UNIVERSITY HOSPITALS HEALTH SYSTEM INC: Form 990, tax year 2012
View the entire original 990 at ProPublica ↗
- Organization
- UNIVERSITY HOSPITALS HEALTH SYSTEM INC (EIN 34-0714535)
- Tax period
- 2012-01-01 to 2012-12-31
- Filed
- 2013-11-07
- IRS object ID
- 201343119349302084
- Schema version
- 2012v2.1
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
- Return header
- Form 990
- Schedule A
- Schedule B
- Schedule C
- Schedule D
- Schedule H
- Schedule I
- Schedule J
- Schedule K
- Schedule M
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2013-11-07T17:20:08-06:00 | Timestamp |
| Tax Period End Date | 2012-12-31 | 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 STREET | 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 | 2012-01-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 340714535 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SAMARITAN REGIONAL HEALTH SYSTEM | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | SAMA | NameControl |
| Phone | 4192890491 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1025 CENTER STREET | AddressLine1 |
| City | ASHLAND | City |
| State | OH | State |
| ZIP Code | 44805 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | DANNY L BOGGS | Name |
| Title | PRESIDENT & CEO | Title |
| Phone | 4192890491 | Phone |
| Date Signed | 2013-10-29 | 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 | 2012 | TaxYear |
| Build TS | 2016-02-24 21:20:13Z | BuildTS |
Form 990 IRS990
Doing Business As DoingBusinessAs
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SEE SCHEDULE O | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | DANNY L BOGGS | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1025 CENTER STREET | AddressLine1 |
| City | ASHLAND | City |
| State | OH | State |
| ZIP Code | 44805 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 79102501 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | WWW.SAMARITANHOSPITAL.ORG | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1910 | YearFormation |
| State Legal Domicile | OH | StateLegalDomicile |
| Activity Or Mission Description | SEE SCHEDULE OSAMARITAN REGIONAL HEALTH SYSTEM PROVIDES QUALITY MEDICAL HEALTHCARE SERVICES AND EDUCATION REGARDLESS OF RACE, CREED, SEX, NATIONAL ORIGIN, HANDICAP, AGE, OR ABILITY TO PAY. THE HOSPITAL PROVIDES CARE TO PERSONS COVERED BY GOVERNMENTAL PROGRAMS. SERVICES PROVIDED TO MEDICARE AND MEDICAID PATIENTS ARE SOMETIMES PROVIDED BELOW COST. TO THE EXTENT REIMBURSEMENT IS BELOW COST, THE HOSPITAL RECOGNIZES THESE AMOUNTS AS CHARITY CARE. CHARITY CARE IS ALSO PROVIDED THROUGHOUT THE YEAR BASED UPON ACTIVITIES AND SERVICES WHICH THE HOSPITAL BELIEVES WILL SERVE A BONA FIDE COMMUNITY HEALTH NEED. CHARITY CARE FOR 2012 WAS VALUED AT $2,460,000. DURING 2012, THE HOSPITAL ALSO PROVIDED NUMEROUS OUTREACH PROGRAMS WHICH SERVE AND EDUCATE THE COMMUNITY. SEE PART III FOR ADETAILED LISTING OF THESE PROGRAMS. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 15 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 12 | NbrIndependentVotingMembers |
| Total Nbr Employees | 665 | TotalNbrEmployees |
| Total Nbr Volunteers | 190 | TotalNbrVolunteers |
| Total Gross UBI | 2564196 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | -481089 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 537596 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 1298898 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 76395028 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 73144624 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 15034 | InvestmentIncomePriorYear |
| Investment Income Current Year | -42545 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 5151818 | OtherRevenuePriorYear |
| Other Revenue Current Year | 4327352 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 82099476 | TotalRevenuePriorYear |
| Total Revenue Current Year | 78728329 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 2690576 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 40972 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 34360467 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 35203568 | 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 | 41976569 | OtherExpensePriorYear |
| Other Expenses Current Year | 42033574 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 79027612 | TotalExpensesPriorYear |
| Total Expenses Current Year | 77278114 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 3071864 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 1450215 | RevenuesLessExpensesCY |
| Total Assets BOY | 75191324 | TotalAssetsBOY |
| Total Assets EOY | 72908236 | TotalAssetsEOY |
| Total Liabilities BOY | 29268362 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 28432281 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 45922962 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 44475955 | NetAssetsOrFundBalancesEOY |
| Mission Description | THE MISSION OF SAMARITAN REGIONAL HEALTH SYSTEM IS TO TAKE THE LEAD IN PROMOTING THE HEALTH AND WELLNESS OF PEOPLE IN THE COMMUNITIES WE SERVE. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 68104420 | Expense |
| Grants | 40972 | Grants |
| Revenue | 73144624 | Revenue |
| Description | SEE SCHEDULE O | Description |
| Total Program Service Expense | 68104420 | 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 | 0 | 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 | 0 | 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 | 1 | 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 | 51 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | 1 | ComplianceWithBackupWitholding |
