OHIOHEALTH CORPORATION: Form 990, tax year 2012
View the entire original 990 at ProPublica ↗
- Organization
- OHIOHEALTH CORPORATION (EIN 34-4429514)
- Tax period
- 2012-01-01 to 2012-12-31
- Filed
- 2013-11-22
- IRS object ID
- 201303269349300505
- 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
- Form 990
- Schedule A
- Schedule B
- Schedule C
- Schedule D
- Schedule G
- Schedule H
- Schedule J
- Schedule K
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2013-11-22T08:21:56-06:00 | Timestamp |
| Tax Period End Date | 2012-12-31 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 351178661 | EIN |
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BLUE & CO LLC | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| 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 | ReturnType |
| Tax Period Begin Date | 2012-01-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 344429514 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | VAN WERT COUNTY HOSPITAL ASSOCIATION | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | VANW | NameControl |
| Phone | 4192388609 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1250 SOUTH WASHINGTON STREET | AddressLine1 |
| City | VAN WERT | City |
| State | OH | State |
| ZIP Code | 45891 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | MICHAEL T HOLLIDAY | Name |
| Title | VICE PRESIDENT | Title |
| Phone | 4192388609 | Phone |
| Date Signed | 2013-11-21 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | NANCY KIRCHNER | Name |
| PTIN | P00386751 | PTIN |
| Phone | 6148852583 | Phone |
| Date Prepared | 2013-11-21 | DatePrepared |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2012 | TaxYear |
| Build TS | 2016-02-25 16:41:14Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Amended Return | X | AmendedReturn |
| Name Of Principal Officer Person | MICHAEL T HOLLIDAY | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1250 SOUTH WASHINGTON STREET | AddressLine1 |
| City | VAN WERT | City |
| State | OH | State |
| ZIP Code | 45891 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 47656191 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | WWW.VANWERTHOSPITAL.ORG | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1905 | YearFormation |
| State Legal Domicile | OH | StateLegalDomicile |
| Activity Or Mission Description | PROVIDE A CONTINUUM OF HEALTH CARE SERVICES IN INPATIENT AND AMBULATORY SETTINGS AND MAINTAIN OR EXTEND ALL NECESSARY ELEMENTS OF CARE TO ADDRESS THE NEEDS OF EVERY PATIENT IN A COMPASSIONATE MANNER. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 14 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 12 | NbrIndependentVotingMembers |
| Total Nbr Employees | 365 | TotalNbrEmployees |
| Total Nbr Volunteers | 13 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 387834 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 453985 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 46366564 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 43609288 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 1760772 | InvestmentIncomePriorYear |
| Investment Income Current Year | 1672422 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 699481 | OtherRevenuePriorYear |
| Other Revenue Current Year | 1240608 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 49214651 | TotalRevenuePriorYear |
| Total Revenue Current Year | 46976303 | 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 | 20506342 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 18651151 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 1934 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 25082666 | OtherExpensePriorYear |
| Other Expenses Current Year | 24588481 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 45589008 | TotalExpensesPriorYear |
| Total Expenses Current Year | 43239632 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 3625643 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 3736671 | RevenuesLessExpensesCY |
| Total Assets BOY | 73153577 | TotalAssetsBOY |
| Total Assets EOY | 79593368 | TotalAssetsEOY |
| Total Liabilities BOY | 13511844 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 12397760 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 59641733 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 67195608 | NetAssetsOrFundBalancesEOY |
| Info In Schedule O Part III | X | InfoInScheduleOPartIII |
| Mission Description | VAN WERT COUNTY HOSPITAL WILL MEET THE COMMUNITY HEALTH CARE NEEDS BY CONTINUALLY ENDEAVORING TO IMPROVE THE QUALITY OF PATIENT CARE WE PROVIDE WITHIN OUR RESOURCE CAPABILITIES. PROGRAMS AND SERVICES SPONSORED BY THE VAN WERT COUNTY HOSPITAL WILL SERVE AS AN ACCESS POINT TO HEALTH CARE WITHIN OUR COMMUNITY. WE ACCEPT RESPONSIBILITY FOR PROVIDING COMMUNITY LEADERSHIP. VAN WERT COUNTY HOSPITAL ASSURES THAT HEALTH CARE SERVICES PROVIDED ARE AVAILABLE TO ALL MEMBERS OF THE COMMUNITIES WE SERVE REGARDLESS OF RACE, CREED, SEX, NATIONAL ORIGIN, OR ABILITY TO PAY, WHILE AT THE SAME TIME RESPECTING BOTH THE RIGHTS AND RESPONSIBILITIES OF OUR PATIENTS. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 7348947 | Expense |
| Revenue | 10492912 | Revenue |
| Description | INPATIENT CARE SERVICES | Description |
Activity2 Activity2
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | 22036695 | Expense |
| Revenue | 26122120 | Revenue |
| Description | OUTPATIENT CARE SERVICES | Description |
Activity3 Activity3
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | 4300635 | Expense |
| Revenue | 7358756 | Revenue |
| Description | EMERGENCY PATIENT CARE SERVICES | Description |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Expense | 33686277 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 1 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 1 | 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 | 1 | 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 | 1 | ReportOtherLiabilities |
| Report Fin48 Footnote | 1 | 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 | 1 | FundraisingActivities |
| Gaming | 0 | Gaming |
| Hospital | 1 | Hospital |
| Financial Stmt Attached | 1 | FinancialStmtAttached |
| Grants To Organizations | 0 | GrantsToOrganizations |
| Grants To Individuals | 0 | GrantsToIndividuals |
| Schedule J Required | 1 | ScheduleJRequired |
| Tax Exempt Bonds | 1 | TaxExemptBonds |
| Invest Tax Exempt Bonds | 0 | InvestTaxExemptBonds |
| Escrow Account | 0 | EscrowAccount |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuer |
| 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 | 1 | DisregardedEntity |
| Related Entity | 1 | RelatedEntity |
| Related Org Controlled Entity | 1 | RelatedOrgControlledEntity |
| Transaction Related Entity | 0 | TransactionRelatedEntity |
| Transfers To Exempt Non Chrtbl Org | 0 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 75 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | 1 | ComplianceWithBackupWitholding |
| Number Of Employees | 365 | NumberOfEmployees |
| Employment Tax Returns Filed | 1 | EmploymentTaxReturnsFiled |
