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MCCULLOUGH-HYDE MEMORIAL HOSPITAL INCORPORATED: Form 990, tax year 2012

View the entire original 990 at ProPublica ↗

Organization
MCCULLOUGH-HYDE MEMORIAL HOSPITAL INCORPORATED (EIN 31-0650283)
Tax period
2012-01-01 to 2012-12-31
Filed
2013-11-12
IRS object ID
201313169349304346
Schema version
2012v2.1
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Timestamp2013-11-12T14:27:56-06:00Timestamp
Tax Period End Date2012-12-31TaxPeriodEndDate

Preparer Firm PreparerFirm

FieldValueIRS element (for citing)
EIN351178661EIN

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1BLUE & CO LLCBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line18800 LYRA DRIVE SUITE 450AddressLine1
CityCOLUMBUSCity
StateOHState
ZIP Code43240ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2012-01-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN310650283EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1MCCULLOUGH-HYDE MEMORIAL HOSPITALBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlMCCUNameControl
Phone5135245310Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line1110 NORTH POPLAR STREETAddressLine1
CityOXFORDCity
StateOHState
ZIP Code45056ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameJOHN CLEMENTSName
TitleVICE PRESIDENT/CFOTitle
Phone5135245310Phone
Date Signed2013-11-12DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameNANCY KIRCHNERName
PTINP00386751PTIN
Phone6148852583Phone
Date Prepared2013-11-12DatePrepared
FieldValueIRS element (for citing)
Tax Year2012TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonJOHN CLEMENTSNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line1110 NORTH POPLAR STREETAddressLine1
CityOXFORDCity
StateOHState
ZIP Code45056ZIPCode
FieldValueIRS element (for citing)
Gross Receipts61831629GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501c3XOrganization501c3
Web SiteWWW.MHMH.ORGWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1953YearFormation
State Legal DomicileOHStateLegalDomicile
Activity Or Mission DescriptionACUTE CARE HOSPITAL FACILITY DELIVERING QUALITY SERVICES TO OUR PATIENTS AND THE COMMUNITIES WE SERVE.ActivityOrMissionDescription
Nbr Voting Members Governing Body10NbrVotingMembersGoverningBody
Nbr Independent Voting Members10NbrIndependentVotingMembers
Total Nbr Employees647TotalNbrEmployees
Total Nbr Volunteers311TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income-57756NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year320518ContributionsGrantsPriorYear
Contributions Grants Current Year1369732ContributionsGrantsCurrentYear
Program Service Revenue Prior Year61910538ProgramServiceRevenuePriorYear
Program Service Revenue CY59762684ProgramServiceRevenueCY
Investment Income Prior Year83268InvestmentIncomePriorYear
Investment Income Current Year27436InvestmentIncomeCurrentYear
Other Revenue Prior Year1030425OtherRevenuePriorYear
Other Revenue Current Year671777OtherRevenueCurrentYear
Total Revenue Prior Year63344749TotalRevenuePriorYear
Total Revenue Current Year61831629TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year34322GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY18650GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year28385199SalariesEtcPriorYear
Salaries Etc Current Year28007913SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year33959927OtherExpensePriorYear
Other Expenses Current Year33654733OtherExpensesCurrentYear
Total Expenses Prior Year62379448TotalExpensesPriorYear
Total Expenses Current Year61681296TotalExpensesCurrentYear
Revenues Less Expenses Prior Year965301RevenuesLessExpensesPriorYear
Revenues Less Expenses CY150333RevenuesLessExpensesCY
Total Assets BOY45819702TotalAssetsBOY
Total Assets EOY45799306TotalAssetsEOY
Total Liabilities BOY22027599TotalLiabilitiesBOY
Total Liabilities EOY21957803TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY23792103NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY23841503NetAssetsOrFundBalancesEOY
Info In Schedule O Part IIIXInfoInScheduleOPartIII
Mission DescriptionACUTE CARE HOSPITAL FACILITY DELIVERING QUALITY SERVICES TO OUR PATIENTS AND THE COMMUNITIES WE SERVE.MissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
Expense4540732Expense
Revenue15290244Revenue
DescriptionPHARMACY-CONSISTING OF CARE PROVIDED TO INPATIENTS (24%) AND OUTPATIENTS (76%). OUTPATIENT CARE INCLUDES A MAJOR PROGRAM FOR ONCOLOGY TREATMENT.Description

Activity2 Activity2

FieldValueIRS element (for citing)
Expense4164020Expense
Revenue25767924Revenue
DescriptionIMAGING-COMPRISED OF A FULL RANGE OF RADIOLOGY SERVICES INCLUDING XRAY, ULTRASOUND, CT, MRI AND NUCLEAR MEDICINE. TOTAL PROCEDURE VOLUME IS 41,218 CONSISTING OF IP CARE (11%) AND OUTPATIENT CARE (89%).Description

Activity3 Activity3

FieldValueIRS element (for citing)
Expense3986376Expense
Revenue18336382Revenue
DescriptionLAB-COMPRISED OF A FULL RANGE OF LABORATORY SERVICES INCLUDING PATHOLOGY, REFERENCE LAB SERVICES AND BLOOD BANK. TOTAL TEST VOLUME IS 267,434 CONSISTING OF IP CARE (18%) AND OUTPATIENT CARE (82%).Description

