GALION COMMUNITY HOSPITAL: Form 990, tax year 2011
View the entire original 990 at ProPublica ↗
- Organization
- GALION COMMUNITY HOSPITAL (EIN 34-4451872)
- Tax period
- 2011-07-01 to 2012-06-30
- Filed
- 2013-05-15
- IRS object ID
- 201321359349306162
- 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 I
- Schedule J
- Schedule K
- Schedule L
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2013-05-15T13:40:43-05:00 | 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 | 344451872 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | GALION COMMUNITY HOSPITAL | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | GALI | NameControl |
| Phone | 4194684841 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 269 PORTLAND WAY SOUTH | AddressLine1 |
| City | GALION | City |
| State | OH | State |
| ZIP Code | 448332399 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | D ERIC DRAIME | Name |
| Title | CFO | Title |
| Phone | 4194684841 | Phone |
| Date Signed | 2013-05-10 | 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 | 2016-02-24 21:20:13Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | D ERIC DRAIME | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 269 PORTLAND WAY SOUTH | AddressLine1 |
| City | GALION | City |
| State | OH | State |
| ZIP Code | 448332399 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 105402199 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | WWW.AVITAHEALTH.ORG | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1954 | YearFormation |
| State Legal Domicile | OH | StateLegalDomicile |
| Activity Or Mission Description | TO IMPROVE THE HEALTH AND WELL-BEING OF THOSE WE SERVE. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 19 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 16 | NbrIndependentVotingMembers |
| Total Nbr Employees | 969 | TotalNbrEmployees |
| Total Nbr Volunteers | 333 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 303607 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 74329 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 79948220 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 103956113 | ProgramServiceRevenueCY |
| Investment Income Prior Year | -199634 | InvestmentIncomePriorYear |
| Investment Income Current Year | 27372 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 640704 | OtherRevenuePriorYear |
| Other Revenue Current Year | 1113511 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 80692897 | TotalRevenuePriorYear |
| Total Revenue Current Year | 105171325 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 2015339 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 1478865 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 34213739 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 29195042 | 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 | 41151372 | OtherExpensePriorYear |
| Other Expenses Current Year | 68829414 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 77380450 | TotalExpensesPriorYear |
| Total Expenses Current Year | 99503321 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 3312447 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 5668004 | RevenuesLessExpensesCY |
| Total Assets BOY | 74192103 | TotalAssetsBOY |
| Total Assets EOY | 75282573 | TotalAssetsEOY |
| Total Liabilities BOY | 47731086 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 51484311 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 26461017 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 23798262 | NetAssetsOrFundBalancesEOY |
| Mission Description | TO IMPROVE THE HEALTH AND WELL-BEING OF THOSE WE SERVE. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 42989577 | Expense |
| Grants | 1478865 | Grants |
| Revenue | 67512794 | Revenue |
| Description | GALION COMMUNITY HOSPITAL IS A 25 BED CRITICAL ACCESS HOSPITAL LOCATED WITHIN THE CITY OF GALION, OH. IT SERVES THE GREATER GALION AREA INCLUDING MUCH OF CRAWFORD COUNTY. THE FACILITY SERVES THE GENERAL PUBLIC AND IS OPEN SEVEN DAYS A WEEK, TWENTY-FOUR HOURS PER DAY. DURING THE FISCAL YEAR OF 2012, GALION HOSPITAL AND ITS AFFILIATES SERVED 1,977 INPATIENTS, 18,865 EMERGENCY VISITS, AND 75,101 OUTPATIENT VISITS. THESE WERE ALL SERVED REGARDLESS OF THE ABILITY TO PAY. GALION HOSPITAL IS AN INTRICATE PART OF THE COMMUNITY. IT IS ONE OF THE LARGEST EMPLOYERS IN THE COUNTY AT 529 FULL TIME EQUIVALENTS. | Description |
Activity2 Activity2
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | 22438047 | Expense |
| Grants | 0 | Grants |
| Revenue | 36541465 | Revenue |
| Description | BCH ACQUISITION LLC (BUCYRUS COMMUNITY HOSPITAL) IS A 25 BED CRITICAL ACCESS HOSPITAL LOCATED WITHIN THE CITY OF BUCYRUS, OH. IT SERVES THE GREATER BUCYRUS AREA. THE FACILITY SERVES THE GENERAL PUBLIC AND IS OPEN SEVEN DAYS A WEEK, TWENTY-FOUR HOURS PER DAY. DURING THE FISCAL YEAR OF 2012, BUCYRUS HOSPITAL SERVED 1,078 INPATIENTS, 14,752 EMERGENCY VISITS, AND 32,824 OUTPATIENT VISITS. THESE WERE ALL SERVED REGARDLESS OF THE ABLIITY TO PAY. BCH ACQUISITION LLC IS AN INTRICATE PART OF THE COMMUNITY. IT IS ONE ON THE LARGEST EMPLOYERS IN THE COUNTY AT 213 FULL TIME EQUIVALENTS. | Description |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Expense | 65427624 | 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 | 0 | TermOrPermanentEndowments |
| Report Land Bldg Equip | 1 | ReportLandBldgEquip |
| Report Invest Oth Securities | 1 | ReportInvestOthSecurities |
| Report Prog Rel Invest | 0 | ReportProgRelInvest |
| Report Other Assets | 0 | 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 | 1 | GrantsToOrganizations |
| Grants To Individuals | 1 | 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 | 1 | 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 | 163 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | 1 | ComplianceWithBackupWitholding |
| Number Of Employees | 969 | NumberOfEmployees |
| Employment Tax Returns Filed | 1 | EmploymentTaxReturnsFiled |
| Unrelated Business Income | 0 | UnrelatedBusinessIncome |
