTRATIVE AND SUPPORT DEPARTMENT PROFESSIONAL DEVELOPMENT. | Desc |
Prog Srvc Accom Acty3 ProgSrvcAccomActy3Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $63,058 | ExpenseAmt |
| Grant | $63,058 | GrantAmt |
| Desc | CAPITAL EQUIPMENT SUPPORT:FUNDED ALL OR PART OF 5 EQUIPMENT PURCHASES INCLUDING LAB, SLEEP LAB AND EMERGENCY DEPARTMENT. IN ADDITION, PURCHASED ART DISPLAYED THROUGHOUT THE HOSPITAL THAT ADDS TO THE HEALING ENVIRONMENT. | Desc |
Prog Srvc Accom Acty Other ProgSrvcAccomActyOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $57,485 | ExpenseAmt |
| Grant | $57,485 | GrantAmt |
| Desc | SUPPORT FOR HEALTH PROGRAMS. PROVIDED SUPPORT FOR NEEDY PATIENTS REQUIRING TRANSPORTATION, ONCOLOGY MEDS AND TEMPORATY ASSISTANCE DURING MEDICAL EMERGENCIES. | Desc |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Prog Srvc Expense | $57,485 | TotalOtherProgSrvcExpenseAmt |
| Total Other Prog Srvc Grant | $57,485 | TotalOtherProgSrvcGrantAmt |
| Total Program Service Expenses | $410,379 | 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 | Yes (1) | 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 | 0 | 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 | Yes (1) | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | 0 | OperateHospitalInd |
| Grants To Organizations | Yes (1) | 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 | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | 0 | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | Yes (1) | RelatedOrganizationCtrlEntInd |
| Transaction With Control Ent | 0 | TransactionWithControlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 0 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Employee | 0 | EmployeeCnt |
| 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 | Yes (1) | QuidProQuoContributionsInd |
| Quid Pro Quo Contri Discl | Yes (1) | QuidProQuoContriDisclInd |
| 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 | 10 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 10 | 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 | 0 | CompensationProcessCEOInd |
| Compensation Process Other | 0 | 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
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | JAMES MILLER CONTROLLER | PersonNm |
| Phone | 5135245310 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 110 NORTH POPLAR STREET | AddressLine1 |
| City | OXFORD | City |
| State | OH | State |
| ZIP Code | 45056 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionAGrp (14 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt |
|---|---|---|---|---|---|---|---|
| JOHN HARLAND MD | |||||||
| VICE CHAIRMAN | 1.00 | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 |
| SUSAN CROSS LIPNICKEY | |||||||
| DIRECTOR | 1.00 | 1.00 | Yes (X) | $0 | $0 | $0 | |
| JACK MANN | |||||||
| DIRECTOR | 1.00 | 1.00 | Yes (X) | $0 | $0 | $0 | |
| RICHARD M NORMAN | |||||||
| CHAIRMAN | 1.00 | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 |
| ALAN OAK | |||||||
| SECRETARY-TREASURER | 1.00 | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 |
| STEPHEN FLEE | |||||||
| DIRECTOR | 1.00 | 1.00 | Yes (X) | $0 | $0 | $0 | |
| WILLIAM DOUGLAS ROSS DO | |||||||
| DIRECTOR | 1.00 | 1.00 | Yes (X) | $0 | $0 | $0 | |
| THOMAS W SPEH | |||||||
| DIRECTOR | 1.00 | 1.00 | Yes (X) | $0 | $0 | $0 | |
| RALPH GUTOWSKI | |||||||
| DIRECTOR | 1.00 | 1.00 | Yes (X) | $0 | $0 | $0 | |
| PAIGE WOOD | |||||||
| DIRECTOR | 1.00 | 1.00 | Yes (X) | $0 | $0 | $0 | |
| BRYAN HEHEMANN | |||||||
| PRESIDENT AND CEO | 40.00 | 40.00 | Yes (X) | $0 | $206,702 | $25,126 | |
| JOHN CLEMENTS | |||||||
| VICE PRESIDENT AND CFO | 40.00 | 40.00 | Yes (X) | $0 | $141,240 | $12,499 | |
| PAMELA COLLINS | |||||||
| VICE PRESIDENT AND CHIEF P | 40.00 | 40.00 | Yes (X) | $0 | $126,237 | $12,674 | |
| TAMMY LANGDON | |||||||
| VICE PRESIDENT AND CHIEF A | 40.00 | 40.00 | Yes (X) | $0 | $66,822 | $9 | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $0 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $541,001 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $50,308 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 0 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