Activity Other ActivityOther

FieldValueIRS element (for citing)
Expense38413035Expense
Grants18650Grants
Revenue68548793Revenue
DescriptionINPATIENT VOLUME CONSISTED OF 2,384 DISCHARGES AND 8,516 PATIENT DAYS WITH AN AVERAGE LENGTH OF STAY OF 3.6 DAYS. BIRTHS TOTALED 413 WITH A TOTAL OF 736 OBSERVATION DAYS OF SERVICE. OVERALL, INPATIENT AND OUTPATIENT CARE REPRESENT 28% AND 72% OF GROSS PATIENT REVENUE, RESPECTIVELY.Description
FieldValueIRS element (for citing)
Total Of Other Program Service Exp38413035TotalOfOtherProgramServiceExp
Total Of Other Program Service Grnt18650TotalOfOtherProgramServiceGrnt
Total Of Other Program Service Rev68548793TotalOfOtherProgramServiceRev
Total Program Service Expense51104163TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required1ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities1LobbyingActivities
Subject To Proxy Tax0SubjectToProxyTax
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling0CreditCounseling
Term Or Permanent Endowments0TermOrPermanentEndowments
Report Land Bldg Equip1ReportLandBldgEquip
Report Invest Oth Securities0ReportInvestOthSecurities
Report Prog Rel Invest0ReportProgRelInvest
Report Other Assets1ReportOtherAssets
Report Other Liabilities1ReportOtherLiabilities
Report Fin48 Footnote1ReportFin48Footnote
Independent Audit Financial Stmt1IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt1ConsolidatedAuditFinancialStmt
School0School
Foreign Office0ForeignOffice
Foreign Activities0ForeignActivities
More Than5000 K To Organizations0MoreThan5000KToOrganizations
More Than5000 K To Individuals0MoreThan5000KToIndividuals
Professional Fundraising0ProfessionalFundraising
Fundraising Activities0FundraisingActivities
Gaming0Gaming
Hospital1Hospital
Financial Stmt Attached1FinancialStmtAttached
Grants To Organizations1GrantsToOrganizations
Grants To Individuals0GrantsToIndividuals
Schedule J Required1ScheduleJRequired
Tax Exempt Bonds1TaxExemptBonds
Invest Tax Exempt Bonds0InvestTaxExemptBonds
Escrow Account0EscrowAccount
On Behalf Of Issuer0OnBehalfOfIssuer
Excess Benefit Transaction0ExcessBenefitTransaction
Prior Excess Benefit Transaction0PriorExcessBenefitTransaction
Loan To Officer Or DQP0LoanToOfficerOrDQP
Grant To Related Person0GrantToRelatedPerson
Bsnss Rltnshp With Organization0BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member0BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp0OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions0DeductibleNonCashContributions
Deductible Contributions Of Art0DeductibleContributionsOfArt
Terminated0Terminated
Partial Liquidation0PartialLiquidation
Disregarded Entity0DisregardedEntity
Related Entity1RelatedEntity
Related Org Controlled Entity0RelatedOrgControlledEntity
Transfers To Exempt Non Chrtbl Org0TransfersToExemptNonChrtblOrg
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With109649NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup Witholding1ComplianceWithBackupWitholding
Number Of Employees647NumberOfEmployees
Employment Tax Returns Filed1EmploymentTaxReturnsFiled
Unrelated Business Income1UnrelatedBusinessIncome
Form990-T Filed1Form990-TFiled
Foreign Financial Account0ForeignFinancialAccount
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTrans
Taxable Party Notification0TaxablePartyNotification
Non Deductible Contributions0NonDeductibleContributions
Quid Pro Quo Contributions0QuidProQuoContributions
Form8282 Property Disposed Of0Form8282PropertyDisposedOf
Funds To Pay Premiums0FundsToPayPremiums
Premiums Paid0PremiumsPaid
Indoor Tanning Services0IndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members10NbrVotingGoverningBodyMembers
Number Independent Voting Members10NumberIndependentVotingMembers
Family Or Business Relationship0FamilyOrBusinessRelationship
Delegation Of Management Duties0DelegationOfManagementDuties
Changes To Organizing Docs0ChangesToOrganizingDocs
Material Diversion Or Misuse0MaterialDiversionOrMisuse
Members Or Stockholders0MembersOrStockholders
Election Of Board Members0ElectionOfBoardMembers
Decisions Subject To Approval0DecisionsSubjectToApproval
Minutes Of Governing Body1MinutesOfGoverningBody
Minutes Of Committees1MinutesOfCommittees
Officer Mailing Address0OfficerMailingAddress
Local Chapters0LocalChapters
Form990 Provided To Governing Body1Form990ProvidedToGoverningBody
Conflict Of Interest Policy1ConflictOfInterestPolicy
Annual Disclosure Covered Persons1AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement1RegularMonitoringEnforcement
Whistleblower Policy1WhistleblowerPolicy
Document Retention Policy1DocumentRetentionPolicy
Compensation Process CEO1CompensationProcessCEO
Compensation Process Other1CompensationProcessOther
Investment In Joint Venture0InvestmentInJointVenture
States Where Copy Of Return Is FiledINStatesWhereCopyOfReturnIsFiled
States Where Copy Of Return Is FiledOHStatesWhereCopyOfReturnIsFiled
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1JAMES MILLERBusinessNameLine1
FieldValueIRS element (for citing)
Telephone Number5135245310TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1110 NORTH POPLAR STREETAddressLine1
CityOXFORDCity
StateOHState
ZIP Code450561292ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (19 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationOfficerOfficerHighest Compensated EmployeeHighestCompensatedEmployee
JOHN HARLAND MD
VICE CHAIRMAN1.00X000
SUSAN CROSS LIPNICKEY
TRUSTEE1.00X000
JACK MANN
TRUSTEE1.00X000
RICHARD M NORMAN
CHAIRMAN1.00X000
ALAN OAK
SECRETARY-TREASURER1.00X000
WILLIAM DOUGLAS ROSS DO
TRUSTEE1.00X000
THOMAS W SPEH
TRUSTEE1.00X000
PAIGE WOOD
TRUSTEE1.00X000
STEPHEN FLEE
TRUSTEE1.00X000
RALPH R GUTOWSKI
TRUSTEE1.00X000
BRYAN HEHEMANN
CEO40.00206743021438X
JOHN CLEMENTS
VP & CFO40.00142937011197X
PAMELA COLLINS
VP & CPSO40.0012784609934X
TAMMY LANGDON
VP & CAO40.00120232020954X
KENNETH KELLER
PHYSICIAN40.0024683501389X
MATTHEW BIRKLE
PHYSICIAN40.0019522601099X
MARK CRISTELL
PT DIRECTOR40.00135452021039X
MATTHEW DAGGY
PHYSICIAN40.0023709001335X
MARY BROWN
DIRECTOR OF IMAGING SERVICES40.00113753020430X
FieldValueIRS element (for citing)
Total Reportable Comp From Org1526114TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs0TotalReportableCompFrmRltdOrgs
Total Other Compensation108815TotalOtherCompensation
Number Individuals GT100 K13NumberIndividualsGT100K
Formers Listed0FormersListed
Total Comp GT150 K1TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources

