OHIOHEALTH CORPORATION: Form 990, tax year 2011
View the entire original 990 at ProPublica ↗
- Organization
- OHIOHEALTH CORPORATION (EIN 31-4446959)
- Tax period
- 2011-07-01 to 2012-06-30
- Filed
- 2013-05-08
- IRS object ID
- 201321289349301932
- Schema version
- 2011v1.5
- 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 H
- Schedule J
- Schedule K
- Schedule L
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2013-05-08T15:41:38-05:00 | Timestamp |
| Tax Period End Date | 2012-06-30 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 381357951 | EIN |
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | PLANTE & MORAN PLLC | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 65 EAST STATE ST STE 600 | AddressLine1 |
| City | COLUMBUS | City |
| State | OH | State |
| ZIP Code | 43215 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2011-07-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 314446959 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SHELTERING ARMS HOSPITAL FOUNDATION | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | SHEL | NameControl |
| Phone | 7405935551 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 55 HOSPITAL DRIVE | AddressLine1 |
| City | ATHENS | City |
| State | OH | State |
| ZIP Code | 45701 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | KEN DICKEN | Name |
| Title | CFO | Title |
| Phone | 7405935551 | Phone |
| Date Signed | 2013-05-02 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | BERNIE OSTROWSKI | Name |
| PTIN | P00366367 | PTIN |
| Phone | 6148493000 | Phone |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2011 | TaxYear |
| Build TS | 2016-02-25 16:41:14Z | BuildTS |
Form 990 IRS990
Doing Business As DoingBusinessAs
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | O'BLENESS MEMORIAL HOSPITAL O'BLENESS MEMORIAL FOUNDATION | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | GREG LONG | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 55 HOSPITAL DRIVE | AddressLine1 |
| City | ATHENS | City |
| State | OH | State |
| ZIP Code | 45701 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 83584329 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | WWW.OBLENESS.ORG | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1948 | YearFormation |
| State Legal Domicile | OH | StateLegalDomicile |
| Activity Or Mission Description | TO PROVIDE SUPERIOR HEALTHCARE AT A COST THAT REPRESENTS VALUE TO THE COMMUNITY. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 11 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 9 | NbrIndependentVotingMembers |
| Total Nbr Employees | 585 | TotalNbrEmployees |
| Total Nbr Volunteers | 237 | TotalNbrVolunteers |
| Total Gross UBI | 8683216 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | -3347514 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 462880 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 123132 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 73137198 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 80159827 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 241702 | InvestmentIncomePriorYear |
| Investment Income Current Year | 584777 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | -1968224 | OtherRevenuePriorYear |
| Other Revenue Current Year | 1462087 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 71873556 | TotalRevenuePriorYear |
| Total Revenue Current Year | 82329823 | 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 | 31301742 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 36462389 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 0 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 37457827 | OtherExpensePriorYear |
| Other Expenses Current Year | 43594333 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 68759569 | TotalExpensesPriorYear |
| Total Expenses Current Year | 80056722 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 3113987 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 2273101 | RevenuesLessExpensesCY |
| Total Assets BOY | 74721530 | TotalAssetsBOY |
| Total Assets EOY | 74008787 | TotalAssetsEOY |
| Total Liabilities BOY | 44149330 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 41235556 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 30572200 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 32773231 | NetAssetsOrFundBalancesEOY |
| Mission Description | TO PROVIDE SUPERIOR HEALTHCARE AT A COST THAT REPRESENTS VALUE TO THE COMMUNITY. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 71504421 | Expense |
| Grants | 0 | Grants |
| Revenue | 72848474 | Revenue |
| Description | PATIENT CARE PROVIDED INCLUDED 8,418 INPATIENT DAYS OF CARE TO 2,914 ACUTE PATIENTS; 28,276 EMERGENCY ROOM VISITS; 91,119 OTHER OUTPATIENT VISITS; 1,876 INPATIENT AND OUTPATIENT SURGERIES; AND 691 BIRTHS. PROCEDURES AND TESTS PERFORMED INCLUDED 889,267 LAB TESTS; 26,531 X-RAYS; 3,201 MAMMOGRAPHIES; 2,553 ULTRASOUNDS; 1,351 NUCLEAR MEDICINE SCANS; 7,009 CT SCANS; 286 CARDIOVASCULAR CATHETERIZATIONS; 18,149 PHYSICAL THERAPY MODALITIES; 73,514 CARDIOPULMONARY PROCEDURES; 2,187 MRIS; AND 10,227 EKGS. THE HOSPITAL ALSO SPONSORED OR PARTICIPATED IN VARIOUS FAIRS OR HEALTH SCREENINGS THROUGHOUT THE COMMUNITY AND SURROUNDING AREAS. CHARGES FOREGONE FOR CHARITY AMOUNTED TO $11,914,261. | Description |
| Total Program Service Expense | 71504421 | 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 | 0 | 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 | 1 | LoanToOfficerOrDQP |
| Grant To Related Person | 0 | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | 0 | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | 0 | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | 0 | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | 0 | DeductibleNonCashContributions |
| Deductible Contributions Of Art | 0 | DeductibleContributionsOfArt |
| Terminated | 0 | Terminated |
| Partial Liquidation | 0 | PartialLiquidation |
| Disregarded Entity | 0 | DisregardedEntity |
| Related Entity | 1 | RelatedEntity |
| Related Org Controlled Entity | 1 | RelatedOrgControlledEntity |
| Transaction Related Entity | 1 | TransactionRelatedEntity |
| Transfers To Exempt Non Chrtbl Org | 0 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 90 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | 1 | ComplianceWithBackupWitholding |
| Number Of Employees | 585 | NumberOfEmployees |
| Employment Tax Returns Filed | 1 | EmploymentTaxReturnsFiled |
| Unrelated Business Income | 1 | UnrelatedBusinessIncome |
| Form990-T Filed | 1 | Form990-TFiled |