| 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 | 14 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 12 | 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 | 1 | 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 | 1 | WhistleblowerPolicy |
| Document Retention Policy | 1 | DocumentRetentionPolicy |
| Compensation Process CEO | 1 | CompensationProcessCEO |
| Compensation Process Other | 1 | CompensationProcessOther |
| Investment In Joint Venture | 0 | InvestmentInJointVenture |
| States Where Copy Of Return Is Filed | OH | StatesWhereCopyOfReturnIsFiled |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Person | MICHAEL HOLLIDAY | NamePerson |
| Telephone Number | 4192388609 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1250 SOUTH WASHINGTON STREET | AddressLine1 |
| City | VAN WERT | City |
| State | OH | State |
| ZIP Code | 45891 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionA (21 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | OfficerOfficer | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | Key EmployeeKeyEmployee | Highest Compensated EmployeeHighestCompensatedEmployee |
|---|---|---|---|---|---|---|---|---|
| JON BAGLEY | ||||||||
| CHAIRPERSON | 2.00 | X | X | 0 | 0 | 0 | ||
| BARB KOHNEN | ||||||||
| VICE-CHAIRPERSON | 2.00 | X | X | 0 | 0 | 0 | ||
| GEORGE BROOKS | ||||||||
| TRUSTEE | 2.00 | X | 0 | 0 | 0 | |||
| ANDY CZAJKOWSKI | ||||||||
| TRUSTEE | 2.00 | X | 0 | 0 | 0 | |||
| DR ERIC JELINGER | ||||||||
| TRUSTEE | 2.00 | X | 0 | 0 | 0 | |||
| DR JOEL KNERR | ||||||||
| TRUSTEE | 2.00 | X | 0 | 0 | 0 | |||
| GARY ADAMS | ||||||||
| TRUSTEE | 2.00 | X | 0 | 0 | 0 | |||
| AARON MECHLING | ||||||||
| TRUSTEE | 2.00 | X | 0 | 0 | 0 | |||
| JON RHOADES | ||||||||
| TRUSTEE | 2.00 | X | 0 | 0 | 0 | |||
| GARY CLAY | ||||||||
| SECRETARY | 2.00 | X | X | 0 | 0 | 0 | ||
| DR BASHAR HAMDI | ||||||||
| TRUSTEE | 2.00 | X | 0 | 0 | 0 | |||
| TIM JURCZYK | ||||||||
| TRUSTEE | 2.00 | X | 0 | 0 | 0 | |||
| MARK MINICK | ||||||||
| CEO | 40.00 | X | X | 555531 | 0 | 225473 | ||
| THOMAS CONTE MD | ||||||||
| PHYSICIAN | 40.00 | X | 342069 | 0 | 20332 | |||
| MICHAEL HOLLIDAY | ||||||||
| VICE PRESIDENT FISCAL & AD | 40.00 | X | 198534 | 0 | 8155 | |||
| PATRICK BRUNO MD | ||||||||
| PHYSICIAN | 40.00 | 155503 | 0 | 19878 | X | |||
| THOMAS LAUTZENHEISER MD | ||||||||
| PHYSICIAN | 40.00 | 162369 | 0 | 9153 | X | |||
| JOCELYN WRAY MD | ||||||||
| PHYSICIAN | 40.00 | 177469 | 0 | 22101 | X | |||
| SCOTT JARVIS MD | ||||||||
| PHYSICIAN | 40.00 | 239102 | 0 | 22306 | X | |||
| DOUGLAS MOORE MD | ||||||||
| PHYSICIAN | 40.00 | 213584 | 0 | 22302 | X | |||
| PAM BAKER | ||||||||
| VP NURSING | 40.00 | 209843 | 0 | 6803 | X | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 2254004 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 0 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 356503 | TotalOtherCompensation |
| Number Individuals GT100 K | 17 | NumberIndividualsGT100K |
| Formers Listed | 0 | FormersListed |
| Total Comp GT150 K | 1 | TotalCompGT150K |
| Compensation From Other Sources | 0 | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (5 entries)
| Address Line1AddressOfContractor/AddressUS/AddressLine1 | CityAddressOfContractor/AddressUS/City | StateAddressOfContractor/AddressUS/State | ZIP CodeAddressOfContractor/AddressUS/ZIPCode | Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|---|---|---|---|
| THERAPY SOLUTIONS | |||||
| 120 W MAIN STREET | VAN WERT | OH | 45891 | PHYSICAL THERAPY SERVICES | 1416102 |
| NEW VISION MEDICAL LABORATORY | |||||
| 750 WEST HIGH STREET | LIMA | OH | 45801 | LABORATORY SERVICES | 1320000 |
| CLINICAL COLLEAGUES | |||||
| 613 TATEM AVE | COLLINGSWOOD | NJ | 08108 | ANESTHESIA PROFESSIONAL SERVICES | 1028032 |
| PHOENIX PHYSICIANS | |||||
| 3114 CROADSDAILE DRIVE SUITE 200 | DURHAM | NC | 27705 | ER PHYSICIAN SERVICES | 702224 |
| SIEMENS MEDICAL SOLUTIONS USA | |||||
| 51 VALLEY STREAM PARKWAY | MALVERN | PA | 19355 | INFORMATION SYSTEMS | 645256 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 18 | NumberOfContractorsGT100K |
| Membership Dues | 50 | MembershipDues |
| Related Organizations | 100000 | RelatedOrganizations |
| All Other Contributions | 353935 | AllOtherContributions |
| Total Contributions | 453985 | TotalContributions |
Program Service Revenue ProgramServiceRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | PATIENT SERVICE REVENUE | Description |
| Business Code | 900099 | BusinessCode |
| Total Revenue Column | 43609288 | TotalRevenueColumn |
| Related Or Exempt Function Income | 43609288 | RelatedOrExemptFunctionIncome |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 43609288 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 2049577 | TotalRevenueColumn |
| Exclusion | $2,049,577 | ExclusionAmount |
Gross Rents GrossRents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 902391 | Real |
Less Rental Expenses LessRentalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 289838 | Real |
Rental Income Or Loss RentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 612553 | Real |
Net Rental Income Or Loss NetRentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 612553 | TotalRevenueColumn |
| Exclusion | $612,553 | ExclusionAmount |
Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | 377155 | Other |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | -377155 | Other |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -377155 | TotalRevenueColumn |
| Exclusion | -$377,155 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Income Fundraising Events | 25594 | GrossIncomeFundraisingEvents |
| Fundraising Direct Expenses | 12895 | FundraisingDirectExpenses |
Net Income From Fundraising Events NetIncomeFromFundraisingEvents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 12699 | TotalRevenueColumn |
| Exclusion | $12,699 | ExclusionAmount |
Other Revenue Misc OtherRevenueMisc (3 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome | ExclusionExclusionAmount |
|---|---|---|---|---|
| MISCELLANEOUS INCOME | 900099 | 239659 | 239659 | |
| CAFETERIA/VENDING | 900099 | 195186 | $195,186 | |
| WELLNESS INCOME | 900099 | 133841 | 133841 |
Miscellaneous Revenue MiscellaneousRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 46670 | TotalRevenueColumn |
| Exclusion | $46,670 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 615356 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 46976303 | TotalRevenueColumn |
| Related Or Exempt Function Income | 43982788 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $2,539,530 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | X | InfoInScheduleOPartIX |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2617857 | Total |
| Management And General | 2617857 | ManagementAndGeneral |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 11472385 | Total |
| Program Services | 8719013 | ProgramServices |
| Management And General | 2753372 | ManagementAndGeneral |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 452336 | Total |