Contractor Compensation ContractorCompensation (5 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
CPSI
6600 WALL STREETMOBILEAL36695COMPUTER SYSTEMS629438
NEACE LUKENS-COLUMBUS
400 SMITH ROADCINCINNATIOH45209INSURANCE495237
MAYO MEDICAL LABORATORIES
PO BOX 9146MINNEAPOLISMN55480MEDICAL418326
GE HEALTHCARE
PO BOX 96483CHICAGOIL60693MEDICAL EQUIPMENT REPAIR394428
SOAP
118 EAST SUPERIOR STREETWAYLANDMI49348TRANSCRIPTION349150
FieldValueIRS element (for citing)
Number Of Contractors GT100 K29NumberOfContractorsGT100K
Related Organizations361439RelatedOrganizations
All Other Contributions1008293AllOtherContributions
Total Contributions1369732TotalContributions

Program Service Revenue ProgramServiceRevenue

FieldValueIRS element (for citing)
DescriptionPATIENT SERVICESDescription
Business Code900099BusinessCode
Total Revenue Column59762684TotalRevenueColumn
Related Or Exempt Function Income59762684RelatedOrExemptFunctionIncome
FieldValueIRS element (for citing)
Total Program Service Revenue59762684TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column23046TotalRevenueColumn
Exclusion$23,046ExclusionAmount

Gross Rents GrossRents

FieldValueIRS element (for citing)
Real117028Real

Less Rental Expenses LessRentalExpenses

FieldValueIRS element (for citing)
Real0Real

Rental Income Or Loss RentalIncomeOrLoss

FieldValueIRS element (for citing)
Real117028Real

Net Rental Income Or Loss NetRentalIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column117028TotalRevenueColumn
Exclusion$117,028ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Securities4390Securities

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Securities0Securities

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Securities4390Securities

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column4390TotalRevenueColumn
Exclusion$4,390ExclusionAmount

Other Revenue Misc OtherRevenueMisc (3 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnExclusionExclusionAmount
DIETARY722210211089$211,089
MISCELLANEOUS900099153717$153,717
WELLNESS CENTER900099112522$112,522

Miscellaneous Revenue MiscellaneousRevenue

FieldValueIRS element (for citing)
Total Revenue Column77421TotalRevenueColumn
Exclusion$77,421ExclusionAmount
FieldValueIRS element (for citing)
Total Other Revenue554749TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column61831629TotalRevenueColumn
Related Or Exempt Function Income59762684RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$699,213ExclusionAmount
FieldValueIRS element (for citing)
Info In Schedule O Part IXXInfoInScheduleOPartIX

Grants To Domestic Orgs GrantsToDomesticOrgs

FieldValueIRS element (for citing)
Total18650Total
Program Services18650ProgramServices

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total661281Total
Program Services473902ProgramServices
Management And General187379ManagementAndGeneral

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total21664964Total
Program Services20046843ProgramServices
Management And General1618121ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total333194Total
Program Services238781ProgramServices
Management And General94413ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total3754519Total
Program Services2690650ProgramServices
Management And General1063869ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total1593955Total
Program Services1142297ProgramServices
Management And General451658ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total130744Total
Management And General130744ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total106200Total
Management And General106200ManagementAndGeneral

Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees

FieldValueIRS element (for citing)
Total760Total
Program Services543ProgramServices
Management And General217ManagementAndGeneral

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total6447340Total
Program Services5623586ProgramServices
Management And General823754ManagementAndGeneral

Advertising Advertising

FieldValueIRS element (for citing)
Total345795Total
Program Services252245ProgramServices
Management And General93550ManagementAndGeneral

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total842998Total
Program Services643885ProgramServices
Management And General199113ManagementAndGeneral

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total1547956Total
Program Services1378938ProgramServices
Management And General169018ManagementAndGeneral

Occupancy Occupancy

FieldValueIRS element (for citing)
Total2215499Total
Program Services1029751ProgramServices
Management And General1185748ManagementAndGeneral

Travel Travel

FieldValueIRS element (for citing)
Total58388Total
Program Services27951ProgramServices
Management And General30437ManagementAndGeneral

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total58276Total
Program Services33933ProgramServices
Management And General24343ManagementAndGeneral

Interest Interest

FieldValueIRS element (for citing)
Total711633Total
Program Services509987ProgramServices
Management And General201646ManagementAndGeneral

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total4348836Total
Program Services3116563ProgramServices
Management And General1232273ManagementAndGeneral

Insurance Insurance

FieldValueIRS element (for citing)
Total364347Total
Program Services261204ProgramServices
Management And General103143ManagementAndGeneral

Other Expenses OtherExpenses (3 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneral
MEDICAL SUPPLIES8676750859689979851
BAD DEBT685114149098231941318
OTHER EXPENSES948070107732840338

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total61681296Total
Program Services51104163ProgramServices
Management And General10577133ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY700BOY
EOY2325EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY3495515BOY
EOY4925984EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY8206772BOY
EOY8518246EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY1176581BOY
EOY1120098EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY1302270BOY
EOY1479791EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis74295969LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec48160762LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY28856919BOY
EOY26135207EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY2780945BOY
EOY3617655EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY45819702BOY
EOY45799306EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY4241958BOY
EOY4156380EOY

Tax Exempt Bond Liabilities TaxExemptBondLiabilities

FieldValueIRS element (for citing)
BOY17328895BOY
EOY15101425EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY456746BOY
EOY2699998EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY22027599BOY
EOY21957803EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY23792103BOY
EOY23841503EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY23792103BOY
EOY23841503EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY45819702BOY
EOY45799306EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses150333ReconcilationRevenueExpenses
Reconciliation Unrealized Invest-2992ReconciliationUnrealizedInvest
Reconcilation Other Changes-97941ReconcilationOtherChanges
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited1FSAudited

FS Audited Basis FSAuditedBasis

FieldValueIRS element (for citing)
Financial Statement BothXFinancialStatementBoth
FieldValueIRS element (for citing)
Audit Committee1AuditCommittee
Federal Grant Audit Required0FederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Hospital170b1 AiiiXHospital170b1Aiii

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

FieldValueIRS element (for citing)
Contributor NumberRESTRICTEDContributorNumber

Contributor Name Business ContributorNameBusiness

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor Address US ContributorAddressUS