| 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 | 11 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 9 | NumberIndependentVotingMembers |
| Family Or Business Relationship | 1 | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | 1 | DelegationOfManagementDuties |
| Changes To Organizing Docs | 0 | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuse |
| Members Or Stockholders | 0 | MembersOrStockholders |
| Election Of Board Members | 0 | ElectionOfBoardMembers |
| Decisions Subject To Approval | 0 | DecisionsSubjectToApproval |
| Minutes Of Governing Body | 1 | MinutesOfGoverningBody |
| Minutes Of Committees | 1 | MinutesOfCommittees |
| Officer Mailing Address | 0 | OfficerMailingAddress |
| Local Chapters | 0 | LocalChapters |
| Form990 Provided To Governing Body | 1 | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | 1 | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | 1 | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | 1 | RegularMonitoringEnforcement |
| Whistleblower Policy | 1 | WhistleblowerPolicy |
| Document Retention Policy | 1 | DocumentRetentionPolicy |
| Compensation Process CEO | 1 | CompensationProcessCEO |
| Compensation Process Other | 0 | CompensationProcessOther |
| Investment In Joint Venture | 1 | InvestmentInJointVenture |
| Written Policy Or Procedure | 1 | WrittenPolicyOrProcedure |
| States Where Copy Of Return Is Filed | OH | StatesWhereCopyOfReturnIsFiled |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | KEN DICKEN | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 7405935551 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 55 HOSPITAL DRIVE | AddressLine1 |
| City | ATHENS | City |
| State | OH | State |
| ZIP Code | 45701 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionA (19 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | OfficerOfficer | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | Highest Compensated EmployeeHighestCompensatedEmployee |
|---|---|---|---|---|---|---|---|
| GREG LONG | |||||||
| CEO/PRESIDENT | 40.00 | X | X | 0 | 0 | 0 | |
| DOUGLAS BOLON PHD | |||||||
| VICE-CHAIR | 2.00 | X | X | 0 | 0 | 0 | |
| DON COOLEY | |||||||
| TREASURER | 2.00 | X | X | 0 | 0 | 0 | |
| MICHAEL BERNSTEIN | |||||||
| DIRECTOR | 2.00 | X | 0 | 0 | 0 | ||
| SUSAN QUINN OD | |||||||
| CHAIR | 2.00 | X | X | 0 | 0 | 0 | |
| JACQUELINE LEGG | |||||||
| SECRETARY | 2.00 | X | X | 0 | 0 | 0 | |
| CANDY KEMMERER | |||||||
| DIRECTOR | 2.00 | X | 0 | 0 | 0 | ||
| GERALD A MOLLICA | |||||||
| DIRECTOR | 2.00 | X | 0 | 0 | 0 | ||
| BRENDA NOFTZ | |||||||
| DIRECTOR | 2.00 | X | 0 | 0 | 0 | ||
| DAWN SAMMONS | |||||||
| DIRECTOR | 2.00 | X | 0 | 0 | 0 | ||
| JOHN YANES | |||||||
| IMMEDIATE PAST CEO/PRESIDENT | 40.00 | X | X | 0 | 0 | 0 | |
| LARRY THORNHILL | |||||||
| INTERIM CEO/PRESIDENT | 40.00 | X | X | 0 | 0 | 0 | |
| BOB NORRIS | |||||||
| IMMEDIATE PAST CHAIR | 2.00 | X | X | 0 | 0 | 0 | |
| KEN DICKEN | |||||||
| CFO | 40.00 | X | 0 | 0 | 0 | ||
| DERRICK REEDUS | |||||||
| PHYSICIAN | 40.00 | 561911 | 0 | 24128 | X | ||
| STENNETH ADAMS | |||||||
| PHYSICIAN | 40.00 | 377826 | 0 | 22102 | X | ||
| MARK ROTHSTEIN | |||||||
| PHYSICIAN | 40.00 | 392393 | 0 | 18528 | X | ||
| NEAL NESBIT | |||||||
| PHYSICIAN | 40.00 | 419850 | 0 | 13973 | X | ||
| JASON REED | |||||||
| PHYSICIAN | 40.00 | 1317245 | 0 | 26910 | X | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 3069225 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 0 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 105641 | TotalOtherCompensation |
| Number Individuals GT100 K | 21 | 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 |
|---|---|---|---|---|---|
| OHIOHEALTH HOSPITAL MANAGEMENT SERVICES | |||||
| 3535 OLENTANGY RIVER ROAD | COLUMBUS | OH | 43214 | MANAGEMENT | 1319051 |
| BRICKER & ECKLER LLP | |||||
| 100 SOUTH THIRD STREET | COLUMBUS | OH | 432154291 | LEGAL SERVICES | 543828 |
| OLOGIE LLC | |||||
| 447 EAST MAIN STREET | COLUMBUS | OH | 43215 | MARKETING | 286096 |
| ACCESS HEALTH ATHENS LLC | |||||
| 7450 HUNTINGTON PARK DRIVE SUITE 1 | COLUMBUS | OH | 43235 | HEALTHCARE | 273654 |
| DAWSON HEALTHCARE | |||||
| 3650 OLENTANGY RIVER ROAD SUITE 45 | COLUMBUS | OH | 43214 | HEALTHCARE STAFFING SOLUTION | 158735 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 6 | NumberOfContractorsGT100K |
| All Other Contributions | 123132 | AllOtherContributions |
| Total Contributions | 123132 | TotalContributions |
Program Service Revenue ProgramServiceRevenue (3 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome | Unrelated Business RevenueUnrelatedBusinessRevenue |
|---|---|---|---|---|
| PATIENT SERVICES | 622110 | 79931491 | 71754053 | 8177438 |
| SCORP INVESTMENTS | 621500 | 161136 | 161136 | |
| RENT FROM AFFILIATE | 631110 | 67200 | 67200 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 80159827 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 248320 | TotalRevenueColumn |
| Exclusion | $248,320 | ExclusionAmount |
Gross Rents GrossRents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 1331233 | Real |
Less Rental Expenses LessRentalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 1241009 | Real |
Rental Income Or Loss RentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 90224 | Real |
Net Rental Income Or Loss NetRentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 90224 | TotalRevenueColumn |
| Exclusion | $90,224 | ExclusionAmount |
Gross Amount Sales Assets GrossAmountSalesAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 349954 | Securities |
Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 0 | Securities |
| Other | 13497 | Other |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 349954 | Securities |
| Other | -13497 | Other |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 336457 | TotalRevenueColumn |
| Exclusion | $336,457 | ExclusionAmount |
Other Revenue Misc OtherRevenueMisc (3 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome | Unrelated Business RevenueUnrelatedBusinessRevenue |
|---|---|---|---|---|
| CAFETERIA | 722210 | 399908 | 399908 | |
| AMA CONTRACTED SVCS | 900099 | 289502 | 289502 | |
| PHARMACY | 561000 | 162503 | 162503 |
Miscellaneous Revenue MiscellaneousRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 519950 | TotalRevenueColumn |
| Related Or Exempt Function Income | 464810 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 55140 | UnrelatedBusinessRevenue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 1371863 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 82329823 | TotalRevenueColumn |
| Related Or Exempt Function Income | 72848474 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 8683216 | UnrelatedBusinessRevenue |