| Program Services | 343775 | ProgramServices |
| Management And General | 108561 | ManagementAndGeneral |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3122842 | Total |
| Program Services | 2373360 | ProgramServices |
| Management And General | 749482 | ManagementAndGeneral |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 985731 | Total |
| Program Services | 749156 | ProgramServices |
| Management And General | 236575 | ManagementAndGeneral |
Fees For Services Management FeesForServicesManagement
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 704672 | Total |
| Program Services | 704672 | ProgramServices |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 44579 | Total |
| Program Services | 6687 | ProgramServices |
| Management And General | 37892 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 76601 | Total |
| Management And General | 76601 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 7633772 | Total |
| Program Services | 6604039 | ProgramServices |
| Management And General | 1029567 | ManagementAndGeneral |
| Fundraising | 166 | Fundraising |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 295201 | Total |
| Program Services | 259777 | ProgramServices |
| Management And General | 35424 | ManagementAndGeneral |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 739230 | Total |
| Program Services | 561815 | ProgramServices |
| Management And General | 177415 | ManagementAndGeneral |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 739157 | Total |
| Program Services | 502627 | ProgramServices |
| Management And General | 236530 | ManagementAndGeneral |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2095974 | Total |
| Program Services | 1718699 | ProgramServices |
| Management And General | 377275 | ManagementAndGeneral |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 176796 | Total |
| Program Services | 53039 | ProgramServices |
| Management And General | 121989 | ManagementAndGeneral |
| Fundraising | 1768 | Fundraising |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 301319 | Total |
| Program Services | 256121 | ProgramServices |
| Management And General | 45198 | ManagementAndGeneral |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2392181 | Total |
| Program Services | 1818058 | ProgramServices |
| Management And General | 574123 | ManagementAndGeneral |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 677303 | Total |
| Program Services | 636665 | ProgramServices |
| Management And General | 40638 | ManagementAndGeneral |
Other Expenses OtherExpenses (4 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral |
|---|---|---|---|
| MEDICAL SUPPLIES | 4655004 | 4655004 | |
| BAD DEBT EXPENSE | 2258391 | 2258391 | |
| MISCELLANEOUS | 1130629 | 859278 | 271351 |
| COLLECTIONS | 411126 | 411126 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 256546 | Total |
| Program Services | 194975 | ProgramServices |
| Management And General | 61571 | ManagementAndGeneral |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 43239632 | Total |
| Program Services | 33686277 | ProgramServices |
| Management And General | 9551421 | ManagementAndGeneral |
| Fundraising | 1934 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 876695 | BOY |
| EOY | 1688 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 336694 | BOY |
| EOY | 806884 | EOY |
Pledges And Grants Receivable PledgesAndGrantsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 585949 | BOY |
| EOY | 286336 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 5269409 | BOY |
| EOY | 4478829 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 695007 | BOY |
| EOY | 655861 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 555395 | BOY |
| EOY | 509920 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 58537366 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 39707538 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 19958500 | BOY |
| EOY | 18829828 | EOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 40423669 | BOY |
| EOY | 49701593 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4452259 | BOY |
| EOY | 4322429 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 73153577 | BOY |
| EOY | 79593368 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4503758 | BOY |
| EOY | 4697927 | EOY |
Tax Exempt Bond Liabilities TaxExemptBondLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 6269804 | BOY |
| EOY | 5494995 | EOY |
Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1740020 | BOY |
| EOY | 1347699 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 998262 | BOY |
| EOY | 857139 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 13511844 | BOY |
| EOY | 12397760 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 55510039 | BOY |
| EOY | 63303702 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 817424 | BOY |
| EOY | 491251 | EOY |
Permanently Restricted Net Assets PermanentlyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3314270 | BOY |
| EOY | 3400655 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 59641733 | BOY |
| EOY | 67195608 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 73153577 | BOY |
| EOY | 79593368 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | 3736671 | ReconcilationRevenueExpenses |
| Reconciliation Unrealized Invest | 3804309 | ReconciliationUnrealizedInvest |
| Reconcilation Other Changes | 12895 | 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) |
|---|---|---|
| Hospital170b1 Aiii | X | Hospital170b1Aiii |
Schedule B IRS990ScheduleB
Contributor Info ContributorInfo
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor Number | RESTRICTED | ContributorNumber |
Contributor Name Business ContributorNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor Address US ContributorAddressUS
| 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) |
|---|---|---|
| Aggregate Contributions | RESTRICTED | AggregateContributions |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | 0 | Volunteers |
| Paid Staff Or Management | 0 | PaidStaffOrManagement |
| Media Advertisements | 0 | MediaAdvertisements |
| Mailings Members | 0 | MailingsMembers |
| Publications Or Broadcast | 0 | PublicationsOrBroadcast |
| Grants Other Organizations | 0 | GrantsOtherOrganizations |
| Direct Contact Legislators | 0 | DirectContactLegislators |
| Rallies Demonstrations | 0 | RalliesDemonstrations |
| Other Activities | 1 | OtherActivities |
| Other Activities | $3,006 | OtherActivitiesAmount |
| Total Lobbying Expenditures IIB | 3006 | TotalLobbyingExpendituresIIB |
| Not Described In501c3 | 0 | NotDescribedIn501c3 |
Form990 Schedule C Part IV Form990ScheduleCPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | EXPLANATION OF LOBBYING ACTIVITIES: | Identifier |
| Return Reference | PART II-B, LINE 1: | ReturnReference |
| Explanation | PORTION OF DUES PAID TO THE OHIO HOSPITAL ASSOCIATION IS USED FOR POLITICAL PURPOSES. | Explanation |
Schedule D IRS990ScheduleD
Current Year CurrentYear
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 6717856 | BeginningOfYearBalance |