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Aggregate ContributionsRESTRICTEDAggregateContributions

Schedule C IRS990ScheduleC

FieldValueIRS element (for citing)
Political Expenditures6463PoliticalExpenditures
Volunteers0Volunteers
Paid Staff Or Management0PaidStaffOrManagement
Media Advertisements0MediaAdvertisements
Mailings Members0MailingsMembers
Publications Or Broadcast0PublicationsOrBroadcast
Grants Other Organizations0GrantsOtherOrganizations
Direct Contact Legislators0DirectContactLegislators
Rallies Demonstrations0RalliesDemonstrations
Other Activities1OtherActivities
Other Activities$6,463OtherActivitiesAmount
Total Lobbying Expenditures IIB6463TotalLobbyingExpendituresIIB
Not Described In501c30NotDescribedIn501c3

Form990 Schedule C Part IV Form990ScheduleCPartIV (2 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
ORGANIZATIONS DIRECT AND INDIRECT POLITICAL CAMPAIGN ACTIVITIES:PART I-A, LINE 1:SUPPORT PROVIDED THROUGH DUES PAID TO OHA AND AHA FOR DIRECT COMMUNICATION WITH CERTAIN MEMBERS OF FEDERAL, STATE OR LOCAL GOVERNMENT TO INFLUENCE LEGISLATION.
EXPLANATION OF LOBBYING ACTIVITIES:PART II-B, LINE 1:SUPPORT PROVIDED THRU DUES PAID TO OHA AND AHA FOR DIRECT COMMUNICATION WITH CERTAIN MEMBERS OF FEDERAL, STATE, OR LOCAL GOVERNMENT.

Schedule D IRS990ScheduleD

Land Land

FieldValueIRS element (for citing)
Other Cost Or Other Basis2035418OtherCostOrOtherBasis
Book Value2035418BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis26557968OtherCostOrOtherBasis
Depreciation13691284Depreciation
Book Value12866684BookValue

Leasehold Improvements LeaseholdImprovements

FieldValueIRS element (for citing)
Other Cost Or Other Basis4269936OtherCostOrOtherBasis
Depreciation2412583Depreciation
Book Value1857353BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis40873939OtherCostOrOtherBasis
Depreciation32056895Depreciation
Book Value8817044BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis558708OtherCostOrOtherBasis
Book Value558708BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings26135207TotalOfBookValueLandBuildings

Other Assets OtherAssets (6 entries)

DescriptionDescriptionBook ValueBookValue
UNAMORTIZED FINANCE COSTS77978
DOCTORS' LOANS RECEIVABLE494998
CASH SURRENDER VALUE134507
DUE FROM RELATED PARTY1912570
ACCRUED INVESTMENT INCOME446
BOARD DESIGNATED INVESTMENTS997156
FieldValueIRS element (for citing)
Total Book Value Other Assets3617655TotalBookValueOtherAssets

Other Liabilities OtherLiabilities (4 entries)

DescriptionDescriptionAmountAmount
ESTIMATED THIRD PARTY SETTLEMENTS$536,796
A/R CREDIT BALANCE - UNCLAIMED FUNDS$1,182,662
INCOME GUARANTEE$131,250
OTHER LIABILITIES$849,290
FieldValueIRS element (for citing)
Total Of Amounts2699998TotalOfAmounts
Tot Revenue Etc Audited Fincl Stmt61963541TotRevenueEtcAuditedFinclStmt
Net Unrealized Gains Investments-2992NetUnrealizedGainsInvestments
Other Revenues134904OtherRevenues
Revenue Not Rptd F990131912RevenueNotRptdF990
Revenue Subtotal61831629RevenueSubtotal
Revenue Not Rptd On Fin Stmt0RevenueNotRptdOnFinStmt
Total Revenue Per Form99061831629TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt61914141TotExpensesEtcAuditedFinclStmt
Other Expenses Included232845OtherExpensesIncluded
Expenses Not Rptd F990232845ExpensesNotRptdF990
Expenses Subtotal61681296ExpensesSubtotal
Expenses Not Rptd On Fin Stmt0ExpensesNotRptdOnFinStmt
Total Expenses Per Form99061681296TotalExpensesPerForm990

Form990 Schedule D Part XIII Form990ScheduleDPartXIII (3 entries)

IdentifierIdentifierExplanationExplanation
PART XI, LINE 2D - OTHER ADJUSTMENTS:AMOUNT REPORTED ON 990T 134,904.
PART XII, LINE 2D - OTHER ADJUSTMENTS:EXPENSES REPORTED ON 990T 232,845.
ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA REQUIRE MANAGEMENT TO EVALUATE TAX POSITIONS TAKEN BY THE HOSPITAL AND RECOGNIZE A TAX LIABILITY IF THE HOSPITAL HAS TAKEN AN UNCERTAIN POSITION THAT MORE LIKELY THAN NOT WOULD NOT BE SUSTAINED UPON EXAMINATION BY VARIOUS FEDERAL AND STATE TAXING AUTHORITIES. MANAGEMENT HAS ANALYZED THE TAX POSITIONS TAKEN BY THE HOSPITAL, AND HAS CONCLUDED THAT AS OF DECEMBER 31, 2012 AND 2011, THERE ARE NO UNCERTAIN POSITIONS TAKEN OR EXPECTED TO BE TAKEN THAT WOULD REQUIRE RECOGNITION OF A LIABILITY OR DISCLOSURE IN THE ACCOMPANYING FINANCIAL STATEMENTS. THE HOSPITAL IS SUBJECT TO ROUTINE AUDITS BY TAXING JURISDICTIONS; HOWEVER, THERE ARE CURRENTLY NO AUDITS FOR ANY TAX PERIODS IN PROGRESS.

