2013-11-01T09:11:16-05:00 2012-12-31 341827159 GILMORE JASION & MAHLER LTD 1715 INDIAN WOOD CIRCLE STE 100 MAUMEE OH 43537 990 2012-01-01 341116795 HOSPITAL COUNCIL OF NORTHWEST OHIO HOSP 4198420800 3231 CENTRAL PARK WEST NO 200 TOLEDO OH 43617 W SCOTT FRY 4198420800 2013-11-01 1 HEIDI FERGUSON P00410007 4197942000 2013-10-30 2012 2016-03-07 17:11:31Z W SCOTT FRY 3231 CENTRAL PARK WEST NO 200 TOLEDO OH 43617 4032902 0 X WWW.HCNO.ORG X 1973 OH SEE BELOW.THE HOSPITAL COUNCIL OF NORTHWEST OHIO IS A MEMBER DRIVEN ORGANIZATION THAT REPRESENTS AND ADVOCATES ON BEHALF OF ITS MEMBER HOSPITALS AND HEALTH SYSTEMS AND PROVIDES COLLABORATIVE OPPORTUNITIES TO ENHANCE THE HEALTH STATUS OF THE CITIZENS OF NORTHWEST OHIO. THE HOSPITAL COUNCIL IS DEDICATED TO: -BRINGING TOGETHER NORTHWEST OHIO'S HEALTH CARE LEADERS. -PROVIDING COLLABORATIVE OPPORTUNITIES TO ADDRESS HEALTHCARE PROVIDERS' SHARED CONCERNS. -DEVELOPING CREATIVE HEALTH-RELATED INITIATIVES TO IMPROVE THE REGION'S HEALTH STATUS. -PROVIDING EDUCATIONAL PROGRAMS FOR THE HEALTHCARE SECTOR. 22 21 21 46 0 0 2952844 1846679 1501231 2141688 3038 1882 35711 21906 4492824 4012155 1709819 1905276 0 0 1343439 1478150 0 0 0 825330 1201683 3878588 4585109 614236 -572954 3814577 3374968 424645 557990 3389932 2816978 X THE HOSPITAL COUNCIL OF NORTHWEST OHIO IS A MEMBER DRIVEN ORGANIZATION THAT REPRESENTS AND ADVOCATES ON BEHALF OF ITS MEMBER HOSPITALS AND HEALTH SYSTEMS AND PROVIDES COLLABORATIVE OPPORTUNITIES TO ENHANCE THE HEALTH STATUS OF THE CITIZENS OF NORTHWEST OHIO. -BRINGING TOGETHER NORTHWEST OHIO'S HEALTH CARE LEADERS. -PROVIDING COLLABORATIVE OPPORTUNITIES TO ADDRESS HEALTHCARE PROVIDERS' SHARED CONCERNS. -DEVELOPING CREATIVE HEALTH-RELATED INITIATIVES TO IMPROVE THE REGION'S HEALTH STATUS. -PROVIDING EDUCATIONAL PROGRAMS FOR THE HEALTHCARE SECTOR. 0 0 4323563 1905276 2170151 -PROVIDING COLLABORATIVE OPPORTUNITIES TO ADDRESS HEALTHCARE PROVIDERS' SHARED CONCERNS.-DEVELOPING, IMPLEMENTING, AND SECURING FUNDING FOR CREATIVE HEALTH-RELATED INITIATIVES TO IMPROVE THE REGION'S HEALTH STATUS.-PROVIDING EDUCATIONAL PROGRAMS FOR THE HEALTHCARE SECTOR. 4323563 1 1 0 1 0 0 0 0 1 0 1 0 0 0 0 1 1 0 0 0 0 0 0 0 1 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 44 0 1 21 1 0 0 0 0 0 0 0 0 0 0 X 22 21 0 0 0 0 1 1 1 1 1 0 0 0 1 1 1 1 1 1 1 0 OH X W SCOTT FRY 4198420800 3231 CENTRAL PARK WEST TOLEDO OH 43617 W SCOTT FRY 19.70 20.70 X X 101628 107053 55618 ALAN SATTLER 4.00 X 0 0 0 BRADLEY BERTKE 4.00 X 0 0 0 DALE THORNTON 4.00 X 0 0 0 DANIEL L WAKEMAN 4.00 X X 0 0 0 DANIEL SCHWANKE 4.00 X 0 0 0 E DEAN BECK 4.00 