| Number Of Employees | 665 | 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 | 15 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 12 | 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 | 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 | 1 | CompensationProcessOther |
| Investment In Joint Venture | 0 | InvestmentInJointVenture |
| 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 | MARY GRIEST CFO | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 4192077837 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 663 EAST MAIN STREET | AddressLine1 |
| City | ASHLAND | City |
| State | OH | State |
| ZIP Code | 44805 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionA (23 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Average Hours Per Week RelatedAverageHoursPerWeekRelated | Individual Trustee Or DirectorIndividualTrusteeOrDirector | OfficerOfficer | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | Key EmployeeKeyEmployee | Highest Compensated EmployeeHighestCompensatedEmployee |
|---|---|---|---|---|---|---|---|---|---|
| DANNY L BOGGS | |||||||||
| PRESIDENT/CEO | 35.00 | 11.00 | X | X | 387147 | 0 | 34979 | ||
| STEPHEN L STUART PHD | |||||||||
| CHAIR | 2.00 | 1.00 | X | X | 0 | 0 | 0 | ||
| HAROLD KEENER PHD | |||||||||
| VICE CHAIR | 2.00 | 0.00 | X | X | 0 | 0 | 0 | ||
| ANNE BEER | |||||||||
| SECRETARY | 2.00 | 1.00 | X | X | 0 | 0 | 0 | ||
| MARY MACDONALD MD | |||||||||
| MEDICAL STAFF PRESIDENT | 2.00 | 40.00 | X | 0 | 357290 | 42018 | |||
| MICHAEL MARTIN MD | |||||||||
| MEDICAL STAFF PRESIDENT-EL | 2.00 | 0.00 | X | 2300 | 0 | 0 | |||
| PAUL R MYERS | |||||||||
| BOARD MEMBER | 2.00 | 1.00 | X | 0 | 0 | 0 | |||
| JERRY SEITER | |||||||||
| BOARD MEMBER | 2.00 | 0.00 | X | 0 | 0 | 0 | |||
| VICKY STEPHENSON | |||||||||
| BOARD MEMBER | 2.00 | 0.00 | X | 0 | 0 | 0 | |||
| MICHAEL D STENCEL MD | |||||||||
| BOARD MEMBER | 2.00 | 0.00 | X | 11000 | 0 | 0 | |||
| ROGER KRAMER CPA | |||||||||
| BOARD MEMBER | 2.00 | 1.00 | X | 0 | 0 | 0 | |||
| POLLY CHANDLER START 82812 | |||||||||
| BOARD MEMBER | 2.00 | 0.00 | X | 0 | 0 | 0 | |||
| RALPH KELSAY START 42612 | |||||||||
| BOARD MEMBER | 2.00 | 0.00 | X | 0 | 0 | 0 | |||
| ROGER HARRAMAN THRU 42612 | |||||||||
| BOARD MEMBER | 2.00 | 0.00 | X | 0 | 0 | 0 | |||
| TIM COWEN | |||||||||
| BOARD MEMBER | 2.00 | 1.00 | X | 0 | 0 | 0 | |||
| SUE HEIMANN | |||||||||
| BOARD MEMBER | 2.00 | 0.00 | X | 0 | 0 | 0 | |||
| MARY L GRIEST | |||||||||
| VP FINANCE/CFO | 40.00 | 5.00 | X | 174922 | 0 | 23707 | |||
| CHRISTOPHER HUNT | |||||||||
| VP CLINICAL SERVICES | 40.00 | 0.00 | 156251 | 0 | 15642 | X | |||
| PHILIP MYERS MD | |||||||||
| VP MEDICAL AFFAIRS | 40.00 | 1.00 | 165578 | 0 | 24508 | X | |||
| RONALD MANCHESTER | |||||||||
| VP SUPPORT SERVICES | 40.00 | 0.00 | 148757 | 0 | 18361 | X | |||
| ALYCE LEGG | |||||||||
| VP RESOURCE DEVELOPMENT | 40.00 | 0.00 | 140562 | 0 | 19962 | X | |||
| KARIN SCHWAN | |||||||||
| VP PATIENT CARE/CNO | 40.00 | 0.00 | 131689 | 0 | 27265 | X | |||
| JEFFREY COOK | |||||||||
| DIRECTOR PHARMACY | 40.00 | 0.00 | 121123 | 0 | 23348 | X | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 1439329 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 357290 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 229790 | TotalOtherCompensation |
| Number Individuals GT100 K | 14 | 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 |
|---|---|---|---|---|---|
| CERNER CORPORATION | |||||
| PO BOX 412702 | KANSAS CITY | MO | 64141 | IT SERVICES | 1304373 |
| SIEMENS MEDICAL SOLUTIONS USA | |||||
| C/O MELLON BANK PO BOX 120001 DEPT | DALLAS | TX | 753120733 | IT MANAGEMENT SERVICES | 1155247 |
| CARETECH SOLUTIONS | |||||
| PO BOX 764271 | DETROIT | MI | 482674271 | IT SERVICES | 1088941 |
| HMP OF ASHLAND | |||||
| PO BOX 645037 | CINCINNATI | OH | 452645037 | HOSPITALISTS | 984154 |
| ASHLAND ANESTHESIA PSC INC | |||||
| C/O COMPREHENSIVE MEDICAL MGMT 601 | NEWPORT | KY | 41070 | ANESTHESIA SERVICES | 976914 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 15 | NumberOfContractorsGT100K |
| Related Organizations | 1168127 | RelatedOrganizations |
| All Other Contributions | 130771 | AllOtherContributions |
| Noncash Contributions | 93853 | NoncashContributions |
| Total Contributions | 1298898 | TotalContributions |
Program Service Revenue ProgramServiceRevenue (2 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome |
|---|---|---|---|
| PATIENT SERVICES | 900099 | 73018832 | 73018832 |
| RENTS FROM AFFILIATE | 900099 | 125792 | 125792 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 73144624 | TotalProgramServiceRevenue |
Gross Rents GrossRents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 303537 | Real |
Less Rental Expenses LessRentalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 331627 | Real |
Rental Income Or Loss RentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | -28090 | Real |
Net Rental Income Or Loss NetRentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -28090 | TotalRevenueColumn |
| Exclusion | -$28,090 | ExclusionAmount |
Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | 42545 | Other |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | -42545 | Other |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -42545 | TotalRevenueColumn |
| Exclusion | -$42,545 | ExclusionAmount |
Other Revenue Misc OtherRevenueMisc (3 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Unrelated Business RevenueUnrelatedBusinessRevenue | ExclusionExclusionAmount |
|---|---|---|---|---|
| PHARMACY RETAIL | 446110 | 2170668 | 2170668 | |
| OTHER SERVICES- LAB | 621500 | 1176394 | 651 | $1,175,743 |
| ARRA INCENTIVE PAYMENTS | 621110 | 262574 | $262,574 |
Miscellaneous Revenue MiscellaneousRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 745806 | TotalRevenueColumn |