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Charity Care Policy1CharityCarePolicy
Written Policy1WrittenPolicy
FPG Reference Free Care1FPGReferenceFreeCare
Pcent100XPcent100
FPG Reference Discounted Care1FPGReferenceDiscountedCare
Pcent300XPcent300
Free Disc Care Medically Indigent1FreeDiscCareMedicallyIndigent
Amounts Budgeted For Charity Care1AmountsBudgetedForCharityCare
Expenses Exceeded Budget0ExpensesExceededBudget
Annual Community Benefit Report1AnnualCommunityBenefitReport
Report Publically Available1ReportPublicallyAvailable

Charity Care At Cost CharityCareAtCost

FieldValueIRS element (for citing)
Total Community Benefit Expense1629389TotalCommunityBenefitExpense
Net Community Benefit Expense1629389NetCommunityBenefitExpense
Percent Of Total Expense0.02970PercentOfTotalExpense

Unreimbursed Medicaid UnreimbursedMedicaid

FieldValueIRS element (for citing)
Total Community Benefit Expense8369667TotalCommunityBenefitExpense
Direct Offsetting Revenue4127816DirectOffsettingRevenue
Net Community Benefit Expense4241851NetCommunityBenefitExpense
Percent Of Total Expense0.07740PercentOfTotalExpense

Total Charity Care TotalCharityCare

FieldValueIRS element (for citing)
Total Community Benefit Expense9999056TotalCommunityBenefitExpense
Direct Offsetting Revenue4127816DirectOffsettingRevenue
Net Community Benefit Expense5871240NetCommunityBenefitExpense
Percent Of Total Expense0.10710PercentOfTotalExpense

Community Health Services CommunityHealthServices

FieldValueIRS element (for citing)
Total Community Benefit Expense147805TotalCommunityBenefitExpense
Net Community Benefit Expense147805NetCommunityBenefitExpense
Percent Of Total Expense0.00270PercentOfTotalExpense

Total Other Benefits TotalOtherBenefits

FieldValueIRS element (for citing)
Total Community Benefit Expense147805TotalCommunityBenefitExpense
Net Community Benefit Expense147805NetCommunityBenefitExpense
Percent Of Total Expense0.00270PercentOfTotalExpense

Total Community Benefits TotalCommunityBenefits

FieldValueIRS element (for citing)
Total Community Benefit Expense10146861TotalCommunityBenefitExpense
Direct Offsetting Revenue4127816DirectOffsettingRevenue
Net Community Benefit Expense6019045NetCommunityBenefitExpense
Percent Of Total Expense0.10980PercentOfTotalExpense

Community Support CommunitySupport

FieldValueIRS element (for citing)
Total Community Building Expense54935TotalCommunityBuildingExpense
Net Community Building Expense54935NetCommunityBuildingExpense
Percent Of Total Expense0.00100PercentOfTotalExpense

Health Improvement Advocacy HealthImprovementAdvocacy

FieldValueIRS element (for citing)
Total Community Building Expense92870TotalCommunityBuildingExpense
Net Community Building Expense92870NetCommunityBuildingExpense
Percent Of Total Expense0.00170PercentOfTotalExpense

Total Total

FieldValueIRS element (for citing)
Total Community Building Expense147805TotalCommunityBuildingExpense
Net Community Building Expense147805NetCommunityBuildingExpense
Percent Of Total Expense0.00270PercentOfTotalExpense
FieldValueIRS element (for citing)
Bad Debt Expense Reported1BadDebtExpenseReported
Bad Debt Expense$2,808,968BadDebtExpenseAmount
Amount Reimbursed By Medicare8691709AmountReimbursedByMedicare
Cost Of Care Reimbursed By Medicare10738607CostOfCareReimbursedByMedicare
Medicare Surplus Or Shortfall-2046898MedicareSurplusOrShortfall

Costing Methodology Used CostingMethodologyUsed

FieldValueIRS element (for citing)
Cost To Charge RatioXCostToChargeRatio
FieldValueIRS element (for citing)
Written Debt Collection Policy1WrittenDebtCollectionPolicy
Provision For Charity Care1ProvisionForCharityCare
Number Of Hospital Facilities1NumberOfHospitalFacilities

Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA

FieldValueIRS element (for citing)
Facility Number1FacilityNumber

Name Name

FieldValueIRS element (for citing)
Business Name Line1MCCULLOUGH HYDE MEMORIAL HOSPITALBusinessNameLine1

Address Address

FieldValueIRS element (for citing)
Address Line1110 N POPLAR STAddressLine1
CityOXFORDCity
StateOHState
ZIP Code45056ZIPCode
FieldValueIRS element (for citing)
Licensed HospitalXLicensedHospital
General Medical And SurgicalXGeneralMedicalAndSurgical
Er24 HoursXEr24Hours

Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB

Hospital Facility Name HospitalFacilityName

FieldValueIRS element (for citing)
Business Name Line1MCCULLOUGH-HYDE MEMORIAL HOSPITALBusinessNameLine1
FieldValueIRS element (for citing)
Hospital Facility Number1HospitalFacilityNumber
Eligibility Criteria Explained1EligibilityCriteriaExplained
Uses FPG Free1UsesFPGFree
FPG Free Percent100.000000000000FPGFreePercent
Uses FPG Discounted1UsesFPGDiscounted
FPG Discount Percent300.000000000000FPGDiscountPercent
Explains Basis1ExplainsBasis
Income LevelXIncomeLevel
Explains Application Method1ExplainsApplicationMethod
Includes Publicity Measures1IncludesPublicityMeasures
Attached To InvoicesXAttachedToInvoices
Posted In Emergency RoomXPostedInEmergencyRoom
Posted In Admission OfficeXPostedInAdmissionOffice
Available On RequestXAvailableOnRequest
Actions On Nonpayment1ActionsOnNonpayment
Permit Report To Credit AgencyXPermitReportToCreditAgency
Permit LawsuitXPermitLawsuit
Collection Activities1CollectionActivities
Report To Credit AgencyXReportToCreditAgency
Notify Before DischargeXNotifyBeforeDischarge
Notified All PatientsXNotifiedAllPatients
Documented DeterminationXDocumentedDetermination
Nondiscrim Emergency Care Policy1NondiscrimEmergencyCarePolicy
Used Other MethodXUsedOtherMethod
Amounts Generally Billed0AmountsGenerallyBilled
Gross Charges0GrossCharges

Form990 Schedule H Part VI Form990ScheduleHPartVI (9 entries)