| Contributions | 86376 | Contributions |
| Investment Earnings Or Losses | 1031004 | InvestmentEarningsOrLosses |
| Other Expenditures | 172628 | OtherExpenditures |
| Administrative Expenses | 33806 | AdministrativeExpenses |
| End Of Year Balance | 7628802 | EndOfYearBalance |
Current Year Minus1 Year CurrentYearMinus1Year
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 6894036 | BeginningOfYearBalance |
| Contributions | 690 | Contributions |
| Investment Earnings Or Losses | 55154 | InvestmentEarningsOrLosses |
| Other Expenditures | 205252 | OtherExpenditures |
| Administrative Expenses | 26772 | AdministrativeExpenses |
| End Of Year Balance | 6717856 | EndOfYearBalance |
Current Year Minus2 Years CurrentYearMinus2Years
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 6496893 | BeginningOfYearBalance |
| Contributions | 29533 | Contributions |
| Investment Earnings Or Losses | 612733 | InvestmentEarningsOrLosses |
| Other Expenditures | 217775 | OtherExpenditures |
| Administrative Expenses | 27348 | AdministrativeExpenses |
| End Of Year Balance | 6894036 | EndOfYearBalance |
Current Year Minus3 Years CurrentYearMinus3Years
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 5715171 | BeginningOfYearBalance |
| Contributions | 2535 | Contributions |
| Investment Earnings Or Losses | 1004939 | InvestmentEarningsOrLosses |
| Other Expenditures | 202203 | OtherExpenditures |
| Administrative Expenses | 23549 | AdministrativeExpenses |
| End Of Year Balance | 6496893 | EndOfYearBalance |
Current Year Minus4 Years CurrentYearMinus4Years
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 5998772 | BeginningOfYearBalance |
| Contributions | 63420 | Contributions |
| Investment Earnings Or Losses | -111884 | InvestmentEarningsOrLosses |
| Other Expenditures | 207220 | OtherExpenditures |
| Administrative Expenses | 27917 | AdministrativeExpenses |
| End Of Year Balance | 5715171 | EndOfYearBalance |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Board Designated EOY Balance | 0.55000 | BoardDesignatedEOYBalance |
| Permanent Endowment EOY Balance | 0.45000 | PermanentEndowmentEOYBalance |
| Endowments Held By Unrelated Orgs | 0 | EndowmentsHeldByUnrelatedOrgs |
| Endowments Held By Related Orgs | 0 | EndowmentsHeldByRelatedOrgs |
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 943059 | OtherCostOrOtherBasis |
| Book Value | 943059 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 28474778 | OtherCostOrOtherBasis |
| Depreciation | 16735086 | Depreciation |
| Book Value | 11739692 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 29054262 | OtherCostOrOtherBasis |
| Depreciation | 22972452 | Depreciation |
| Book Value | 6081810 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 65267 | OtherCostOrOtherBasis |
| Book Value | 65267 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 18829828 | TotalOfBookValueLandBuildings |
Other Assets OtherAssets (4 entries)
| DescriptionDescription | Book ValueBookValue |
|---|---|
| DEBT ISSUANCE COST, NET | 26950 |
| INVESTMENT IN JOINT VENTURES | 419913 |
| OTHER ASSETS | 269996 |
| ASSETS WHOSE USE IS LIMITED | 3605570 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | 4322429 | TotalBookValueOtherAssets |
Other Liabilities OtherLiabilities (3 entries)
| DescriptionDescription | AmountAmount |
|---|---|
| THIRD PARTY SETTLEMENTS | $679,136 |
| INTEREST RATE SWAP | $123,998 |
| ESTIMATED LIABILITY CLAIMS | $54,005 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 857139 | TotalOfAmounts |
| Footnote In Part XIII | X | FootnoteInPartXIII |
Form990 Schedule D Part XIII Form990ScheduleDPartXIII (2 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: | PART V, LINE 4: | THE INVESTMENT INCOME GENERATED BY THE ENDOWMENT FUNDS DISTRIBUTED TO THE HOSPITAL IS ABLE TO BE USED FOR GENERAL OPERATING AND CAPITAL EQUIPMENT NEEDS. |
| SCHEDULE D, PART X, LINE 2 - ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA REQUIRE MANAGEMENT TO EVALUATE TAX POSITIONS TAKEN AND RECOGNIZE A TAX LIABILITY IF AN UNCERTAIN POSITION HAS BEEN TAKEN 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 THESE ENTITIES AND HAS CONCLUDED THAT AS OF DECEMBER 31, 2012 AND 2011, THERE ARE NO UNCERTAIN TAX POSITIONS TAKEN OR EXPECTED TO BE TAKEN THAT WOULD REQUIRE RECOGNITION OF A LIABILITY OR DISCLOSURE IN THE ACCOMPANYING FINANCIAL STATEMENTS. |
Schedule G IRS990ScheduleG
Events Information EventsInformation
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Event1 | VAN WERT COMMUNITY HOSPITAL GOLF OU | NameOfEvent1 |
| Gross Receipts Event1 | 25594 | GrossReceiptsEvent1 |
| Gross Revenue Event1 | 25594 | GrossRevenueEvent1 |
| Non Cash Prizes Event1 | 2096 | NonCashPrizesEvent1 |
| Food And Beverage Event1 | 4091 | FoodAndBeverageEvent1 |
| Other Direct Expenses Event1 | 6708 | OtherDirectExpensesEvent1 |
| Gross Receipts Total | 25594 | GrossReceiptsTotal |
| Gross Revenue Total Events | 25594 | GrossRevenueTotalEvents |
| Non Cash Prizes Total Events | 2096 | NonCashPrizesTotalEvents |
| Food And Beverage Total Events | 4091 | FoodAndBeverageTotalEvents |
| Other Direct Expenses Total Events | 6708 | OtherDirectExpensesTotalEvents |
| Direct Expense Summary Events | 12895 | DirectExpenseSummaryEvents |
| Net Income Summary | 12699 | NetIncomeSummary |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Charity Care Policy | 1 | CharityCarePolicy |
| Written Policy | 1 | WrittenPolicy |
| FPG Reference Free Care | 1 | FPGReferenceFreeCare |
| Pcent100 | X | Pcent100 |
| FPG Reference Discounted Care | 1 | FPGReferenceDiscountedCare |
| Pcent200 D | X | Pcent200D |
| Free Disc Care Medically Indigent | 1 | FreeDiscCareMedicallyIndigent |
| Amounts Budgeted For Charity Care | 1 | AmountsBudgetedForCharityCare |
| Expenses Exceeded Budget | 0 | ExpensesExceededBudget |
| Annual Community Benefit Report | 1 | AnnualCommunityBenefitReport |
| Report Publically Available | 1 | ReportPublicallyAvailable |
Charity Care At Cost CharityCareAtCost
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 852612 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 852612 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.02080 | PercentOfTotalExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 5069677 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 2389770 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 2679907 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.06540 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 5922289 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 2389770 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 3532519 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.08620 | PercentOfTotalExpense |
Community Health Services CommunityHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 214656 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 6194 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 208462 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00510 | PercentOfTotalExpense |
Health Professions Education HealthProfessionsEducation
