2012-11-15T12:06:54-06:00 2011-12-31 341827159 GILMORE JASION & MAHLER LTD 1715 INDIAN WOOD CIRCLE STE 100 MAUMEE OH 43537 990 2011-01-01 341116795 HOSPITAL COUNCIL OF NORTHWEST OHIO HOSP 4198420800 3231 CENTRAL PARK WEST NO 200 TOLEDO OH 43617 W SCOTT FRY 4198420800 2012-11-15 1 HEIDI FERGUSON P00410007 4197942000 2012-11-15 2011 2016-02-24 21:20:13Z W SCOTT FRY 3231 CENTRAL PARK WEST NO 200 TOLEDO OH 43617 4508266 0 X WWW.HCNO.ORG X 1973 OH SEE BELOW.THE HOSPITAL COUNCIL OF NORTHWEST OHIO IS A MEMBER DRIVEN ORGANIZATION THAT REPRESENTS AND ADVOCATES ON BEHALF OF ITS MEMBER HOSPITALS AND HEALTH SYSTEMS AND PROVIDES COLLABORATIVE OPPORTUNITIES TO ENHANCE THE HEALTH STATUS OF THE CITIZENS OF NORTHWEST OHIO. THE HOSPITAL COUNCIL IS DEDICATED TO: -BRINGING TOGETHER NORTHWEST OHIO'S HEALTH CARE LEADERS. -PROVIDING COLLABORATIVE OPPORTUNITIES TO ADDRESS HEALTHCARE PROVIDERS' SHARED CONCERNS. -DEVELOPING CREATIVE HEALTH-RELATED INITIATIVES TO IMPROVE THE REGION'S HEALTH STATUS. -PROVIDING EDUCATIONAL PROGRAMS FOR THE HEALTHCARE SECTOR. 21 21 18 51 0 0 2370103 2952844 1214702 1501231 3652 3038 27487 35711 3615944 4492824 1114853 1709819 0 0 1240306 1343439 0 0 0 1021247 825330 3376406 3878588 239538 614236 2984131 3814577 208294 424645 2775837 3389932 X THE HOSPITAL COUNCIL OF NORTHWEST OHIO IS A MEMBER DRIVEN ORGANIZATION THAT REPRESENTS AND ADVOCATES ON BEHALF OF ITS MEMBER HOSPITALS AND HEALTH SYSTEMS AND PROVIDES COLLABORATIVE OPPORTUNITIES TO ENHANCE THE HEALTH STATUS OF THE CITIZENS OF NORTHWEST OHIO. -BRINGING TOGETHER NORTHWEST OHIO'S HEALTH CARE LEADERS. -PROVIDING COLLABORATIVE OPPORTUNITIES TO ADDRESS HEALTHCARE PROVIDERS' SHARED CONCERNS. -DEVELOPING CREATIVE HEALTH-RELATED INITIATIVES TO IMPROVE THE REGION'S HEALTH STATUS. -PROVIDING EDUCATIONAL PROGRAMS FOR THE HEALTHCARE SECTOR. 0 0 3620810 1709819 1530821 -BRINGING TOGETHER NORTHWEST OHIO'S HEALTH CARE LEADERS.-PROVIDING COLLABORATIVE OPPORTUNITIES TO ADDRESS HEALTHCARE PROVIDERS' SHARED CONCERNS.-DEVELOPING CREATIVE HEALTH-RELATED INITIATIVES TO IMPROVE THE REGION'S HEALTH STATUS.-PROVIDING EDUCATIONAL PROGRAMS FOR THE HEALTHCARE SECTOR. 3620810 1 1 0 1 0 0 0 0 1 0 1 0 0 0 0 1 1 0 0 0 0 0 0 0 1 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 40 0 1 18 1 0 0 0 0 0 0 0 0 0 0 X 21 21 0 0 0 0 1 1 1 1 1 0 0 0 1 1 1 1 1 1 1 0 OH X W SCOTT FRY 4198420800 3231 CENTRAL PARK WEST TOLEDO OH 43617 JOHN C YANES 4.00 X 0 0 0 WESLEY OSWALD 4.00 X 0 0 0 PATRICK MARTIN 4.00 X X 0 0 0 E DEAN BECK 4.00 X 0 0 0 KIM BORDENKIRCHER 4.00 X 0 0 0 DALE THORNTON 4.00 X 0 0 0 SCOTT C MALANEY 4.00 X 0 0 0 GARY ADKINS 4.00 X X 0 0 0 IMRAN A ANDRABI MD 4.00 X 0 0 0 KEVIN COOK 