ExplanationExplanationIdentifierIdentifier
PART I, LINE 7, COLUMN (F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $ 6851141.
PART II: MCCULLOUGH-HYDE MEMORIAL HOSPITAL PROMOTES HEALTH AND WELLBEING IN OUR COMMUNITY IN NUMEROUS WAYS NOT LISTED IN THE COMMUNITY EVENTS AND PROGRAMS SECTION OF THE 990. EXAMPLES INCLUDE: 1. MHMH HELPED PROMOTE WELLNESS BY PROVIDING MEETING SPACE TO THE INFANT/CHILD LOSS BEREAVEMENT SUPPORT GROUP AND FIBROMYALGIA SUPPORT GROUP. 2. MHMH ASSISTED OUR LOCAL SCHOOL DISTRICT WITH IDENTIFIEDHEALTH/WELLNESS NEEDS. EXAMPLES INCLUDE: A. DEVELOPED AND PROVIDED CRISIS CARDS FOR ALL 8TH GRADERS AND ALL COUNSELORS IN THE SCHOOL DISTRICT B. DEVELOPED CURRICULUM THAT COMBINED TRADITIONAL LEARNING WITH EXERCISE TO HELP FIGHT OBESITY IN OUR ELEMENTARY STUDENTS C. DEVELOPED AND HELD MINI HEALTH SEMINARS FOR 6TH GRADE STUDENTS ON SLEEP, NUTRITION, EXERCISE AND MENTAL HEALTH 3. MHMH PROVIDED OFFICE SPACE AND MEETING SPACE FOR THE OXFORD COLLEGE CORNER CLINIC, WHICH IS A CLINIC THAT PROVIDES FREE HEALTH CARE TO THE UNINSURED AND UNDERINSURED ADULTS IN OUR COMMUNITY 4. MHMH IMPROVED THEIR EMPLOYEE WELLNESS PROGRAM BY: A. IMPLEMENTING A HEALTH RISK ASSESSMENT FOR THEIR EMPLOYEES TO IDENTIFY HEALTH NEEDS/CONCERNS IN OUR EMPLOYEE POPULATION B. OFFERING MAMMOGRAMS AND PROSTATE SCREENING TO APPROPRIATE EMPLOYEES FREE OF CHARGE C. INCENTIVIZING EMPLOYEES TO ADOPT HEALTHIER BEHAVIOR
PART III, LINE 4: THE HOSPITAL HAS A DETAILED FINANCIAL ASSISTANCE POLICY WHICH STATES THAT TO PARTICIPATE IN CHARITY CARE CANDIDATES MUST COOPERATE FULLY. IN ADDITION THE HOSPITAL EDUCATES PATIENTS WITH LIMITED ABILITY TO PAY REGARDING FINANCIAL ASSISTANCE. FOR THIS REASON THE ORGANIZATION BELIEVES THAT IT ACCURATELY CAPTURES ALL CHARITY CARE DEDUCTIONS PROVIDED ACCORDING TO THE FINANCIAL ASSISTANCE POLICY AND THE AMOUNT OF BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S CHARITY CARE POLICY IS NEGLIGIBLE.
PART III, LINE 8: THE SOURCE USED TO DETERMINE THE AMOUNT OF MEDICARE ALLOWABLE COSTS REPORTED FOR PART III, SECTION B, MEDICARE HAS BEEN PROVIDED FROM THE YEAR ENDED DECEMBER 31, 2012 REPORT: HOSPITAL STATEMENT OF REIMBURSABLE COST.
PART III, LINE 9B: ONCE IT HAS BEEN DETERMINED THAT A PATIENT QUALIFIES FOR CHARITY CARE/FINANCIAL ASSISTANCE, COLLECTION PRACTICES ARE STOPPED.
PART V, SECTION B, LINE 20D: DISCOUNT BASED ON AVG COMMERCIAL INSURANCE WRITEDOWNMCCULLOUGH-HYDE MEMORIAL HOSPITAL
PART VI, LINE 2: MCCULLOUGH-HYDE USES A PROCESS OF ASSESSMENT TO GAUGE THE HEALTHCARE NEEDS OF THE COMMUNITY WE SERVE. THE COMPONENTS OF THAT PROCESS FOR 2011 WERE:1. A NINE-MONTH STRATEGIC PLANNING PROCESS WITH INPUT FROM VARIOUS STAKEHOLDER GROUPS INCLUDING THE MEDICAL STAFF, THE LOCAL COMMUNITY FOUNDATION, THE LOCAL FREE MEDICAL CLINIC (OXFORD COLLEGE CORNER CLINIC), THE LOCAL SOCIAL NEEDS UMBRELLA ORGANIZATION (FAMILY RESOURCE CENTER), AND SEVERAL SMALLER FOCUS GROUPS OF PATIENTS, COMMUNITY LEADERS, AND NON-PATIENTS.2. ALL UNINSURED EMERGENCY DEPARTMENT PATIENTS ARE ASSESSED BY STAFF AND REFERRED TO THE LOCAL FREE MEDICAL CLINIC FOR FOLLOW-UP CARE AND ASSISTANCE, WHEN APPROPRIATE. THAT DATA INFORMS POTENTIAL EDUCATION AND SERVICE PROGRAMS THAT THE HOSPITAL OFFERS TO THE COMMUNITY.3. ON-GOING PARTNERSHIPS WITH MIAMI UNIVERSITY, THE CITY OF OXFORD, AND THE LOCAL SCHOOL DISTRICT TO JOINTLY ADDRESS SPECIFIC HEALTH CARE NEEDS OF THEIR RESPECTIVE POPULATIONS.4. AN ON-GOING, LESS FORMAL PROGRAM, GATHERS INPUT FROM MINISTERS IN OUR CHAPLAIN PROGRAM AND FROM OUR MANY VOLUNTEERS.
PART VI, LINE 3: FINANCIAL COUNSELORS ARE LOCATED IN THE PATIENT ACCESS AREAS AND PATIENTS ARE OFTEN REFERRED TO THEM AFTER THE COMPLETION OF THE REGISTRATION PROCESS. IN THE EVENT THAT FINANCIAL COUNSELORS ARE NOT AVAILABLE PATIENT ACCESS STAFF IS EDUCATED ON THE CHARITY CARE/FINANCIAL ASSISTANCE POLICIES AND HAVE APPLICATIONS AVAILABLE. CHARITY CARE INFORMATION IS ALSO INCLUDED ON OUR PATIENT STATEMENTS. ALL CUSTOMER SERVICE REPRESENTATIVES ARE FAMILIAR WITH OUR POLICIES AND CAN SPEAK TO OUR CUSTOMERS ABOUT CHARITY CARE/FINANCIAL ASSISTANCE ELIGIBILITY. BROCHURES EXPLAINING CHARITY CARE/FINANCIAL ASSISTANCE ARE ALSO AVAILABLE IN VARIOUS LOCATIONS THROUGHOUT THE HOSPITAL.
PART VI, LINE 4: MCCULLOUGH HYDE MEMORIAL HOSPITAL SERVES A DIVERSE DEMOGRAPHIC INCLUDING THE NORTHWESTERN CORNER OF BUTLER COUNTY, OHIO, THE SOUTHWESTERN CORNER OF PREBLE COUNTY, OHIO AND THE COUNTIES OF FRANKLIN, UNION AND FAYETTE IN INDIANA. THE MAIN CAMPUS IS LOCATED IN OXFORD, OHIO, THE HOME OF MIAMI UNIVERSITY WITH A POPULATION RANGING TO NEARLY 30,000 DURING THE SCHOOL YEAR TO HALF THAT NUMBER DURING THE SUMMER.MHMH COUNTS ITS PRIMARY SERVICE AREA AS THE FOLLOWING: OXFORD,OH - 45056 - POPULATION 29,739 BROOKVILLE, IN - 47012 - POPULATION 10,455 COLLEGE CORNER, OH - 45003 - POPULATION 971 EATON, OH - 45320 - POPULATION 15,354 SOMERSVILLE, OH - 45064 - 2,963 CAMDEN, OH - 45311 - 7,215 LIBERTY, IN - 47353 - 5,698 WEST COLLEGE CORNER, IN - 47003 - 834 TOTAL PRIMARY SERVICE AREA POPULATION = 73,229AND ITS PRIMARY AND ITS SECONDARY SERVICE AREAS ARE THE FOLLOWING: HAMILTON, OH - 45013 - 54,814 CONNERSVILLE, IN - 47331 - 23,438 METAMORA, IN - 47030 - 1,631 OKEANA, OH - 45053 - 3,712 TOTAL SECONDARY SERVICE AREA POPULATION = 83,595IN TERMS OF SOCIO-ECONOMIC DEMOGRAPHICS, THE EDUCATIONAL ATTAINMENT IS LOWER THAN COUNTY, STATE AND NATIONAL AVERAGES AND THE UNEMPLOYMENT HIGHER THAN COUNTY, STATE AND NATIONAL AVERAGES IN ALL OF THE UNINCORPORATED AND RURAL AREAS SERVED BY MHMH. ALL OF THE AREAS IN INDIANA AND THE RURAL AREAS IN PREBLE AND BUTLER COUNTIES (CAMDEN, SOMERVILLE) ARE DESIGNATED AS HEALTH PROFESSIONAL SHORTAGE AREAS BY THE NATIONAL HEALTH SERVICE CORPS.MCCULLOUGH HYDE HAS RECRUITED, SUPPORTED AND WILL CONTINUE TO RECRUIT AND SUPPORT BOTH PRIMARY CARE PHYSICIANS AND SPECIALISTS TO MEET THE NEEDS OF RESIDENTS OF THESE COMMUNITIES.