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 9019 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 9019 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00020 | PercentOfTotalExpense |
Subsidized Health Services SubsidizedHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 537 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 537 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00000 | PercentOfTotalExpense |
Cash And In Kind Contributions CashAndInKindContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 16019 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 16019 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00040 | PercentOfTotalExpense |
Total Other Benefits TotalOtherBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 240231 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 6194 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 234037 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00570 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 6162520 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 2395964 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 3766556 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.09190 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 0 | BadDebtExpenseReported |
| Bad Debt Expense | $1,374,394 | BadDebtExpenseAmount |
| Amount Attributable To | 27488 | AmountAttributableTo |
| Amount Reimbursed By Medicare | 8902460 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 9832500 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | -930040 | MedicareSurplusOrShortfall |
Costing Methodology Used CostingMethodologyUsed
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | X | CostToChargeRatio |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | 1 | WrittenDebtCollectionPolicy |
| Provision For Charity Care | 1 | ProvisionForCharityCare |
Form990 Schedule H Part IV Form990ScheduleHPartIV (9 entries)
| Description Ent Primary ActivityDescriptionEntPrimaryActivity | Organization Profit Or OwnershipOrganizationProfitOrOwnership | Physicans Profit Or OwnershipPhysicansProfitOrOwnership |
|---|---|---|
| 1 VAN WERT MEDICAL SERVICES | ||
| MEDICAL PROFESSIONAL SERVICES | 1.00000 | |
| 2 SARAH JANE LIVING CENTER | ||
| LONG TERM ALZHEIMER'S CARE | 0.50000 | |
| 3 HOME HEALTH CARE SOLUTIONS | ||
| HOME HEALTHCARE SERVICES | 0.50000 | |
| 4 THERAPY SOLUTIONS | ||
| PHYSICAL THERAPY SOLUTIONS | 0.50000 | |
| 5 COMMUNITY CARE SYSTEMS | ||
| MANAGED CARE CONTRACTING | 0.50000 | 0.50000 |
| 6 DELPHOS REAL ESTATE LLC | ||
| REAL ESTATE | 0.50000 | |
| 7 CONVOY HEALTH FACILITIES LLC | ||
| HEALTH FACILITY | 0.50000 | |
| 8 WEST CENTRAL OHIO HOSPITAL CONSORTIUM LTD | ||
| HEALTHCARE FACILITIES | 0.33330 | |
| 9 NEW VISION MEDICAL LABORATORIES LLC | ||
| MEDICAL LABORATORIES | 0.20000 | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Hospital Facilities | 1 | NumberOfHospitalFacilities |
Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility Number | 1 | FacilityNumber |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | VAN WERT COUNTY HOSPITAL | BusinessNameLine1 |
Address Address
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1250 WASHINGTON STREET | AddressLine1 |
| City | VAN WERT | City |
| State | OH | State |
| ZIP Code | 45891 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Licensed Hospital | X | LicensedHospital |
| General Medical And Surgical | X | GeneralMedicalAndSurgical |
| Er24 Hours | X | Er24Hours |
Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | THE VAN WERT COUNTY HOSPITAL ASSOCIATION | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital Facility Number | 1 | HospitalFacilityNumber |
| Eligibility Criteria Explained | 1 | EligibilityCriteriaExplained |
| Uses FPG Free | 1 | UsesFPGFree |
| FPG Free Percent | 100.000000000000 | FPGFreePercent |
| Uses FPG Discounted | 1 | UsesFPGDiscounted |
| FPG Discount Percent | 200.000000000000 | FPGDiscountPercent |
| Explains Basis | 1 | ExplainsBasis |
| Income Level | X | IncomeLevel |
| Asset Level | X | AssetLevel |
| Medical Indigency | X | MedicalIndigency |
| Insurance Status | X | InsuranceStatus |
| Uninsured Discount | X | UninsuredDiscount |
| Medicaid Medicare | X | MedicaidMedicare |
| State Regulation | X | StateRegulation |
| Explains Application Method | 1 | ExplainsApplicationMethod |
| Includes Publicity Measures | 1 | IncludesPublicityMeasures |
| Posted On Website | X | PostedOnWebsite |
| Attached To Invoices | X | AttachedToInvoices |
| Posted In Emergency Room | X | PostedInEmergencyRoom |
| Posted In Admission Office | X | PostedInAdmissionOffice |
| Provided On Admission | X | ProvidedOnAdmission |
| Actions On Nonpayment | 1 | ActionsOnNonpayment |
| Collection Activities | 0 | CollectionActivities |
| Notify Upon Admission | X | NotifyUponAdmission |
| Notify Before Discharge | X | NotifyBeforeDischarge |
| Notified All Patients | X | NotifiedAllPatients |
| Documented Determination | X | DocumentedDetermination |
| Nondiscrim Emergency Care Policy | 1 | NondiscrimEmergencyCarePolicy |
| Lowest Negotiated Rates | X | LowestNegotiatedRates |
| Amounts Generally Billed | 0 | AmountsGenerallyBilled |
| Gross Charges | 0 | GrossCharges |
Form990 Schedule H Part V Section C Form990ScheduleHPartVSectionC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Other Facilities | 2 | NumberOfOtherFacilities |
Other Facilities OtherFacilities (2 entries)
| Address Line1Address/AddressLine1 | CityAddress/City | StateAddress/State | ZIP CodeAddress/ZIPCode | Facility TypeFacilityType |
|---|---|---|---|---|
| SARAH JANE LIVING CENTER | ||||
| 328 W 2ND ST | DELPHOS | OH | 45833 | LONG TERM ALZHEIMERS CARE |
| VANCREST OF CONVOY | ||||
| 510 TULLY DR | CONVOY | OH | 45832 | LONG TERM NURSING CARE |
Form990 Schedule H Part VI Form990ScheduleHPartVI (11 entries)
| ExplanationExplanation |
|---|
| PART I, LINE 3C: THE ORGANIZATION USED THE FPG TO DETERMINE ELIGIBILITY FOR FREE AND DISCOUNTED CARE. |
| PART I, LINE 7: THE ORGANIZATION REPORTS BAD DEBTS AS AN OPERATING EXPENSE. THE COSTING METHODOLOGY USED IN REPORTING BAD DEBT DATA IS A COST TO CHARGE RATIO METHODOLOGY. THE ORGANIZATION DOES NOT CLAIM BAD DEBT EXPENSE AS A COMMUNITY BENEFIT. |
| PART I, L7 COL(F): THE ASSOCIATION PROVIDES CARE TO PATIENTS WHO MEET CERTAIN CRITERIA UNDER ITS CHARITY CARE POLICY WITHOUT CHARGE OR AT AMOUNTS LESS THAN ITS ESTABLISHED RATES. BECAUSE THE ASSOCIATION DOES NOT PURSUE COLLECTION OF AMOUNTS DETERMINED TO QUALIFY AS CHARITY, SUCH AMOUNTS ARE NOT REPORTED AS REVENUE. BAD DEBTS ARE SHOWN AS AN EXPENSE VALUED AS REVENUE NOT RECEIVED AND WRITTEN OFF AS REVENUE. MANAGEMENT ESTIMATES AN ALLOWANCE FOR DOUTFUL ACCOUNTS BASED UPON FACTORS UNIQUE TO THE ASSOCIATION'S OPERATIONS. |