| Exclusion | $675,001 | ExclusionAmount |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 27066754 | Total |
| Program Services | 24251811 | ProgramServices |
| Management And General | 2814943 | ManagementAndGeneral |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1405419 | Total |
| Program Services | 1259255 | ProgramServices |
| Management And General | 146164 | ManagementAndGeneral |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 6116638 | Total |
| Program Services | 5480508 | ProgramServices |
| Management And General | 636130 | ManagementAndGeneral |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1873578 | Total |
| Program Services | 1678726 | ProgramServices |
| Management And General | 194852 | ManagementAndGeneral |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 771181 | Total |
| Management And General | 771181 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 257544 | Total |
| Management And General | 257544 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 14076266 | Total |
| Program Services | 12612335 | ProgramServices |
| Management And General | 1463931 | ManagementAndGeneral |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 454583 | Total |
| Program Services | 407307 | ProgramServices |
| Management And General | 47276 | ManagementAndGeneral |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 14095249 | Total |
| Program Services | 12629343 | ProgramServices |
| Management And General | 1465906 | ManagementAndGeneral |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 23865 | Total |
| Program Services | 21383 | ProgramServices |
| Management And General | 2482 | ManagementAndGeneral |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 434200 | Total |
| Program Services | 389043 | ProgramServices |
| Management And General | 45157 | ManagementAndGeneral |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 153809 | Total |
| Program Services | 137813 | ProgramServices |
| Management And General | 15996 | ManagementAndGeneral |
Conferences Meetings ConferencesMeetings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 28135 | Total |
| Program Services | 25209 | ProgramServices |
| Management And General | 2926 | ManagementAndGeneral |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2118413 | Total |
| Program Services | 1898098 | ProgramServices |
| Management And General | 220315 | ManagementAndGeneral |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2441253 | Total |
| Program Services | 2187362 | ProgramServices |
| Management And General | 253891 | ManagementAndGeneral |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2016520 | Total |
| Program Services | 1806802 | ProgramServices |
| Management And General | 209718 | ManagementAndGeneral |
Other Expenses OtherExpenses (3 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral |
|---|---|---|---|
| BAD DEBTS EXPENSE | 6565420 | 6565420 | |
| MEMBERSHIP DUES | 120504 | 120504 | |
| CONTRACTED LABOR | 37391 | 33502 | 3889 |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 80056722 | Total |
| Program Services | 71504421 | ProgramServices |
| Management And General | 8552301 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 17753513 | BOY |
| EOY | 11293554 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3690328 | BOY |
| EOY | 8720400 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 9706500 | BOY |
| EOY | 8098990 | EOY |
Receivables From Officers Etc ReceivablesFromOfficersEtc
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 188525 | BOY |
| EOY | 291885 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 752993 | BOY |
| EOY | 799178 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1289115 | BOY |
| EOY | 2422067 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 80951048 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 49486893 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 30687112 | BOY |
| EOY | 31464155 | EOY |
Investments Other Securities InvestmentsOtherSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 755893 | BOY |
| EOY | 1166120 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 9897551 | BOY |
| EOY | 9752438 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 74721530 | BOY |
| EOY | 74008787 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 5923382 | BOY |
| EOY | 3196277 | EOY |
Tax Exempt Bond Liabilities TaxExemptBondLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 27937083 | BOY |
| EOY | 27407500 | EOY |
Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 798941 | BOY |
| EOY | 848555 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 9489924 | BOY |
| EOY | 9783224 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 44149330 | BOY |
| EOY | 41235556 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 29801418 | BOY |
| EOY | 32110934 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 160914 | BOY |
| EOY | 52429 | EOY |
Permanently Restricted Net Assets PermanentlyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 609868 | BOY |
| EOY | 609868 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 30572200 | BOY |
| EOY | 32773231 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 74721530 | BOY |
| EOY | 74008787 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | 2273101 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | -72068 | ReconcilationOtherChanges |
| Info In Schedule O Part XII | X | InfoInScheduleOPartXII |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | 0 | AccountantCompileOrReview |
| FS Audited | 1 | FSAudited |
| Audit Committee | 1 | AuditCommittee |
| Financial Statement Consolidated | X | FinancialStatementConsolidated |
| 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 | $1,584 | OtherActivitiesAmount |
| Total Lobbying Expenditures IIB | 1584 | 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 | LOBBYING EXPENSES RELATE TO THE PORTION OF DUES PAID TO THE OHIO HOSPITAL ASSOCIATION WHICH IS USED FOR LOBBYING. | Explanation |
Schedule D IRS990ScheduleD
Current Year CurrentYear
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 770777 | BeginningOfYearBalance |
| Investment Earnings Or Losses | -108483 | InvestmentEarningsOrLosses |
| End Of Year Balance | 662294 | EndOfYearBalance |
Current Year Minus1 Year CurrentYearMinus1Year
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 786504 | BeginningOfYearBalance |
| Investment Earnings Or Losses | -15727 | InvestmentEarningsOrLosses |
| End Of Year Balance | 770777 | EndOfYearBalance |
Current Year Minus2 Years CurrentYearMinus2Years
