2013-11-07T17:53:34-06:00 2012-12-31 381357951 PLANTE & MORAN PLLC 65 EAST STATE ST STE 600 COLUMBUS OH 43215 990 2012-01-01 341893452 UHHSCSAHS - CUYAHOGA INC UHHS 4407402180 6935 TREELINE DRIVE NO J BRECKSVILLE OH 441413393 ALLEN TRACY 4407402180 2013-11-07 1 BERNIE OSTROWSKI P00366367 6148493000 2012 2016-03-07 17:11:31Z ALLEN TRACY 6935 TREELINE DRIVE NO J BRECKSVILLE OH 441413393 14231265 0 X N/A X 1999 OH SEE SCHEDULE OUHHS/CSAHS-CUYAHOGA, INC (CUYAHOGA) IS AN ORGANIZATION JOINTLY OWNED BY THE SISTERS OF CHARITY HEALTH SYSTEM AND UNIVERSITY HOSPITALS HEALTH SYSTEM, INC. (THE MEMBERS) OPERATED FOR THE EXCLUSIVE BENEFIT OF THE MEMBERS AND THEIR RELATED SUBSIDIARIES. BOTH MEMBERS ARE TAX-EXEMPT 501(C)3 CHARITABLE ORGANIZATIONS. CUYAHOGA PROVIDES ADMINISTRATIVE SUPPORT SERVICES FOR ORGANIZATIONS OPERATED BY THE MEMBERS. 4 4 0 4 0 0 0 0 78396403 14196239 291 109 30717 34917 78427411 14231265 0 0 0 0 72025154 6005644 0 0 0 6811197 8370876 78836351 14376520 -408940 -145255 16359426 8267801 13594731 6648361 2764695 1619440 X UHHS/CSAHS-CUYAHOGA, INC (CUYAHOGA) IS AN ORGANIZATION JOINTLY OWNED BY THE SISTERS OF CHARITY HEALTH SYSTEM AND UNIVERSITY HOSPITALS HEALTH SYSTEM, INC. (THE MEMBERS) OPERATED FOR THE EXCLUSIVE BENEFIT OF THE MEMBERS AND THEIR RELATED SUBSIDIARIES. BOTH MEMBERS ARE TAX-EXEMPT 501(C)3 CHARITABLE ORGANIZATIONS. CUYAHOGA PROVIDES ADMINISTRATIVE SUPPORT SERVICES FOR ORGANIZATIONS OPERATED BY THE MEMBERS. 0 1 14376520 14196239 SEE PART III, LINE 1 MISSION STATEMENT. 14376520 1 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 1 1 0 0 0 1 16 0 1 0 0 0 0 0 0 0 0 0 0 0 X 4 4 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 0 X MARY KOWTUN 4407402181 6935 TREELINE DRIVE BRECKSVILLE OH 441413393 X ALLEN TRACY 2.00 X X 0 0 0 MELISSA ROGERS 2.00 X X 0 0 0 PAUL TAIT 2.00 X X 0 0 0 JOHN RUSNACZYK 2.00 X X 0 0 0 0 0 0 0 0 0 0 MEDICAL INFORMATION TECHNOLOGY PO BOX 74569 CHICAGO IL 60696 IT SUPPORT 1145621 HUMAN ARC 1457 EAST 40TH STREET CLEVELAND OH 44103 COLLECTION SERVICES 451505 REVENUE GROUP 3770 PARK EAST STE 240 POBOX 2212 BEACHWOOD OH 44122 COLLECTION SERVICES 295227 HYBRIDGE SOLUTIONS PO BOX 1077 INMAN SC 29349 IT SUPPORT 237847 VELOCITY TECHNOLOGY 850 3RD AVE1003 NEW YORK NY 10022 IT SUPPORT 230769 8 MEMBER REVENUES 561000 14196239 14196239 14196239 109 109 OTHER REVENUE 900099 34917 34917 34917 14231265 14196239 0 35026 185304 185304 4396432 4396432 241207 241207 887363 887363 295338 295338 85160 85160 31066 31066 390248 390248 471184 471184 2882678 2882678 334502 334502 27820 27820 3300 3300 1852841 1852841 40796 40796 COLLECTION FEES 1862227 1862227 BANK FEES 374892 374892 DUES/SUBSCRIPTIONS 13201 13201 MISCELLANEOUS OTHER EXP 961 961 14376520 14376520 0 0 967778 1243837 1003789 1206425 955500 857984 17952664 12993109 4908370 4959555 8523989 0 16359426 8267801 2704510 