| Foreign Financial Account | 0 | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTrans |
| Taxable Party Notification | 0 | TaxablePartyNotification |
| Non Deductible Contributions | 0 | NonDeductibleContributions |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributions |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | 0 | FundsToPayPremiums |
| Premiums Paid | 0 | PremiumsPaid |
| Indoor Tanning Services | 0 | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 19 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 16 | NumberIndependentVotingMembers |
| Family Or Business Relationship | 0 | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | 0 | DelegationOfManagementDuties |
| Changes To Organizing Docs | 0 | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuse |
| Members Or Stockholders | 1 | MembersOrStockholders |
| Election Of Board Members | 1 | ElectionOfBoardMembers |
| Decisions Subject To Approval | 1 | DecisionsSubjectToApproval |
| Minutes Of Governing Body | 1 | MinutesOfGoverningBody |
| Minutes Of Committees | 0 | 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 | D ERIC DRAIME | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 4194680501 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 269 PORTLAND WAY SOUTH | AddressLine1 |
| City | GALION | City |
| State | OH | State |
| ZIP Code | 44833 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part VII | X | InfoInScheduleOPartVII |
Form990 Part VII Section A Form990PartVIISectionA (27 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 |
|---|---|---|---|---|---|---|---|
| DOUGLAS SCHILLING | |||||||
| CHAIR | 1.90 | X | X | 0 | 0 | 0 | |
| KYMBERLY FOX | |||||||
| VICE CHAIR | 1.90 | X | X | 0 | 0 | 0 | |
| REX CRAMER | |||||||
| TREASURER | 1.90 | X | X | 0 | 0 | 0 | |
| LINDA CHAMBERS | |||||||
| SECRETARY | 1.90 | X | X | 0 | 0 | 0 | |
| DONALD BARR | |||||||
| DIRECTOR | 0.80 | X | 0 | 0 | 0 | ||
| ALAN BASINGER | |||||||
| DIRECTOR | 0.80 | X | 0 | 0 | 0 | ||
| PHILLIP BROWN | |||||||
| DIRECTOR | 0.80 | X | 0 | 0 | 0 | ||
| SHERRI CLEVENGER | |||||||
| DIRECTOR | 0.80 | X | 0 | 0 | 0 | ||
| BOYD EPPERSON | |||||||
| DIRECTOR | 0.80 | X | 0 | 0 | 0 | ||
| ERIC GEYER | |||||||
| DIRECTOR | 0.80 | X | 0 | 0 | 0 | ||
| JANET HERMAN | |||||||
| DIRECTOR | 0.80 | X | 0 | 0 | 0 | ||
| KAY MCDONALD | |||||||
| DIRECTOR | 0.80 | X | 0 | 0 | 0 | ||
| MICHELE MCELLIGOTT | |||||||
| DIRECTOR | 0.80 | X | 0 | 0 | 0 | ||
| JASON MCMULLEN | |||||||
| DIRECTOR | 0.80 | X | 0 | 0 | 0 | ||
| MARK SCHNEIDER | |||||||
| DIRECTOR | 0.80 | X | 0 | 0 | 0 | ||
| JOSEPH SHADEED | |||||||
| DIRECTOR | 0.80 | X | 0 | 0 | 0 | ||
| CHARLES WALKER | |||||||
| DIRECTOR | 0.80 | X | 0 | 0 | 0 | ||
| DR JAMES KERBS | |||||||
| DIRECTOR/PHYSICIAN | 40.00 | X | 0 | 533717 | 165180 | ||
| DR GRANT HOPE | |||||||
| DIRECTOR/PHYSICIAN | 40.00 | X | 84350 | 0 | 0 | ||
| JERRY MORASKO | |||||||
| CEO | 40.00 | X | 94437 | 162205 | 0 | ||
| D ERIC DRAIME | |||||||
| CFO | 40.00 | X | 56189 | 124439 | 0 | ||
| ANDREW DANIELS | |||||||
| COO | 40.00 | X | 132067 | 0 | 0 | ||
| JAMES GOUDY | |||||||
| PHYSICIAN | 40.00 | 540122 | 0 | 13903 | X | ||
| JOHN HANNA | |||||||
| PHYSICIAN | 40.00 | 325712 | 0 | 16638 | X | ||
| ERIC KUIVINEN | |||||||
| PHYSICIAN | 40.00 | 315321 | 0 | 3929 | X | ||
| MARK WOOD | |||||||
| PHYSICIAN | 40.00 | 230544 | 0 | 28227 | X | ||
| GOHAR GHAZARIAN | |||||||
| PHYSICIAN | 40.00 | 213773 | 0 | 40347 | X | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 1992515 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 820361 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 268224 | TotalOtherCompensation |
| Number Individuals GT100 K | 19 | 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 |
|---|---|---|---|---|---|
| MID AMERICAN THERAPY | |||||
| 7652 EAGLE DRIVE | FINDLAY | OH | 45840 | PHYSICAL THERAPY | 1378441 |
| GALION ANESTHESIA SERVICES INC | |||||
| 4575 TOWNSHIP ROAD 126 | CARDINGTON | OH | 43315 | ANESTHESIA | 1169033 |
| CALFEE HALTER & GRISWOLD LLP | |||||
| 1400 KEYBANK CTR | CLEVELAND | OH | 441142688 | LEGAL SERVICES | 394434 |
| LABORATORY CORP OF AMERICA | |||||
| PO BOX 2140 | BURLINGTON | NC | 272162140 | LAB SERVICES | 339233 |
| PLANTE & MORAN PLLC | |||||
| PO BOX 353090 | TOLEDO | OH | 436353090 | ACCOUNTING SERVICES | 213204 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 11 | NumberOfContractorsGT100K |
| Related Organizations | 3705 | RelatedOrganizations |
| All Other Contributions | 70624 | AllOtherContributions |
| Total Contributions | 74329 | TotalContributions |
Program Service Revenue ProgramServiceRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | NET PATIENT REVENUE | Description |
| Business Code | 621110 | BusinessCode |
| Total Revenue Column | 103956113 | TotalRevenueColumn |
| Related Or Exempt Function Income | 103956113 | RelatedOrExemptFunctionIncome |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 103956113 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 239420 | TotalRevenueColumn |
| Exclusion | $239,420 | ExclusionAmount |
Gross Rents GrossRents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 116972 | Real |
Less Rental Expenses LessRentalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 18826 | Real |
Rental Income Or Loss RentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 98146 | Real |
Net Rental Income Or Loss NetRentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 98146 | TotalRevenueColumn |
| Related Or Exempt Function Income | 98146 | RelatedOrExemptFunctionIncome |
Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | 212048 | Other |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | -212048 | Other |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -212048 | TotalRevenueColumn |
| Exclusion | -$212,048 | ExclusionAmount |
Other Revenue Misc OtherRevenueMisc (3 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | ExclusionExclusionAmount |
|---|---|---|---|