X 0 0 0 GARY ADKINS 4.00 X X 0 0 0 GARY CATES 4.00 X 0 0 0 HOLLY BRISTOLL 4.00 X 0 0 0 KEVIN COOK 4.00 X 0 0 0 KEVIN WEBB PHD 4.00 X 0 0 0 KIM BORDENKIRCHER 4.00 X 0 0 0 LYNN DETTERMAN 4.00 X 0 0 0 MICHAEL LONG 4.00 X 0 0 0 MICHAEL WINTHROP 4.00 X 0 0 0 NORMA TOMLINSON 4.00 X 0 0 0 PAM JENSEN 4.00 X 0 0 0 PATRICK MARTIN 4.00 X X 0 0 0 PATTI FINN 4.00 X X 0 0 0 ROBERT E GOSPODAREK 4.00 X X 0 0 0 SCOTT C MALANEY 4.00 X 0 0 0 SCOTT SCARBOROUGH 4.00 X 0 0 0 STANLEY KORDUCKI 4.00 X 0 0 0 TODD ALMENOINGER 4.00 X 0 0 0 WESLEY OSWALD 4.00 X 0 0 0 JAN RUMA 43.30 X 147881 0 48333 249509 107053 103951 2 0 1 0 0 2600 903242 940837 1846679 CONTRACT INCOME 900099 1741780 1741780 MEMBERSHIP DUES 900099 399908 399908 2141688 1882 1882 14190 2600 20747 -6557 -6557 28463 28463 28463 4012155 2170151 0 -4675 1905276 1905276 264299 178204 86095 874970 832045 42925 85122 75759 9363 172440 153472 18968 81319 72374 8945 2276 2276 20619 20619 325574 315651 9923 16128 9128 7000 175266 147457 27809 31086 26764 4322 79560 71398 8162 46601 42661 3940 22905 13515 9390 2938 2439 499 17313 16482 831 PROGRAM EXPENSE 456226 456226 ORG DUES AND MEMBERSHIP 3330 2946 384 SUBSCRIPTIONS 1085 1061 24 TRAINING 776 705 71 4585109 4323563 261546 0 1808832 1098602 1650497 1985673 72453 12000 257939 263639 15361 4987 95193 85126 9495 10067 3814577 3374968 126539 202440 295838 348656 2268 6894 424645 557990 X 1716027 1913057 1673905 903921 3389932 2816978 3814577 3374968 -572954 0 X X 0 1 X 1 1 1 X 3459099 3633414 2370103 2952844 1846679 14262139 3459099 3633414 2370103 2952844 1846679 14262139 14262139 44580 14229 3652 3038 1882 67381 31696 27087 27487 51153 42653 180076 14509596 7006287 0.98290 0.97950 X SCHEDULE A, PART II, LINE 10, EXPLANATION OF OTHER INCOME: REIMBURSEMENT INCOME SPECIAL EVENT INCOME RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 0 0 0 0 1 196 0 0 196 0 0 1 X 36269 30601 5668 58924 54525 4399 10067 X 4085902 53000 53000 4032902 -20747 -20747 4012155 4608856 23747 23747 4585109 0 4585109 PART IV, LINE 2B: HOSPITAL COUNCIL IS A FISCAL AGENT FOR THE LUCAS COUNTY SUICIDE PREVENTION COALITION. DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X, LINE 2: MANAGEMENT OF THE ORGANIZATION IS REQUIRED TO DETERMINE WHETHER A TAX POSITION OF THE ORGANIZATION IS MORE LIKELY THAN NOT TO BE SUSTAINED UPON EXAMINATION BY THE APPLICABLE TAXING AUTHORITY, INCLUDING RESOLUTION OF ANY RELATED APPEALS OR LITIGATION PROCESSES, BASED ON THE TECHNICAL MERITS OF THE POSITION. MANAGEMENT OF THE ORGANIZATION IS NOT AWARE OF ANY TAX POSITIONS FOR WHICH IT IS REASONABLY POSSIBLE