| Unrelated Business Revenue | 392877 | UnrelatedBusinessRevenue |
| Exclusion | $352,929 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 4355442 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 78728329 | TotalRevenueColumn |
| Related Or Exempt Function Income | 73144624 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 2564196 | UnrelatedBusinessRevenue |
| Exclusion | $1,720,611 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | X | InfoInScheduleOPartIX |
Grants To Domestic Individuals GrantsToDomesticIndividuals
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 40972 | Total |
| Program Services | 40972 | ProgramServices |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 566888 | Total |
| Program Services | 11000 | ProgramServices |
| Management And General | 555888 | ManagementAndGeneral |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 24515819 | Total |
| Program Services | 19612655 | ProgramServices |
| Management And General | 4903164 | ManagementAndGeneral |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1516102 | Total |
| Program Services | 1212882 | ProgramServices |
| Management And General | 303220 | ManagementAndGeneral |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 6795550 | Total |
| Program Services | 5436440 | ProgramServices |
| Management And General | 1359110 | ManagementAndGeneral |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1809209 | Total |
| Program Services | 1447367 | ProgramServices |
| Management And General | 361842 | ManagementAndGeneral |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 55967 | Total |
| Management And General | 55967 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 92200 | Total |
| Management And General | 92200 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 10037877 | Total |
| Program Services | 9928124 | ProgramServices |
| Management And General | 109753 | ManagementAndGeneral |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 46264 | Total |
| Program Services | 46264 | ProgramServices |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1340980 | Total |
| Program Services | 1079489 | ProgramServices |
| Management And General | 261491 | ManagementAndGeneral |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 175916 | Total |
| Program Services | 175916 | ProgramServices |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3060961 | Total |
| Program Services | 3060961 | ProgramServices |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 222070 | Total |
| Program Services | 177656 | ProgramServices |
| Management And General | 44414 | ManagementAndGeneral |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 432681 | Total |
| Program Services | 432681 | ProgramServices |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 6315335 | Total |
| Program Services | 6315335 | ProgramServices |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 583227 | Total |
| Program Services | 466582 | ProgramServices |
| Management And General | 116645 | ManagementAndGeneral |
Other Expenses OtherExpenses (4 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral |
|---|---|---|---|
| MEDICAL SUPPLIES | 14700937 | 14700937 | |
| PROVISION FOR BAD DEBTS | 3507707 | 3507707 | |
| OHIO FRANCHISE FEE | 1010000 | 1010000 | |
| EDUCATION PROGRAMS | 157992 | 157992 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 293460 | Total |
| Program Services | 293460 | ProgramServices |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 77278114 | Total |
| Program Services | 68104420 | ProgramServices |
| Management And General | 9173694 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3009771 | BOY |
| EOY | 14268323 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 17149461 | BOY |
| EOY | 9140377 | EOY |
Other Notes Loans Receivable Net OtherNotesLoansReceivableNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2322781 | BOY |
| EOY | 1606139 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1456549 | BOY |
| EOY | 1503288 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2559537 | BOY |
| EOY | 1923211 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 104445744 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 62358181 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 46239008 | BOY |
| EOY | 42087563 | EOY |
Investments Program Related InvestmentsProgramRelated
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 112207 | BOY |
| EOY | 59979 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2342010 | BOY |
| EOY | 2319356 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 75191324 | BOY |
| EOY | 72908236 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 8486076 | BOY |
| EOY | 7575230 | EOY |
Tax Exempt Bond Liabilities TaxExemptBondLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 17616323 | BOY |
| EOY | 16625246 | EOY |
Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 221321 | BOY |
| EOY | 170485 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2944642 | BOY |
| EOY | 4061320 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 29268362 | BOY |
| EOY | 28432281 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 45802010 | BOY |
| EOY | 44371927 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 120952 | BOY |
| EOY | 104028 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 45922962 | BOY |
| EOY | 44475955 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 75191324 | BOY |
| EOY | 72908236 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | 1450215 | ReconcilationRevenueExpenses |
| Reconciliation Unrealized Invest | 66783 | ReconciliationUnrealizedInvest |
| Reconcilation Other Changes | -2964003 | 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 |