| CAFETERIA & CATERING | 621110 | 511907 | $511,907 |
| REBATES | 621110 | 161230 | $161,230 |
| VENDING MACHINE REV | 621110 | 2010 | $2,010 |
Miscellaneous Revenue MiscellaneousRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 340218 | TotalRevenueColumn |
| Exclusion | $340,218 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 1015365 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 105171325 | TotalRevenueColumn |
| Related Or Exempt Function Income | 104054259 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $1,042,737 | ExclusionAmount |
Grants To Domestic Orgs GrantsToDomesticOrgs
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1468969 | Total |
| Program Services | 1468969 | ProgramServices |
Grants To Domestic Individuals GrantsToDomesticIndividuals
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 9896 | Total |
| Program Services | 9896 | ProgramServices |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 792504 | Total |
| Management And General | 792504 | ManagementAndGeneral |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 25927440 | Total |
| Program Services | 22816147 | ProgramServices |
| Management And General | 3111293 | ManagementAndGeneral |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2475098 | Total |
| Program Services | 2178086 | ProgramServices |
| Management And General | 297012 | ManagementAndGeneral |
Fees For Services Management FeesForServicesManagement
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 24900193 | Total |
| Management And General | 24900193 | ManagementAndGeneral |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 517338 | Total |
| Management And General | 517338 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 245510 | Total |
| Management And General | 245510 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 4736660 | Total |
| Program Services | 4168261 | ProgramServices |
| Management And General | 568399 | ManagementAndGeneral |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 324003 | Total |
| Program Services | 285123 | ProgramServices |
| Management And General | 38880 | ManagementAndGeneral |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 18637435 | Total |
| Program Services | 16400943 | ProgramServices |
| Management And General | 2236492 | ManagementAndGeneral |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 4449135 | Total |
| Program Services | 3915239 | ProgramServices |
| Management And General | 533896 | ManagementAndGeneral |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 152454 | Total |
| Program Services | 134160 | ProgramServices |
| Management And General | 18294 | ManagementAndGeneral |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 862036 | Total |
| Program Services | 758592 | ProgramServices |
| Management And General | 103444 | ManagementAndGeneral |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3420188 | Total |
| Program Services | 3009765 | ProgramServices |
| Management And General | 410423 | ManagementAndGeneral |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1247169 | Total |
| Program Services | 1097509 | ProgramServices |
| Management And General | 149660 | ManagementAndGeneral |
Other Expenses OtherExpenses (3 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral |
|---|---|---|---|
| BAD DEBT EXPENSE | 7737437 | 7737437 | |
| PHYSICIAN RECRUITING | 1151713 | 1013507 | 138206 |
| OHIO FRANCHISE TAX FEE | 330202 | 330202 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 117941 | Total |
| Program Services | 103788 | ProgramServices |
| Management And General | 14153 | ManagementAndGeneral |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 99503321 | Total |
| Program Services | 65427624 | ProgramServices |
| Management And General | 34075697 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3426191 | BOY |
| EOY | 7860414 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 13101357 | BOY |
| EOY | 12010402 | EOY |
Receivables From Officers Etc ReceivablesFromOfficersEtc
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 103459 | BOY |
| EOY | 30185 | EOY |
Other Notes Loans Receivable Net OtherNotesLoansReceivableNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 356355 | BOY |
| EOY | 461516 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 586327 | BOY |
| EOY | 737713 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 956246 | BOY |
| EOY | 1288371 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 75942196 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 35845665 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 37812721 | BOY |
| EOY | 40096531 | EOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 6434924 | BOY |
| EOY | 6549729 | EOY |
Investments Other Securities InvestmentsOtherSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 8091663 | BOY |
| EOY | 5691931 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3322860 | BOY |
| EOY | 555781 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 74192103 | BOY |
| EOY | 75282573 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 6304965 | BOY |
| EOY | 8139769 | EOY |
Tax Exempt Bond Liabilities TaxExemptBondLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 29063249 | BOY |
| EOY | 27829864 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 12362872 | BOY |
| EOY | 15514678 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 47731086 | BOY |
| EOY | 51484311 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 25702870 | BOY |
| EOY | 23060750 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 482372 | BOY |
| EOY | 474512 | EOY |
Permanently Restricted Net Assets PermanentlyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 275775 | BOY |
| EOY | 263000 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 26461017 | BOY |
| EOY | 23798262 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 74192103 | BOY |