| Cntrct Rcvd Greater Than100 K | 0 | CntrctRcvdGreaterThan100KCnt |
| All Other Contributions | $265,525 | AllOtherContributionsAmt |
| Total Contributions | $265,525 | TotalContributionsAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $319,406 | TotalRevenueColumnAmt |
| Exclusion | $319,406 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $66,361 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $67,546 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | -$1,185 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$1,185 | TotalRevenueColumnAmt |
| Exclusion | -$1,185 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $260,670 | SecuritiesAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $0 | SecuritiesAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $260,670 | SecuritiesAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $260,670 | TotalRevenueColumnAmt |
| Exclusion | $260,670 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Fundraising Gross Income | $118,481 | FundraisingGrossIncomeAmt |
| Fundraising Direct Expenses | $33,913 | FundraisingDirectExpensesAmt |
Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $84,568 | TotalRevenueColumnAmt |
| Exclusion | $84,568 | ExclusionAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $928,984 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $0 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $663,459 | ExclusionAmt |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $410,379 | TotalAmt |
| Program Services | $410,379 | ProgramServicesAmt |
Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $55,710 | TotalAmt |
| Management And General | $55,710 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $16,700 | TotalAmt |
| Management And General | $16,700 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | BANK FEES | Desc |
| Total | $756 | TotalAmt |
| Management And General | $756 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $483,545 | TotalAmt |
| Program Services | $410,379 | ProgramServicesAmt |
| Management And General | $73,166 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $539,743 | BOYAmt |
| EOY | $859,639 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $10,553 | BOYAmt |
| EOY | $2,500 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $51,091 | BOYAmt |
| EOY | $59,091 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $1,083,092 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $517,964 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $609,754 | BOYAmt |
| EOY | $565,128 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $10,045,353 | BOYAmt |
| EOY | $11,548,642 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $11,256,494 | BOYAmt |
| EOY | $13,035,000 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $23,820 | BOYAmt |
| EOY | $24,775 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,912,570 | BOYAmt |
| EOY | $2,265,495 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,936,390 | BOYAmt |
| EOY | $2,290,270 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,243,785 | BOYAmt |
| EOY | $8,240,600 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $188,048 | BOYAmt |
| EOY | $460,960 | EOYAmt |
Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,888,271 | BOYAmt |
| EOY | $2,043,170 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $9,320,104 | BOYAmt |
| EOY | $10,744,730 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $11,256,494 | BOYAmt |
| EOY | $13,035,000 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $445,439 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | $979,187 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | $0 | OtherChangesInNetAssetsAmt |
| 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) |
|---|---|---|
| Supporting Organization509a3 | Yes (X) | SupportingOrganization509a3Ind |
| Supporting Org Type1 | Yes (X) | SupportingOrgType1Ind |
| Contribution Controller | 0 | ContributionControllerInd |
| Contribution Family | 0 | ContributionFamilyInd |
| Contribution35 Controlled | 0 | Contribution35ControlledInd |
Supported Org Information SupportedOrgInformationGrp