3032646 2366232 3615715 8523989 0 13594731 6648361 X 2764695 1619440 2764695 1619440 16359426 8267801 X -145255 -1000000 X X 0 1 X 1 0 X 4323300 2947818 7271118 254084234 254804865 72325306 78396403 14196239 673807047 6067111 9412849 20637 30717 34917 15566231 264474645 267165532 72345943 78427120 14231156 696644396 0 70878362 76444197 13769301 161091860 70878362 76444197 13769301 161091860 535552536 2274357 172216 1319 291 109 2448292 2274357 172216 1319 291 109 2448292 266749002 267337748 72347262 78427411 14231265 699092688 0.76610 0.99250 0.00350 0.00630 X 204666 196693 7973 17747998 12796416 4951582 4959555 X 14231266 1 1 14231265 0 14231265 14376520 0 14376520 0 14376520 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X, LINE 2: THE COMPANY IS A NONPROFIT, TAX-EXEMPT ORGANIZATION AND ACCORDINGLY, NO TAX PROVISION IS REFLECTED IN THE FINANACIAL STATEMENTS. WITH FEW EXCEPTIONS, THE COMPANY IS NO LONGER SUBJECT TO U.S. FEDERAL, STATE AND LOCAL,OR NON-U.S. INCOME TAX EXAMINATIONS BY TAX AUTHORITIES FOR YEARS BEFORE 2009. ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA REQUIRE MANAGEMENT TO EVALUATE TAX POSITIONS TAKEN BY THE COMPANY AND RECOGNIZE A TAX LIABILITY IF THE COMPANY HAS TAKEN AN UNCERATIN TAX POSITION THAT MORE LIKELY THAN NOT WOULD NOT BE SUSTAINED UPON EXAMINATION BY THE INTERNAL REVENUE SERVICE OR OTHER APPLICABLE TAXING AUTHORITIES. MANAGEMENT HAS ANALYZED THE TAX POSITIONS TAKEN BY THE COMPANY AND HAS CONCLUDED THAT AS OF DECEMBER 31, 2012, THERE ARE NO UNCERTAIN TAX POSITIONS TAKEN OR EXPECTED TO BE TAKEN THAT WOULD REQUIRE RECOGNITION OF A LIABILITY OR DISCLOSURE IN THE FINANCIAL STATEMENTS. PART XI, LINE 2D - OTHER ADJUSTMENTS: ROUNDING ON AUDITED FINANCIAL STATEMENTS 1. LEASE BACK EMPLOYMENT RECEIVABLE 2012-01-01 8523989 BOOK VALUE 341260978 ST JOHN MEDICAL CENTER 29000 CENTER RIDGE ROAD WESTLAKE OH 44145 501 (C) 3 0 0 0 0 CHANGES IN PROGRAM SERVICES FORM 990, PART III, LINE 3 THE ORGANIZATION CEASED ITS LEASEBACK ARRANGEMENT AS OF 12/31/11 FOR THE EMPLOYEES OF ST JOHN MEDICAL CENTER HOSPITAL. ST JOHN MEDICAL CENTER NOW DIRECTLY EMPLOYS THESE INDIVIDUALS. IN 2012, THERE WAS A REDUCTION IN REVENUE,EXPENSE, ASSETS,AND LIABILTIES RELATED TO THE CHANGE IN THIS LEASEBACK ARRANGEMENT. FORM 990, PART VI, SECTION A, LINE 6 THE ORGANIZATION HAS TWO CORPORATE MEMBERS: SISTERS OF CHARITY HEALTH SYSTEM AND UNIVERSITY HOSPITALS HEALTH SYSTEM. FORM 990, PART VI, SECTION A, LINE 7A THE ORGANIZATION'S MEMBERS MAY ELECT MEMBERS OF THE GOVERNING BODY. FORM 990, PART VI, SECTION A, LINE 7B CERTAIN DECISIONS OF THE GOVERNING BODY, SUCH AS APPROVAL OF BUDGETS, CAPITAL EXPENDITURES AND ACQUISITION OF LAND, MUST BE APPROVED BY THE BOARD OF THE MEMBER ORGANIZATION. FORM 990, PART VI, SECTION B, LINE 11 AFTER THE 990 RETURN IS REVIEWED INTERNALLY; IT IS SUBMITTED FOR REVIEW TO OUR TAX