MCCULLOUGH-HYDE MEMORIAL HOSPITAL ENDOWMENT FUND: Form 990, tax year 2012
View the entire original 990 at ProPublica ↗
- Organization
- MCCULLOUGH-HYDE MEMORIAL HOSPITAL ENDOWMENT FUND (EIN 23-7374256)
- Tax period
- 2012-01-01 to 2012-12-31
- Filed
- 2013-11-12
- IRS object ID
- 201343169349304034
- 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 ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2013-11-12T14:27:56-06:00 | Timestamp |
| Tax Period End Date | 2012-12-31 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 351178661 | EIN |
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BLUE & CO LLC | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 8800 LYRA DRIVE SUITE 450 | AddressLine1 |
| City | COLUMBUS | City |
| State | OH | State |
| ZIP Code | 43240 | 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 | 237374256 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MCCULLOUGH-HYDE MEMORIAL HOSPITAL ENDOWMENT FUND | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | MCCU | NameControl |
| Phone | 5135245310 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 110 NORTH POPLAR | AddressLine1 |
| City | OXFORD | City |
| State | OH | State |
| ZIP Code | 45056 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | JOHN CLEMENTS | Name |
| Title | CFO | Title |
| Phone | 5135245310 | Phone |
| Date Signed | 2013-11-12 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | NANCY KIRCHNER | Name |
| PTIN | P00386751 | PTIN |
| Phone | 6148852583 | Phone |
| Date Prepared | 2013-11-12 | DatePrepared |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2012 | TaxYear |
| Build TS | 2016-03-07 17:11:31Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | JOHN CLEMENTS | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 110 NORTH POPLAR STREET | AddressLine1 |
| City | OXFORD | City |
| State | OH | State |
| ZIP Code | 45056 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 622302 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | WWW.MHMH.ORG | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1942 | YearFormation |
| State Legal Domicile | OH | StateLegalDomicile |
| Activity Or Mission Description | TO SUPPORT HEALTH, EDUCATIONAL, AND BUILDING PROGRAMS OF MCCULLOUGH-HYDE MEMORIAL HOSPITAL | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 10 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 10 | NbrIndependentVotingMembers |
| Total Nbr Employees | 0 | TotalNbrEmployees |
| Total Nbr Volunteers | 0 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 296717 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 185162 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 0 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 0 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 380590 | InvestmentIncomePriorYear |
| Investment Income Current Year | 351847 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 70895 | OtherRevenuePriorYear |
| Other Revenue Current Year | 10662 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 748202 | TotalRevenuePriorYear |
| Total Revenue Current Year | 547671 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 15575 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 310728 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 0 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 0 | 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 | 547170 | OtherExpensePriorYear |
| Other Expenses Current Year | 104878 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 562745 | TotalExpensesPriorYear |
| Total Expenses Current Year | 415606 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 185457 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 132065 | RevenuesLessExpensesCY |
| Total Assets BOY | 10167153 | TotalAssetsBOY |
| Total Assets EOY | 11256494 | TotalAssetsEOY |
| Total Liabilities BOY | 1701503 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 1936390 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 8465650 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 9320104 | NetAssetsOrFundBalancesEOY |