4.00 X 0 0 0 MICHAEL WINTHROP 4.00 X 0 0 0 DANIEL L WAKEMAN 4.00 X X 0 0 0 STANLEY KORDUCKI 4.00 X X 0 0 0 LYNN DETTERMAN 4.00 X 0 0 0 ROBERT E GOSPODAREK 4.00 X X 0 0 0 WILLIAM MUELLER 4.00 X 0 0 0 KEVIN WEBB PHD 4.00 X 0 0 0 ALAN SATTLER 4.00 X 0 0 0 CAROL WHITTAKER 4.00 X 0 0 0 BRADLEY BERTKE 4.00 X 0 0 0 GARY CATES 4.00 X 0 0 0 DANIEL SCHWANKE 4.00 X 0 0 0 MICHAEL LONG 4.00 X 0 0 0 SCOTT SCARBOROUGH 4.00 X 0 0 0 W SCOTT FRY 20.60 X 101766 100553 58220 JAN RUMA 42.70 X 140530 0 47638 242296 100553 105858 2 0 1 0 0 43044 1392051 1517749 2952844 CONTRACT INCOME 900099 1102673 1102673 MEMBERSHIP DUES 900099 398558 398558 1501231 3038 3038 21563 15442 6121 6121 29590 29590 29590 4492824 1530821 0 9159 1709819 1709819 260540 177419 83121 779112 740156 38956 76683 68248 8435 151311 134667 16644 75793 67255 8538 2530 2530 23618 23618 163404 139188 24216 14477 14477 207568 178239 29329 26355 23229 3126 68183 60785 7398 37364 34831 2533 17857 10341 7516 2852 2367 485 13885 13045 840 PROGRAM EXPENSE 239741 239741 ORG DUES AND MEMBERSHIP 2714 2260 454 TRAINING 2448 2430 18 SUBSCRIPTIONS 459 438 21 1875 1875 3878588 3620810 257778 0 695 1808832 2874198 1650497 72453 99918 257939 6472 15361 93559 84064 2848 9495 2984131 3814577 113219 126539 89675 295838 5400 2268 208294 424645 X 1575659 1716027 1200178 1673905 2775837 3389932 2984131 3814577 X 614236 -141 X X 0 1 1 X 1 1 X 2616389 3459099 3633414 2370103 2952844 15031849 2616389 3459099 3633414 2370103 2952844 15031849 15031849 88195 44580 14229 3652 3038 153694 22989 31696 27087 27487 51153 160412 15345955 5925434 0.97950 0.97450 X SCHEDULE A, PART II, LINE 10, EXPLANATION OF OTHER INCOME: REIMBURSEMENT INCOME SPECIAL EVENT INCOME RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 0 1 245 0 1 500 1 429 1 96 0 1270 0 0 1 36689 30532 6157 56870 53532 3338 9495 4492824 3878588 614236 -141 -50000 -50141 564095 4618125 -141 110000 109859 4508266 -15442 -15442 4492824 4054030 175442 175442 3878588 0 3878588 PART IV, LINE 2B: HOSPITAL COUNCIL IS A FISCAL AGENT FOR THE LUCAS COUNTY SUICIDE PREVENTION COALITION. DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: MANAGEMENT OF THE ORGANIZATION IS REQUIRED TO DETERMINE WHETHER A TAX POSITION OF THE ORGANIZATION IS MORE LIKELY THAN NOT TO BE SUSTAINED UPON EXAMINATION BY THE APPLICABLE TAXING AUTHORITY, INCLUDING RESOLUTION OF ANY RELATED APPEALS OR LITIGATION PROCESSES, BASED ON THE TECHNICAL MERITS OF THE POSITION. MANAGEMENT OF THE ORGANIZATION IS NOT AWARE OF ANY TAX POSITIONS FOR WHICH IT IS REASONABLY POSSIBLE THAT THE TOTAL AMOUNTS OF UNRECOGNIZED TAX BENEFITS WILL SIGNIFICANTLY CHANGE IN THE NEXT TWELVE