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 801779 | BeginningOfYearBalance |
| Investment Earnings Or Losses | -15275 | InvestmentEarningsOrLosses |
| End Of Year Balance | 786504 | EndOfYearBalance |
Current Year Minus3 Years CurrentYearMinus3Years
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 663242 | BeginningOfYearBalance |
| Contributions | 138537 | Contributions |
| End Of Year Balance | 801779 | EndOfYearBalance |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Board Designated EOY Balance | 0.07920 | BoardDesignatedEOYBalance |
| Permanent Endowment EOY Balance | 0.92080 | 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 | 2389777 | OtherCostOrOtherBasis |
| Book Value | 2389777 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 33085636 | OtherCostOrOtherBasis |
| Depreciation | 16550965 | Depreciation |
| Book Value | 16534671 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 41248631 | OtherCostOrOtherBasis |
| Depreciation | 30922521 | Depreciation |
| Book Value | 10326110 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 4227004 | OtherCostOrOtherBasis |
| Depreciation | 2013407 | Depreciation |
| Book Value | 2213597 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 31464155 | TotalOfBookValueLandBuildings |
Other Assets OtherAssets (4 entries)
| DescriptionDescription | Book ValueBookValue |
|---|---|
| BOND ISSUE COSTS | 955723 |
| COST REPORT SETTLEMENT RECEIVABLE | 205361 |
| OTHER CURRENT ASSETS | 8058854 |
| OTHER NONCURRENT ASSETS | 532500 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | 9752438 | TotalBookValueOtherAssets |
Other Liabilities OtherLiabilities (4 entries)
| DescriptionDescription | AmountAmount |
|---|---|
| LEASED PROPERTY DEPOSITS | $3,748,813 |
| ACCRUED WAGES | $3,289,451 |
| OTHER ACCRUED LIABILITIES | $1,756,077 |
| OTHER LIABILITIES | $988,883 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 9783224 | TotalOfAmounts |
Form990 Schedule D Part XIV Form990ScheduleDPartXIV (2 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: | PART V, LINE 4: | THE ENDOWMENTS ARE INTENDED FOR THE SUPPORT OF THE ORGANIZATION'S HEALTHCARE ACTIVITIES. |
| DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: | PART X: | O'BLENESS MEMORIAL HOSPITAL AND THE APPALACHIAN COMMUNITY VISITING NURSE ASSOCIATION HOSPICE AND HEALTH SERVICES, INC. ARE EXEMPT FROM FEDERAL TAXES UNDER SECTION 501(A) AS AN ORGANIZATION DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. ATHENS MEDICAL LABORATORY ASSOCIATES, INC., ATHENS SURGERY CENTER, LTD., ATHENS MEDICAL ASSOCIATES, LLC, AND O'BLENESS MEMORIAL PAIN MANAGEMENT CLINIC, LLC ARE FOR-PROFIT SUBSIDIARIES SUBJECT TO FEDERAL INCOME TAXES. FEDERAL INCOME TAX EXPENSE IS NOT MATERIAL TO THE CONSOLIDATED FINANCIAL STATEMENTS. 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 THE IRS OR OTHER APPLICABLE TAXING AUTHORITIES. MANAGEMENT HAS ANALYZED THE TAX POSITIONS TAKEN BY THE HOSPITAL AND HAS CONCLUDED THAT AS OF JUNE 30, 2012, THERE ARE NO UNCERTAIN POSITIONS TAKEN OR EXPECTED TO BE TAKEN THAT WOULD REQUIRE RECOGNITION OF A LIABILITY OR DISCLOSURE IN THE FINANCIAL STATEMENTS. THE HOSPITAL IS SUBJECT TO ROUTINE AUDITS BY TAXING JURISDICTIONS; HOWEVER, THERE ARE CURRENTLY NO AUDITS FOR ANY TAX PERIODS IN PROGRESS. MANAGEMENT BELIEVES IT IS NO LONGER SUBJECT TO INCOME TAX EXAMINATIONS FOR YEARS PRIOR TO JUNE 30, 2009. |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Charity Care Policy | 1 | CharityCarePolicy |
| Written Policy | 1 | WrittenPolicy |
| Policy Applied To All Hospitals | X | PolicyAppliedToAllHospitals |
| FPG Reference Free Care | 1 | FPGReferenceFreeCare |
| Pcent150 | X | Pcent150 |
| 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 | 1 | ExpensesExceededBudget |
| Unable To Provide Care | 0 | UnableToProvideCare |
| Annual Community Benefit Report | 0 | AnnualCommunityBenefitReport |
Charity Care At Cost CharityCareAtCost
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 5456758 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 1858726 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 3598032 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.04900 | PercentOfTotalExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 14850425 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 6616686 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 8233739 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.11200 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 20307183 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 8475412 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 11831771 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.16100 | PercentOfTotalExpense |
Community Health Services CommunityHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 4816 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 290 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 4526 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00010 | PercentOfTotalExpense |
Health Professions Education HealthProfessionsEducation
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 924557 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 846593 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 77964 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00110 | PercentOfTotalExpense |
Total Other Benefits TotalOtherBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 929373 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 846883 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 82490 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00120 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 21236556 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 9322295 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 11914261 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.16220 | PercentOfTotalExpense |
Community Support CommunitySupport
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 1 | NumberOfActivitiesOrPrograms |
| Total Community Building Expense | 15400 | TotalCommunityBuildingExpense |
| Direct Offsetting Revenue | 0 | DirectOffsettingRevenue |
| Net Community Building Expense | 15400 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00020 | PercentOfTotalExpense |
Total Total
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 1 | NumberOfActivitiesOrPrograms |
| Total Community Building Expense | 15400 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 15400 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00020 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 1 | BadDebtExpenseReported |