| Mission Description | SUPPORT THE HOSPITAL WITH HEALTH PROGRAMS, EDUCATION ASSISTANCE, BUILDING AND EQUIPMENT NEEDS | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 129605 | Expense |
| Grants | 129605 | Grants |
| Description | DEVELOPMENT OFFICE SUPPORT:THE TRUST PROVIDES SUPPORT FOR THE HOSPITAL DEVELOPMENT DEPARTMENTTHAT ACTS AS A LIASON BETWEEN THE HOSPITAL AND THE DONOR COMMUNITY.EFFORTS OF THIS OFFICE OVER THE YEARS HAS PRODUCED AN ENDOWMENT OF APPROX $8 MILLION IN UNRESTRICTED CONTRIBUTIONS AND $2 MILLION IN DESIGNATED GIFTS. | Description |
Activity2 Activity2
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | 122242 | Expense |
| Grants | 122242 | Grants |
| Description | CAPITAL EQUIPMENT SUPPORT:FUNDED ALL OR PART OF 9 EQUIPMENT PURCHASES FOR DEPARTMENTS INCLUDINGONCOLOGY CLINIC, OBSTETRICS, CRITICAL CARE, MEDICAL-SURGICIAL NURSING,LAB, NUTRITION SERVICES, RESPIRATORY THERAPY, VOLUNTEER SERVICES AND INFORMATION TECHNOLOGY (SYSTEM-WIDE ELECTRONIC PHYSICIAN ORDER ENTRY SYSTEM) | Description |
Activity3 Activity3
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | 58881 | Expense |
| Grants | 58881 | Grants |
| Description | EDUCATION SUPPORT:FUNDED ALL OR PART OF 27 EDUCATIONAL ACTIVITIES INCLUDING THREE FOR HEALTHCAREER ADVANCEMENT, 13 RELATED TO CLINICIAL SKILLS DEVELOPMENT AND 11RELATED TO ADMINISTRATIVE AND SUPPORT DEPARTMENT PROFESSIONAL DEVELOPMENT. | Description |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Expense | 310728 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 1 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 0 | LobbyingActivities |
| Subject To Proxy Tax | 0 | SubjectToProxyTax |
| Donor Advised Funds | 1 | DonorAdvisedFunds |
| Conservation Easements | 0 | ConservationEasements |
| Collections Of Art | 0 | CollectionsOfArt |
| Credit Counseling | 0 | CreditCounseling |
| Term Or Permanent Endowments | 1 | TermOrPermanentEndowments |
| Report Land Bldg Equip | 1 | ReportLandBldgEquip |
| Report Invest Oth Securities | 0 | ReportInvestOthSecurities |
| Report Prog Rel Invest | 0 | ReportProgRelInvest |
| Report Other Assets | 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 | 0 | Hospital |
| Grants To Organizations | 1 | GrantsToOrganizations |
| Grants To Individuals | 0 | GrantsToIndividuals |
| Schedule J Required | 1 | ScheduleJRequired |
| Tax Exempt Bonds | 0 | TaxExemptBonds |
| 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 | 0 | DeductibleNonCashContributions |
| Deductible Contributions Of Art | 0 | DeductibleContributionsOfArt |
| Terminated | 0 | Terminated |
| Partial Liquidation | 0 | PartialLiquidation |
| Disregarded Entity | 0 | DisregardedEntity |
| Related Entity | 1 | RelatedEntity |
| Related Org Controlled Entity | 0 | RelatedOrgControlledEntity |
| Transfers To Exempt Non Chrtbl Org | 0 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 3 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | 1 | ComplianceWithBackupWitholding |
| Number Of Employees | 0 | 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 | 10 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 10 | 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 | 0 | CompensationProcessCEO |
| Compensation Process Other | 0 | 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
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Person | JAMES MILLER CONTROLLER | NamePerson |
| Telephone Number | 5135245310 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 110 NORTH POPLAR STREET | AddressLine1 |
| City | OXFORD | City |
| State | OH | State |
| ZIP Code | 45056 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionA (19 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | OfficerOfficer | Highest Compensated EmployeeHighestCompensatedEmployee |
|---|---|---|---|---|---|---|---|
| JOHN HARLAND MD | |||||||
| VICE CHAIRMAN | 1.00 | X | 0 | 0 | 0 | ||
| SUSAN CROSS LIPNICKEY | |||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | ||
| JACK MANN | |||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | ||
| RICHARD M NORMAN | |||||||
| CHAIRMAN | 1.00 | X | 0 | 0 | 0 | ||
| ALAN OAK | |||||||
| SECRETARY-TREASURER | 1.00 | X | 0 | 0 | 0 | ||
| STEPHEN FLEE | |||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | ||