| EOY | 75282573 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | 5668004 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | -8330759 | 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 | $2,386 | OtherActivitiesAmount |
| Total Lobbying Expenditures IIB | 2386 | 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 | GALION COMMUNITY HOSPITAL PAYS DUES TO OHIO HOSPITAL ASSOCIATION. THE PORTION OF DUES RELATED TO LOBBYING ACTIVITIES WAS $2,386 WHICH IS 5.3% OF DUES. | Explanation |
Schedule D IRS990ScheduleD
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 623627 | OtherCostOrOtherBasis |
| Book Value | 623627 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 43943184 | OtherCostOrOtherBasis |
| Depreciation | 17351123 | Depreciation |
| Book Value | 26592061 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 28398188 | OtherCostOrOtherBasis |
| Depreciation | 17784865 | Depreciation |
| Book Value | 10613323 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 2977197 | OtherCostOrOtherBasis |
| Depreciation | 709677 | Depreciation |
| Book Value | 2267520 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 40096531 | TotalOfBookValueLandBuildings |
Other Securities OtherSecurities (3 entries)
| DescriptionDescription | Book ValueBookValue | Method Of ValuationMethodOfValuation |
|---|---|---|
| CERTIFICATES OF DEPOSIT | 563723 | F |
| HELD BY TRUSTEE | 3163051 | F |
| OTHER INVESTMENTS | 1965157 | F |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Securities | 5691931 | TotalOfBookValueSecurities |
Other Liabilities OtherLiabilities (7 entries)
| DescriptionDescription | AmountAmount |
|---|---|
| FV OF INTEREST RATE SWAP AGMT | $843,474 |
| ACCRUED PENSION | $12,053,836 |
| CAPITAL LEASES | $1,105,369 |
| INTEREST PAYABLE | $639 |
| ESTIMATED THIRD-PARTY PAYOR SETTLEMENT | $1,177,443 |
| INTERCOMPANY PAYABLE | $1,235 |
| NOTE CAT SCANNER | $332,682 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 15514678 | TotalOfAmounts |
Form990 Schedule D Part XIV Form990ScheduleDPartXIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: | Identifier |
| Return Reference | PART X: | ReturnReference |
| Explanation | THE INTERNAL REVENUE SERVICE HAS RULED THAT GCH, CHA, NCOFCC, BCH, FOUNDATION, AND HOMECARE MATTERS ARE TAX-EXEMPT ORGANIZATIONS AS DEFINED UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. AVITA AND GCH ACQUISITION SUB HAVE APPLIED WITH THE INTERNAL REVENUE SERVICE FOR TAX-EXEMPT ORGANIZATION STATUS AS DEFINED UNDER SECTION 501(C)(3), WHICH IS PENDING AS OF JUNE 30, 2012. ACCORDINGLY, NO PROVISION FOR FEDERAL INCOME TAXES HAS BEEN MADE IN THE CONSOLIDATED FINANCIAL STATEMENTS. ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA REQUIRE MANAGEMENT TO EVALUATE TAX POSITIONS TAKEN BY THE SYSTEM AND RECOGNIZE A TAX LIABILITY IF THE SYSTEM 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 SYSTEM 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 SYSTEM 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. | Explanation |
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 |
| Pcent200 | X | Pcent200 |
| FPG Reference Discounted Care | 1 | FPGReferenceDiscountedCare |
| Pcent400 | X | Pcent400 |
| Free Disc Care Medically Indigent | 1 | FreeDiscCareMedicallyIndigent |
| Amounts Budgeted For Charity Care | 1 | AmountsBudgetedForCharityCare |
| Expenses Exceeded Budget | 0 | ExpensesExceededBudget |
| Annual Community Benefit Report | 0 | AnnualCommunityBenefitReport |
Charity Care At Cost CharityCareAtCost
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 2535370 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 963594 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 1571776 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.01770 | PercentOfTotalExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 8365147 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 1808215 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 6556932 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.07380 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 10900517 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 2771809 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 8128708 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.09150 | PercentOfTotalExpense |
Community Health Services CommunityHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 4 | NumberOfActivitiesOrPrograms |
| Persons Served | 490 | PersonsServed |
| Total Community Benefit Expense | 23114 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 23114 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00030 | PercentOfTotalExpense |
Total Other Benefits TotalOtherBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 4 | NumberOfActivitiesOrPrograms |
| Persons Served | 490 | PersonsServed |
| Total Community Benefit Expense | 23114 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 23114 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00030 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 4 | NumberOfActivitiesOrPrograms |
| Persons Served | 490 | PersonsServed |
| Total Community Benefit Expense | 10923631 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 2771809 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 8151822 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.09180 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 0 | BadDebtExpenseReported |
| Bad Debt Expense | $3,734,872 | BadDebtExpenseAmount |
| Amount Attributable To | 186744 | AmountAttributableTo |
| Amount Reimbursed By Medicare | 30723128 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 30795847 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | -72719 | 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 (2 entries)
| Description Ent Primary ActivityDescriptionEntPrimaryActivity | Organization Profit Or OwnershipOrganizationProfitOrOwnership | Officers Etc Profit Or OwnershipOfficersEtcProfitOrOwnership | Physicans Profit Or OwnershipPhysicansProfitOrOwnership |
|---|---|---|---|
| 1 GALION COMMUNITY VASCULAR SERVICES LLC | |||