| Bad Debt Expense | $6,565,420 | BadDebtExpenseAmount |
| Amount Attributable To | 196963 | AmountAttributableTo |
| Amount Reimbursed By Medicare | 15834298 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 14718718 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | 1115580 | 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
Name Of Entity NameOfEntity
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | 1 ATHENS SURGERY CENTER LTD | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description Ent Primary Activity | OUTPATIENT SURGERY | DescriptionEntPrimaryActivity |
| Organization Profit Or Ownership | 0.59790 | OrganizationProfitOrOwnership |
| Officers Etc Profit Or Ownership | 0.04120 | OfficersEtcProfitOrOwnership |
| Physicans Profit Or Ownership | 0.36090 | PhysicansProfitOrOwnership |
| 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 | O'BLENESS MEMORIAL HOSPITAL | BusinessNameLine1 |
Address Address
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 55 HOSPITAL DRIVE | AddressLine1 |
| City | ATHENS | City |
| State | OH | State |
| ZIP Code | 45701 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Licensed Hospital | X | LicensedHospital |
| General Medical And Surgical | X | GeneralMedicalAndSurgical |
| Teaching Hospital | X | TeachingHospital |
| 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 | O'BLENESS MEMORIAL HOSPITAL | 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 | 150.000000000000 | FPGFreePercent |
| Uses FPG Discounted | 1 | UsesFPGDiscounted |
| FPG Discount Percent | 200.000000000000 | FPGDiscountPercent |
| Explains Basis | 1 | ExplainsBasis |
| Income Level | X | IncomeLevel |
| Insurance Status | X | InsuranceStatus |
| Medicaid Medicare | X | MedicaidMedicare |
| State Regulation | X | StateRegulation |
| Explains Application Method | 1 | ExplainsApplicationMethod |
| Includes Publicity Measures | 0 | IncludesPublicityMeasures |
| Actions On Nonpayment | 1 | ActionsOnNonpayment |
| Collection Activities | 0 | CollectionActivities |
| Nondiscrim Emergency Care Policy | 1 | NondiscrimEmergencyCarePolicy |
| Used Other Method | X | UsedOtherMethod |
| 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 | 1 | NumberOfOtherFacilities |
Other Facilities OtherFacilities
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ATHENS MEDICAL ASSOCIATES LLC | BusinessNameLine1 |
Address Address
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 55 HOSPITAL DRIVE | AddressLine1 |
| City | ATHENS | City |
| State | OH | State |
| ZIP Code | 45701 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility Type | PHYSICIAN SERVICES | FacilityType |
Form990 Schedule H Part VI Form990ScheduleHPartVI (13 entries)
| ExplanationExplanation | IdentifierIdentifier |
|---|---|
| PART I, LINE 3C: THE HOSPITAL HAS MORE THAN ONE POLICY CONCERNING FREE OR DISCOUNTED CARE. O'BLENESS MEMORIAL HOSPITAL WILL OFFER AND PROVIDE FREE CARE TO ANY PATIENT WHO MEETS THE ELIGIBILITY REQUIREMENT FOR FREE CARE UNDER THE OCAP OR HCAP FINANCIAL ASSISTANCE POLICIES. THE FOLLOWING STEPS WILL BE USED TO DETERMINE ELIGIBILITY FOR FREE CARE UNDER OCAP (O'BLENESS CARE ASSURANCE PROGRAM): 1. A RECIPIENT OF THE OHIO MEDICAID PROGRAM IS NOT ELIGIBLE. (OAC RULE 5 10 1 :3-2-07.17) 2. IF THE PATIENT IS COVERED UNDER A THIRD-PARTY INSURER OR A GOVERNMENTAL PROGRAM, THE THIRD PARTY WILL BE BILLED AND ANY PAYMENT RECEIVED WILL BE APPLIED TO THE ACCOUNT FIRST. ANY BALANCE ON THE ACCOUNT WILL BE CONSIDERED FOR THE OCAP WRITE-OFF. 3. OCAP ASSISTANCE WILL BE APPROVED ONLY WHEN SERVICES ARE PROVIDED BY O'BLENESS MEMORIAL HOSPITAL. THESE SERVICES ALSO INCLUDE ANESTHESIA PROFESSIONAL FEES, PHYSICIAN INTERPRETATION FEES FOR CARDIOPULMONARY SERVICES, AND SERVICE PROVIDED IN THE O'BLENESS FAMILY PRACTICE CLINIC.4. FAMILY INCOME IS BETWEEN 100 TO 150% OF THE FEDERAL POVERTY GUIDELINES. FAMILY: FAMILY SHALL BE DEFINED AS THE PATIENT, THE PATIENT'S SPOUSE, AND ALL OF THE PATIENT'S CHILDREN, NATURAL AND ADOPTIVE UNDER THE AGE OF EIGHTEEN WHO LIVE AT HOME. IF THE PATIENT IS UNDER THE AGE OF EIGHTEEN THE FAMILY SHALL INCLUDE THE PATIENT, THE PATIENT'S NATURAL OR ADOPTIVE PARENT(S) AND THE PARENT(S) CHILDREN, NATURAL OR ADOPTIVE UNDER THE AGE OF EIGHTEEN WHO LIVE IN THE HOME. IF THE PATIENT IS A CHILD OF A MINOR PARENT WHO STILL RESIDES IN THE HOME OF THE PATIENT'S GRANDPARENTS, THE FAMILY SHALL INCLUDE ONLY THE PARENT(S) OF ANY OF THE PARENT(S) NATURAL OR ADOPTIVE CHILDREN WHO RESIDE IN THE HOME. INCOME: INCOME SHALL BE DEFINED AS THE TOTAL SALARIES, WAGES AND CASH RECEIPTS BEFORE TAXES: RECEIPTS THAT REFLECT REASONABLE DEDUCTION FOR BUSINESS EXPENSES SHALL BE COUNTED FOR BOTH FARM AND NON-FARM SELF-EMPLOYMENT. THE FOLLOWING STEPS WILL BE USED TO DETERMINE ELIGIBILITY FOR FREE CARE UNDER HCAP (HOSPITAL CARE ASSURANCE PROGRAM): 1. A COMPLETED APPLICATION WILL BE OBTAINED FROM ALL PATIENTS SEEKING FREE CARE UNDER HCAP. 2. A PATIENT MUST BE A RESIDENT OF THE STATE OF OHIO TO BE ELIGIBLE FOR HCAP. 3. O'BLENESS MEMORIAL HOSPITAL WILL DEFINE INCOME REQUIREMENTS USING THE FEDERAL POVERTY GUIDELINES AS INDICATED YEARLY. 4. O'BLENESS MEMORIAL HOSPITAL WILL DEFINE A FAMILY AS INDICATED IN BALDWIN'S OHIO ADMINISTRATIVE CODE CHAPTER 5101:3-2-0717. 5. THE INCOME PROVIDED BY THE APPLICANT WILL BE VERIFIED VIA SWORN SIGNATURE. 6. A RECIPIENT OF THE OHIO MEDICAID PROGRAM IS NOT ELIGIBLE (OAC RULE: 5101:3-2-0717) IF A PATIENT HAS INSURANCE COVERAGE, O'BLENESS MEMORIAL HOSPITAL WILL FIRST BILL THE INSURANCE AND RECEIVE A PAYMENT OF A DENIAL BEFORE THE HCAP APPLICATION IS PROCESSED. | |
| PART I, LINE 7: THE COST OF CHARITY CARE, UNREIMBURSED MEDICAID AND OTHER MEANS-TESTED GOVERNMENT PROGRAMS WAS ESTIMATED USING A COST TO CHARGE RATIO DERIVED FROM WORKSHEET 2 OF THE SCHEDULE H INSTRUCTIONS. COSTING METHODOLOGY USED TO DETERMINE THE COST OF COMMUNITY HEALTH IMPROVEMENT SERVICES AND COMMUNITY BENEFIT OPERATIONS: THE HOSPITAL USES THE COMPUTER SOFTWARE CBISA TO TRACK OUR PROGRAMS THAT HAPPEN IN THE COMMUNITY OR AT THE HOSPITAL FOR THE COMMUNITY. THE COMPUTER TRACKS DIRECT EXPENSES ASSOCIATED WITH THE PROGRAMS AS WELL AS ANY OFFSETTING REVENUE THAT WILL DECREASE THE COMMUNITY BENEFIT. THE SYSTEM ACCOUNTS FOR UTILITIES USED IF THE ACTIVITY OCCURS AT THE FACILITY (HOSPITAL). THE SYSTEM ALSO ACCOUNTS FOR ANY SUPPLIES USED AND WAGES OF ANY EMPLOYEE THAT IS PRESENT AT THE ACTIVITY. A HOSPITAL WIDE WAGE AVERAGE IS USED IN DETERMINING THE AMOUNT OF SALARY TO USE IN THE DIRECT EXPENSES. | |
| 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 $ 6565420. | |