FS Audited Basis FSAuditedBasis
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Statement Consolidated | X | FinancialStatementConsolidated |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | 1 | AuditCommittee |
| 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 | $6,292 | OtherActivitiesAmount |
| Total Lobbying Expenditures IIB | 6292 | 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 | MEMBERSHIP DUES IN THE AMOUNT OF $20,126 AND $27,659 WERE PAID TO THE AMERICAN HOSPITAL ASSOCIATION AND THE OHIO HOSPITAL ASSOCIATION, RESPECTIVELY. $4,826 AND $1,466 OF THE DUES PAYMENTS WERE FOR LOBBYING EXPENSES. | Explanation |
Schedule D IRS990ScheduleD
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 2346208 | OtherCostOrOtherBasis |
| Book Value | 2346208 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 17169160 | OtherCostOrOtherBasis |
| Depreciation | 7969807 | Depreciation |
| Book Value | 9199353 | BookValue |
Leasehold Improvements LeaseholdImprovements
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 2105226 | OtherCostOrOtherBasis |
| Depreciation | 1627783 | Depreciation |
| Book Value | 477443 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 41021159 | OtherCostOrOtherBasis |
| Depreciation | 29487983 | Depreciation |
| Book Value | 11533176 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 41803991 | OtherCostOrOtherBasis |
| Depreciation | 23272608 | Depreciation |
| Book Value | 18531383 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 42087563 | TotalOfBookValueLandBuildings |
Other Liabilities OtherLiabilities (2 entries)
| DescriptionDescription | AmountAmount |
|---|---|
| COST REPORT SETTLEMENT PAYABLE | $3,318,375 |
| INTEREST RATE SWAP | $742,945 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 4061320 | TotalOfAmounts |
| Footnote In Part XIII | X | FootnoteInPartXIII |
Form990 Schedule D Part XIII Form990ScheduleDPartXIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: | Identifier |
| Return Reference | PART X, LINE 2: | ReturnReference |
| Explanation | 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 DECEMBER 31, 2012, THERE ARE NO UNCERTAIN POSITIONS TAKEN OR EXPECTED TO BE TAKEN THAT WOULD REQUIRE RECOGNITION OF A LIABILTIY OR DISCLOSURE IN THE CONSOLIDATED FINANCIAL STATEMENTS. THE SYSTEM FILES FEDERAL AND STATE TAX RETURNS AND IS NO LONGER SUBJECT TO FEDERAL, STATE, OR LOCAL INCOME TAX EXAMINATIONS BY TAX AUTHORITIES FOR THE YEARS BEFORE FISCAL YEAR 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 |
| Pcent200 D | X | Pcent200D |
| Free Disc Care Medically Indigent | 1 | FreeDiscCareMedicallyIndigent |
| Amounts Budgeted For Charity Care | 1 | AmountsBudgetedForCharityCare |
| Expenses Exceeded Budget | 0 | ExpensesExceededBudget |
| Annual Community Benefit Report | 1 | AnnualCommunityBenefitReport |
| Report Publically Available | 1 | ReportPublicallyAvailable |
Charity Care At Cost CharityCareAtCost
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 2631528 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 769155 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 1862373 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.02430 | PercentOfTotalExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 7658765 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 4208758 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 3450007 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.04500 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 10290293 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 4977913 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 5312380 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.06930 | PercentOfTotalExpense |
Community Health Services CommunityHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 110479 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 4140 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 106339 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00140 | PercentOfTotalExpense |
Health Professions Education HealthProfessionsEducation
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 621 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 621 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00000 | PercentOfTotalExpense |
Cash And In Kind Contributions CashAndInKindContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 33163 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 33163 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00040 | PercentOfTotalExpense |
Total Other Benefits TotalOtherBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 144263 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 4140 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 140123 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00180 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 10434556 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 4982053 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 5452503 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.07110 | PercentOfTotalExpense |
Economic Development EconomicDevelopment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 320 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 320 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00000 | PercentOfTotalExpense |
Coalition Building CoalitionBuilding
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 1741 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 1741 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00000 | PercentOfTotalExpense |
Health Improvement Advocacy HealthImprovementAdvocacy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 12439 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 12439 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00020 | PercentOfTotalExpense |