ADVISORS. THEY REVIEW FOR COMPLETENESS AND COMMUNICATE ANY CONCERNS THAT THEY IDENTIFY WITHIN THE DOCUMENTS AND WORKSHEETS OF THE TAX RETURN. ITEMS IDENTIFIED ARE REVIEWED BY STAFF AND ANY NEEDED CORRECTIONS ARE MADE. THE RETURN IS THEN PROVIDED TO THE PRESIDENT FOR REVIEW AND APPROVAL. IT IS THEN SUBMITTED TO THE BOARD FOR REVIEW. FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION HAS IN PLACE A CONFLICT OF INTEREST POLICY AS WELL AS A NON-RETALIATION POLICY (WHISTLE-BLOWER) MANAGED THROUGH THE COMPLIANCE OFFICER. THE CONFLICT OF INTEREST FORMS ARE SENT OUT ANNUALLY TO ADMINISTRATION, AND OTHER LEADERSHIP EMPLOYEES AS WELL AS BOARD MEMBERS. THE FORMS ARE RETURNED TO ADMINISTRATION. ONCE RETURNED, THEY ARE REVIEWED BY THE COMPLIANCE OFFICER AND CEO TO DETERMINE IF ANYTHING WOULD BE DEEMED A POTENTIAL CONFLICT OF INTEREST. IF THERE IS A CONFLICT, THE CEO, COMPLIANCE OFFICER AND EMPLOYEE/INDIVIDUAL MEET TO DISCUSS. THE RESULTS OF THOSE MEETINGS ARE AN AGENDA ITEM AT THE ORGANIZATION'S ADMINISTRATIVE COMPLIANCE COMMITTEE MEETING AND IT IS FURTHER DISCUSSED THERE. ONCE A DECISION IS MADE REGARDING THE CONFLICT, FOLLOW-UP IS MADE BY THE COMPLIANCE OFFICER/CEO WITH THE EMPLOYEE, IF APPROPRIATE. THE ORGANIZATION ALSO DISCUSSES THE RESULTS OF THE CONFLICT OF INTERESTS WITH THE BOARD OF TRUSTEES. HUMAN RESOURCES REVIEWS EMPLOYEE COMPENSATION LEVELS BY USING MARKET BASED RESOURCES AND ESTABLISHES COMPENSATION LEVELS TO BE WITHIN COMPETITIVE RANGE OF THE REGIONAL MARKET. FORM 990, PART VI, SECTION C, LINE 18 FORMS 990 AND 1023 ARE AVAILABLE TO PUBLIC UPON REQUEST AT THE FINANCIAL SERVICE CENTER LOCATION. FORM 990, PART VI, SECTION C, LINE 19 GOVERNING DOCUMENTS, THE FINANCIAL STATEMENTS, AND THE CONFLICT OF INTEREST POLICY ARE AVAILABLE TO PUBLIC UPON REQUEST AT THE FINANCIAL SERVICE CENTER LOCATION. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 9: EQUAL DISTRIBUTION TO MEMBERS -1,000,000. SCHEDULE R, PART II UHHS/CSAHS - CUYAHOGA, INC. HAS TWO CORPORATE MEMBERS, UNIVERSITY HOSPITALS HEALTH SYSTEM AND THE SISTERS OF CHARITY OF ST. AUGUSTINE. THE ENTIRE BOARD OF UHHS/CSAHS - CUYAHOGA, INC. ARE EMPLOYEES OF ONE OF THE CORPORATE MEMBERS AND THEREFORE RECEIVE COMPENSATION FROM ONE OF THE CORPORATE MEMBERS. NEITHER CORPORATE MEMBER MEETS THE NECESSARY ELEMENT OF CONTROL TO BE CONSIDERED A RELATED ORGANIZATION AND ARE THEREFORE NOT REPORTED ON SCHEDULE R. ACCORDINGLY, THERE IS NO COMPENSATION REPORTED FOR THE BOARD MEMBERS SINCE THEY ARE NOT COMPENSATED BY THE ORGANIZATION OR A RELATED ORGANIZATION. AS A RESULT, ALL FOUR BOARD MEMBERS HAVE BEEN LISTED ON FORM 990, PART VI, AND LINE B AS NOT LACKING INDEPENDENCE. UHHSCSAHS-CUYAHOGA HOLDING COMPANY INC 6935 TREELINE DRIVE BRECKSVILLE OH 44141 341895400 HOLDING CO OH UHHSCSAHS CUYAHOGA INC C 1.00000 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0