Supported Organization Name SupportedOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MCCULLOUGH-HYDE MEMORIAL HOSPITAL INC | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 310650283 | EIN |
| Organization Type | 509(A)(3)(A) | OrganizationTypeDesc |
| Governing Document Listed | 0 | GoverningDocumentListedInd |
| Supported Org Notified | Yes (1) | SupportedOrgNotifiedInd |
| US Organized | Yes (1) | USOrganizedInd |
| Support | $410,379 | SupportAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Supported Organizations Total | 1 | SupportedOrganizationsTotalCnt |
| Support Sum | $410,379 | SupportSumAmt |
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 D IRS990ScheduleD
| Field | Value | IRS element (for citing) |
|---|---|---|
| Donor Advised Funds Held | 10 | DonorAdvisedFundsHeldCnt |
| Donor Advised Funds Contri | $135,586 | DonorAdvisedFundsContriAmt |
| Donor Advised Funds Grants | $40,047 | DonorAdvisedFundsGrantsAmt |
| Donor Advised Funds Vl EOY | $183,644 | DonorAdvisedFundsVlEOYAmt |
| Disclosed Org Leg Ctrl | Yes (1) | DisclosedOrgLegCtrlInd |
| Disclosed For Charitable Prps | Yes (1) | DisclosedForCharitablePrpsInd |
CY Endwmt Fund CYEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $10,045,352 | BeginningYearBalanceAmt |
| Contributions | $384,066 | ContributionsAmt |
| Investment Earnings Or Losses | $1,270,951 | InvestmentEarningsOrLossesAmt |
| Grants Or Scholarships | $151,727 | GrantsOrScholarshipsAmt |
| End Year Balance | $11,548,642 | EndYearBalanceAmt |
CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $9,014,757 | BeginningYearBalanceAmt |
| Contributions | $97,325 | ContributionsAmt |
| Investment Earnings Or Losses | $1,099,844 | InvestmentEarningsOrLossesAmt |
| Grants Or Scholarships | $166,574 | GrantsOrScholarshipsAmt |
| End Year Balance | $10,045,352 | EndYearBalanceAmt |
CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $9,551,600 | BeginningYearBalanceAmt |
| Contributions | $296,717 | ContributionsAmt |
| Investment Earnings Or Losses | -$706,525 | InvestmentEarningsOrLossesAmt |
| Grants Or Scholarships | $127,035 | GrantsOrScholarshipsAmt |
| End Year Balance | $9,014,757 | EndYearBalanceAmt |
CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $8,626,691 | BeginningYearBalanceAmt |
| Contributions | $137,514 | ContributionsAmt |
| Investment Earnings Or Losses | $970,829 | InvestmentEarningsOrLossesAmt |
| Grants Or Scholarships | $183,434 | GrantsOrScholarshipsAmt |
| End Year Balance | $9,551,600 | EndYearBalanceAmt |
CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $7,180,113 | BeginningYearBalanceAmt |
| Contributions | $372,373 | ContributionsAmt |
| Investment Earnings Or Losses | $1,080,059 | InvestmentEarningsOrLossesAmt |
| Grants Or Scholarships | $5,854 | GrantsOrScholarshipsAmt |
| End Year Balance | $8,626,691 | EndYearBalanceAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Board Designated Balance EOY | 0.96000 | BoardDesignatedBalanceEOYPct |
| Term Endowment Balance EOY | 0.04000 | TermEndowmentBalanceEOYPct |
| Endowments Held Unrelated Org | Yes (1) | EndowmentsHeldUnrelatedOrgInd |
| Endowments Held Related Org | 0 | EndowmentsHeldRelatedOrgInd |
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | $149,670 | InvestmentCostOrOtherBasisAmt |
| Book Value | $149,670 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | $872,486 | InvestmentCostOrOtherBasisAmt |
| Depreciation | $483,308 | DepreciationAmt |
| Book Value | $389,178 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | $29,955 | InvestmentCostOrOtherBasisAmt |
| Depreciation | $16,305 | DepreciationAmt |
| Book Value | $13,650 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | $30,981 | InvestmentCostOrOtherBasisAmt |
| Depreciation | $18,351 | DepreciationAmt |
| Book Value | $12,630 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $565,128 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | DUE TO RELATED MCCULLOUGH-HYDE MEMORIAL HOSPITAL | Desc |
| Amt | $2,265,495 | Amt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $2,265,495 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART V, LINE 4: | HEALTH EDUCATION, HOSPITAL EQUIPMENT, COMMUNITY HEALTH |