| PART II: THE COMMUNITY BUILDING ACTIVITY INCLUDES A SPONSORSHIP OF A LOCAL BASEBALL TEAM. THIS SPONSORSHIP HELPS ADVISE THE HOSPITAL AS WELL AS PROMOTE WELLNESS AND THE IMPORTANCE OF AN ACTIVE LIFESYLE. | |
| PART III, LINE 4: PATIENT ACCOUNTS RECEIVABLES ARE CARRIED AT THE ORIGINAL CHARGE LESS AN ESTIMATE MADE FOR DOUBTFUL OR UNCOLLECTIBLE ACCOUNTS. THE ALLOWANCE IS BASED UPON A REVIEW OF THE OUTSTANDING BALANCES AGED BY FINANCIAL CLASS. MANAGEMENT USES COLLECTION PERCENTAGES BASED UPON HISTORICAL COLLECTION EXPERIENCE TO DETERMINE COLLECTABILITY. MANAGEMENT ALSO REVIEWS TROUBLED, AGED ACCOUNTS TO DETERMINE COLLECTION POTENTIAL. PATIENT ACCOUNTS RECEIVABLES ARE WRITTEN OFF WHEN DEEMED UNCOLLECTIBLE. RECOVERIES OF ACCOUNTS PREVIOUSLY WRITTEN OFF ARE RECORDED AS A REDUCTION TO BAD DEBT EXPENSE WHEN RECEIVED. INTEREST IS NOT CHARGED ON PATIENT ACCOUNTS RECEIVABLE.FINANCIAL STATEMENT FOOTNOTE: ACCOUNTS RECEIVABLE ARE STATED NET OF CONTRACTUAL ALLOWANCES AND THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. THE ALLOWANCE FOR DOUBTFUL ACCOUNTS IS DETERMINED UTILIZING A NUMBER OF FACTORS INCLUDING ACCOUNT AGING AND FINANCIAL CLASS INFORMATION AS WELL AS RECENT AND HISTORICAL COLLECTION ACTIVITY.THE BAD DEBT WAS DETERMINED BASED ON FORM 990, PART IX. THE ESTIMATED AMOUNT OF THE ORGANIZATIONS BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATIONS FINANCIAL ASSISTANCE POLICY IS ESTIMATED AT 3% OF BAD DEBT. | |
| PART III, LINE 8: MEDICARE ALLOWABLE COSTS WERE CALCULATED USING METHODOLOGY REQUIRED FOR THE MEDICARE COST REPORT (COST TO CHARGE RATIO). | |
| PART III, LINE 9B: PATIENTS KNOWN TO QUALIFY FOR CHARITY CARE OR FINANCIAL ASSISTANCE ARE ASKED TO FILL OUT THE PAPERWORK ASSOCIATED WITH THE PROGRAMS WE HAVE AVAILABLE TO PATIENTS WITH LOW INCOME. WE DO NOT HAVE A COLLECTIONS PROCESS FOR CHARITY CARE PATIENTS AND THE FULL AMOUNT IS WRITTEN OFF TO THE ASSOCIATED PROGRAM. THIS DOES NOT APPLY TO PATIENTS THAT DO NOT QUALIFY FOR EITHER OF THE PROGRAMS. IF IT IS DETERMINED THAT THE PATIENT IS CAPABLE OF PAYING FOR THEIR MEDICAL CARE, THEN AT THAT POINT THEY ARE BILLED AT A DISCOUNTED RATE FOR THE SERVICES PROVIDED. IF THEY FAIL TO PAY AT THE DISCOUNTED RATE THEN COLLECTION PRACTICES ENSUE. | |
| PART V, SECTION B, LINE 19D: THE MAXIMUM AMOUNTS CHARGED TO FINANCIAL ASSISTANCE POLICY ELIGIBLE INDIVIDUALS FOR EMERGENCY OR OTHER MEDICALLY NECESSARY IS $0 FOR PATIENTS WHO FALL WITHIN 150% OF THE FPG AND 50% OF CHARGEMASTER RATES FOR PATIENTS WHO FALL WITHIN 200% OF THE FPG. | O'BLENESS MEMORIAL HOSPITAL |
| PART VI, LINE 2: THE HOSPITAL IS CURRENTLY ACTIVELY INVOLVED IN CONDUCTING A COMMUNITY HEALTH NEEDS ASSESSMENT TO BEST SERVE THE NEEDS OF THE PATIENTS AND BE IN COMPLIANCE WITH FUTURE HEALTHCARE LEGISLATION. | |
| PART VI, LINE 3: THE HOSPITAL INFORMS PATIENTS OF THEIR ELIGIBILITY FOR ASSISTANCE IN DIFFERENT WAYS. THERE IS A SIGN IN THE ADMITTING AREA THAT DIRECTS THEIR ATTENTION TO THE FACT THAT THERE IS AVAILABLE CARE AT A REDUCED FEE OR FREE OF CHARGE. ON EACH DATA MAILER THAT IS SENT OUT TO PATIENTS, THERE IS A SECTION THAT INFORMS THEM OF THE AVAILABILITY OF THIS CARE. ANY PATIENT THAT COMES IN WITHOUT INSURANCE OR PROOF OF INSURANCE IS SUPPLIED A SELF-PAY PACKET. IN THIS PACKET IS AN OUTLINE ON HOW TO OBTAIN FREE OR DISCOUNTED CARE; THE PACKET ALSO DETAILS THE PARAMETERS OF EACH PROGRAM. IF ANY OF OUR EMPLOYEES ARE ASKED IN ADMISSIONS OR DURING THEIR CARE IF THERE ARE ANY OPTIONS AVAILABLE FOR PAYMENT OF THEIR CARE, THE EMPLOYEES WILL DESCRIBE TO THE PATIENTS THE PROGRAMS AVAILABLE OR PROVIDE THEM WITH MATERIALS ON HOW TO APPLY AND BE ACCEPTED INTO THE FREE OR DISCOUNTED CARE PROGRAMS. | |
| PART VI, LINE 4: O'BLENESS MEMORIAL HOSPITAL IS A COMMUNITY HOSPITAL IN A RURAL AREA OF APPALACHIA. OUR PRIMARY SERVICE AREA INCLUDES THE COMMUNITIES WITHIN ATHENS COUNTY, OHIO, WHICH HAS BEEN IDENTIFIED BY THE APPALACHIAN REGIONAL COMMISSION AS AN ARC-DESIGNATED DISTRESSED COUNTY. ACCORDING TO THE UNITED STATES CENSUS BUREAU, THE POPULATION OF ATHENS COUNTY IN 2012 WAS 64,304. THE MEDIAN INCOME OF $33,546 IS NOT TRULY REPRESENTATIVE OF THE POPULATION, AS THE COMMUNITY INCLUDES A MAJOR UNIVERSITY. ATHENS COUNTY HAS THE HIGHEST POVERTY LEVEL OF ANY COUNTY IN OHIO, AS 31.5% OF THE COMMUNITY RESIDENTS HAVE INCOMES AT OR BELOW THE FEDERAL POVERTY GUIDELINE. UNINSURED INDIVIDUALS IN ATHENS COUNTY REPRESENT 21% OF THE POPULATION. THE HOSPITAL'S PATIENT POPULATION INCLUDES 8.8% WHO ARE UNINSURED AND 23.18% WHO ARE MEDICAID RECIPIENTS. LOCATED WITHIN O'BLENESS' PRIMARY SERVICE AREA OF ATHENS COUNTY IS ONE ADDITIONAL HOSPITAL, DOCTORS HOSPITAL OF NELSONVILLE AFFILIATED WITH OHIOHEALTH BASED IN COLUMBUS, OHIO. PORTIONS OF THE PATIENT POPULATION ARE ALSO SERVED BY EIGHT OTHER HOSPITALS IN WASHINGTON, GALLIA, JACKSON, HOCKING, FAIRFIELD AND ROSS COUNTIES IN OHIO AND WOOD COUNTY IN WEST VIRGINIA, AS WELL AS THREE MAJOR HEALTH SYSTEMS WITH MULTIPLE FACILITIES IN FRANKLIN COUNTY, OHIO. TWO TOWNSHIPS IN ATHENS COUNTY HAVE BEEN DESIGNATED AS MEDICALLY UNDERSERVED AREAS/POPULATIONS BY THE U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES: LODI AND TRIMBLE. | |
| PART VI, LINE 5: AT O'BLENESS MEMORIAL HOSPITAL IT IS OUR GOAL TO GIVE ACCESS TO ANY PERSON IN OUR COMMUNITY TO MODERN DAY HEALTHCARE AT A COST EFFECTIVE PRICE. AS THE ONLY HOSPITAL IN ATHENS, WE STRIVE TO GIVE HELP WHERE HELP IS NEEDED. TO FURTHER OUR COMMITMENT TO THE COMMUNITY AND OUR EXEMPT PURPOSE WE ENGAGE IN MANY ACTIVITIES. OUR BOARD IS COMPILED OF PEOPLE WHO RESIDE IN OUR COMMUNITY WITHOUT A CONFLICT OF INTEREST WITH THE HOSPITAL. WE BELIEVE THE MORE DIVERSE THE BOARD THE BETTER THEY WILL BE ABLE TO IDENTIFY THE NEEDS OF THE COMMUNITY. THE MAJORITY OF THE BOARD HAS NO CONNECTION TO THE ORGANIZATION NOR ARE CONTRACTED WITH THE HOSPITAL. THEY PROVIDE THEIR CONSULT AND GUIDANCE OUT OF THE PURE DESIRE TO SEE THEIR COMMUNITY BE AFFORDED THE SAME QUALITY OF CARE AS BIGGER MARKETS. WE EXTEND MEDICAL PRIVILEGES TO QUALIFIED PHYSICIANS THAT HAVE A DESIRE TO PRACTICE WITHIN OUR FACILITIES. WE CONTINUE TO SEARCH FOR PROGRAMS AND ACTIVITIES THAT WILL BE NEW TO THE COMMUNITY IN ORDER TO GIVE THE POPULATION VARIETY AND HEALTH ORIENTED ALTERNATIVES. FUNDS ARE USED TO PURCHASE CAPITAL EQUIPMENT THAT IS VITAL IN KEEPING UP WITH AN EVER EVOLVING MEDICAL WORLD. IT IS ALSO USED TO FUND ACTIVITIES INSIDE AND OUTSIDE OF THE HOSPITAL THAT INVOLVES THE COMMUNITY ON VARIOUS LEVELS WHETHER IT BE A HEALTH FAIR OR AN INTERACTIVE EXERCISE PROGRAM. WE HAVE MANY VOLUNTEERS FROM THE COMMUNITY THAT ARE INSTRUMENTAL IN CARRYING OUT VARIOUS ACTIVITIES. | |