| PART II: THE HOSPITAL ENGAGES IN A NUMBER OF HEALTH COALITION INITIATIVES TO IMPROVE HEALTH STATUS OF OUR POPULATION. THE HOSPITAL PROVIDED A STARTUP GRANT & ONGOING SUPPORT FOR THE FAMILY HEALTH CARE OF NORTHWEST OHIO, A FQHC CURRENTLY WITH LOOK-ALIKE STATUS. FAMILY HEALTH CARE OF NORTHWEST OHIO IS CURRENTLY SERVING RESIDENTS OF VAN WERT, PAULDING & MERCER COUNTIES. THROUGH THE HOSPITAL'S HELP OF PROVIDING PRIMARY CARE PHYSICIANS AND FUNDING, THIS CLINIC SERVES AS A SAFETY NET PROVIDER TO CITIZENS THAT CURRENTLY HAD NO PRIMARY CARE PHYSICIAN OR ACCESS TO PRIMARY CARE SERVICES. IN 2009, THE HOSPITAL UNDERTOOK AN EXPANSION OF OUR EMERGENCY SERVICES DEPARTMENT, BECAUSE OF INCREASING VISITS DUE TO ECONOMIC, BEHAVIORAL, AND AGING POPULATION THE HOSPITAL EXPERIENCED INCREASING VOLUMES. IN PARTNERSHIP WITH OUR COMMUNITY THROUGH A CAPITAL RAISING CAMPAIGN CONSTRUCTION IS UNDERWAY. THIS STATE-OF THE-ART FACILITY WILL BETTER SERVE OUR POPULATION WITH EXPANDED TREATMENT AREAS (12,000 SQ. FT.) AND NEW TECHNOLOGY. THIS EXPANSION HAS ALSO PROVIDED ENHANCED OUR DISASTER RESPONSE CAPABILITIES. THE SIZE OF THE PROJECT ALSO INCLUDES MANY ECONOMIC BENEFITS FOR OUR COMMUNITY BEYOND THE CONSTRUCTION PHASE. THE HOSPITAL ALSO PARTICIPATES IN INITIATIVES WITH OTHER PROVIDERS AND AFFILIATES IN PROVISION OF SERVICES AND/OR DONATIONS. THE PROVISIONS OF LOW COST HEALTH SCREENING SERVICES IN COLLABORATION WITH OTHER ORGANIZATIONS HELP US IDENTIFY CONDITIONS ON A PROACTIVE BASIS TO BETTER IMPROVE OUR CITIZEN'S HEALTH OR MANAGEMENT OF CHRONIC DISEASES. THE CO-ORDINATION OF CARE THROUGH OUR HOME HEALTH REHABILITATIVE AND LONG TERM CARE PROVIDERS SERVE TO BETTER MEET THE NEEDS OF OUR PATIENTS AND POPULATION. OUR REGIONAL LABORATORY INITIATIVE HAS SHORTENED TURNAROUND TIME FOR TESTS AND HAS LOWERED COST TO OUR PATIENTS. THE HOSPITAL ALSO PARTICIPATES IN ECONOMIC DEVELOPMENT EFFORTS THROUGH ITS MEMBERSHIP IN THE CHAMBER OF COMMERCE AND OTHER ORGANIZATIONS. |
| PART III, LINE 4: THE ORGANIZATION REPORTS BAD DEBTS AS AN OPERATING EXPENSE. THE COSTING METHODOLOGY USED IN REPORTING BAD DEBT DATA IS A COST TO CHARGE RATIO METHODOLOGY. THE ORGANIZATION DOES NOT CLIAM BAD DEBT EXPENSE AS A COMMUNITY BENEFIT. |
| PART III, LINE 8: THE ORGANIZATION DOES NOT CONSIDER THE MEDICARE SHORTFALL AS A COMMUNITY BENEFIT. |
| PART III, LINE 9B: FOLLOWING THE GUIDELINES AND PROCESSES AS INDICATED IN QUESTION 3, PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE, THE ORGANIZATION APPROPRIATELY IDENTIFIES ACCOUNTS AS TO THE TYPE OF ASSISTANCE QUALIFIED FOR. THE AMOUNTS ELIGIBLE FOR ASSISTANCE ARE WRITTEN OFF TO THE APPROPRIATE PROGRAM AND COLLECTION ACTIVITY CEASES IN REGARD TO THOSE AMOUNTS. THE GOAL OF THE ORGANIZATION'S POLICIES IS TO INDENTIY ACCOUNTS ELIGIBLE FOR ASSISTANCE AND BRING THE ACCOUNT TO AN APPROPRIATE CONCLUSION AS EARLY IN THE BILLING CYCLE AS POSSIBLE. |
| PART VI, LINE 2: THE ORGANIZATION USES A VARIETY OF METHODS TO ASSESS HEALTH CARE NEEDS. DATA PROVIDED BY THE STATE OF OHIO IS USED TO DETERMINE EPIDEMIOLOGIES RELATED TO CHRONIC CONDITIONS AND CANCER REGISTRIES PROVIDING PREVALENCE. INTERNAL DATA IS ALSO USED AS WELL AS INPUT FROM OTHER PROVIDERS. THE HOSPITAL ALSO USES PATIENT ORIGIN DATA PROVIDED BY THE OHIO HOSPITAL ASSOCIATION TO DETERMINE CURRENT TREATMENT PATTERNS AND DIAGNOSIS FOR CURRENT RESIDENTS BEING TREATED IN VAN WERT COUNTY HOSPITAL AND OTHER SURROUNDING PROVIDERS. THE HOSPITAL ALSO SPONSORS A NUMBER OF HEALTH FAIRS/ASSESSMENTS TO BOTH ADULT AND PEDIATRIC POPULATIONS OF VAN WERT THAT IS ALSO EXAMINED FOR FREQUENCY AND NEEDS. A NUMBER OF STAFF AS WELL AS BOARD OF TRUSTEES MEMBERS ALSO SERVED ON COMMUNITY HEALTH PROVIDER BOARDS AND PROVIDE INPUT TO THE PLANNING PROCESS.THE HOSPITAL IS ALSO SUBSCRIBED TO A NUMBER OF BENCHMARKING ORGANIZATIONS THAT PROVIDE BEST OF INDUSTRY APPLICATIONS TO ASSESS METHODOLOGIES FOR TREATING OUR RESIDENTS. |
| PART VI, LINE 3: PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE BEGINS AT THE PATIENT ACCESS TO CARE AREAS. INFORMATIONAL SIGNAGE IS POSTED IN ALL PATIENT ACCESS AREAS IDENTIFYING FINANCIAL ASSISTANCE PROGRAMS AND INSTRUCTIONS OF HOW TO SEEK OUT THESE PROGRAMS. SIMILAR INFORMATION IS ALSO FOUND IN PATIENT INFORMATIONAL BROCHURES PROVIDED TO PATIENTS PRIOR TO THE RENDERING OF CARE BASED UPON THE TYPE OF CARE BEING PROVIDED. ALSO, AVAILABLE AT ALL PATIENT ACCESS POINTS ARE THE PATIENT FINANCIAL ASSISTANCE BROCHURE.PATIENT REGISTRATION STAFF AT ALL PATIENT ACCESS POINTS ARE TRAINED IN THE PATIENT FINANCIAL ASSISTANCE PROGRAMS AVAILABLE AT THE HOSPITAL. THEY BECOME A VALUABLE RESOURCE TO PATIENTS DIRECTING THEM TO THE PROGRAMS THEY MAY QUALIFY FOR AND THE PROCESS WITH WHICH TO SEEK THE APPROPRIATE ASSISTANCE.THE HOSPITAL UTILIZES THE HOSPITAL WEBSITE AS AN ON-LINE AND TECHNOLOGICALLY CURRENT SOURCE OF FINANCIAL ASSISTANCE INFORMATION FOR PATIENTS THAT PREFER FINDING EDUCATIONAL INFORMATION IN THIS FORMAT. FINANCIAL ASSISTANCE PROGRAMS, POLICIES, ELIGIBILITY CRITERIA, AND ON-LINE APPLICATIONS FOR THE VARIOUS PROGRAMS ARE AVAILABLE.PATIENT BILLING STATEMENTS PROVIDE ANOTHER AVENUE FOR EDUCATING PATIENTS AS TO FINANCIAL ASSISTANCE PROGRAMS AVAILABLE AND HOW TO CONTACT THE HOSPITAL TO DETERMINE ELIGIBILITY. THIS INFORMATION IS LOCATED ON THE BACK OF EACH BILLING STATEMENT RECEIVED BY THE PATIENT.THE EXISTENCE OF A FINANCIAL COUNSELOR IN THE PATIENT ACCOUNTING FUNCTION IS ANOTHER MECHANISM UTILIZED IN EDUCATING PATIENTS REGARDING FINANCIAL ASSISTANCE AVAILABLE FOR HOSPITAL SERVICES. ALL UNINSURED OR SELF-PAY POTENTIAL ACCOUNTS ARE IDENTIFIED TO THE FINANCIAL COUNSELOR UPON PATIENT REGISTRATION. PATIENTS MAY BE CONTACTED UPON COMPLETION OF SERVICES. ALL PATIENTS THAT WERE NOT CONTACTED UPON COMPLETION OF SERVICES RECEIVE A FINANCIAL ASSISTANCE APPLICATION THROUGH THE MAIL THAT INCLUDES INFORMATION REGARDING ALL FINANCIAL ASSISTANCE PROGRAMS. THE COUNSELOR PROVIDES FOLLOW-UP AND ASSISTANCE TO IDENTIFY THE PATIENT WITH THE APPROPRIATE FINANCIAL ASSISTANCE PROGRAM. |
| PART VI, LINE 4: VAN WERT COUNTY HOSPITAL IS LOCATED IN THE RURAL COUNTY OF VAN WERT, OHIO THAT BOARDERS THE INDIANA STATE LINE ALONG ALLEN COUNTY INDIANA. OUR PRIMARY SERVICE AREA COMPRISES VAN WERT AND SOME PORTIONS OF PAULDING, PUTNAM AND MERCER COUNTIES. OHIO NUMERICALLY THIS BREAKS DOWN TO APPROXIMATELY 50,000 RESIDENTS IN OUR PRIMARY MARKET AREA. THE HOSPITAL IS LOCATED WITHIN THE CITY OF VAN WERT, WHICH POSSESSES A POPULATION OF 10,700. OUR POPULATION IS PREDOMINANTLY WHITE (97.1%) WITH HISPANIC (1.9%) A MIX OF MINORITIES COMPRISE THE REMAINDER. VAN WERT IS RURAL IN NATURE WITH EMPLOYMENT NOT ONLY IN AGRICULTURAL SERVICES BUT ALSO IN THE MANUFACTURING AND SERVICE SECTOR. OUR COUNTY HAS SEEN INCREASED UNEMPLOYMENT DUE TO THE LOSS OF MANUFACTURING JOBS RELATED TO THE AUTO SECTOR. THE UNEMPLOYMENT RATE IN 2009 WAS IN EXCESS OF 13%. THIS SITUATION HAS ALSO INCREASED THE NUMBER OF CITIZENS COVERED UNDER THE MEDICAID PROGRAM AND QUALIFYING FOR THE HOSPITAL'S CHARITY CARE PROGRAM AS WELL AS INCREASING BAD DEBT (IN 2000 4.2% OF THE POPULATION WAS BELOW FPG). LIKE MANY MIDWEST COMMUNITIES THE REGION IS EXPERIENCING AGING POPULATIONS OF 18.3% OVER 65 AND 27.2% 45-64 ACCORDING TO THE 2000 CENSUS. THE HOSPITAL ALSO HAS FACILITIES IN THE COMMUNITIES OF CONVOY AND DELPHOS PROVIDING LONG TERM CARE TO THESE GROUPS. BEHAVIORAL RISK FACTORS INCLUDE (2002 OHIO BEHAVIORAL RISK SURVEY) SMOKING (19.3%), ALCOHOL ABUSE (14%) AND OBESITY AT (34.1%) THESE BEHAVIORAL RISK FACTORS INFLUENCE THE INCIDENCE OF CHRONIC DISEASES WE TREAT. |