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Records Maintained1RecordsMaintained

Recipient Table RecipientTable (2 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEIN Of RecipientEINOfRecipientAmount Of Cash GrantAmountOfCashGrantPurpose Of GrantPurposeOfGrant
TALAWANDA SCHOOL DISTRICT
131 WEST CHESTER STOXFORDOH4505631600534011150SCHOOL PROGRAMS
SANE OF BUTLER COUNTY
PO BOX 18818FAIRFIELDOH450183116040367500FORENSIC CARE
FieldValueIRS element (for citing)
Total Nbr Of501 C3 And Govt Grants27TotalNbrOf501C3AndGovtGrants
Total Nbr Of Other Organizations6TotalNbrOfOtherOrganizations

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Independent ConsultantXIndependentConsultant
Written Employment ContractXWrittenEmploymentContract
Compensation SurveyXCompensationSurvey
Board Or Committee ApprovalXBoardOrCommitteeApproval
Severance Payment0SeverancePayment
Supplemental Nonqual Retire Plan1SupplementalNonqualRetirePlan
Equity Based Comp Arrangement0EquityBasedCompArrangement
Comp Based On Revenue Of Filing Org0CompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related Orgs0CompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing Org0CompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate Orgs0CompBasedNetEarningsRelateOrgs
Any Non Fixed Payments0AnyNonFixedPayments
Initial Contract Exception0InitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (6 entries)

TitleTitleBase Compensation Filing OrgBaseCompensationFilingOrgComp Based On Related OrgsCompBasedOnRelatedOrgsBonus Filing OrgBonusFilingOrgBonus Related OrgsBonusRelatedOrgsOther Compensation Filing OrgOtherCompensationFilingOrgOther Compensation Related OrgsOtherCompensationRelatedOrgsDeferred Comp Filing OrgDeferredCompFilingOrgDeferred Comp Related OrgsDeferredCompRelatedOrgsNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgNontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgsTotal Compensation Filing OrgTotalCompensationFilingOrgTotal Compensation Related OrgsTotalCompensationRelatedOrgsComp Report Prior990 Filing OrgCompReportPrior990FilingOrgComp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs
BRYAN HEHEMANN
CEO202156000458709380205000228181000
JOHN CLEMENTS
VP & CFO139950000298709380102590154134000
KENNETH KELLER
PHYSICIAN242265000457000013890248224000
MATTHEW BIRKLE
PHYSICIAN195226000000010990196325000
MARK CRISTELL
PT DIRECTOR121552086630523709380201010156491000
MATTHEW DAGGY
PHYSICIAN237090000000013350238425000

Form990 Schedule J Part III Form990ScheduleJPartIII

FieldValueIRS element (for citing)
Return ReferencePART I, LINE 4BReturnReference
ExplanationBRYAN 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 12/31/12 AT $45,503.Explanation

Schedule K IRS990ScheduleK

Form990 Schedule K Part I Form990ScheduleKPartI (2 entries)

Bond ReferenceBondReferenceCdIssuer EINIssuerEINDate IssuedDateIssuedIssue PriceIssuePriceDescription Of PurposeDescriptionOfPurposeDefeasedDefeasedOn Behalf Of IssuerOnBehalfOfIssuerPool FinancingPoolFinancing
BUTLER COUNTY-SERIES 2009A
A3160000612003-05-0717223844CONTRUCTION/EXPANSION000
BUTLER COUNTY-SERIES 2009B
B3160000612003-05-074776156CONTRUCTION/EXPANSION000