| PART VI, LINE 6: THE O'BLENESS HEALTH SYSTEM IS DESIGNED TO OFFER THE MOST COMPREHENSIVE MEDICAL ATTENTION TO A MAINLY CENTRALIZED LOCATION TO THE COMMUNITY IN WHICH WE LIVE. THE AFFILIATES OF THE SYSTEM WORK TOGETHER IN A COLLABORATIVE EFFORT TO INCREASE THE EFFICIENCY AND COST OF HEALTHCARE TO THE PATIENT. THE O'BLENESS MEMORIAL HOSPITAL IS THE MAIN COMPONENT OF THE HEALTH SYSTEM. AT THE HOSPITAL WE OFFER A VARIETY OF INPATIENT AND OUTPATIENT SERVICES. THE EMERGENCY DEPARTMENT IS OPERATIONAL 24 HOURS A DAY 7 DAYS A WEEK. WE OFFER CARE TO ANYONE REGARDLESS OF ABILITY TO PAY. WE ARE THE ONLY FULLY FUNCTIONAL HOSPITAL IN THE COMMUNITY. IT IS OUR GOAL NOT TO EXCLUDE ANYONE FROM OUR COMMUNITY THAT IS IN NEED OF CARE. THE ATHENS MEDICAL LAB (AML) IS AN AFFILIATE OF THE SYSTEM THAT IS A MEDICAL REFERENCE LAB THAT OFFERS CONVENIENCE AND COST EFFICIENCY FOR THE PATIENT. THIS ALLOWS US TO KEEP PATIENTS CLOSE TO HOME AND SPEED UP RESULT TIME. THE ATHENS MEDICAL ASSOCIATES (AMA) IS A MULTI-PHYSICIAN PRACTICE THAT OFFERS A VARIETY OF SERVICES TO PATIENTS. AMA IS COMPRISED OF A MULTIFACETED OB/GYN PRACTICE, AN ORTHOPEDIC SURGEON, AND A FAMILY PRACTICE CLINIC THAT SERVICE NUMEROUS MEMBERS OF THE COMMUNITY. THERE IS ALSO APPALACHIAN COMMUNITY VISITING NURSES ASSOCIATION, HOSPICE AND HEALTH SERVICES (ACVNAHHS). THIS AFFILIATE PROVIDES HOSPICE SERVICES TO NOT ONLY ATHENS COUNTY BUT SURROUNDING COUNTIES. THEY ARE ALSO PROVIDERS OF VISITING NURSES THAT SERVE OUR CLIENTS OUT OF THE COMFORT OF THEIR OWN HOME. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Severance Payment | 0 | SeverancePayment |
| Supplemental Nonqual Retire Plan | 0 | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | 0 | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | 0 | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | 0 | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | 0 | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | 0 | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | 0 | AnyNonFixedPayments |
| Initial Contract Exception | 0 | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (5 entries)
| 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| DERRICK REEDUS | |||||||||||||
| 430000 | 0 | 0 | 0 | 131911 | 0 | 7500 | 0 | 16628 | 0 | 586039 | 0 | 0 | 0 |
| STENNETH ADAMS | |||||||||||||
| 315000 | 0 | 0 | 0 | 62826 | 0 | 7500 | 0 | 14602 | 0 | 399928 | 0 | 0 | 0 |
| MARK ROTHSTEIN | |||||||||||||
| 332304 | 0 | 0 | 0 | 60089 | 0 | 7500 | 0 | 11028 | 0 | 410921 | 0 | 0 | 0 |
| NEAL NESBIT | |||||||||||||
| 390000 | 0 | 0 | 0 | 29850 | 0 | 7500 | 0 | 6473 | 0 | 433823 | 0 | 0 | 0 |
| JASON REED | |||||||||||||
| 650000 | 0 | 647893 | 0 | 19352 | 0 | 7500 | 0 | 19410 | 0 | 1344155 | 0 | 0 | 0 |
Form990 Schedule J Part III Form990ScheduleJPartIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Reference | PART I, LINE 3 | ReturnReference |
| Explanation | THE CEO IS COMPENSATED THROUGH AN UNRELATED MANAGEMENT COMPANY, OHIOHEALTH HOSPITAL MANAGEMENT SERVICES, LLC. THE CONTRACT WITH THE MANAGEMENT COMPANY IS REVIEWED AND APPROVED BY THE BOARD. THE COMPENSATION FOR THE CEO IS REVIEWED AND APPROVED BY THE MANAGEMENT COMPANY. | Explanation |
Schedule K IRS990ScheduleK
Form990 Schedule K Part I Form990ScheduleKPartI
Issuer Name IssuerName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | COUNTY OF ATHENS OHIO | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Issuer EIN | 316400063 | IssuerEIN |
| CUSIP Number | 047075BA3 | CUSIPNumber |
| Date Issued | 2003-08-21 | DateIssued |
| Issue Price | 31263724 | IssuePrice |
| Description Of Purpose | BOND REFUNDING, HOSPITAL CONSTRUCTION & RENOVATION | 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) |
|---|---|---|
| Total Proceeds | 31263724 | TotalProceeds |
| Amount In Reserve Fund | 2493855 | AmountInReserveFund |
| Issuance Costs From Proceeds | 625274 | IssuanceCostsFromProceeds |
| Year Of Subst Completion | 2005 | YearOfSubstCompletion |
| Current Refunding | 0 | 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) |
|---|---|---|
| Owning Bond Financed Property | 0 | OwningBondFinancedProperty |
| Any Lease Arrangements | 0 | AnyLeaseArrangements |
| Mngment Cntrct Bond Financd Prprty | 0 | MngmentCntrctBondFinancdPrprty |
| Any Research Agreements | 0 | AnyResearchAgreements |
| Prcntge Prvt Business Use By Others | 0.00000 | PrcntgePrvtBusinessUseByOthers |
| Percentage Of Prvt Business Re UBI | 0.00000 | PercentageOfPrvtBusinessReUBI |
| Total Private Business Use | 0.00000 | TotalPrivateBusinessUse |
| Post Issuance Compliance Procdrs | 1 | PostIssuanceComplianceProcdrs |
Form990 Schedule K Part IV Form990ScheduleKPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form8038 T Filed | 0 | Form8038TFiled |
| 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 |
| Exception To Rebate | 0 | ExceptionToRebate |
Schedule L IRS990ScheduleL
Loan Table LoanTable (5 entries)
| Purpose Of LoanPurposeOfLoan | Loan From OrganizationLoanFromOrganization | Original PrincipalOriginalPrincipalAmount | Balance DueBalanceDue | DefaultDefault | Approved By BoardApprovedByBoard | Written AgreementWrittenAgreement |
|---|---|---|---|---|---|---|
| JASON REED | ||||||
| PHYSICIAN EDUCATION LOAN | X | $170,000 | 56667 | 0 | 1 | 1 |
| DAWN SAMMONS | ||||||
| PHYSICIAN EDUCATION LOAN | X | $250,000 | 42000 | 0 | 1 | 1 |
| STENNETH ADAMS | ||||||
| PHYSICIAN EDUCATION LOAN | X | $50,000 | 20192 | 0 | 1 | 1 |
| MARK ROTHSTEIN | ||||||
| PHYSICIAN EDUCATION LOAN | X | $50,000 | 33333 | 0 | 1 | 1 |
| DERRICK REEDUS | ||||||
| PHYSICIAN EDUCATION LOAN | X | $178,624 | 139693 | 0 | 1 | 1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Balance Due | 291885 | TotalBalanceDue |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (11 entries)
| Return ReferenceReturnReference | ExplanationExplanation | IdentifierIdentifier |
|---|---|---|
| FORM 990, PART VI, SECTION A, LINE 2 | BUSINESS RELATIONSHIP BETWEEN MICHAEL BERNSTEIN (BOARD MEMBER), LARRY THORNHILL (OFFICER AND BOARD MEMBER), GREG LONG (OFFICER AND BOARD MEMBER). CANDY KEMMERER (BOARD MEMBER) IS AN EMPLOYEE OF HOCKING VALLEY BANK WITH WHOM WE HAVE ACCOUNTS. | |
| FORM 990, PART VI, SECTION A, LINE 3 | THE ORGANIZATION ENTERED INTO A MANAGEMENT AGREEMENT WITH OHIOHEALTH HOSPITAL MANAGEMENT SERVICES, LLC, AN OHIO NONPROFIT LIMITED LIABILITY COMPANY, EFFECTIVE AUGUST 1, 2010 FOR A FIVE YEAR TERM. OHIOHEALTH HOSPITAL MANAGEMENT SERVICES, LLC IS A WHOLLY OWNED SUBSIDIARY OF OHIOHEALTH CORPORATION, AN OHIO NONPROFIT CORPORATION THAT IS EXEMPT FROM FEDERAL INCOME TAX UNDER SECTION 501(C)(3) OF THE IRS. | |
| FORM 990, PART VI, SECTION B, LINE 11 | THE CHIEF FINANCIAL OFFICER REVIEWS THE FORM 990 THROUGHOUT THE PREPARATION PROCESS AND ALSO CONDUCTS A FINAL REVIEW BEFORE PRESENTATION TO THE BOARD PRIOR TO FILING. | |