Workforce Development WorkforceDevelopment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 88 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 88 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00000 | PercentOfTotalExpense |
Total Total
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 14588 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 14588 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00020 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 1 | BadDebtExpenseReported |
| Bad Debt Expense | $3,507,707 | BadDebtExpenseAmount |
| Amount Attributable To | 118789 | AmountAttributableTo |
| Amount Reimbursed By Medicare | 11353434 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 15052281 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | -3698847 | 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 |
| 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 | SAMARITAN HOSPITAL | BusinessNameLine1 |
Address Address
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1025 CENTER STREET | AddressLine1 |
| City | ASHLAND | City |
| State | OH | State |
| ZIP Code | 44805 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Licensed Hospital | X | LicensedHospital |
| General Medical And Surgical | X | GeneralMedicalAndSurgical |
| 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 | SAMARITAN REGIONAL HEALTH SYSTEM | 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 | 200.000000000000 | FPGFreePercent |
| Uses FPG Discounted | 1 | UsesFPGDiscounted |
| FPG Discount Percent | 200.000000000000 | FPGDiscountPercent |
| Explains Basis | 1 | ExplainsBasis |
| Income Level | X | IncomeLevel |
| Other Factors | X | OtherFactors |
| Explains Application Method | 1 | ExplainsApplicationMethod |
| Includes Publicity Measures | 1 | IncludesPublicityMeasures |
| Attached To Invoices | X | AttachedToInvoices |
| Posted In Emergency Room | X | PostedInEmergencyRoom |
| Provided On Admission | X | ProvidedOnAdmission |
| Available On Request | X | AvailableOnRequest |
| 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 | 7 | NumberOfOtherFacilities |
Other Facilities OtherFacilities (7 entries)
| Address Line1Address/AddressLine1 | CityAddress/City | StateAddress/State | ZIP CodeAddress/ZIPCode | Facility TypeFacilityType |
|---|---|---|---|---|
| SAMARITAN HEALTH & REHAB CENTER | ||||
| 2163 CLAREMONT AVENUE | ASHLAND | OH | 44805 | OUTPATIENT PHYS, OCC, SPEECH REHAB |
| KETTERING SAMARITAN HEALTH CENTER | ||||
| 546 NORTH UNION STREET | ASHLAND | OH | 44842 | OUTPATIENT ANCILLARY SVC |
| SAMARITAN PROFESSIONAL PARK | ||||
| 2212 MIFFLIN AVENUE | ASHLAND | OH | 44805 | OUTPATIENT ENDOSCOPY |
| SAMARITAN PROFESSIONAL PARK | ||||
| 2212 MIFFLIN AVENUE | ASHLAND | OH | 44805 | WOMEN'S HEALTH, OCC MEDICINE |
| SAMARITAN PROFESSIONAL PARK | ||||
| 2212 MIFFLIN AVENUE | ASHLAND | OH | 44805 | SLEEP LAB, PHYSICIAN OFFICES |
| SAMARITAN BANEY RD OUTPATIENT FACILITY | ||||
| 1941 BANEY ROAD | ASHLAND | OH | 44805 | OUTPATIENT ANCILLARY SVCS |
| SAMARITAN ADMINISTRATIVE BUILDING | ||||
| 663 EAST MAIN STREET | ASHLAND | OH | 44805 | ADMINISTRATIVE OFFICES |
Form990 Schedule H Part VI Form990ScheduleHPartVI (16 entries)
| ExplanationExplanation | IdentifierIdentifier | Return ReferenceReturnReference |
|---|---|---|
| PART I, LINE 3C: SAMARITAN'S POLICY INCLUDES FEDERAL POVERTY GUIDELINES TO DETERMINE ELIGIBILITY FOR CHARITY CARE. IN SOME CIRCUMSTANCES WHEN A PATIENT DOES NOT MEET THE CRITERIA, FURTHER DOCUMENTATION MAY BE REQUESTED (RELATED TO INCOME AND EXPENSES), AND THE CFO MAY GRANT A DISCOUNT AS A SPECIAL CIRCUMSTANCE. | ||
| PART I, LINE 7: CHARITY CARE AND MEDICAID COSTS WERE CALCULATED USING A COST TO CHARGE RATIO USING THE WORKSHEET 2 METHOD TO CALCULATE THE COST TO CHARGE RATIO. | ||
| PART I, LINE 7G: NOT APPLICABLE | ||
| 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 $ 3507707. | ||
| PART II: SAMARITAN PROVIDES A NUMBER OF FREE TO THE PUBLIC EDUCATIONAL SEMINARS RELATED TO VARIOUS HEALTHCARE TOPICS. THROUGH THESE EFFORTS THE PUBLIC IN OUR SERVICE AREA RELY ON SAMARITAN FOR BOTH INFORMATION AND THEN TREATMENT. | ||
| PART III, LINE 4: FINANCIAL STATEMENT FOOTNOTE: AN ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS IS ESTABLISHED ON AN AGGREGATE BASIS BY USING HISTORICAL WRITE-OFF 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 SYSTEM'S ABILITY TO COLLECT OUTSTANDING AMOUNTS. UNCOLLECTIBLE AMOUNTS ARE WRITTEN OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS IN THE PERIOD THEY ARE DETERMINED TO BE UNCOLLECTIBLE.THE BAD DEBT ESTIMATE ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE FINANCIAL ASSISTANCE POLICY WAS DETERMINED BY USING THE PERCENTAGE OF ACCOUNTS WRITTEN OFF TO BAD DEBT AND LATER REVERSED FROM BAD DEBT TO WRITE OFF AS A CHARITY ACCOUNT. THIS PERCENTAGE WAS APPLIED TO ALL BAD DEBT WRITE OFFS, THEN THE COST TO CHARGE RATIO APPLIED. | ||
| PART III, LINE 8: SAMARITAN IS CLASSIFIED AS A MEDICARE DEPENDANT HOSPITAL. IN ORDER TO GAIN THIS CLASSIFICATION, SAMARITAN HAS TO DOCUMENT MEDICARE VOLUME OVER A ROLLING 3 YEAR PERIOD. DURING THAT PERIOD, THE MEDICARE INPATIENT VOLUME MUST BE A MINIMUM OF 60% OF THE TOTAL INPATIENT VOLUME FOR 2 OF THE 3 YEARS. SAMARITAN CONTINUES TO QUALIFY FOR THIS DESIGNATION. BASED ON A COST TO CHARGE RATIO, THE COSTS OF PROVIDING CARE TO THE MEDICARE POPULATION IN 2012 WAS $15,052,281. THE PAYMENTS RELATED TO THESE SERVICES WERE $11,353,434. LEAVING A MEDICARE SHORTFALL OF $3,698,847 FOR THE YEAR. | ||
| PART III, LINE 9B: PATIENTS RECEIVE 3 STATEMENTS FOR SELF PAY BALANCES. FOR BALANCES GREATER THAN $200, ONE ATTEMPT IS MADE TO CALL THE PATIENT TO MAKE PAYMENT ARRANGEMENTS. | ||