THAT THE TOTAL AMOUNTS OF UNRECOGNIZED TAX BENEFITS WILL SIGNIFICANTLY CHANGE IN THE NEXT TWELVE MONTHS. HOWEVER, MANAGEMENT'S CONCLUSIONS MAY BE SUBJECT TO REVIEW AND ADJUSTMENT AT A LATER DATE BASED ON FACTORS INCLUDING, BUT NOT LIMITED TO, NEW TAX LAWS, REGULATIONS AND ADMINISTRATIVE INTERPRETATIONS (INCLUDING RELEVANT COURT DECISIONS). THE ORGANIZATION'S FEDERAL TAX RETURNS FOR THE PRIOR THREE YEARS REMAIN SUBJECT TO EXAMINATION BY THE INTERNAL REVENUE SERVICE. NO INTEREST OR PENALTIES WERE INCURRED OR RECOGNIZED IN 2012 OR 2011. PART XI, LINE 2D - OTHER ADJUSTMENTS: INTERCOMPANY TRANSACTIONS 53,000. PART XI, LINE 4B - OTHER ADJUSTMENTS: SPECIAL EVENT EXPENSE -20,747. PART XII, LINE 2D - OTHER ADJUSTMENTS: INTERCOMPANY TRANSACTIONS 3,000. SPECIAL EVENT EXPENSE 20,747. BLACK SWAMP GOLF 16790 2600 14190 2864 3536 2514 11834 16790 2600 14190 2864 3536 2514 11834 20748 -6558 1 BELLEVUE HOSPITAL 1400 WEST MAIN STREET BELLEVUE OH 44811 344428205 17752 SUPPORT BLANCHARD VALLEY HEALTH SYSTEM 1900 SOUTH MAIN STREET FINDLAY OH 45840 341369963 44362 SUPPORT BLUFFTON HOSPITAL 139 GARAU STREET BLUFFTON OH 45817 341369963 12398 SUPPORT BOWLING GREEN FIRE DIVISION 552 EAST COURT STREET BOWLING GREEN OH 43402 346400148 18799 SUPPORT COMMUNITY HOSPITALS AND WELLNESS CENTERSBRYAN 433 W HIGH STREET BRYAN OH 43506 341048666 18999 SUPPORT COMMUNITY HOSPITALS AND WELLNESS CENTERSMONTPELIER 909 SNYDER MONTPELIER OH 43543 341048666 18285 SUPPORT COMMUNITY MEMORIAL HOSPITAL 208 N COLUMBUS STREET HICKSVILLE OH 43526 346401873 21495 SUPPORT FIRELANDS PHYSICIAN 1031 PIERCE STREET SUITE D SANDUSKY OH 44870 341608091 19500 SUPPORT FIRELANDS REGIONAL MEDICAL CENTER 1101 DECATUR STREET SANDUSKY OH 44870 344428218 21460 SUPPORT FISHER-TITUS MEDICAL CENTER 272 BENEDICT AVE NORWALK OH 44857 344430716 70965 SUPPORT FULTON COUNTY HEALTH CENTER 725 SOUTH SHOOP AVENUE WAUSEON OH 43567 344428214 32086 SUPPORT HENRY COUNTY HOSPITAL 1600 EAST RIVERVIEW AVENUE NAPOLEON OH 43545 344477047 30902 SUPPORT ISTHMUS LTD 240 BRYANT AVE WORTHINGTON OH 43085 010730930 57899 SUPPORT JOINT TOWNSHIP DISTRICT MEMORIAL HOSPITAL 200 ST CLAIR STREET ST MARYS OH 45885 341623770 14124 SUPPORT LIMA MEMORIAL HOSPITAL 1001 BELLEFONTAINE AVE LIMA OH 43504 341883284 33805 SUPPORT LUCAS COUNTY AMATEUR RADIO EMERGENCY SERVICES INC 4463 HOLLY HILL DRIVE TOLEDO OH 43614 341343662 9664 SUPPORT LUCAS COUNTY REGIONAL HEALTH DEPARTMENT 635 N ERIE STREET TOLEDO OH 43604 346400806 6000 SUPPORT MAGRUDER HOSPITAL 615 FULTON STREET PORT CLINTON OH 43452 344441792 13043 SUPPORT MEMORIAL HOSPITAL 715 SOUTH TAFT AVENUE