| WILLIAM DOUGLAS ROSS DO | |||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | ||
| THOMAS W SPEH | |||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | ||
| RALPH GUTOWSKI | |||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | ||
| PAIGE WOOD | |||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | ||
| BRYAN HEHEMANN | |||||||
| PRESIDENT AND CEO | 40.00 | 0 | 206743 | 21438 | X | ||
| JOHN CLEMENTS | |||||||
| VICE PRESIDENT AND CFO | 40.00 | 0 | 142936 | 11197 | X | ||
| PAMELA COLLINS | |||||||
| VICE PRESIDENT AND CHIEF PATIENT SERVICES OFFICER | 40.00 | 0 | 127845 | 9934 | X | ||
| TAMMY LANGDON | |||||||
| VICE PRESIDENT AND CHIEF ADMINISTRATIVE OFFICER | 40.00 | 0 | 120232 | 20954 | X | ||
| KENNETH KELLER | |||||||
| PHYSICIAN | 40.00 | 0 | 246835 | 1389 | X | ||
| MATTHEW BIRKLE | |||||||
| PHYSICIAN | 40.00 | 0 | 195226 | 1099 | X | ||
| MARK CRISTELL | |||||||
| PT DIRECTOR | 40.00 | 0 | 135452 | 21039 | X | ||
| MATTHEW DAGGY | |||||||
| PHYSICIAN | 40.00 | 0 | 237090 | 1335 | X | ||
| MARY BROWN | |||||||
| DIRECTOR OF IMAGING SERVICES | 40.00 | 0 | 113753 | 20430 | X | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 0 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 1526112 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 108815 | TotalOtherCompensation |
| Number Individuals GT100 K | 0 | NumberIndividualsGT100K |
| Formers Listed | 0 | FormersListed |
| Total Comp GT150 K | 1 | TotalCompGT150K |
| Compensation From Other Sources | 0 | CompensationFromOtherSources |
| Number Of Contractors GT100 K | 0 | NumberOfContractorsGT100K |
| All Other Contributions | 185162 | AllOtherContributions |
| Total Contributions | 185162 | TotalContributions |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 195508 | TotalRevenueColumn |
| Exclusion | $195,508 | ExclusionAmount |
Gross Rents GrossRents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 85293 | Real |
Less Rental Expenses LessRentalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 74631 | Real |
Rental Income Or Loss RentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 10662 | Real |
Net Rental Income Or Loss NetRentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 10662 | TotalRevenueColumn |
| Exclusion | $10,662 | ExclusionAmount |
Gross Amount Sales Assets GrossAmountSalesAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 156339 | Securities |
Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 0 | Securities |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 156339 | Securities |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 156339 | TotalRevenueColumn |
| Exclusion | $156,339 | ExclusionAmount |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 547671 | TotalRevenueColumn |
| Related Or Exempt Function Income | 0 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $362,509 | ExclusionAmount |
Grants To Domestic Orgs GrantsToDomesticOrgs
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 310728 | Total |
| Program Services | 310728 | ProgramServices |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 200 | Total |
| Management And General | 200 | ManagementAndGeneral |
Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 50410 | Total |
| Management And General | 50410 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2744 | Total |
| Management And General | 2744 | ManagementAndGeneral |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 27618 | Total |
| Management And General | 27618 | ManagementAndGeneral |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 9102 | Total |
| Management And General | 9102 | ManagementAndGeneral |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 13703 | Total |
| Management And General | 13703 | ManagementAndGeneral |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1101 | Total |
| Management And General | 1101 | ManagementAndGeneral |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 415606 | Total |
| Program Services | 310728 | ProgramServices |
| Management And General | 104878 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 787997 | BOY |
| EOY | 539743 | EOY |