| PART V, SECTION B, LINE 12H: FAMILY SIZE IS USED TO DETERMINE CHARGES TO PATIENTS | SAMARITAN REGIONAL HEALTH SYSTEM | |
| PART V, SECTION B, LINE 20D: ALL SELF PAY PATIENTS ARE BILLED GROSS CHARGES UNTIL THEY INDICATE AN INABILITY TO PAY. THEY MAY THEN APPLY FOR FINANCIAL ASSISTANCE AND IF THEY MEET THE CRITERIA IN THE POLICY THEIR BILL IS DISCOUNTED OR WRITTEN OFF ENTIRELY. | SAMARITAN REGIONAL HEALTH SYSTEM | |
| PART VI, LINE 2: THE ORGANIZATION IS IN THE PROCESS OF DEVELOPING A SURVEY TOOL TO ASSESS COMMUNITY HEALTH NEEDS ALONG WITH FOCUS GROUPS FROM A CROSS SECTION OF COMMUNITY MEMBERS AND KEY STAKEHOLDERS. WE WILL ALSO COLLABORATE WITH OTHER NON-PROFIT AGENCIES WHO CONDUCT SIMILAR STUDIES AND VIEW THEIR FINDINGS USEFUL AND PRACTICAL. OUR OCCUPATIONAL MEDICINE PROGRAM SERVES INDUSTRY AND FUNCTIONS AS A "LISTENING POST" TO GATHER INPUT FROM OUR BUSINESS COMMUNITY. | ||
| PART VI, LINE 3: INFORMATION RELATED TO THE CHARITY PROGRAM AT SAMARITAN IS PROVIDED IN A NUMBER OF WAYS. BROCHURES ARE PROVIDED AT EACH POINT OF ADMISSION ALONG WITH THE PUBLICLY POSTED INFORMATION NOTICES. EACH STATEMENT SENT LISTS THE FEDERAL POVERTY GUIDELINES AND WHAT INFORMATION IS NEEDED TO QUALIFY. AN APPLICATION FOR FREE CARE IS ON THE BACK OF EACH STATEMENT SENT TO PATIENTS. | ||
| PART VI, LINE 4: SAMARITAN REGIONAL HEALTH SYSTEM DEFINES ASHLAND COUNTY AND THE 10 ZIP CODES THAT COMPRISE IT AS OUR PRIMARY SERVICE AREA (PSA). FURTHER, WE INCLUDE AT LEAST ONE ZIP CODE FROM EACH OF THE 5 CONTIGUOUS COUNTIES WITHIN OUR PSA. OUR PSA IS PRIMARILY RURAL WITH GREATER THAN 50% OF THE POPULATION LIVING IN THE 44805 ZIP CODE AREA. AS A COMMUNITY HOSPITAL WE MEET A BROAD RANGE OF NEEDS FOR A COMMUNITY THAT IS DIVERSE IN AGE AND SOCIO ECONOMIC MAKE-UP. OUR COMMUNITY INCLUDES A LARGE AMISH POPULATION AND A DEMOGRAPHIC THAT HAS BEEN SEVERLY IMPACTED BY THE ECONOMIC DOWNTURN DUE TO THE DECLINE IN MANUFACTURING BASE OVER THE PAST SEVERAL YEARS. | ||
| PART VI, LINE 5: SAMARITAN REGIONAL HEALTH SYSTEM IS VIEWED AS THE LEADER IN THE COMMUNITY FOR PROVIDING INFORMATION THAT LEADS TO EARLY TREATMENT AND BETTER OUTCOMES WITH LOWER ASSOCIATED COSTS. SAMARITAN HAS AN EFFECTIVE EDUCATIONAL PROGRAM (FREE OF CHARGE) THAT GATHERS DIRECT INPUT AS TO THE NEEDS AND CONCERNS OF THE COMMUNITY. | ||
| PART VI, LINE 6: SAMARITAN REGIONAL HEALTH SYSTEM IS A GENERAL ACUTE-CARE FACILITY LOCATED IN ASHLAND, OHIO WHERE IT OPERATES FOUR MEDICAL OFFICE BUILDINGS, AN OUTPATIENT CLINIC, AN OFFSITE REHAB FACILITY, AND AN ADMINISTRATIVE OFFICE BUILDING. SRHS IS THE PARENT ORGANIZATION OF SAMARITAN PROFESSIONAL CORPORATION AND THE SOLE BENEFICIARY OF SAMARITAN HOSPITAL FOUNDATION.SAMARITAN PROFESSIONAL CORPORATION CONTINUED ITS MISSION TO RETAIN QUALITY PHYSICIANS AND EXPAND SERVICES IN THE COMMUNITY. THE STRUCTURE OF THE ORGANIZATION ENABLED THE PHYSICIANS TO CONTINUE THEIR OPERATIONS AND TO ENHANCE SERVICES PROVIDED BY THE LOCAL HEALTHCARE NETWORK.SAMARITAN HOSPITAL FOUNDATION PROVIDES A PROVISION OF FUNDRAISING AND ASSET MANAGEMENT IN SUPPORT OF SAMARITAN REGIONAL HEALTH SYSTEM. | ||
| OH | REPORTS FILED WITH STATES | PART VI, LINE 7 |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Records Maintained | 1 | RecordsMaintained |
Form990 Schedule I Part III Form990ScheduleIPartIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Type Of Grant | MEDICAL FINANCIAL ASSISTANCE | TypeOfGrant |
| Number Of Recipients | 17 | NumberOfRecipients |
| Amount Of Cash Grant | 40972 | AmountOfCashGrant |
Form990 Schedule I Part IV Form990ScheduleIPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | PROCEDURE FOR MONITORING GRANTS IN THE U.S.: | Identifier |
| Return Reference | PART I, LINE 2: | ReturnReference |
| Explanation | SCHEDULE I, PART I, LINE 2: SAMARITAN REGIONAL HEALTH SYSTEM MAKES CONTRIBUTIONS IN SUPPORT OF ITS RELATED PARTIES AS WELL AS ORGANIZATIONS WITHIN THE COMMUNITY. WHEN A PATIENT APPLIES FOR FINANCIAL ASSISTANCE, THE FINANCIAL COUNSELOR FOLLOWS THE FINANCIAL ASSISTANCE POLICY. IF THE PATIENT IS OVER INCOME GUIDELINES AND MAY NOT BE ABLE TO RETURN TO WORK DUE TO THE ILLNESS, THE FINANCIAL COUNSELOR WRITES AN EXCEPTION LETTER EXPLAINING THE PATIENT'S CIRCUMSTANCES. THIS LETTER IS ATTACHED TO THE SUPPORTING PAPERWORK AND FORWARDED TO THE CFO FOR APPROVAL. AN E-MAIL IS SENT TO THE FOUNDATION OFFICE EXPLAINING THE PATIENT'S CIRCUMSTANCES WITHOUT GIVING PERSONAL INFORMATION. THE OFFICE MAINTAINS A LOG OF ACCOUNTS WRITTEN OFF USING FOUNDATION FUNDS. | Explanation |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Travel For Companions | X | TravelForCompanions |
| Club Dues Or Fees | X | ClubDuesOrFees |
| Written Policy Re T And E Expenses | 1 | WrittenPolicyReTAndEExpenses |
| Substantiation Required | 1 | SubstantiationRequired |
| Compensation Committee | X | CompensationCommittee |
| Independent Consultant | X | IndependentConsultant |
| Written Employment Contract | X | WrittenEmploymentContract |
| Compensation Survey | X | CompensationSurvey |
| Board Or Committee Approval | X | BoardOrCommitteeApproval |
| 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 (8 entries)
| TitleTitle | 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| DANNY L BOGGS | ||||||||||||||
| PRESIDENT/CEO | 332046 | 0 | 47582 | 0 | 7519 | 0 | 29100 | 0 | 5879 | 0 | 422126 | 0 | 0 | 0 |
| MARY MACDONALD MD | ||||||||||||||
| MEDICAL STAFF PRESIDENT | 0 | 329261 | 0 | 11000 | 0 | 17029 | 0 | 29100 | 0 | 12918 | 0 | 399308 | 0 | 0 |
| MARY L GRIEST | ||||||||||||||
| VP FINANCE/CFO | 162856 | 0 | 9127 | 0 | 2939 | 0 | 18895 | 0 | 4812 | 0 | 198629 | 0 | 0 | 0 |
| CHRISTOPHER HUNT | ||||||||||||||
| VP CLINICAL SERVICES | 139140 | 0 | 7216 | 0 | 9895 | 0 | 15642 | 0 | 0 | 0 | 171893 | 0 | 0 | 0 |