| PART X, LINE 2: | ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA REQUIRE MANAGEMENT TO EVALUATE TAX POSITIONS TAKEN BY THE TRUST AND THE HOSPITAL AND RECOGNIZE A TAX LIABILITY IF THEY HAVE 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, 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 TRUST AND THE HOSPITAL ARE SUBJECT TO ROUTINE AUDITS BY TAXING JURISDICTIONS; HOWEVER, THERE ARE CURRENTLY NO AUDITS FOR ANY TAX PERIODS IN PROGRESS. |
Schedule G IRS990ScheduleG
| Field | Value | IRS element (for citing) |
|---|---|---|
| Mail Solicitations | Yes (X) | MailSolicitationsInd |
| Email Solicitations | Yes (X) | EmailSolicitationsInd |
| Phone Solicitations | Yes (X) | PhoneSolicitationsInd |
| In Person Solicitations | Yes (X) | InPersonSolicitationsInd |
| Special Fundraising Events | Yes (X) | SpecialFundraisingEventsInd |
| Agrmt Prof Fundraising Acty | 0 | AgrmtProfFundraisingActyInd |
Fundraiser Activity Info FundraiserActivityInfoGrp
Organization Business Name OrganizationBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SKYSTONE | BusinessNameLine1 |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 635 W 7TH ST 107 | AddressLine1 |
| City | CINCINNATI | City |
| State | OH | State |
| ZIP Code | 45203 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activity | CONSULTING | ActivityTxt |
| Fundraiser Control Of Funds | 0 | FundraiserControlOfFundsInd |
| Gross Receipts | $0 | GrossReceiptsAmt |
| Retained By Contractor | $0 | RetainedByContractorAmt |
| Net To Organization | $0 | NetToOrganizationAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Licensed States | OH | LicensedStatesCd |
| Licensed States | IN | LicensedStatesCd |
Fundraising Event Information FundraisingEventInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Event1 | CHEF CELEBRATION | NameOfEvent1Amt |
| Gross Receipts Event1 | $118,481 | GrossReceiptsEvent1Amt |
| Gross Revenue Event1 | $118,481 | GrossRevenueEvent1Amt |
| Rent Facility Costs Event1 | $11,543 | RentFacilityCostsEvent1Amt |
| Food And Beverage Event1 | $9,516 | FoodAndBeverageEvent1Amt |
| Entertainment Event1 | $600 | EntertainmentEvent1Amt |
| Other Direct Expenses Event1 | $12,254 | OtherDirectExpensesEvent1Amt |
| Gross Receipts Total | $118,481 | GrossReceiptsTotalAmt |
| Gross Revenue Total Events | $118,481 | GrossRevenueTotalEventsAmt |
| Rent Fclty Costs Total Events | $11,543 | RentFcltyCostsTotalEventsAmt |
| Food And Beverage Total Events | $9,516 | FoodAndBeverageTotalEventsAmt |
| Entertainment Total Events | $600 | EntertainmentTotalEventsAmt |
| Oth Direct Expnss Total Events | $12,254 | OthDirectExpnssTotalEventsAmt |
| Direct Expense Summary Events | $33,913 | DirectExpenseSummaryEventsAmt |
| Net Income Summary | $84,568 | NetIncomeSummaryAmt |
Persons With Books Name PersonsWithBooksName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | JAMES MILLER | BusinessNameLine1 |
Persons With Books US Address PersonsWithBooksUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 110 N POPLAR | AddressLine1 |
| City | OXFORD | City |
| State | OH | State |
| ZIP Code | 45056 | ZIPCode |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Records Maintained | Yes (1) | GrantRecordsMaintainedInd |
Recipient Table RecipientTable (2 entries)
| Address Line1USAddress/AddressLine1 | CityUSAddress/City | StateUSAddress/State | ZIP CodeUSAddress/ZIPCode | Recipient EINRecipientEIN | IRC SectionIRCSectionDesc | Cash GrantCashGrantAmt | Purpose Of GrantPurposeOfGrantTxt |
|---|---|---|---|---|---|---|---|
| OXFORD FREE CLINIC | |||||||
| PO BOX 18818 | FAIRFIELD | OH | 45018 | 204253386 | 501(C)(3) | $15,304 | HEALTH CLINIC |
| MCCULLOUGH-HYDE MEMORIAL HOSPITAL | |||||||
| 110 NORTH POPLAR STREET | OXFORD | OH | 45056 | 310650283 | 501(C)(3) | $395,075 | PROGRAM DEVELOPMENT, HEALTH PROGRAM FUNDING, EDUCATION PROGRAMS, BUILDING AND FACILITY SUPPORT |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total501c3 Org | 2 | Total501c3OrgCnt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART I, LINE 2: | FormAndLineReferenceDesc |
| Explanation | THE ORGANIZATION HAS REPRESENTATION ON THE BOARD THAT OVERSEES OPERATIONS. | ExplanationTxt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Severance Payment | Yes (1) | 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 (2 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| BRYAN HEHEMANN | ||||||||||||||