| FORM 990, PART VI, SECTION B, LINE 12C | ALL OFFICERS AND DIRECTORS ANNUALLY DISCLOSE INTERESTS THAT COULD GIVE RISE TO CONFLICT THROUGH AN ANNUAL QUESTIONNAIRE. ADDITIONALLY, CONFLICTS THAT ARISE THROUGHOUT THE YEAR ARE TO BE DISCLOSED AS SOON AS POSSIBLE. CONFLICTS ARE ADDRESSED BY IMPOSING RESTRICTIONS SUCH AS PROHIBITIONS AGAINST PARTICIPATING IN GOVERNING BODY'S DELIBERATIONS, AND MAKING DECISIONS RELATIVE TO TRANSACTIONS RELATED TO THE CONFLICT, ANY TIME THE CONFLICT ITSELF CANNOT BE REVERSED. | |
| FORM 990, PART VI, SECTION B, LINE 15A | COMPENSATION OF THE EXECUTIVE DIRECTOR IS DETERMINED BASED ON COMPARABILITY DATA, CONTEMPORANEOUS SUBSTANTIATION OF THE DELIBERATION AND DECISION AND BY A COMPENSATION COMMITTEE WITH THE FULL BOARD'S APPROVAL. THE EXECUTIVE IS PAID THROUGH OHIOHEALTH HOSPITAL MANAGEMENT SERVICES, LLC. THE LAST COMPENSATION REVIEW WAS COMPLETED IN 2012. | |
| FORM 990, PART VI, SECTION C, LINE 18 | FORM 1023, 990 AND 990-T ARE AVAILABLE UPON REQUEST. | |
| FORM 990, PART VI, SECTION C, LINE 19 | THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. | |
| FORM 990, PART XI, LINE 5: | NET UNREALIZED LOSSES ON INVESTMENTS: -427,526. REDUCTION IN PLEDGE RECEIVABLE VALUE -101,016. CAPITAL CONTRIBUTION FROM AFFILIATE 608,918. S-CORPORATION INCOME TAXABLE ON RETURN NOT ON BOOKS -161,136. PAIN MANAGEMENT INCOME ON RETURN NOT ON BOOKS 8,692. TOTAL TO FORM 990, PART XI, LINE 5: -72,068. | CHANGES IN NET ASSETS OR FUND BALANCES: |
| FORM 990, PART XII, LINE 2C | THE ORGANIZATION HAS A COMMITTEE THAT ASSUMES RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT AND SELECTION OF THE INDEPENDENT ACCOUNTANT. THIS PROCESS DID NOT CHANGE FROM THE PRIOR YEAR. | |
| FORM 990, PART I, LINE 6 | O'BLENESS HAD 237 VOLUNTEERS SERVE DURING THE 2012 FISCAL YEAR. TOTAL WAGES ACCORDING TO THE BUREAU OF LABOR STATISTICS IS $496,416 (BASED ON NON-FARM LABOR PLUS BENEFITS). | |
| FORM 990, PART VII | THE OFFICERS OF THE ORGANIZATION ARE CONTRACTED THROUGH OHIOHEALTH HOSPITAL MANAGEMENT SERVICES, LLC WHICH IS A MANAGEMENT COMPANY THAT THE ORGANIZATION HAS A FIVE YEAR AGREEMENT. THIS MANAGEMENT COMPANY IS UNRELATED TO THE ORGANIZATION. |
Schedule R IRS990ScheduleR
Form990 Schedule R Part I Form990ScheduleRPartI
Name Of Disregarded Entity NameOfDisregardedEntity
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ATHENS MEDICAL ASSOCIATES LLC | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 75 HOSPITAL DRIVE | AddressLine1 |
| City | ATHENS | City |
| State | OH | State |
| ZIP Code | 45701 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 020734615 | EIN |
| Primary Activities | PHYSICIAN SERVICES | PrimaryActivities |
| Legal Domicile State | OH | LegalDomicileState |
| Total Income | 8522080 | TotalIncome |
| EOY Assets | 1971590 | EOYAssets |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SHELTERING ARMS HOSPITAL FOUNDATION | BusinessNameLine1 |
Form990 Schedule R Part II Form990ScheduleRPartII
Name Of Disregarded Entity NameOfDisregardedEntity
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | APPALACHIAN COMMUNITY VISITING NURSE ASSOCIATION | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 30 HERROLD AVENUE | AddressLine1 |
| City | ATHENS | City |
| State | OH | State |
| ZIP Code | 45701 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 311045101 | EIN |
| Primary Activities | HOSPICE AND HEALTH SERVICES | PrimaryActivities |
| Legal Domicile State | OH | LegalDomicileState |
| Exempt Code Section | 501(C)(3) | ExemptCodeSection |
| Public Charity Status | LINE 3 | PublicCharityStatus |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SHELTERING ARMS HOSPITAL FOUNDATION | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Controlled Org | 1 | ControlledOrg |
Form990 Schedule R Part III Form990ScheduleRPartIII (2 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| ATHENS SURGERY CENTER LTD | |||||||||||||
| 75 HOSPITAL DRIVE | ATHENS | OH | 45701 | 550840856 | OUTPATIENT SURGERY | OH | N/A | RELATED | 1537633 | 341864 | 0 | 0 | 0.59790 |
| O'BLENESS MEMORIAL PAIN MANAGEMENT CLINIC LLC | |||||||||||||
| 55 HOSPITAL DRIVE | ATHENS | OH | 45701 | 454587317 | PAIN MANAGEMENT | OH | N/A | RELATED | 55 | 51055 | 0 | 0 | 0.51000 |
Form990 Schedule R Part IV Form990ScheduleRPartIV
Name Of Related Org NameOfRelatedOrg
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ATHENS MEDICAL LABORATORY ASSOCIATES INC | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 265 WEST UNION STREET SUITE B | AddressLine1 |
| City | ATHENS | City |
| State | OH | State |
| ZIP Code | 45701 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 311381808 | EIN |
| Primary Activity | MEDICAL LABORATORY | PrimaryActivity |
| Legal Domicile State | OH | LegalDomicileState |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SHELTERING ARMS HOSPITAL FOUNDATION | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Type Of Entity | S | TypeOfEntity |
| Share Of Total Income | 1567238 | ShareOfTotalIncome |
| Share Of EOY Assets | 1270656 | ShareOfEOYAssets |
| Percentage Ownership | 1.00000 | PercentageOwnership |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | 1 | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | 0 | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | 0 | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | 1 | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | 0 | LoansOrGuaranteesFromOtherOrg |
| 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 | 1 | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | 0 | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | 1 | SharingOfFacilities |
| Sharing Of Paid Employees | 1 | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | 1 | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | 1 | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | 0 | OtherTransferToOtherOrg |
| Other Transfer From Other Org | 1 | OtherTransferFromOtherOrg |
Transactions Related Orgs Table TransactionsRelatedOrgsTable (6 entries)
| Transaction TypeTransactionType | Amount InvolvedAmountInvolved | Method Of Amt DeterminationMethodOfAmtDetermination |
|---|---|---|
| ATHENS SURGERY CENTER LTD | ||
| O | 71689 | ALLOCATION OF COSTS |
| ATHENS MEDICAL LABORATORY ASSOCIATES INC | ||
| O | 48834 | ALLOCATION OF COSTS |
| APPALACHIAN COMMUNITY VISITING NURSE ASSOCIATION | ||
| A | 67200 | LEASE AGREEMENT |
| ATHENS SURGERY CENTER LTD | ||
| A | 458803 | LEASE AGREEMENT |
| APPALACHIAN COMMUNITY VISITING NURSE ASSOCIATION | ||
| D | 100000 | LOAN AGREEMENT |
| ATHENS SURGERY CENTER LTD | ||
| R | 249691 | DISTRIBUTIONS |