| PHILIP MYERS MD | ||||||||||||||
| VP MEDICAL AFFAIRS | 160778 | 0 | 4800 | 0 | 0 | 0 | 18629 | 0 | 5879 | 0 | 190086 | 0 | 0 | 0 |
| RONALD MANCHESTER | ||||||||||||||
| VP SUPPORT SERVICES | 133321 | 0 | 7034 | 0 | 8402 | 0 | 15177 | 0 | 3184 | 0 | 167118 | 0 | 0 | 0 |
| ALYCE LEGG | ||||||||||||||
| VP RESOURCE DEVELOPMENT | 131192 | 0 | 7532 | 0 | 1838 | 0 | 14981 | 0 | 4981 | 0 | 160524 | 0 | 0 | 0 |
| KARIN SCHWAN | ||||||||||||||
| VP PATIENT CARE/CNO | 123442 | 0 | 7095 | 0 | 1152 | 0 | 14347 | 0 | 12918 | 0 | 158954 | 0 | 0 | 0 |
Form990 Schedule J Part III Form990ScheduleJPartIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Reference | PART I, LINE 1A | ReturnReference |
| Explanation | AIRFARE OF $538 FOR THE CEO'S SPOUSE IS REPORTED ON FORM W2, BOX 5. THE PRESIDENT/CEO RECEIVES HEALTH/SOCIAL CLUB DUES WHICH ARE NON TAXABLE. THE HOSPITAL IS REIMBURSED FOR ANY PERSONAL USE. | Explanation |
Schedule K IRS990ScheduleK
Form990 Schedule K Part I Form990ScheduleKPartI (3 entries)
| Bond ReferenceBondReferenceCd | Issuer EINIssuerEIN | Date IssuedDateIssued | Issue PriceIssuePrice | Description Of PurposeDescriptionOfPurpose | DefeasedDefeased | On Behalf Of IssuerOnBehalfOfIssuer | Pool FinancingPoolFinancing |
|---|---|---|---|---|---|---|---|
| COUNTY OF ASHLAND OHIO | |||||||
| A | 346000122 | 2008-12-19 | 9500000 | ED & OB BUILDING & STRUCTURE RENOVATION & IMPROVEMENTS; EQUIPMENT | 1 | 0 | 0 |
| COUNTY OF ASHLAND OHIO | |||||||
| B | 346000122 | 2009-01-09 | 4495023 | REFUND PRIOR ISSUE | 1 | 0 | 0 |
| COUNTY OF ASHLAND OHIO | |||||||
| C | 346000122 | 2009-01-27 | 6004977 | BUILDING & STRUCTURE RENOVATION; EQUIPMENT | 1 | 0 | 0 |
Form990 Schedule K Part II Form990ScheduleKPartII (3 entries)
| Bond ReferenceBondReferenceCd | Amount RetiredAmountRetired | Total ProceedsTotalProceeds | Issuance Costs From ProceedsIssuanceCostsFromProceeds | Working Capital ExpendituresWorkingCapitalExpenditures | Capital ExpendituresCapitalExpenditures | Year Of Subst CompletionYearOfSubstCompletion | Current RefundingCurrentRefunding | Advance RefundingAdvanceRefunding | Final Allocation MadeFinalAllocationMade | Adequate Books And Recds MaintaindAdequateBooksAndRecdsMaintaind | Refunding EscrowRefundingEscrow |
|---|---|---|---|---|---|---|---|---|---|---|---|
| A | 1602959 | 9665616 | 119942 | 1744 | 9543930 | 2010 | 0 | 0 | 1 | 1 | |
| B | 751923 | 4495023 | 4495023 | 2006 | 1 | 0 | 1 | 1 | 4495023 | ||
| C | 1019872 | 6208273 | 41424 | 57 | 6166792 | 2011 | 0 | 0 | 1 | 1 |
Form990 Schedule K Part III Form990ScheduleKPartIII (3 entries)
| Bond ReferenceBondReferenceCd | Owning Bond Financed PropertyOwningBondFinancedProperty | Any Lease ArrangementsAnyLeaseArrangements | Mngment Cntrct Bond Financd PrprtyMngmentCntrctBondFinancdPrprty | Any Research AgreementsAnyResearchAgreements | Prcntge Prvt Business Use By OthersPrcntgePrvtBusinessUseByOthers | Percentage Of Prvt Business Re UBIPercentageOfPrvtBusinessReUBI | Total Private Business UseTotalPrivateBusinessUse | Bond Iss Meet Prvt Security Pay TestBondIssMeetPrvtSecurityPayTest | Change In Use Bond Financed PropChangeInUseBondFinancedProp | Non Qualified Bond Remed ProcdrsNonQualifiedBondRemedProcdrs |
|---|---|---|---|---|---|---|---|---|---|---|
| A | 0 | 0 | 0 | 0 | 0.00000 | 0.00000 | 0.00000 | 0 | 0 | 1 |
| B | 0 | 0 | 0 | 0 | 0.00000 | 0.00000 | 0.00000 | 0 | 0 | 1 |
| C | 0 | 0 | 0 | 0 | 0.00000 | 0.00000 | 0.00000 | 0 | 0 | 1 |
Form990 Schedule K Part IV Form990ScheduleKPartIV (3 entries)
| Bond ReferenceBondReferenceCd | Form8038 T FiledForm8038TFiled | Rebate Not Due YetRebateNotDueYet | Exception To RebateExceptionToRebate | No Rebate DueNoRebateDue | Variable Rate IssueVariableRateIssue | Hedge Identified In Books And RecdsHedgeIdentifiedInBooksAndRecds | Term Of HedgeTermOfHedge | Superintegrated HedgeSuperintegratedHedge | Hedge TerminatedHedgeTerminated | Gross Proceeds Invested In GICGrossProceedsInvestedInGIC | Gross Proceeds InvestedGrossProceedsInvested | Written Proc To Monitor ReqsWrittenProcToMonitorReqs |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| FIFTH THIRD BANK | ||||||||||||
| A | 0 | 0 | 0 | 0 | 1 | 1 | 6.900000000000 | 0 | 0 | 0 | 0 | 0 |
| FIFTH THIRD BANK | ||||||||||||
| B | 0 | 0 | 1 | 0 | 1 | 1 | 6.900000000000 | 0 | 0 | 0 | 0 | 0 |
| FIFTH THIRD BANK | ||||||||||||
| C | 0 | 0 | 0 | 0 | 1 | 1 | 6.900000000000 | 0 | 0 | 0 | 0 | 0 |
Schedule M IRS990ScheduleM
Other Non Cash Contributions Table OtherNonCashContributionsTable
| Field | Value | IRS element (for citing) |
|---|---|---|
| Non Cash Checkbox | X | NonCashCheckbox |
| Description | EQUIPMENT | Description |
| Number Of Contributions | 3 | NumberOfContributions |
| Noncash Contribs Rptd F990 | 93853 | NoncashContribsRptdF990 |
| Method Of Determining Revenues | COST OF THE EQUIPMENT | MethodOfDeterminingRevenues |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Any Property That Must Be Held | 0 | AnyPropertyThatMustBeHeld |
| Review Process Unusual NC Gifts | 0 | ReviewProcessUnusualNCGifts |
| Third Parties Used | 0 | ThirdPartiesUsed |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (10 entries)
| Return ReferenceReturnReference | ExplanationExplanation | IdentifierIdentifier |
|---|---|---|
| FORM 990, PART VI, SECTION B, LINE 11 | THE CFO REVIEWS THE 990 PRIOR TO FILING. THE 990 IS REVIEWED AT THE BOARD OF DIRECTORS MEETING WITH SUFFICIENT TIME TO MAKE ANY AND ALL INQUIRIES REGARDING THE INFORMATION CONTAINED THEREIN. A COPY OF THE FORM 990 IS AVAILABLE TO EACH BOARD MEMBER BEFORE IT IS FILED. | |