Pledges And Grants Receivable PledgesAndGrantsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 19275 | BOY |
| EOY | 10553 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 43207 | BOY |
| EOY | 51091 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 1083092 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 473338 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 301917 | BOY |
| EOY | 609754 | EOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 9014757 | BOY |
| EOY | 10045353 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 10167153 | BOY |
| EOY | 11256494 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 21759 | BOY |
| EOY | 23820 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1679744 | BOY |
| EOY | 1912570 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1701503 | BOY |
| EOY | 1936390 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 6488323 | BOY |
| EOY | 7243785 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 176893 | BOY |
| EOY | 188048 | EOY |
Permanently Restricted Net Assets PermanentlyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1800434 | BOY |
| EOY | 1888271 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 8465650 | BOY |
| EOY | 9320104 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 10167153 | BOY |
| EOY | 11256494 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expenses | 132065 | ReconcilationRevenueExpenses |
| Reconciliation Unrealized Invest | 722389 | ReconciliationUnrealizedInvest |
| Reconcilation Other Changes | 0 | ReconcilationOtherChanges |
| 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) |
|---|---|---|
| Supporting Organization509a3 | X | SupportingOrganization509a3 |
| Supporting Org509a3 Type1 | X | SupportingOrg509a3Type1 |
| Contrib By Controlling Individual | 0 | ContribByControllingIndividual |
| Contribution By Related Party | 0 | ContributionByRelatedParty |
| Contrib By35 Controlled Entity | 0 | ContribBy35ControlledEntity |
Supported Org Information SupportedOrgInformation
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MCCULLOUGH-HYDE MEMORIAL HOSPITAL INC | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 310650283 | EIN |
| Type Of Organization | 509(A)(3)(A) | TypeOfOrganization |
| Listed In Governing Doc | 0 | ListedInGoverningDoc |
| Supported Organization Notified | 1 | SupportedOrganizationNotified |
| Organized In US | 1 | OrganizedInUS |
| Amount | $295,578 | Amount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Number Of Supported Orgs | 1 | TotalNumberOfSupportedOrgs |
| Sum Of Amounts | 295578 | SumOfAmounts |
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 D IRS990ScheduleD
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number DA Fs Held | 10 | NumberDAFsHeld |
| Donor Advised Contributions | 32316 | DonorAdvisedContributions |
| Grants Paid From Donor Funds | 98184 | GrantsPaidFromDonorFunds |
| Aggregate DAF Value | 88105 | AggregateDAFValue |
| Disclosed Orgs Legal Control | 1 | DisclosedOrgsLegalControl |
| Disclosed For Charitable Purposes | 1 | DisclosedForCharitablePurposes |
Current Year CurrentYear
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 9014757 | BeginningOfYearBalance |
| Contributions | 97325 | Contributions |
| Investment Earnings Or Losses | 1099844 | InvestmentEarningsOrLosses |
| Grants Or Scholarships | 166574 | GrantsOrScholarships |
| End Of Year Balance | 10045352 | EndOfYearBalance |
Current Year Minus1 Year CurrentYearMinus1Year
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 9551600 | BeginningOfYearBalance |
| Contributions | 296717 | Contributions |
| Investment Earnings Or Losses | -706525 | InvestmentEarningsOrLosses |
| Grants Or Scholarships | 127035 | GrantsOrScholarships |
| End Of Year Balance | 9014757 | EndOfYearBalance |
Current Year Minus2 Years CurrentYearMinus2Years
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 8626691 | BeginningOfYearBalance |
| Contributions | 137514 | Contributions |
| Investment Earnings Or Losses | 970829 | InvestmentEarningsOrLosses |
| Grants Or Scholarships | 183434 | GrantsOrScholarships |
| End Of Year Balance | 9551600 | EndOfYearBalance |