MONTHS. HOWEVER, MANAGEMENT'S CONCLUSIONS MAY BE SUBJECT TO REVIEW AND ADJUSTMENT AT A LATER DATE BASED ON FACTORS INCLUDING, BUT NOT LIMITED TO, NEW TAX LAWS, REGULATIONS AND ADMINISTRATIVE INTERPRETATIONS (INCLUDING RELEVANT COURT DECISIONS). THE ORGANIZATION'S FEDERAL TAX RETURNS FOR THE PRIOR THREE YEARS REMAIN SUBJECT TO EXAMINATION BY THE INTERNAL REVENUE SERVICE. NO INTEREST OR PENALTIES WERE INCURRED OR RECOGNIZED IN 2011 OR 2010. PART XI, LINE 8 - OTHER ADJUSTMENTS: INTERCOMPANY DEFERRED INCOME -50,000. PART XII, LINE 2D - OTHER ADJUSTMENTS: INTERCOMPANY TRANSACTIONS 110,000. PART XII, LINE 4B - OTHER ADJUSTMENTS: SPECIAL EVENT EXPENSE -15,442. PART XIII, LINE 2D - OTHER ADJUSTMENTS: INTERCOMPANY TRANSACTIONS 160,000. SPECIAL EVENT EXPENSE 15,442. BLACK SWAMP GOLF 21563 21563 4196 2 4326 6918 21563 21563 4196 2 4326 6918 15442 6121 1 ADVANCED SPEC HOSP 1015 GARDEN LAKE PARKWAY TOLEDO OH 43614 208286960 8000 SUPPORT BLUFFTON HOSPITAL 139 GARAU STREET BLUFFTON OH 45817 341369963 12762 SUPPORT BLANCHARD VALLEY HEALTH SYSTEM 1900 SOUTH MAIN STREET FINDLAY OH 45840 341369963 42679 SUPPORT COMMUNITY HOSPITALS AND WELLNESS CENTERSBRYAN 433 W HIGH STREET BRYAN OH 43506 341048666 22269 SUPPORT COMMUNITY HOSPITALS AND WELLNESS CENTERSMONTPELIER 909 SNYDER MONTPELIER OH 43543 341048666 12174 SUPPORT COMMUNITY HEALTH SERVICES 410 BIRCHARD AVENUE FREMONT OH 43420 341120194 18749 SUPPORT COMMUNITY MEMORIAL HOSPITAL 208 N COLUMBUS STREET HICKSVILLE OH 43526 311597925 27511 SUPPORT EAST TOLEDO FAMILY 1020 VARLAND AVE TOLEDO OH 43605 344429426 6000 SUPPORT ELMWOOD AT SPRINGS 401 NORTH BROADWAY STREET GREEN SPRINGS OH 44836 270420203 7774 SUPPORT FIRELANDS PHYSICIAN 1031 PIERCE STREET SUITE D SANDUSKY OH 44870 341608091 32700 SUPPORT FIRELANDS REGIONAL MEDICAL CENTER 1101 DECATUR STREET SANDUSKY OH 44870 344428218 21203 SUPPORT FISHER-TITUS MEDICAL CENTER 272 BENEDICT AVE NORWALK OH 44857 344430716 22534 SUPPORT FULTON COUNTY HEALTH CENTER 725 SOUTH SHOOP AVENUE WAUSEON OH 43567 344428214 13900 SUPPORT HENRY COUNTY HOSPITAL 1600 EAST RIVERVIEW AVENUE NAPOLEON OH 43545 344477047 17577 SUPPORT ISTHMUS LTD 240 BRYANT AVE WORTHINGTON OH 43085 010730930 78816 SUPPORT JOINT TOWNSHIP DISTRICT MEMORIAL HOSPITAL 200 ST CLAIR STREET ST MARYS OH 45885 341623770 59206 SUPPORT LIMA MEMORIAL HOSPITAL 1001 BELLEFONTAINE AVE LIMA OH 43504 341883284 19424 SUPPORT LITTLE SISTERS OF THE POOR SACRED HEART HOME 930 S WYNN ROAD OREGON OH 43616 340901052 7811 SUPPORT MAGRUDER HOSPITAL 615 FULTON STREET PORT CLINTON OH 43452 344441792 10689 SUPPORT MEMORIAL HOSPITAL 715 SOUTH TAFT AVENUE FREMONT OH 43420 344430849 11999 SUPPORT MERCER COUNTY JT TWP COMMUNITY