| SERVICES FOR VASCULAR DIFFICULTIES | 0.51000 | 0.00000 | 0.49000 |
| 2 GALION COMMUNITY PAIN MANAGEMENT LLC | |||
| PAIN CLINIC | 0.51000 | 0.00000 | 0.49000 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Hospital Facilities | 2 | NumberOfHospitalFacilities |
Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA (2 entries)
| Facility NumberFacilityNumber | Address Line1Address/AddressLine1 | CityAddress/City | StateAddress/State | ZIP CodeAddress/ZIPCode | Licensed HospitalLicensedHospital | General Medical And SurgicalGeneralMedicalAndSurgical | Critical Access HospitalCriticalAccessHospital | Er24 HoursEr24Hours |
|---|---|---|---|---|---|---|---|---|
| GALION COMMUNITY HOSPITAL | ||||||||
| 1 | 269 PORTLAND WAY SOUTH | GALION | OH | 44833 | X | X | X | X |
| BCH ACQUISITION LLC | ||||||||
| 2 | 269 PORTLAND WAY SOUTH | GALION | OH | 44833 | X | X | X | X |
Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB (2 entries)
| Hospital Facility NumberHospitalFacilityNumber | Eligibility Criteria ExplainedEligibilityCriteriaExplained | Uses FPG FreeUsesFPGFree | FPG Free PercentFPGFreePercent | Uses FPG DiscountedUsesFPGDiscounted | FPG Discount PercentFPGDiscountPercent | Explains BasisExplainsBasis | Income LevelIncomeLevel | Uninsured DiscountUninsuredDiscount | Explains Application MethodExplainsApplicationMethod | Includes Publicity MeasuresIncludesPublicityMeasures | Posted On WebsitePostedOnWebsite | Attached To InvoicesAttachedToInvoices | Posted In Emergency RoomPostedInEmergencyRoom | Actions On NonpaymentActionsOnNonpayment | Collection ActivitiesCollectionActivities | Nondiscrim Emergency Care PolicyNondiscrimEmergencyCarePolicy | Lowest Negotiated RatesLowestNegotiatedRates | Amounts Generally BilledAmountsGenerallyBilled | Gross ChargesGrossCharges |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| GALION COMMUNITY HOSPITAL | |||||||||||||||||||
| 1 | 1 | 1 | 200.000000000000 | 1 | 400.000000000000 | 1 | X | X | 1 | 1 | X | X | X | 1 | 0 | 1 | X | 0 | 0 |
| BCH ACQUISITION LLC | |||||||||||||||||||
| 2 | 1 | 1 | 200.000000000000 | 1 | 400.000000000000 | 1 | X | X | 1 | 1 | X | X | X | 1 | 0 | 1 | X | 0 | 0 |
Form990 Schedule H Part V Section C Form990ScheduleHPartVSectionC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Other Facilities | 8 | NumberOfOtherFacilities |
Other Facilities OtherFacilities (8 entries)
| Address Line1Address/AddressLine1 | CityAddress/City | StateAddress/State | ZIP CodeAddress/ZIPCode | Facility TypeFacilityType |
|---|---|---|---|---|
| GCH SURGICAL SERVICES | ||||
| 1593 OLENTANGY ROAD | GALION | OH | 44833 | SURGERY |
| GCH HEALTH SERVICES | ||||
| 270 PORTLAND WAY SOUTH | GALION | OH | 44833 | CARDIOLOGY |
| GCH PHYSICIAN PRACTICES | ||||
| 385 N SELTZER STREET | CRESTLINE | OH | 44827 | PHYSICIAN |
| GCH ORTHOPEDICS CENTER | ||||
| 955 HOSFORD ROAD | GALION | OH | 44833 | ORTHOPEDIC |
| BUCYRUS COMMUNITY PHYSICIANS | ||||
| 120 W MAIN STREET | NEW WASHINGTON | OH | 44854 | PHYSICIAN |
| BUCYRUS COMMUNITY PHYSICIANS | ||||
| 140 HILL STREET | BUCYRUS | OH | 44820 | PHYSICIAN |
| BUCYRUS CARDIOLOGY | ||||
| 725 N SANDUSKY AVENUE | BUCYRUS | OH | 44820 | CARDIOLOGY |
| GCH SPECIALTY CENTER | ||||
| 130 HILL STREET | BUCYRUS | OH | 44820 | OTOLARYNGOLOGY |
Form990 Schedule H Part VI Form990ScheduleHPartVI (12 entries)
| ExplanationExplanation | IdentifierIdentifier | Return ReferenceReturnReference |
|---|---|---|
| PART I, LINE 7: THE COST-TO-CHARGE RATIO DERIVED FROM WORKSHEET 2 USED COSTING METHOD. | ||
| PART I, LINE 7G: NOT APPLICABLE | ||
| PART I, L7 COL(F): COLUMN F IS CALCULATED BASED ON THE TOTAL OF FORM 990, PART IX, LESS BAD DEBT EXPENSE ($7,737,437) REPORTED IN PART IX. | ||
| PART III, LINE 4: FINANCIAL STATEMENT FOOTNOTE: AN ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS IS ESTABLISHED ON AN AGGREGATE BASIS BY USING HISTORICAL LOSS RATE FACTORS APPLIED TO UNPAID ACCOUNTS BASED ON AGING. LOSS RATE FACTORS ARE BASED ON HISTORICAL LOSS EXPERIENCE AND ADJUSTED FOR ECONOMIC CONDITIONS AND OTHER TRENDS AFFECTING THE HOSPITAL'S ABILITY TO COLLECT OUTSTANDING AMOUNTS. UNCOLLECTIBLE AMOUNTS ARE WRITTEN OFF AGAINST THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS IN THE PERIOD THEY ARE DETERMINED TO BE UNCOLLECTIBLE.BAD DEBT AT COST WAS CALCULATED USING A COST-TO-CHARGE RATIO. GALION COMMUNITY HOSPITAL DOES NOT BELIEVE BAD DEBT SHOULD BE INCLUDED AS A COMMUNITY BENEFIT.ADDITIONAL BAD DEBT ATTRIBUTABLE TO PATIENTS IDENTIFIED UNDER CHARITY CARE WAS CALCULATED USING ACTUAL COSTS FROM SPECIFICALLY IDENTIFIED PATIENTS THAT WERE MISCLASSIFIED AS BAD DEBT ORIGINALLY. GALION COMMUNITY HOSPITAL AND BCH ACQUISITION LLC DOES NOT BELIEVE BAD DEBT IDENTIFIED UNDER CHARITY CARE SHOULD BE INCLUDED AS A COMMUNITY BENEFIT. | ||
| PART III, LINE 8: WE REPORT MEDICARE COSTS BY THE COST TO CHARGE METHOD. BECAUSE WE ARE A CRITICAL ACCESS HOSPITAL WE DO NOT HAVE A MEDICARE SHORTFALL. WE ARE REIMBURSED 1% ABOVE OUR COST. | ||
| PART III, LINE 9B: EVEN IF THE HOSPITAL KNOWS A PATIENT QUALIFIES FOR FINANCIAL AID, IT IS NOT PROVIDED WITHOUT A SIGNED APPLICATION. GALION COMMUNITY HOSPITAL AND BCH ACQUISITION LLC DO MAKE AN EFFORT TO GET THE APPLICATION TO ALL PATIENTS. THE FINANCIAL COUNSELORS WILL TRY TO MAKE PHONE CONTACT WITH THOSE WHO ARE KNOWN TO QUALIFY TO ENCOURAGE COMPLETION OF THE FORMS. HOWEVER, THE PROCESS IS THE SAME FOR ALL PATIENTS. GALION COMMUNITY HOSPITAL AND BCH ACQUISITION LLC UTILIZES INTERNAL AND EXTERNAL COLLECTION EFFORTS (INCLUDING COLLECTION AGENCIES) FOR ALL PATIENTS. | ||
| PART VI, LINE 2: COMMUNITY HEALTH SCREENINGS ARE CONDUCTED TO EVALUATE BLOOD PRESSURE, BLOOD SUGAR LEVELS, AND CHOLESTEROL. THE SCREENINGS ARE MONITORED TO DETERMINE THE TEACHING NEEDS OF THE COMMUNITY. GALION HOSPITAL ALSO DOES SCREENINGS FOR LOCAL BUSINESS AND COMMUNITY OUTREACH EVENTS. WE PARTICIPATE IN EVENTS SPONSORED BY THE CHAMBER OF COMMERCE AND THE CRAWFORD COUNTY FAIR. WE OFFER FREE DIABETES SUPPORT GROUPS AND PROSTATE CANCER SUPPORT GROUPS. GALION HOSPITAL ALSO MONITORS THE LOCAL HEALTH DEPARTMENT FOR ADVICE ON FLU TRENDS AND VACCINATION NEEDS. | ||