Current Year Minus3 Years CurrentYearMinus3Years
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 7180113 | BeginningOfYearBalance |
| Contributions | 372373 | Contributions |
| Investment Earnings Or Losses | 1080059 | InvestmentEarningsOrLosses |
| Grants Or Scholarships | 5854 | GrantsOrScholarships |
| End Of Year Balance | 8626691 | EndOfYearBalance |
Current Year Minus4 Years CurrentYearMinus4Years
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 8858166 | BeginningOfYearBalance |
| Contributions | 1086641 | Contributions |
| Investment Earnings Or Losses | -2429378 | InvestmentEarningsOrLosses |
| Other Expenditures | 335316 | OtherExpenditures |
| End Of Year Balance | 7180113 | EndOfYearBalance |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Board Designated EOY Balance | 0.98040 | BoardDesignatedEOYBalance |
| Term Endowment EOY Balance | 0.01960 | TermEndowmentEOYBalance |
| Endowments Held By Unrelated Orgs | 1 | EndowmentsHeldByUnrelatedOrgs |
| Endowments Held By Related Orgs | 0 | EndowmentsHeldByRelatedOrgs |
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | 149670 | InvestmentCostOrOtherBasis |
| Book Value | 149670 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | 902441 | InvestmentCostOrOtherBasis |
| Depreciation | 457491 | Depreciation |
| Book Value | 444950 | BookValue |
Leasehold Improvements LeaseholdImprovements
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | 30981 | InvestmentCostOrOtherBasis |
| Depreciation | 15847 | Depreciation |
| Book Value | 15134 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 609754 | TotalOfBookValueLandBuildings |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | DUE TO RELATED MCCULLOUGH-HYDE MEMORIAL HOSPITAL | Description |
| Amount | $1,912,570 | Amount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 1912570 | TotalOfAmounts |
| Footnote In Part XIII | X | FootnoteInPartXIII |
Form990 Schedule D Part XIII Form990ScheduleDPartXIII (2 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: | PART V, LINE 4: | HEALTH EDUCATION, HOSPITAL EQUIPMENT, COMMUNITY HEALTH |
| ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA REQUIRE MANAGEMENT TO EVALUATE TAX POSITIONS TAKEN BY THE TRUST AND THE HOSPITAL AND RECOGNIZE A TAX LIABILITY IF THEY HAVE TAKEN AN UNCERTAIN POSITION THAT MORE LIKELY THAN NOT WOULD NOT BE SUSTAINED UPON EXAMINATION BY VARIOUS FEDERAL AND STATE TAXING AUTHORITIES. MANAGEMENT HAS ANALYZED THE TAX POSITIONS TAKEN, AND HAS CONCLUDED THAT AS OF DECEMBER 31, 2012 AND 2011, THERE ARE NO UNCERTAIN POSITIONS TAKEN OR EXPECTED TO BE TAKEN THAT WOULD REQUIRE RECOGNITION OF A LIABILITY OR DISCLOSURE IN THE ACCOMPANYING FINANCIAL STATEMENTS. THE TRUST AND THE HOSPITAL ARE SUBJECT TO ROUTINE AUDITS BY TAXING JURISDICTIONS; HOWEVER, THERE ARE CURRENTLY NO AUDITS FOR ANY TAX PERIODS IN PROGRESS. |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Records Maintained | 0 | 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 |
|---|---|---|---|---|---|---|---|
| OXFORD FREE CLINIC | |||||||
| PO BOX 18818 | FAIRFIELD | OH | 45018 | 204253386 | 501(C)(3) | 15150 | HEALTH CLINIC |
| MCCULLOUGH-HYDE MEMORIAL HOSPITAL | |||||||
| 110 NORTH POPLAR STREET | OXFORD | OH | 45056 | 310650283 | 501(C)(3) | 295578 | PROGRAM DEVELOPMENT, HEALTH PROGRAM FUNDING, EDUCATION PROGRAMS, BUILDING AND FACILITY SUPPORT |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Nbr Of501 C3 And Govt Grants | 1 | TotalNbrOf501C3AndGovtGrants |
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: THE ORGANIZATION HAS REPRESENTATION ON THE BOARD THAT OVERSEES OPERATIONS. | Explanation |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| 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 (6 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| BRYAN HEHEMANN | ||||||||||||||
| PRESIDENT AND CEO | 0 | 206743 | 0 | 0 | 0 | 0 | 0 | 938 | 0 | 20500 | 0 | 228181 | 0 | 0 |
| JOHN CLEMENTS | ||||||||||||||
| VICE PRESIDENT AND CFO | 0 | 142936 | 0 | 0 | 0 | 0 | 0 | 938 | 0 | 10259 | 0 | 154133 | 0 | 0 |
| KENNETH KELLER | ||||||||||||||
| PHYSICIAN | 0 | 246835 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 1389 | 0 | 248224 | 0 | 0 |