| PRESIDENT AND CEO | $0 | $203,702 | $0 | $3,000 | $0 | $0 | $0 | $0 | $0 | $25,126 | $0 | $231,828 | $0 | $0 |
| JOHN CLEMENTS | ||||||||||||||
| VICE PRESIDENT AND CFO | $0 | $141,240 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $12,499 | $0 | $153,739 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART I, LINES 4A-B | FormAndLineReferenceDesc |
| Explanation | TAMMY LANGDON - SEVERANCE - POSITION ELIMINATION EFFECTIVE 1/11/13 - $60,916 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. | ExplanationTxt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION B, LINE 11 | THE 990 IS REVIEWED BY THE CFO AND FINANCE COMMITTEE OF THE BOARD PRIOR TO SUBMISSION. ALL BOARD MEMBERS ARE INVITED ATTEND. THE FINANCE COMMITTEE REVIEWS WITH THE FULL BOARD AT THE NEXT SCHEDULED MEETING. |
| FORM 990, PART VI, SECTION B, LINE 12C | ALL MEMBERS OF ADMINISTRATION, DEPARTMENT DIRECTORS, MANAGERS, SUPERVISORS AND OTHER INDIVIDUALS WHO ARE, OR MAY BE, RESPONSIBLE FOR THE DIRECT PURCHASE OF GOODS AND/OR SERVICES ON BEHALF OF THE HOSPITAL SHALL BE REQUIRED TO REVIEW THIS POLICY AND COMPLETE A CONFLICT OF INTEREST FORM FOR SUBMISSION TO THE CORPORATE COMPLIANCE OFFICER ANNUALLY. WHEN A CONFLICT OF INTEREST ARISES OR A POTENTIAL CONFLICT OF INTEREST DEVELOPS, THE PERSON WHO IS OR MAY BE IN A CONFLICT OF INTEREST SITUATION IS REQUIRED TO MAKE A FULL WRITTEN DISCLOSURE OF THE SITUATION OR POTENTIAL SITUATION BY COMPLETING AND SIGNING A CONFLICT OF INTEREST QUESTIONNAIRE AND RETURNING IT TO HIS/HER DEPARTMENT DIRECTOR AND/OR APPROPRIATE ADMINISTRATOR, WHO WILL FORWARD THE CONFLICT OF INTEREST FORM TO THE CORPORATE COMPLIANCE OFFICER FOR REVIEW AND APPROPRIATE ACTION. THE CORPORATE COMPLIANCE COMMITTEE SHALL CONDUCT A FULL REVIEW AND ASSESSMENT OF THE POTENTIAL CONFLICT AND WILL PROVIDE ONE OF THE FOLLOWING WRITTEN RECOMMENDATIONS/CONCLUSIONS: 1. THE CIRCUMSTANCES REPORTED DO NOT PRESENT A PROBLEM. 2. ALTERNATE ARRANGEMENTS MADE BY/WITH THE EMPLOYEE ARE ACCEPTABLE AND PRESENT NO PROBLEM. 3. ALTERNATE ARRANGEMENTS ARE NOT ACCEPTABLE AND THE CONFLICT WILL BE DEALT WITH ON AN INDIVIDUAL BASIS. |
| FORM 990, PART VI, SECTION C, LINE 19 | THE DOCUMENTS ARE MADE AVAILABLE UPON REQUEST. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp
Disregarded Entity Name DisregardedEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MCCULLOUGH-HYDE MEMORIAL HOSPITAL INC | BusinessNameLine1 |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 110 N POPLAR STREET | AddressLine1 |
| City | OXFORD | City |
| State | OH | State |
| ZIP Code | 45056 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 310650283 | EIN |
| Primary Activities | HOSPITAL | PrimaryActivitiesTxt |
| Legal Domicile State | OH | LegalDomicileStateCd |
| Exempt Code Section | 501(C)(3) | ExemptCodeSectionTxt |
| Public Charity Status | LINE 3 | PublicCharityStatusTxt |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MCCULLOUGH-HYDE MEMORIAL HOSPITAL ENDOWMENT TRUST | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Controlled Organization | Yes (1) | ControlledOrganizationInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | Yes (1) | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | 0 | 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 | 0 | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | 0 | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | 0 | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | 0 | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | 0 | SharingOfFacilitiesInd |
| Paid Employees Sharing | 0 | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | Yes (1) | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |
Transactions Related Org TransactionsRelatedOrgGrp
Other Organization Name OtherOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MCCULLOUGH-HYDE MEMORIAL HOSPITAL | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Transaction Type | B | TransactionTypeTxt |
| Involved | $273,152 | InvolvedAmt |
| Method Of Amount Determination | COST | MethodOfAmountDeterminationTxt |