HOSPITAL 800 WEST MAIN STREET COLDWATER OH 45828 341101385 21985 SUPPORT MERCY HOSPITAL OF DEFIANCE 1404 E SECOND STREET DEFIANCE OH 43512 020701635 8779 SUPPORT MERCY HOSPITAL OF TIFFIN 485 W MARKET STREET TIFFIN OH 44883 344431174 14071 SUPPORT MERCY HOSPITAL OF WILLARD 110 EAST HOWARD STREET WILLARD OH 44890 341577110 7824 SUPPORT MERCY HEALTH PARTNERS 578 NORTH LEAVITT ROAD AMHERST OH 44001 341803352 24600 SUPPORT MERCY PHYSICIAN ENTERPRISE 2200 JEFFERSON AVE TOLEDO OH 43624 264779623 42600 SUPPORT MOTOROLA 1301 E ALGONQUIN ROAD SCHAUMBURG IL 60196 361115800 6375 SUPPORT PAULDING COUNTY HOSPITAL 1035 W WAYNE STREET PAULDING OH 45879 346405718 18543 SUPPORT ST ANNE MERCY HOSPITAL 3404 SYLVANIA AVENUE TOLEDO OH 43623 311556401 14084 SUPPORT ST CHARLES MERCY HOSPITAL 2600 NAVARRE AVENUE OREGON OH 43616 344445373 21335 SUPPORT PROMEDICA BAY PARK HOSPITAL 2801 BAY PARK DRIVE OREGON OH 43616 341883132 98033 SUPPORT PROMEDICA FLOWER HOSPITAL 5200 HARROUN ROAD SYLVANIA OH 43560 344428794 13077 SUPPORT PROMEDICA DEFIANCE REGIONAL HOSPITAL 1200 RALSTON AVE DEFIANCE OH 43512 344446484 10716 SUPPORT PROMEDICA ST LUKES HOSPITAL 5901 MONCLOVA RD MAUMEE OH 43537 344428232 32969 SUPPORT ST RITA'S MEDICAL CENTER 730 W MARKET STREET LIMA OH 45801 341105619 30126 SUPPORT ST VINCENT MERCY MEDICAL CENTER 2213 CHERRY STREET TOLEDO OH 43608 344428250 53124 SUPPORT NEIGHBORHOOD HEALTH ASSOCIATION 313 JEFFERSON AVE TOLEDO OH 43604 237272741 15300 SUPPORT LUCAS COUNTY REGIONAL HEALTH DEPARTMENT 635 N ERIE STREET TOLEDO OH 43604 346400806 15900 SUPPORT TOLEDO CLINIC 4235 SECOR ROAD TOLEDO OH 43623 340936207 96300 SUPPORT PROMEDICA TOLEDO HOSPITAL 2142 NORTH COVE BLVD TOLEDO OH 43606 344428256 52526 SUPPORT VAN WERT COUNTY CHAPTER-AMERICAN RED CROSS 208 E MAIN STREET VAN WERT OH 45891 344471395 11919 SUPPORT WOOD COUNTY HOSPITAL 950 W WOOSTER STREET BOWLING GREEN OH 43402 344440884 40625 SUPPORT UNIVERSITY OF TOLEDO 3000 ARLINGTON TOLEDO OH 43614 346401483 156068 SUPPORT NORTHERN OHIO MEDICAL SPECIALISTS LLC 3004 HAYES AVE SANDUSKY OH 44870 341933718 69300 SUPPORT PROMEDICA CONT' SVCSDBA LAKE PARK 5855 MONROE STREET SUITE 200 SYLVANIA OH 43560 344492440 16000 SUPPORT WILLIAMS COUNTY HEALTH DEPARTMENT 310 LINCOLN AVE PO BOX 146 MONTPELIER OH 43543 346401595 6486 SUPPORT PROMEDICA PHYSICIANS 5855 MONROE STREET SYLVANIA OH 43560 341880767 47100 SUPPORT SANDUSKY CO EMS 2100 COUNTRYSIDE PLACE FREMONT OH 43420 346401312 28181 SUPPORT SHEALY GROUP LTD 68 PARK AVENUE WEST MANSFIELD OH 44902 010724512 131100 SUPPORT 33 16 PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, PART I, LINE 2: THE PROGRAM STAFF WORK CLOSELY WITH EACH SUB GRANTEE