| FORM 990, PART VI, SECTION B, LINE 12C | BOARD MEMBERS AND KEY EMPLOYEES ARE REQUIRED TO SIGN A DISCLOSURE OF POTENTIAL CONFLICT OF INTEREST & CONFIDENTIALITY OF INFORMATION AGREEMENT ANNUALLY OR WHEN THEY FIRST JOIN. THE FORMS ARE SENT FROM THE CEO'S OFFICE AND ARE MAINTAINED THERE UPON COMPLETION. SHOULD A CONFLICT OF INTEREST ARISE, A BOARD MEMBER MAY RESIGN FROM THE BOARD DEPENDING ON THE LEVEL OF CONFLICT. IN ADDITION, THE BOARD MEMBER WILL ABSTAIN FROM VOTING AND IF APPROPRIATE WILL BE EXCUSED FROM THE BOARD MEETING DURING THE DISCUSSION REGARDING A POTENTIAL CONFLICT. | |
| FORM 990, PART VI, SECTION B, LINE 15 | EVERY TWO YEARS, SINCE 2004, AN INDEPENDENT CONSULTANT PERFORMS A MARKET ANALYSIS OF THE SENIOR LEADERSHIP POSITIONS USING THE RESULTS OF AT LEAST THREE INDEPENDENT WAGE SURVEYS. THEIR REPORT IS USED TO DEVELOP/REVISE WAGE RANGES FOR ALL LEADERSHIP POSITIONS. THE INFORMATION IS THEN PRESENTED TO THE EXECUTIVE COMMITTEE OF THE BOARD OF DIRECTORS FOR THEIR APPROVAL. DECISIONS REGARDING THE CEO'S COMPENSATION ARE DOCUMENTED IN THE BOARD OF DIRECTOR MINUTES WHEN IT IS APPROVED AS WELL AS A NOTIFICATION THAT IS KEPT IN THE CEO'S FILE. IN THE FALL OF 2010 THE SCOPE WAS EXPANDED AND ALL MANAGEMENT POSITIONS WERE REVIEWED. THE PROCESS FOR DETERMINING COMPENSATION OF THE ORGANIZATION'S CEO AND OFFICERS WAS LAST UNDERTAKEN DURING 2010. THE LAST FULL REVIEW OF SENIOR LEADERSHIP AND DEPARTMENT DIRECTORS WAS COMPLETED IN NOVEMBER 2010 FOR THE APRIL 2011 WAGE CYCLE. THE SAME DATA WAS USED FOR WAGE DECISIONS IN 2012. | |
| FORM 990, PART VI, SECTION C, LINE 18 | THE ORGANIZATION MAKES ITS FORM 1023, FORM 990, AND FORM 990-T AVAILABLE TO THE PUBLIC 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 IX, LINE 11G | CONTRACT SERVICES- MEDICAL: PROGRAM SERVICE EXPENSES 6,108,933. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 6,108,933. CONTRACT SERVICES- NON PATIENT: PROGRAM SERVICE EXPENSES 3,500,543. MANAGEMENT AND GENERAL EXPENSES 108,264. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,608,807. WASTE MANAGEMENT: PROGRAM SERVICE EXPENSES 48,134. MANAGEMENT AND GENERAL EXPENSES 1,489. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 49,623. COLLECTION FEES: PROGRAM SERVICE EXPENSES 270,514. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 270,514. | OTHER FEES |
| FORM 990, PART XI, LINE 9: | INTERCOMPANY EQUITY TRANSFERS -3,047,807. NET ASSETS RELEASED FROM RESTRICTION 83,804. | CHANGES IN NET ASSETS OR FUND BALANCES: |
| FORM 990, PAGE 12, PART XII, LINE 2C | THE BOARD OF DIRECTORS ASSUMES RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT AND SELECTION OF THE INDEPENDENT ACCOUNTANT. THIS PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. | |
| FORM 990, PAGE 1, PART I, LINE C | DOING BUSINESS AS: SAMARITAN HOSPITAL PEOPLES HOSPITAL | |
| FORM 990, PAGE 2, PART III, LINE 4A | SAMARITAN REGIONAL HEALTH SYSTEM PROVIDES QUALITY MEDICAL HEALTHCARE SERVICES AND EDUCATION REGARDLESS OF RACE, CREED, SEX, NATIONAL ORIGIN, HANDICAP, AGE, OR ABILITY TO PAY. THE HOSPITAL PROVIDES CARE TO PERSONS COVERED BY GOVERNMENTAL PROGRAMS. SERVICES PROVIDED TO MEDICARE AND MEDICAID PATIENTS ARE SOMETIMES PROVIDED BELOW COST. TO THE EXTENT REIMBURSEMENT IS BELOW COST, THE HOSPITAL RECOGNIZES THESE AMOUNTS AS CHARITY CARE. CHARITY CARE IS ALSO PROVIDED THROUGHOUT THE YEAR BASED UPON ACTIVITIES AND SERVICES WHICH THE HOSPITAL BELIEVES WILL SERVE A BONA FIDE COMMUNITY HEALTH NEED. CHARITY CARE FOR 2012 WAS VALUED AT $2,460,000. DURING 2012, THE HOSPITAL ALSO PROVIDED NUMEROUS OUTREACH PROGRAMS WHICH SERVE AND EDUCATE THE COMMUNITY. PROGRAM - NET EXPENSE - PERSONS SERVED: COMMUNITY HEALTH IMPROVEMENT SERVICES - $96,065 - 1,411 HEALTH PROFESSIONS EDUCATION - $621 - 16 SUBSIDIZED HEALTH SERVICES - $4,196,400 - UNKNOWN FINANCIAL AND IN-KIND CONTRIBUTIONS - $33,163 - 1,183 COMMUNITY BUILDING ACTIVITIES - $14,588 - UNKNOWN COMMUNITY BENEFIT OPERATIONS - $14,414 - UNKNOWN |
Schedule R IRS990ScheduleR
Form990 Schedule R Part II Form990ScheduleRPartII (2 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 |
|---|---|---|---|---|---|---|---|---|---|---|
| SAMARITAN PROFESSIONAL CORPORATION | ||||||||||
| 1025 CENTER STREET | ASHLAND | OH | 44805 | 341856531 | PHYSICIAN BASED HEALTH SERVICES | OH | 501(C)(3) | 3 | SAMARITAN REGIONAL HEALTH SYSTEM | 1 |
| SAMARITAN HOSPITAL FOUNDATION | ||||||||||
| 663 EAST MAIN STREET | ASHLAND | OH | 44805 | 341783215 | FUNDRAISING AND ASSET MANAGEMENT | OH | 501(C)(3) | 11A | SAMARITAN REGIONAL HEALTH SYSTEM | 1 |
| 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 | 1 | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | 0 | LoansOrGuaranteesFromOtherOrg |
| Dividends Related Organization | 0 | DividendsRelatedOrganization |
| 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 | 1 | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | 1 | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | 0 | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | 0 | SharingOfFacilities |
| Sharing Of Paid Employees | 1 | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | 1 | OtherTransferToOtherOrg |
| Other Transfer From Other Org | 1 | OtherTransferFromOtherOrg |
Transactions Related Orgs Table TransactionsRelatedOrgsTable (7 entries)
| Transaction TypeTransactionType | Amount InvolvedAmountInvolved | Method Of Amt DeterminationMethodOfAmtDetermination |
|---|---|---|
| SAMARITAN PROFESSIONAL CORPORATION | ||
| A | 323410 | ACTUAL RENT RECORDED |
| SAMARITAN PROFESSIONAL CORPORATION | ||
| S | 2763949 | CASH VALUE |
| SAMARITAN HOSPITAL FOUNDATION | ||
| C | 1168127 | ACTUAL CONTRIBUTIONS RECEIVED |
| SAMARITAN HOSPITAL FOUNDATION | ||
| K | 228500 | ACTUAL LEASE PAYMENT |
| SAMARITAN PROFESSIONAL CORPORATION | ||
| L | 304873 | ACTUAL PAYROLL PAYMENT |
| SAMARITAN PROFESSIONAL CORPORATION | ||
| O | 98873 | PAYROLL |
| SAMARITAN HOSPITAL FOUNDATION | ||
| S | 283858 | CASH VALUE |