| PART VI, LINE 3: EVERY BILL THAT IS SENT TO A PATIENT HAS INFORMATION ON THE REVERSE SIDE ABOUT HCAP AND THE CRITERIA FOR MEETING THE HCAP REQUIREMENTS. IT ALSO HAS THE GENERAL CHARITY POLICY AND INFORMS THE PATIENT OF AVAILABLE ASSISTANCE. THE PATIENT REPRESENTATIVE OR THE REGISTRATION PERSONNEL ARE ALL WELL VERSED IN THE REQUIREMENTS FOR HCAP AND CHARITY CARE. THEY WOULD BE HAPPY TO HELP ANY PATIENT TO FILL OUT THE FORMS AND REQUEST AID. THERE ARE ALSO SIGNS THROUGHOUT THE HOSPITAL THAT ADVISE THE PATIENT TO ASK ABOUT DISCOUNTS. | ||
| PART VI, LINE 4: GALION AND BUCYRUS COMMUNITY HOSPITALS ARE BOTH LOCATED IN CRAWFORD COUNTY, OHIO. THE COUNTY HAS A TOTAL POPULATION OF 43,784. TWENTY-SIX PERCENT ARE UNDER THE AGE OF 19 AND ALMOST EIGHTEEN PERCENT ARE OVER THE AGE OF 65. THE LATEST STATISTICS FOR CRAWFORD COUNTY SHOW THE MEDIAN HOUSEHOLD INCOME AT $41,336. IT IS AN AREA HARD HIT BY THE RECESSION AND THE MOVEMENT OF JOBS OUT OF OHIO. UNEMPLOYMENT IS 6.8% FOR THE COUNTY. CRAWFORD COUNTY IS ONE OF THE LEADING COUNTIES IN THE STATE FOR PERSONS WITH DRUG ABUSE ISSUES. | ||
| PART VI, LINE 5: GALION COMMUNITY HOSPITAL AND BCH ACQUISITION LLC BELIEVE THAT IT IS THEIR MISSION TO IMPROVE THE HEALTH OF THE COMMUNITY. TO THAT END, THERE ARE MANY PROFESSIONALS WHO VOLUNTEER THEIR TIME IN THE AREA TO WORK WITH LOCAL GROUPS TO SCREEN THE NEEDS OF THE COMMUNITY. GALION AND BUCYRUS ARE VERY ACTIVE IN THE AREA AND VERY PROACTIVE WITH PREVENTIVE DISEASE EDUCATION. VARIOUS HEALTH EDUCATION EVENTS ARE HELD EACH YEAR, INCLUDING WOMEN'S HEALTH CLINIC, PROSTATE CANCER SCREENING, MUSCULOSKELETAL EVALUATION, AND BLOOD PRESSURE SCREENINGS. | ||
| PART VI, LINE 6: GALION COMMUNITY HOSPITAL AND BCH ACQUISITION LLC ARE PART OF A HEALTHCARE SYSTEM AND THEY DO EMPLOYEE PHYSICIANS THROUGH TWO PHYSICIAN GROUPS. COMMUNITY HEALTH ASSOCIATES AND NORTH CENTRAL OHIO FAMILY CARE CENTER. THESE ENTITIES ALL DELIVER CARE TO PATIENTS REGARDLESS OF THEIR ABILITY TO PAY. THE PHYSICIAN OFFICES SEE MANY PATIENTS WHO ARE NOT ABLE TO PAY. THE HOSPITALS WILL ALWAYS TREAT A PATIENT FOR MEDICALLY NECESSARY SERVICES, | ||
| OH | REPORTS FILED WITH STATES | PART VI, LINE 7 |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Records Maintained | 1 | RecordsMaintained |
Recipient Table RecipientTable (2 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EIN Of RecipientEINOfRecipient | IRC SectionIRCSection | Amount Of Cash GrantAmountOfCashGrant | Purpose Of GrantPurposeOfGrant |
|---|---|---|---|---|---|---|---|
| COMMUNITY HEALTH ASSOCIATES INC | |||||||
| 269 PORTLAND WAY SOUTH | GALION | OH | 44833 | 341784017 | 501(C)(3) | 1240341 | CANCEL RELATED ORGANIZATION DEBT |
| NORTH CRENTAL OHIO FAMILY CARE CENTER | |||||||
| 269 PORTLAND WAY SOUTH | GALION | OH | 44833 | 341807906 | 501(C)(3) | 225796 | CANCEL RELATED ORGANIZATION DEBT |
Form990 Schedule I Part III Form990ScheduleIPartIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Type Of Grant | TUITION REIMBURSEMENT FOR GALION COMMUNITY HOSPITAL EMPLOYEES | TypeOfGrant |
| Number Of Recipients | 2 | NumberOfRecipients |
| Amount Of Cash Grant | 9896 | AmountOfCashGrant |
Form990 Schedule I Part IV Form990ScheduleIPartIV (2 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| PROCEDURE FOR MONITORING GRANTS IN THE U.S.: | PART I, LINE 2: | SCHEDULE I, PART I, LINE 2: THE ORGANIZATION MAKES GRANTS TO RELATED EXEMPT ORGANIZATIONS TO FURTHER THEIR EXEMPT PURPOSES. |
| SCHEDULE I, PART III: | ALL GALION COMMUNITY HOSPITAL EMPLOYEES ARE ELIGIBLE FOR REIMBURSEMENT. APPLICATIONS ARE APPROVED BY HUMAN RESOURCES. TUITION INVOICES AND GRADES ARE MONITORED BY THE CONTROLLER TO MAKE SURE THE STUDENT MEETS CERTAIN CRITERIA TO RECEIVE THE FUNDS. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Club Dues Or Fees | X | ClubDuesOrFees |
| Written Policy Re T And E Expenses | 1 | WrittenPolicyReTAndEExpenses |
| Substantiation Required | 1 | SubstantiationRequired |
| Compensation Committee | X | CompensationCommittee |
| Written Employment Contract | X | WrittenEmploymentContract |
| Compensation Survey | X | CompensationSurvey |
| Board Or Committee Approval | X | BoardOrCommitteeApproval |
| Severance Payment | 0 | SeverancePayment |
| Supplemental Nonqual Retire Plan | 1 | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | 0 | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | 0 | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | 0 | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | 0 | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | 0 | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | 0 | AnyNonFixedPayments |
| Initial Contract Exception | 0 | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (8 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| DR JAMES KERBS | |||||||||||||
| 0 | 504912 | 0 | 28805 | 0 | 0 | 0 | 160500 | 0 | 4680 | 0 | 698897 | 0 | 0 |
| JERRY MORASKO | |||||||||||||
| 94437 | 135705 | 0 | 26500 | 0 | 0 | 0 | 0 | 0 | 0 | 94437 | 162205 | 0 | 0 |
| D ERIC DRAIME | |||||||||||||
| 56189 | 102677 | 0 | 21762 | 0 | 0 | 0 | 0 | 0 | 0 | 56189 | 124439 | 0 | 0 |
| JAMES GOUDY | |||||||||||||
| 506183 | 0 | 33939 | 0 | 0 | 0 | 13184 | 0 | 719 | 0 | 554025 | 0 | 0 | 0 |
| JOHN HANNA | |||||||||||||
| 325712 | 0 | 0 | 0 | 0 | 0 | 16500 | 0 | 138 | 0 | 342350 | 0 | 0 | 0 |
| ERIC KUIVINEN | |||||||||||||
| 315321 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 3929 | 0 | 319250 | 0 | 0 | 0 |
| MARK WOOD | |||||||||||||
| 123434 | 0 | 107110 | 0 | 0 | 0 | 22000 | 0 | 6227 | 0 | 258771 | 0 | 0 | 0 |
| GOHAR GHAZARIAN | |||||||||||||
| 156551 | 0 | 57222 | 0 | 0 | 0 | 33000 | 0 | 7347 | 0 | 254120 | 0 | 0 | 0 |
Form990 Schedule J Part III Form990ScheduleJPartIII (2 entries)
| Return ReferenceReturnReference | ExplanationExplanation |
|---|---|
| PART I, LINE 1A | A MEMBERSHIP AT THE LOCAL COUNTRY CLUB IS PAID FOR THE CEO, JERRY MOROSKO. THIS BENEFIT HAS NOT BEEN TREATED AS TAXABLE COMPENSATION. |