FREMONT OH 43420 344430849 39145 SUPPORT MERCER COUNTY JT TWP COMMUNITY HOSPITAL 800 WEST MAIN STREET COLDWATER OH 45828 341101385 10624 SUPPORT MERCY HEALTH PARTNERS 2200 JEFFERSON AVENUE TOLEDO OH 43624 341344482 10144 SUPPORT MERCY HEALTH PARTNERS 578 NORTH LEAVITT ROAD AMHERST OH 44001 341803352 90000 SUPPORT MERCY HOSPITAL OF DEFIANCE 1404 E SECOND STREET DEFIANCE OH 43512 020701635 25938 SUPPORT MERCY HOSPITAL OF TIFFIN 485 W MARKET STREET TIFFIN OH 44883 344431174 13988 SUPPORT MERCY HOSPITAL OF WILLARD 110 EAST HOWARD STREET WILLARD OH 44890 341577110 17854 SUPPORT MERCY PHYSICIAN ENTERPRISE 2200 JEFFERSON AVE TOLEDO OH 43624 264779623 105000 SUPPORT NAPOLEON FIRE & RESCUE 265 W RIVERVIEW AVENUE NAPOLEON OH 43545 346400941 5831 SUPPORT NORTHERN OHIO MEDICAL SPECIALISTS LLC 3004 HAYES AVE SANDUSKY OH 44870 341933718 30000 SUPPORT PAULDING COUNTY HOSPITAL 1035 W WAYNE STREET PAULDING OH 45879 346405718 22438 SUPPORT PAULDING COUNTY EMA 115 N WILLIAMS ST PAULDING OH 45879 346401048 7339 SUPPORT PROMEDICA BAY PARK HOSPITAL 2801 BAY PARK DRIVE OREGON OH 43616 341883132 35660 SUPPORT PROMEDICA DEFIANCE REGIONAL HOSPITAL 1200 RALSTON AVE DEFIANCE OH 43512 344446484 13959 SUPPORT PROMEDICA FLOWER HOSPITAL 5200 HARROUN ROAD SYLVANIA OH 43560 344428794 11997 SUPPORT PROMEDICA FOSTORIA COMMUNITY HOSPITAL 501 VAN BUREN STREET FOSTORIA OH 44830 340898745 17863 SUPPORT PROMEDICA PHYSICIANS 5855 MONROE STREET SYLVANIA OH 43560 341880767 235800 SUPPORT PROMEDICA ST LUKES HOSPITAL 5901 MONCLOVA RD MAUMEE OH 43537 344428232 28139 SUPPORT PROMEDICA TOLEDO HOSPITAL 2142 NORTH COVE BLVD TOLEDO OH 43606 344428256 48568 SUPPORT SANDUSKY CO EMA 2323 COUNTRYSIDE DRIVE SUITE B FREMONT OH 43420 346401312 12225 SUPPORT SHEALY GROUP LTD 68 PARK AVENUE WEST MANSFIELD OH 44902 010724512 76500 SUPPORT ST ANNE MERCY HOSPITAL 3404 SYLVANIA AVENUE TOLEDO OH 43623 311556401 14485 SUPPORT ST CHARLES MERCY HOSPITAL 2600 NAVARRE AVENUE OREGON OH 43616 344445373 19207 SUPPORT ST RITA'S MEDICAL CENTER 730 W MARKET STREET LIMA OH 45801 341105619 37001 SUPPORT ST VINCENT MERCY MEDICAL CENTER 2213 CHERRY STREET TOLEDO OH 43608 344428250 35461 SUPPORT TOLEDO CLINIC 4235 SECOR ROAD TOLEDO OH 43623 340936207 63000 SUPPORT TOLEDO RADIOLOGICAL ASSOCIATES PO BOX 2204 INDIANAPOLIS IN 43206 341029988 13980 SUPPORT UNITED WAY OF GREATER TOLEDO 424 JACKSON STREET TOLEDO OH 43604 344427947 50000 SUPPORT UNIVERSITY OF TOLEDO 3000 ARLINGTON TOLEDO OH 43614 346401483 42905 SUPPORT VAN WERT COUNTY HOSPITAL 1250 SOUTH WASHINGTON STREET VAN WERT OH 45891 344429514 13572 SUPPORT WOOD COUNTY