| PART VI, LINE 5: THE VAN WERT COUNTY HOSPITAL ASSOCIATION BOARD OF TRUSTEES IS COMPRISED OF VOLUNTEERS FROM OUR COMMUNITY. THE MAJORITY OF THESE MEMBERS LIVE AND WORK WITHIN THE COMMUNITY AND ARE INVOLVED WITH OTHER NON-PROFIT AGENCIES. SENIOR LEADERSHIP ALSO LIVES IN THE PRIMARY SERVICE AREA. THIS "SPIRIT" OF COMMUNITY BASED HEALTHCARE RESIDES IN OUR BOARD OF TRUSTEES AND IS FURTHER EVIDENCED BY OUR OPEN MEDICAL STAFF. THE ACCOMMODATION OF SPECIALTY SERVICES NOT CURRENTLY PRESENT IN OUR AREA BEING PROVIDED THROUGH A SPECIALTY CLINIC OF THE HOSPITAL WHICH INCLUDE NEUROLOGY, NEUROSURGERY, IMMUNOLOGY, AND ENT SERVICES. THE HOSPITAL ASSOCIATED PERSONNEL ALSO SIT ON OTHER COMMUNITY BASED GOVERNANCE BOARDS (UNITED WAY, AMERICAN RED CROSS, CHAMBER OF COMMERCE, WRIGHT STATE UNIVERSITY REGIONAL CAMPUS, PUBLIC ACCESS TELEVISION, AMERICAN CANCER SOCIETY & VAN WERT ECONOMIC DEVELOPMENT TO NAME A FEW). THROUGH PHYSICIAN RECRUITMENT WE HAVE BROUGHT IN A NUMBER OF NEW SPECIALTIES INCLUDING OBSTETRICS AND ADDITIONAL LAPAROSCOPIC SURGICAL PROCEDURES. WE ALSO PROVIDE A LOAN FORGIVENESS PROGRAM FOR RESIDENTS INTERESTED IN BECOMING PHYSICIANS AND RETURNING TO OUR AREA. OUR WELLNESS CENTER PROVIDES HEALTH, EDUCATION, AND SOCIAL PROGRAMS FOR TARGETED POPULATIONS. WE HAVE JOINED A REGIONAL STROKE NETWORK AS WELL AS PARTICIPATING IN A NUMBER OF PATIENT AND EDUCATIONAL SUPPORT GROUPS (BETTER BREATHERS, STROKE SUPPORT GROUP, BETTER PARENTING). THE HOSPITAL ALSO PARTICIPATES IN HEALTH PROFESSIONS EDUCATIONAL PROGRAMS. A NUMBER OF OUR PHYSICIANS PROVIDE TRAINING FOR SENIOR MEDICAL STUDENTS THROUGH THE LIMA AREA HEALTH EDUCATION COMMITTEE. A NUMBER OF NURSING EDUCATIONAL PROGRAM USE OUR HOSPITAL TO DO THEIR CLINICAL ROTATIONS. THE HOSPITAL ON AVERAGE SPENDS IN EXCESS OF 1 MILLION DOLLARS IN NEW DIAGNOSTIC TECHNOLOGIES AND OTHER HEALTH RELATED EQUIPMENT TO BETTER DIAGNOSE AND TREAT OUR CLIENTS. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Club Dues Or Fees | X | ClubDuesOrFees |
| Written Policy Re T And E Expenses | 1 | WrittenPolicyReTAndEExpenses |
| Substantiation Required | 1 | SubstantiationRequired |
| Compensation Committee | X | CompensationCommittee |
| Independent Consultant | X | IndependentConsultant |
| Form990 Of Other Organizations | X | Form990OfOtherOrganizations |
| Written Employment Contract | X | WrittenEmploymentContract |
| Compensation Survey | X | CompensationSurvey |
| Board Or Committee Approval | X | BoardOrCommitteeApproval |
| Severance Payment | 1 | 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 (9 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| MARK MINICK | ||||||||||||||
| CEO | 420450 | 0 | 133870 | 0 | 1211 | 0 | 216817 | 0 | 8656 | 0 | 781004 | 0 | 0 | 0 |
| THOMAS CONTE MD | ||||||||||||||
| PHYSICIAN | 238533 | 0 | 102849 | 0 | 687 | 0 | 15000 | 0 | 5332 | 0 | 362401 | 0 | 0 | 0 |
| MICHAEL HOLLIDAY | ||||||||||||||
| VICE PRESIDENT FISCAL & AD | 159207 | 0 | 38869 | 0 | 458 | 0 | 4755 | 0 | 3400 | 0 | 206689 | 0 | 0 | 0 |
| PATRICK BRUNO MD | ||||||||||||||
| PHYSICIAN | 154500 | 0 | 781 | 0 | 222 | 0 | 15000 | 0 | 4878 | 0 | 175381 | 0 | 0 | 0 |
| THOMAS LAUTZENHEISER MD | ||||||||||||||
| PHYSICIAN | 161903 | 0 | 0 | 0 | 466 | 0 | 5739 | 0 | 3414 | 0 | 171522 | 0 | 0 | 0 |
| JOCELYN WRAY MD | ||||||||||||||
| PHYSICIAN | 132320 | 0 | 44768 | 0 | 381 | 0 | 15000 | 0 | 7101 | 0 | 199570 | 0 | 0 | 0 |
| SCOTT JARVIS MD | ||||||||||||||
| PHYSICIAN | 170384 | 0 | 68227 | 0 | 491 | 0 | 15000 | 0 | 7306 | 0 | 261408 | 0 | 0 | 0 |
| DOUGLAS MOORE MD | ||||||||||||||
| PHYSICIAN | 169635 | 0 | 43461 | 0 | 488 | 0 | 15000 | 0 | 7302 | 0 | 235886 | 0 | 0 | 0 |
| PAM BAKER | ||||||||||||||
| VP NURSING | 194476 | 0 | 14807 | 0 | 560 | 0 | 3213 | 0 | 3590 | 0 | 216646 | 0 | 0 | 0 |
Form990 Schedule J Part III Form990ScheduleJPartIII (3 entries)
| Return ReferenceReturnReference | ExplanationExplanation | IdentifierIdentifier |
|---|---|---|
| PART I, LINE 1A | CLUB DUES ARE PROVIDED FOR MARK MINICK AND MIKE HOLLIDAY IN THE AMOUNT OF $1,364 EACH AND IS TAXABLE TO THE INDIVIDUALS. | |
| PART I, LINES 4A-B | MARK MINICK - SUPPLEMENTAL NON-QUALIFIED RETIREMENT PLAN - ACTUARIAL DETERMINED CATCH UP ANNUAL FUNDING FOR PLAN BENEFIT UNDER TERMS OF INCENTIVE AGREEMENT PAM BAKER - SEVERANCE PAYMENT OF $63,360 | |
| PART III | SERP - MARK J MINICK PARTICIPATES IN THE VAN WERT COUNTY HOSPITAL ASSOCIATION'S DEFERRED COMPENSATION PLAN. THE AMOUNT OF $216,817 REPORTED ON SCHEDULE J OF THE FORM 990 REPRESENTS THE ANNUAL INCREASE OR DECREASE IN ACTUARIAL VALUE OF THE BENEFIT PLAN AND A PORTION OF THIS AMOUNT AUGMENTS AMOUNTS PREVIOUSLY UNDERFUNDED. | SUPPLEMENTAL INFORMATION |
Schedule K IRS990ScheduleK
Form990 Schedule K Part I Form990ScheduleKPartI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
Issuer Name IssuerName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | COUNTY OF VAN WERT OHIO | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Issuer EIN | 346401507 | IssuerEIN |
| Date Issued | 2009-10-29 | DateIssued |
| Issue Price | 10755255 | IssuePrice |
| Description Of Purpose | FINANCE ACQUISITION, CONSTRUCTION, & EQUIPPING OF HOSPITAL FACILITIES | DescriptionOfPurpose |
| Defeased | 0 | Defeased |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuer |
| Pool Financing | 0 | PoolFinancing |
Form990 Schedule K Part II Form990ScheduleKPartII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Total Proceeds | 10755255 | TotalProceeds |
| Issuance Costs From Proceeds | 57604 | IssuanceCostsFromProceeds |
| Capital Expenditures | 10697651 | CapitalExpenditures |
| Year Of Subst Completion | 2010 | YearOfSubstCompletion |
| Current Refunding | 1 | CurrentRefunding |
| Advance Refunding | 0 | AdvanceRefunding |
| Final Allocation Made | 1 | FinalAllocationMade |
| Adequate Books And Recds Maintaind | 1 | AdequateBooksAndRecdsMaintaind |
Form990 Schedule K Part III Form990ScheduleKPartIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Owning Bond Financed Property | 0 | OwningBondFinancedProperty |
| Any Lease Arrangements | 0 | AnyLeaseArrangements |
| Mngment Cntrct Bond Financd Prprty | 0 | MngmentCntrctBondFinancdPrprty |
| Any Research Agreements | 0 | AnyResearchAgreements |
| Bond Iss Meet Prvt Security Pay Test | 0 | BondIssMeetPrvtSecurityPayTest |
| Change In Use Bond Financed Prop | 0 | ChangeInUseBondFinancedProp |
| Non Qualified Bond Remed Procdrs | 1 | NonQualifiedBondRemedProcdrs |
Form990 Schedule K Part IV Form990ScheduleKPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Form8038 T Filed | 0 | Form8038TFiled |
| Rebate Not Due Yet | 0 | RebateNotDueYet |
| Exception To Rebate | 0 | ExceptionToRebate |
| No Rebate Due | 0 | NoRebateDue |
| Variable Rate Issue | 0 | VariableRateIssue |
| Hedge Identified In Books And Recds | 0 | HedgeIdentifiedInBooksAndRecds |
| Gross Proceeds Invested In GIC | 0 | GrossProceedsInvestedInGIC |
| Gross Proceeds Invested | 0 | GrossProceedsInvested |