| MATTHEW BIRKLE | ||||||||||||||
| PHYSICIAN | 0 | 195226 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 1099 | 0 | 196325 | 0 | 0 |
| MARK CRISTELL | ||||||||||||||
| PT DIRECTOR | 0 | 126789 | 0 | 8663 | 0 | 0 | 0 | 938 | 0 | 20101 | 0 | 156491 | 0 | 0 |
| MATTHEW DAGGY | ||||||||||||||
| PHYSICIAN | 0 | 237090 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 1335 | 0 | 238425 | 0 | 0 |
Form990 Schedule J Part III Form990ScheduleJPartIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Reference | PART I, LINE 4B | ReturnReference |
| Explanation | BRYAN HEHEMANN - LIFE INSURANCE POLICY - PAID UP POLICY AT 65. FACE AMOUNT IS 100K WITH CASH SURRENDER VALUE. THERE IS AN ANNUAL PREMIUM OF $8,874 WITH THE VALUE AT 12/31/12 AT $45,503. | Explanation |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (3 entries)
| Return ReferenceReturnReference | ExplanationExplanation |
|---|---|
| FORM 990, PART VI, SECTION B, LINE 11 | THE 990 IS REVIEWED BY THE CFO AND FINANCE COMMITTEE OF THE BOARD PRIOR TO SUBMISSION. ALL BOARD MEMBERS ARE INVITED ATTEND. THE FINANCE COMMITTEE REVIEWS WITH THE FULL BOARD AT THE NEXT SCHEDULED MEETING. |
| FORM 990, PART VI, SECTION B, LINE 12C | ALL MEMBERS OF ADMINISTRATION, DEPARTMENT DIRECTORS, MANAGERS, SUPERVISORS AND OTHER INDIVIDUALS WHO ARE, OR MAY BE, RESPONSIBLE FOR THE DIRECT PURCHASE OF GOODS AND/OR SERVICES ON BEHALF OF THE HOSPITAL SHALL BE REQUIRED TO REVIEW THIS POLICY AND COMPLETE A CONFLICT OF INTEREST FORM FOR SUBMISSION TO THE CORPORATE COMPLIANCE OFFICER ANNUALLY. WHEN A CONFLICT OF INTEREST ARISES OR A POTENTIAL CONFLICT OF INTEREST DEVELOPS, THE PERSON WHO IS OR MAY BE IN A CONFLICT OF INTEREST SITUATION IS REQUIRED TO MAKE A FULL WRITTEN DISCLOSURE OF THE SITUATION OR POTENTIAL SITUATION BY COMPLETING AND SIGNING A CONFLICT OF INTEREST QUESTIONNAIRE AND RETURNING IT TO HIS/HER DEPARTMENT DIRECTOR AND/OR APPROPRIATE ADMINISTRATOR, WHO WILL FORWARD THE CONFLICT OF INTEREST FORM TO THE CORPORATE COMPLIANCE OFFICER FOR REVIEW AND APPROPRIATE ACTION. THE CORPORATE COMPLIANCE COMMITTEE SHALL CONDUCT A FULL REVIEW AND ASSESSMENT OF THE POTENTIAL CONFLICT AND WILL PROVIDE ONE OF THE FOLLOWING WRITTEN RECOMMENDATIONS/CONCLUSIONS: 1. THE CIRCUMSTANCES REPORTED DO NOT PRESENT A PROBLEM. 2. ALTERNATE ARRANGEMENTS MADE BY/WITH THE EMPLOYEE ARE ACCEPTABLE AND PRESENT NO PROBLEM. 3. ALTERNATE ARRANGEMENTS ARE NOT ACCEPTABLE AND THE CONFLICT WILL BE DEALT WITH ON AN INDIVIDUAL BASIS. |
| FORM 990, PART VI, SECTION C, LINE 19 | THE DOCUMENTS ARE MADE AVAILABLE UPON REQUEST. |
Schedule R IRS990ScheduleR
Form990 Schedule R Part II Form990ScheduleRPartII
Name Of Disregarded Entity NameOfDisregardedEntity
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MCCULLOUGH-HYDE MEMORIAL HOSPITAL INC | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 110 N POPLAR STREET | AddressLine1 |
| City | OXFORD | City |
| State | OH | State |
| ZIP Code | 45056 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 310650283 | EIN |
| Primary Activities | HOSPITAL | PrimaryActivities |
| Legal Domicile State | OH | LegalDomicileState |
| Exempt Code Section | 501(C)(3) | ExemptCodeSection |
| Public Charity Status | LINE 3 | PublicCharityStatus |
| Direct Controlling Entity NA | N/A | DirectControllingEntityNA |
| Controlled Org | 0 | ControlledOrg |
| 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 |
| 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 | 0 | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | 0 | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | 0 | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | 0 | SharingOfFacilities |
| Sharing Of Paid Employees | 0 | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | 1 | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | 0 | OtherTransferToOtherOrg |
| Other Transfer From Other Org | 0 | OtherTransferFromOtherOrg |
Transactions Related Orgs Table TransactionsRelatedOrgsTable (2 entries)
| Transaction TypeTransactionType | Amount InvolvedAmountInvolved |
|---|---|
| MCCULLOUGH-HYDE MEMORIAL HOSPITAL | |
| B | 113933 |
| MCCULLOUGH-HYDE MEMORIAL HOSPITAL | |
| P | 203971 |