| PART I, LINE 4B | JAMES KERBS PARTICIPATED IN A 457(F) PLAN. THE FOLLOWING AMOUNT WAS ASSOCIATED WITH THE RETIREMENT PLAN: 122,000. |
Schedule K IRS990ScheduleK
Form990 Schedule K Part I Form990ScheduleKPartI
Issuer Name IssuerName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | COUNTY OF CRAWFORD OH | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Issuer EIN | 346400345 | IssuerEIN |
| CUSIP Number | NONEAVAIL | CUSIPNumber |
| Date Issued | 2010-12-29 | DateIssued |
| Issue Price | 27430000 | IssuePrice |
| Description Of Purpose | SEE SCHEDULE O | 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) |
|---|---|---|
| Amount Retired | 30000 | AmountRetired |
| Total Proceeds | 27431825 | TotalProceeds |
| Refunding Escrow | 11180359 | RefundingEscrow |
| Issuance Costs From Proceeds | 541437 | IssuanceCostsFromProceeds |
| Credit Enhancement | 27430 | CreditEnhancement |
| Capital Expenditures | 12635343 | CapitalExpenditures |
| Amount Unspent | 3047256 | AmountUnspent |
| Year Of Subst Completion | 2013 | YearOfSubstCompletion |
| Current Refunding | 1 | CurrentRefunding |
| Advance Refunding | 0 | AdvanceRefunding |
| Final Allocation Made | 0 | 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 | 1 | VariableRateIssue |
| Hedge Identified In Books And Recds | 1 | HedgeIdentifiedInBooksAndRecds |
Name Of Hedge Provider NameOfHedgeProvider
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | FIFTH THIRD BANK | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Term Of Hedge | 5.000000000000 | TermOfHedge |
| Superintegrated Hedge | 0 | SuperintegratedHedge |
| Hedge Terminated | 0 | HedgeTerminated |
| Gross Proceeds Invested In GIC | 0 | GrossProceedsInvestedInGIC |
| Gross Proceeds Invested | 0 | GrossProceedsInvested |
| Exception To Rebate | 0 | ExceptionToRebate |
Form990 Schedule K Part VI Form990ScheduleKPartVI (3 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| SCHEDULE K, PART I | DESCRIPTION OF PURPOSE | REFUND ALL OUTSTANDING COUNTY OF CRAWFORD, OHIO ADJUSTABLE RATE HOSPITAL FACILITIES REVNUE REFUNDING AND IMPROVEMENT BONDS, SERIES 2003 (GALION COMMUNITY HOSPITAL PROJECT) DATED SEPTEMBER 30, 2003. REFUND ALL OUTSTANDING COUNTY OF CRAWFORD, OHIO ADJUSTABLE RATE HOSPITAL FACILITIES REVENUE BONDS, SERIES 2006 (GALION COMMUNITY HOSPITAL PROJECT). CONSRUCT AND EQUIP HOSPITAL FACILITIES. |
| SCHEDULE K, PART II, LINE 6 | PROCEEDS IN REFUNDING ESCROWS | NO BOND PROCEEDS ARE CURRENTLY HELD IN A REFUNDING ESCROW. $11,180,359 OF PROCEEDS RECEIVED FROM THE SALE OF THE SERIES 2010 BONDS WERE USED TO REFUND THE SERIES 2003 AND SERIES 2006 BONDS PRIOR BONDS WITHIN 90 DAYS OF THE ISSUE DATE OF THE SERIES 2010 BONDS. |
| SCHEDULE K, PART IV, LINE 6 | EXCEPTION TO REBATE | THE CURRENT REFUNDING PORTION OF THE SERIES 2010 BONDS QUALIFIED FOR THE 6-MONTH EXCEPTION OF TREAS. REG. 1.148-7(C). |
Schedule L IRS990ScheduleL
Loan Table LoanTable (2 entries)
| Purpose Of LoanPurposeOfLoan | Loan From OrganizationLoanFromOrganization | Original PrincipalOriginalPrincipalAmount | Balance DueBalanceDue | DefaultDefault | Approved By BoardApprovedByBoard | Written AgreementWrittenAgreement |
|---|---|---|---|---|---|---|
| ERIC HOFF | ||||||
| MEDICAL SCHOOL | X | $100,833 | 25826 | 0 | 1 | 1 |
| ROBERT DAWSON | ||||||
| MEDICAL SCHOOL | X | $357,553 | 4359 | 0 | 1 | 1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Balance Due | 30185 | TotalBalanceDue |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (12 entries)
| Return ReferenceReturnReference | ExplanationExplanation | IdentifierIdentifier |
|---|---|---|
| FORM 990, PART VI, SECTION A, LINE 6 | THE SOLE MEMBER OF THE CORPORATION SHALL, AT ALL TIMES, BE AVITA HEALTH SYSTEM. | |
| FORM 990, PART VI, SECTION A, LINE 7A | MEMBERS OR DIRECTORS SHALL HAVE THE APPROVAL OF THE BOARD OF DIRECTORS OF AVITA HEALTH SYSTEM. | |
| FORM 990, PART VI, SECTION A, LINE 7B | THE MEMBER HAS THE RIGHT TO APPROVE OR RATIFY DECISIONS OF THE ORGANIZATION'S GOVERNING BODY, SUCH AS APPEAL OF THE GOVERNING BODY'S ELECTION OR REMOVAL OF MEMBERS. | |
| FORM 990, PART VI, SECTION A, LINE 8B | THE ORGANIZATION DOES NOT HAVE SUB-COMMITTEES WITH THE AUTHORITY TO ACT ON BEHALF OF THE GOVERNING BODY. | |
| FORM 990, PART VI, SECTION B, LINE 11 | THE FORM 990 IS PROVIDED TO THE BOARD OF DIRECTORS AND SENT TO THE EXECUTIVE COMMITTEE OF GALION COMMUNITY HOSPITAL'S BOARD FOR THEIR REVIEW PRIOR TO FILING. THE BOARD EXECUTIVE COMMITTEE APPROVES THE FORM 990 FOLLOWING REVIEW, AS AUTHORIZED BY THE FULL GOVERNING BODY. | |
| FORM 990, PART VI, SECTION B, LINE 12C | BOTH GALION COMMUNITY HOSPITAL AND BCH ACQUISITION LLC HAVE A CONFLICT OF INTEREST POLICY THAT COVERS ALL BOARD OF DIRECTORS AND OFFICERS OF THE CORPORATION. CONFLICT OF INTEREST SURVEYS ARE REVIEWED BY BOARD CHAIRMAN AND THE CEO TO ENSURE COMPLIANCE. VARIOUS RESTRICTIONS ARE IMPOSED ON INDIVIDUALS WITH POTENTIAL CONFLICTS OF INTEREST (I.E. INABILITY TO VOTE) UNTIL DECISION HAS BEEN MADE ON POTENTIAL CONFLICT. | |
| FORM 990, PART VI, SECTION B, LINE 15A | BOTH GALION COMMUNITY HOSPITAL'S AND BCH ACQUISITON LLC'S PROCESS FOR DETERMINING COMPENSATION CONSISTED OF BOARD EXECUTIVE COMMITTEE REVIEW OF OHIO HOSPITAL ASSOCIATION COMPENSATION SURVEYS, AND THE COMMITTEE DETERMINES EXECUTIVE COMPENSATION BASED ON THIS COMPARABILITY DATA. CONTEMPORANEOUS MINUTES ARE KEPT OF MEETINGS HELD BY THE EXECUTIVE COMMITTEE REGARDING DECISIONS AND DELIBERATIONS OF THIS PROCESS. THIS PROCESS WAS LAST COMPLETED IN JUNE OF 2012 FOR 2013 COMPENSATION. | |
| FORM 990, PART VI, SECTION C, LINE 18 | FORM 990 AND FORM 1023 ARE MADE AVAILABLE UPON REQUEST. | |
| FORM 990, PART VI, SECTION C, LINE 19 | NO DOCUMENTS ARE AVAILABLE TO THE PUBLIC. | |
| FORM 990, PART VII | ESTIMATE OF OFFICERS' ALLOCATION OF HOURS WORKED FOR RELATED TAX-EXEMPT ENTITIES: AVITA HEALTH FOUNDATION: -JERRY MORASKO: .2 -D. ERIC DRAIME: .2 COMMUNITY HEALTH ASSOCIATES, INC.: -JERRY MORASKO: .2 -D. ERIC DRAIME: .2 -ANDREW DANIELS: .2 NORTH CENTRAL OHIO FAMILY CARE CENTER: -JERRY MORASKO: .2 -D. ERIC DRAIME: .2 -ANDREW DANIELS: .2 AVITA HEALTH SYSTEM: -JERRY MORASKO: .1 -D. ERIC DRAIME: .1 -ANDREW DANIELS: .1 | |