REGARDING PAPER WORK NEEDED. ALL SUB GRANTEES MUST SUBMIT DOCUMENTATION FOR REIMBURSEMENT OF ALL EXPENDITURES. THE PROGRAM DIRECTOR WORKS WITH FINANCE TO OVERSEE THE GRANT AND MANTAIN COMPLIANCE WITH APPLICABLE MANDATES. X X X 0 0 0 0 0 0 0 0 0 W SCOTT FRY 96860 95706 0 0 4906 4847 15513 15328 13772 13607 131051 129488 0 0 JAN RUMA 139467 0 500 0 563 0 17969 0 29669 0 188168 0 0 0 FORM 990, PART VI, SECTION A, LINE 6 AREA HOSPITALS COMPRISE THE MEMBERSHIP OF HOSPITAL COUNCIL OF NORTHWEST OHIO. FORM 990, PART VI, SECTION A, LINE 7A THESE MEMBER HOSPITALS MAY ELECT ONE OR MORE MEMBERS OF THE GOVERNING BODY. FORM 990, PART VI, SECTION A, LINE 7B THE GOVERNING DECISIONS OF THE FILING ENTITY ARE SUBJECT TO APPROVAL BY THE MEMBER HOSPITALS. FORM 990, PART VI, SECTION B, LINE 11 THE ORGANIZATION'S SIGNING OFFICER SCANS THE FORM 990 FOR COMPLETENESS PRIOR TO SIGNATURE, IN ADDITION TO RELYING UPON THE INDEPENDENT ACCOUNTANT FOR ACCURACY. FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION REGULARLY AND CONSISTENTLY MONITORS AND ENFORCES COMPLIANCE WITH THE CONFLICT OF INTEREST POLICY. FORM 990, PART VI, SECTION B, LINE 15 THE GOVERNING BODY USES A PROCESS FOR DETERMINING COMPENSATION OF THE ORGANIZATION'S CEO OR TOP MANAGEMENT OFFICIALS WHICH INCLUDES A COMPARISON TO OTHER ORGANIZATIONS, SALARY SURVEYS, AND CONTEMPORANEOUS SUBSTANTIATION OF THE DELIBERATION AND DECISION ON AN ANNUAL BASIS. THE ORGANIZATION USES A PROCESS FOR DETERMINING COMPENSATION OF THE ORGANIZATION'S OFFICERS OR KEY EMPLOYEES WHICH INCLUDES A REVIEW AND APPROVAL BY THE CEO, USE OF MANAGEMENT SURVEYS, AND CONTEMPORANEOUS SUBSTANTIATION OF THE DELIBERATION AND DECISION ON AN ANNUAL BASIS. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST. FORM 990, PART VII: W. SCOTT FRY'S TOTAL AVERAGE HOURS PER WEEK ARE 40.9 HOURS. HOURS APPLICABLE TO HOSPITAL COUNCIL OF NORTHWEST OHIO ARE 20.6 HOURS PER WEEK. HOURS FOR THE RELATED ORGANIZATION, NORTHWEST OHIO SHARED SERVICES, ARE 20.3 PER WEEK. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED LOSSES ON INVESTMENTS: -141. FINANCIAL STATEMENTS AND REPORTING FORM 990, PART XII, LINE 2C: THE ORGANIZATION HAS A COMMITTEE THAT ASSUMES REPSONSIBILITY FOR OVERSIGHT OF THE AUDIT OF ITS FINANCIAL STATEMENTS AND SELECTION OF AN INDEPENDENT ACCOUNTANT. NORTHWEST OHIO SHARED SERVICES 3231 CENTRAL PARK WEST DR TOLEDO OH 43617 341388279 PURCHASE CORPORATION OH N/A C 0 0 1 0 0 0 0 0 0 0 1 0 0 1 1 1 0 0 NORTHWEST OHIO SHARED SERVICES INC K 126438 NORTHWEST OHIO SHARED SERVICES INC C 43044 NORTHWEST OHIO SHARED SERVICES INC N 134562 NORTHWEST OHIO SHARED SERVICES INC P 72635 NORTHWEST OHIO SHARED SERVICES INC O 25