HOSPITAL 950 W WOOSTER STREET BOWLING GREEN OH 43402 344440884 56029 SUPPORT 34 15 PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, PART I, LINE 2: THE PROGRAM STAFF WORK CLOSELY WITH EACH SUB GRANTEE REGARDING PAPER WORK NEEDED. ALL SUB GRANTEES MUST SUBMIT DOCUMENTATION FOR REIMBURSEMENT OF ALL EXPENDITURES. WHEN NECESSARY, THE ASSISTANT CONTROLLER TRACKS EXPENDITURES TO ENSURE ADHERENCE TO THE BUDGET; IN ADDITION, THE PROGRAM DIRECTOR WORKS WITH FINANCE TO OVERSEE THE GRANT AND MANTAIN COMPLIANCE WITH APPLICABLE MANDATES. X X X 0 0 0 0 0 0 0 0 0 W SCOTT FRY 97965 103195 0 0 3663 3858 15102 15908 11984 12624 128714 135585 0 0 JAN RUMA 147431 0 0 0 450 0 18960 0 29373 0 196214 0 0 0 FORM 990, PART VI, SECTION A, LINE 6 AREA HOSPITALS COMPRISE THE MEMBERSHIP OF HOSPITAL COUNCIL OF NORTHWEST OHIO. FORM 990, PART VI, SECTION A, LINE 7A THESE MEMBER HOSPITALS MAY ELECT ONE OR MORE MEMBERS OF THE GOVERNING BODY. FORM 990, PART VI, SECTION A, LINE 7B THE GOVERNING DECISIONS OF THE FILING ENTITY ARE SUBJECT TO APPROVAL BY THE MEMBER HOSPITALS. FORM 990, PART VI, SECTION B, LINE 11 THE ORGANIZATION'S SIGNING OFFICER SCANS THE FORM 990 FOR COMPLETENESS PRIOR TO SIGNATURE, IN ADDITION TO RELYING UPON THE INDEPENDENT ACCOUNTANT FOR ACCURACY. FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION REGULARLY AND CONSISTENTLY MONITORS AND ENFORCES COMPLIANCE WITH THE CONFLICT OF INTEREST POLICY. FORM 990, PART VI, SECTION B, LINE 15 THE GOVERNING BODY USES A PROCESS FOR DETERMINING COMPENSATION OF THE ORGANIZATION'S CEO OR TOP MANAGEMENT OFFICIALS WHICH INCLUDES A COMPARISON TO OTHER ORGANIZATIONS, SALARY SURVEYS, AND CONTEMPORANEOUS SUBSTANTIATION OF THE DELIBERATION AND DECISION ON AN ANNUAL BASIS. THE ORGANIZATION USES A PROCESS FOR DETERMINING COMPENSATION OF THE ORGANIZATION'S OFFICERS OR KEY EMPLOYEES WHICH INCLUDES A REVIEW AND APPROVAL BY THE CEO, USE OF MANAGEMENT SURVEYS, AND CONTEMPORANEOUS SUBSTANTIATION OF THE DELIBERATION AND DECISION ON AN ANNUAL BASIS. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST. FINANCIAL STATEMENTS AND REPORTING FORM 990, PART XII, LINE 2C: THE ORGANIZATION HAS A COMMITTEE THAT ASSUMES REPSONSIBILITY FOR OVERSIGHT OF THE AUDIT OF ITS FINANCIAL STATEMENTS AND SELECTION OF AN INDEPENDENT ACCOUNTANT. NORTHWEST OHIO SHARED SERVICES 3231 CENTRAL PARK WEST DR TOLEDO OH 43617 341388279 PURCHASE CORPORATION OH N/A C 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 1 0 1 0 0 NORTHWEST OHIO SHARED SERVICES INC L 120084 NORTHWEST OHIO SHARED SERVICES INC O 140916 NORTHWEST OHIO SHARED SERVICES INC Q 72467