| Written Proc To Monitor Reqs | 0 | WrittenProcToMonitorReqs |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (11 entries)
| Return ReferenceReturnReference | ExplanationExplanation | IdentifierIdentifier |
|---|---|---|
| FORM 990, PART VI, SECTION A, LINE 6 | ANY PERSON, AGE 18 OR OLDER AND RESIDING IN VAN WERT COUNTY HOSPITAL'S GEOGRAPHIC SERVICE AREA, WHO SHALL HAVE CONTRIBUTED THE SUM OF ONE DOLLAR OR MORE TO THE ASSOCIATION DURING THE CALENDAR YEAR, SHALL BE A MEMBER. A CONTRBUTION OF TWENTY-FIVE DOLLARS AT ANY TIME SHALL CONSTITUTE A LIFE MEMBERSHIP. | |
| FORM 990, PART VI, SECTION A, LINE 7A | THE BOARD OF TRUSTEES SHALL BE ELECTED BY THE MEMBERS OF THE ASSOCIATION AT THE REGULAR ANNUAL MEETING. ONE SHALL BE APPOINTED BY THE VAN WERT COUNTY BOARD OF COMMISSIONERS. | |
| FORM 990, PART VI, SECTION A, LINE 7B | SUBJECT TO THE ARTICLES OF INCORPORATION AND THIS CODE OF REGULATIONS, EACH MEMBER OF THE ASSOCIATION IN GOOD STANDING SHALL BE QUALIFIED TO VOTE ON ANY ISSUES THAT MAY PROPERLY COME BEFORE ANY MEETING OF THE MEMBERS OF THE ASSOCIATION. | |
| FORM 990, PART VI, SECTION B, LINE 11 | THE PROCESS OF REVIEWING THE FORM 990 ENTAILS A DETAILED REVIEW BY THE ORGANIZATION'S ACCOUNTING DEPARTMENT. THE AUDIT COMMITTEE REVIEWS AND APPROVES THE 990. IT IS THEN PRESENTED TO THE FULL BOARD DURING A REGULARLY SCHEDULED BOARD MEETING. | |
| FORM 990, PART VI, SECTION B, LINE 12C | THE WRITTEN CONFLICT OF INTEREST POLICY IS REGULARLY AND CONSISTENTLY MONITORED BY THE CHAIRPERSON OF THE BOARD OF TRUSTEES AND THE PRESIDENT & CEO. THE SCOPE OF THIS POLICY INCLUDES ALL STAFF AND BOARD OF TRUSTEES MEMBERS. A CONFLICT OF INTEREST QUESTIONNAIRE IS COMPLETED ON AN ANNUAL BASIS AND REVIEWED BY THE EXECUTIVE COMMITTEE. ANY ISSUES THAT ARISE ARE ADDRESSED WITH THE INDIVIDUAL AT THAT POINT. ANY ISSUES THAT ARISE THOUGHOUT THE YEAR ARE DEALT WITH AS NECESSARY. THIS MAY INVOLVE DECLARING THE CONFLICT OF INTEREST AND ABSTAINING FROM DISCUSSION OR A VOTE ON SPECIFIC TOPICS. THIS COULD ALSO TAKE THE FORM OF RECUSING ONESELF FROM PART OR A WHOLE MEETING AS NECESSARY AND REQUIRED DEPENDING UPON THE TOPIC FOR DISCUSION AND/OR ACTION. | |
| FORM 990, PART VI, SECTION B, LINE 15 | THE COMPENSATION COMMITTEE CONTRACTS WITH AN OUTSIDE, INDEPENDENT FIRM TO PROVIDE A COMPENSATION STUDY AND EVALUATION. THE COMMITTEE THEN USES THE RESULTS OF THE STUDY IN CONSULTATION WITH THE COMPENSATION FIRM AND THEN COMPENSATION PHILOSOPHY POLICY TO MAKE COMPENSATION DECISIONS. THE LAST COMPENSATION REVIEW WAS PERFORMED IN JULY, 2012. | |
| FORM 990, PART VI, SECTION C, LINE 19 | THERE IS AN ANNUAL REPORT PREPARED THAT INCLUDES A STATEMENT OF OPERATIONS. | |
| FORM 990, PART IX, LINE 11G | PURCHASED HEALTH CARE SERVICES: PROGRAM SERVICE EXPENSES 3,260,326. MANAGEMENT AND GENERAL EXPENSES 1,029,567. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 4,289,893. OTHER: PROGRAM SERVICE EXPENSES 3,343,713. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 166. TOTAL EXPENSES 3,343,879. | OTHER FEES |
| FORM 990, PART XI, LINE 9: | CHANGE IN RESTRICTED NET ASSETS 12,895. | CHANGES IN NET ASSETS OR FUND BALANCES: |
| 990T | IN THE PAST THE ORGANIZATION HAS FILED A 990-T, HOWEVER, THIS ORGANIZATION IS NO LONGER REQUIRED TO FILE THAT FORM AS IT HAS NO UNRELATED BUSINESS INCOME TO REPORT. | |
| AMENDED RETURN | THE RETURN HAS BEEN AMENDED IN THE FOLLOWING AREAS: 1. CHANGE IN BOARD OF DIRECTORS INFORMATION-DR. JOEL KNERR IS NO LONGER AN OFFICER IN 2012 2. SCHEDULE H PART VI, LINE 5 - WORDING CHANGES 3. SCHEDULE O PART VI, SECTION A, LINE 7A - WORDING CHANGES |
Schedule R IRS990ScheduleR
Form990 Schedule R Part I Form990ScheduleRPartI
Name Of Disregarded Entity NameOfDisregardedEntity
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | VAN WERT MEDICAL SERVICES | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 140 FOX RD | AddressLine1 |
| City | VAN WERT | City |
| State | OH | State |
| ZIP Code | 45891 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 202812541 | EIN |
| Primary Activities | MEDICAL PROFESSIONAL SERVICES | PrimaryActivities |
| Legal Domicile State | OH | LegalDomicileState |
| Total Income | -1103918 | TotalIncome |
| EOY Assets | 555973 | EOYAssets |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | VAN WERT COUNTY HOSPITAL ASSOCIATION | BusinessNameLine1 |
Form990 Schedule R Part III Form990ScheduleRPartIII (3 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivityPrimaryActivity | Legal Domicile StateLegalDomicileState | Direct Controlling Entity NADirectControllingEntityNA | Predominant Income TypePredominantIncomeType | Share Of Total IncomeShareOfTotalIncome | Share Of EOY AssetsShareOfEOYAssets | Disproportionate AllocationsDisproportionateAllocations | General Or Managing PartnerGeneralOrManagingPartner | Percentage OwnershipPercentageOwnership |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| SARAH JANE LIVING CENTER | |||||||||||||
| 1250 S WASHINGTON ST | VAN WERT | OH | 45891 | 311684009 | LONG TERM ALZHEIMERS CARE | OH | N/A | RELATED | -230805 | 529994 | 0 | 0 | 0.50000 |
| HOME HEALTH CARE SOLUTIONS | |||||||||||||
| 1250 S WASHINGTON ST | VAN WERT | OH | 45891 | 200330544 | HOME HEALTH CARE SOLUTIONS | OH | N/A | RELATED | 50991 | 133426 | 0 | 0 | 0.50000 |
| THERAPY SOLUTIONS | |||||||||||||
| 1250 S WASHINGTON ST | VAN WERT | OH | 45891 | 201417403 | PHYSICAL THERAPY SERVICES | OH | N/A | RELATED | -1560 | 261277 | 0 | 0 | 0.50000 |
Form990 Schedule R Part IV Form990ScheduleRPartIV
Name Of Related Org NameOfRelatedOrg
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | COMMUNITY CARE SYSTEMS INC | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1250 S WASHINGTON ST | AddressLine1 |
| City | VAN WERT | City |
| State | OH | State |
| ZIP Code | 45891 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 341783212 | EIN |
| Primary Activity | HEALTHCARE MANAGEMENT SERVICES | PrimaryActivity |
| Legal Domicile State | OH | LegalDomicileState |
| Direct Controlling Entity NA | N/A | DirectControllingEntityNA |
| Type Of Entity | C | TypeOfEntity |
| Share Of Total Income | -6781 | ShareOfTotalIncome |
| Share Of EOY Assets | 6766 | ShareOfEOYAssets |
| Percentage Ownership | 0.50000 | PercentageOwnership |
| Controlled Org | 0 | ControlledOrg |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | 1 | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | 1 | 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 | 1 | 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 | 0 | SharingOfFacilities |
| Sharing Of Paid Employees | 0 | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | 1 | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | 0 | OtherTransferToOtherOrg |
| Other Transfer From Other Org | 0 | OtherTransferFromOtherOrg |
Transactions Related Orgs Table TransactionsRelatedOrgsTable (2 entries)
| Transaction TypeTransactionType | Amount InvolvedAmountInvolved | Method Of Amt DeterminationMethodOfAmtDetermination |
|---|---|---|
| SARAH JANE LIVING CENTER | ||
| B | 100000 | CASH |
| VAN WERT MEDICAL SERVICES | ||
| P | 1001022 | CASH |