Form990 Schedule K Part II Form990ScheduleKPartII (2 entries)

Bond ReferenceBondReferenceCdTotal ProceedsTotalProceedsIssuance Costs From ProceedsIssuanceCostsFromProceedsCapital ExpendituresCapitalExpendituresYear Of Subst CompletionYearOfSubstCompletionCurrent RefundingCurrentRefundingAdvance RefundingAdvanceRefundingFinal Allocation MadeFinalAllocationMadeAdequate Books And Recds MaintaindAdequateBooksAndRecdsMaintaind
A17223844176587173539720111011
B47761564980748947020111011

Form990 Schedule K Part III Form990ScheduleKPartIII (2 entries)

Bond ReferenceBondReferenceCdOwning Bond Financed PropertyOwningBondFinancedPropertyAny Lease ArrangementsAnyLeaseArrangementsMngment Cntrct Bond Financd PrprtyMngmentCntrctBondFinancdPrprtyAny Research AgreementsAnyResearchAgreementsBond Iss Meet Prvt Security Pay TestBondIssMeetPrvtSecurityPayTestChange In Use Bond Financed PropChangeInUseBondFinancedPropNon Qualified Bond Remed ProcdrsNonQualifiedBondRemedProcdrs
A0000001
B0000001

Form990 Schedule K Part IV Form990ScheduleKPartIV (2 entries)

Bond ReferenceBondReferenceCdForm8038 T FiledForm8038TFiledRebate Not Due YetRebateNotDueYetException To RebateExceptionToRebateNo Rebate DueNoRebateDueVariable Rate IssueVariableRateIssueHedge Identified In Books And RecdsHedgeIdentifiedInBooksAndRecdsGross Proceeds Invested In GICGrossProceedsInvestedInGICGross Proceeds InvestedGrossProceedsInvestedWritten Proc To Monitor ReqsWrittenProcToMonitorReqs
A000000000
B000000000

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (7 entries)

Return ReferenceReturnReferenceExplanationExplanationIdentifierIdentifier
FORM 990, PART VI, SECTION B, LINE 11THE 990 IS PREPARED BY THE CPA FIRM, BLUE & CO LLC AND PRESENTED TO CFO AND FINANCE COMMITTEE FOR REVIEW. THE 990 IS THEN PRESENTED AT THE BOARD MEETING.
FORM 990, PART VI, SECTION B, LINE 12CANNUALLY THE CORPORATE COMPLIANCE OFFICER REQUIRES THE OFFICERS, TRUSTEES, DIRECTORS AND KEY EMPLOYEES TO DISCLOSE IN WRITING ANY INTEREST THAT COULD GIVE RISE TO CONFLICTS.
FORM 990, PART VI, SECTION B, LINE 15THE PROCESS FOR DETERMINING COMPENSATION INCLUDES INDEPENDENT CONSULTANT INPUT, WRITTEN EMPLOYMENT CONTRACT, COMPENSATION SURVEY STUDY AND APPROVAL BY THE BOARD.
FORM 990, PART VI, SECTION C, LINE 19UPON INDIVIDUAL REQUEST
FORM 990, PART IX, LINE 11GCONTRACTED LABOR: PROGRAM SERVICE EXPENSES 2,138,153. MANAGEMENT AND GENERAL EXPENSES 167,234. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,305,387. PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 3,485,433. MANAGEMENT AND GENERAL EXPENSES 656,520. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 4,141,953.OTHER FEES
FORM 990, PART XI, LINE 9:REVENUE REPORTED ON 990T 134,904. EXPENSES REPORTED ON 990T -232,845.CHANGES IN NET ASSETS OR FUND BALANCES:
FORM 990 PAGE 10 PART X LINE 11GCONTRACTED WAGES = $2,305,387 PURCHASED SERVICES = $4,141,954OTHER FEES FOR SERVICE - NON EMPLOYEES

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII

Name Of Disregarded Entity NameOfDisregardedEntity

FieldValueIRS element (for citing)
Business Name Line1MCCULLOUGH-HYDE MEMORIAL HOSPITAL ENDOWMENTBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1110 NORTH POPLARAddressLine1
CityOXFORDCity
StateOHState
ZIP Code45056ZIPCode
FieldValueIRS element (for citing)
EIN237374256EIN
Primary ActivitiesOBTAIN CHARITABLE CONTRIBUTIONS, MANAGE THEM AND DISBURSE BY BOARD DIRECTIONPrimaryActivities
Legal Domicile StateOHLegalDomicileState
Exempt Code Section501(C)(3)ExemptCodeSection
Public Charity StatusLINE 11A, IPublicCharityStatus
Direct Controlling Entity NAN/ADirectControllingEntityNA
Controlled Org0ControlledOrg
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents Royalties0ReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other Org0GiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other Org1GiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other Org0LoansOrGuaranteesFromOtherOrg
Dividends Related Organization0DividendsRelatedOrganization
Sale Of Assets To Other Org0SaleOfAssetsToOtherOrg
Purchase Of Assets From Other Org0PurchaseOfAssetsFromOtherOrg
Exchange Of Assets0ExchangeOfAssets
Rental Of Facilities To Other Orgs0RentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other Orgs0RentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other Orgs0PerformOfServicesForOtherOrgs
Perform Of Services By Other Orgs0PerformOfServicesByOtherOrgs
Sharing Of Facilities0SharingOfFacilities
Sharing Of Paid Employees0SharingOfPaidEmployees
Reimbursement Paid To Other Org0ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org1ReimbursementPaidByOtherOrg
Other Transfer To Other Org0OtherTransferToOtherOrg
Other Transfer From Other Org0OtherTransferFromOtherOrg

Transactions Related Orgs Table TransactionsRelatedOrgsTable (2 entries)

Transaction TypeTransactionTypeAmount InvolvedAmountInvolved
MCCULLOUGH-HYDE MEMORIAL HOSPITAL ENDOWMENT
C113933
MCCULLOUGH-HYDE MEMORIAL HOSPITAL ENDOWMENT
Q203971