| FORM 990, PART XI, LINE 5: | NET UNREALIZED LOSSES ON INVESTMENTS: -100,935. DONATED SERVICES AND USE OF FACILITIES: -37,990. CHANGE IN FAIR VALUE OF INTEREST RATE SWAP AGREEMENTS -214,222. CHANGE IN PENSION COSTS -8,417,579. INCOME FROM RELATED EXEMPT ORGANIZATION 224,010. CONTROLLING INTEREST IN CRAWFORD COUNTY SHARED HEALTH SERVICES, INC. 1,061,362. BCH FOUNDATION UNRESTRICTED 1,734. INHERENT CONTRIBUTION FROM BUSINESS COMBINATION OF HOMECARE MATTERS -847,139. TOTAL TO FORM 990, PART XI, LINE 5: -8,330,759. | CHANGES IN NET ASSETS OR FUND BALANCES: |
| FORM 990, PART XI, LINE 2C | THE ORGANIZATION HAS A FINANCE COMMITTEE WHICH OVERSEES THE AUDIT OF THE FINANCIAL STATEMENTS. THIS PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. |
Schedule R IRS990ScheduleR
Form990 Schedule R Part I Form990ScheduleRPartI (2 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivities | Legal Domicile StateLegalDomicileState | Total IncomeTotalIncome | EOY AssetsEOYAssets | Business Name Line1DirectControllingEntityName/BusinessNameLine1 |
|---|---|---|---|---|---|---|---|---|---|
| BCH ACQUISITION LLC | |||||||||
| 269 PORTLAND WAY SOUTH | GALION | OH | 448332399 | 344451872 | HEALTHCARE | OH | 36820016 | 20990524 | GALION COMMUNITY HOSPITAL |
| BCH PHYSICIAN CO | |||||||||
| 269 PORTLAND WAY SOUTH | GALION | OH | 448332399 | 344451872 | INACTIVE | OH | 0 | 0 | GALION COMMUNITY HOSPITAL |
Form990 Schedule R Part II Form990ScheduleRPartII (6 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivities | Legal Domicile StateLegalDomicileState | Exempt Code SectionExemptCodeSection | Public Charity StatusPublicCharityStatus | Business Name Line1DirectControllingEntityName/BusinessNameLine1 | Controlled OrgControlledOrg | Direct Controlling Entity NADirectControllingEntityNA |
|---|---|---|---|---|---|---|---|---|---|---|---|
| AVITA HEALTH FOUNDATION | |||||||||||
| 269 PORTLAND WAY SOUTH | GALION | OH | 44833 | 200934451 | FUNDRAISING FOR GALION COMMUNITY HOSPITAL | OH | 501(C)(3) | LINE 7 | AVITA HEALTH SYSTEM | 1 | |
| COMMUNITY HEALTH ASSOCIATES INC | |||||||||||
| 955 BUCYRUS ROAD | GALION | OH | 44833 | 341784017 | PHYSICIAN OFFICE | OH | 501(C)(3) | LINE 11A, I | GALION COMMUNITY HOSPITAL | 1 | |
| NORTH CENTRAL OHIO FAMILY CARE CENTER INC | |||||||||||
| 269 PORTLAND WAY SOUTH | GALION | OH | 44833 | 341807906 | PHYSICIAN OFFICE | OH | 501(C)(3) | LINE 11A, I | GALION COMMUNITY HOSPITAL | 1 | |
| AVITA HEALTH SYSTEM | |||||||||||
| 269 PORTLAND WAY SOUTH | GALION | OH | 44833 | 274385692 | HEALTHCARE | OH | 501(C)(3) | LINE 11A, I | 0 | N/A | |
| GCH AQUISITION SUB | |||||||||||
| 269 PORTLAND WAY SOUTH | GALION | OH | 44833 | 383821803 | AQUISITION COMPANY | OH | 501(C)(3) | LINE 9 | GALION COMMUNITY HOSPITAL | 1 | |
| CRAWFORD COUNTY SHARED HEALTH SERVICES INC | |||||||||||
| 1220 NORTH MARKET STREET | GALION | OH | 44833 | 341484014 | HOME HEALTH & HOSPICE | OH | 501(C)(3) | LINE 9 | GALION COMMUNITY HOSPITAL | 1 | |
Form990 Schedule R Part III Form990ScheduleRPartIII (2 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivityPrimaryActivity | Legal Domicile StateLegalDomicileState | Business Name Line1DirectControllingEntityName/BusinessNameLine1 | Predominant Income TypePredominantIncomeType | Share Of Total IncomeShareOfTotalIncome | Share Of EOY AssetsShareOfEOYAssets | Disproportionate AllocationsDisproportionateAllocations | General Or Managing PartnerGeneralOrManagingPartner | Percentage OwnershipPercentageOwnership |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| GALION COMMUNITY PAIN MANAGEMENT LLC | |||||||||||||
| 269 PORTLAND WAY SOUTH | GALION | OH | 44833 | 300602607 | HOSPITAL SUPPORT | OH | GALION COMMUNITY HOSPITAL | RELATED | 1328316 | 434013 | 0 | 0 | 0.51000 |
| GALION COMMUNITY VASCULAR SERVICES LLC | |||||||||||||
| 269 PORTLAND WAY SOUTH | GALION | OH | 44833 | 611613817 | HOSPITAL SUPPORT | OH | GALION COMMUNITY HOSPITAL | RELATED | 1751738 | 550718 | 0 | 0 | 0.51000 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | 0 | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | 1 | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | 0 | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | 0 | LoansOrGuaranteesFromOtherOrg |
| Sale Of Assets To Other Org | 0 | SaleOfAssetsToOtherOrg |
| Purchase Of Assets From Other Org | 0 | PurchaseOfAssetsFromOtherOrg |
| Exchange Of Assets | 0 | ExchangeOfAssets |
| Rental Of Facilities To Other Orgs | 0 | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | 0 | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | 0 | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | 1 | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | 0 | SharingOfFacilities |
| Sharing Of Paid Employees | 0 | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | 1 | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | 1 | OtherTransferToOtherOrg |
| Other Transfer From Other Org | 1 | OtherTransferFromOtherOrg |
Transactions Related Orgs Table TransactionsRelatedOrgsTable (9 entries)
| Transaction TypeTransactionType | Amount InvolvedAmountInvolved | Method Of Amt DeterminationMethodOfAmtDetermination |
|---|---|---|
| COMMUNITY HEALTH ASSOCIATES INC | ||
| R | 3413196 | ACCRUAL TRANSACTION |
| COMMUNITY HEALTH ASSOCIATES INC | ||
| R | 570000 | ACCRUAL TRANSACTION |
| COMMUNITY HEALTH ASSOCIATES INC | ||
| Q | 3936529 | ACCRUAL TRANSACTION |
| COMMUNITY HEALTH ASSOCIATES INC | ||
| P | 802000 | PAYROLL |
| NORTH CENTRAL OHIO FAMILY CARE CENTER | ||
| P | 425687 | PAYROLL |
| NORTH CENTRAL OHIO FAMILY CARE CENTER | ||
| R | 179000 | ACCRUAL TRANSACTION |
| AVITA HEALTH SYSTEM | ||
| L | 24900193 | MANAGEMENT FEE |
| COMMUNITY HEALTH ASSOCIATES INC | ||
| B | 1240341 | FORGIVENESS OF PAYABLE |
| NORTH CENTRAL OHIO FAMILY CARE CENTER | ||
| B | 225796 | FORGIVENESS OF PAYABLE |