HOLZER HOSPITAL FOUNDATION: Form 990, tax year 2010
View the entire original 990 at ProPublica ↗
- Organization
- HOLZER HOSPITAL FOUNDATION (EIN 31-4379491)
- Tax period
- 2010-07-01 to 2011-06-30
- Filed
- 2012-05-15
- IRS object ID
- 201211369349305606
- Schema version
- 2010v3.4
- 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 G
- Schedule H
- Schedule I
- Schedule J
- Schedule L
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2012-05-15T14:06:21-05:00 | Timestamp |
| Tax Period End Date | 2011-06-30 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
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 SUITE 600 | 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 | 2010-07-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 314379491 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | HOLZER HOSPITAL FOUNDATION | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | HOLZ | NameControl |
| Phone | 7404465060 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 100 JACKSON PIKE | AddressLine1 |
| City | GALLIPOLIS | City |
| State | OH | State |
| ZIP Code | 45631 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | KENNETH PAYNE | Name |
| Title | CFO | Title |
| Phone | 7404465060 | Phone |
| Date Signed | 2012-05-15 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | BERNIE OSTROWSKI | Name |
| Phone | 6148493000 | Phone |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2010 | 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 | KENNETH PAYNE | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 100 JACKSON PIKE | AddressLine1 |
| City | GALLIPOLIS | City |
| State | OH | State |
| ZIP Code | 45631 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 122045946 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | WWW.HOLZER.ORG | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1910 | YearFormation |
| State Legal Domicile | OH | StateLegalDomicile |
| Activity Or Mission Description | TO ENCOURAGE WELLNESS AND STRIVE TO IMPROVE THE HEALTH STATUS OF THE PEOPLE AND COMMUNITIES WE SERVE. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 12 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 8 | NbrIndependentVotingMembers |
| Total Nbr Employees | 1251 | TotalNbrEmployees |
| Total Nbr Volunteers | 32 | TotalNbrVolunteers |
| Total Gross UBI | 294999 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | -2579 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 1032065 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 151053 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 117612082 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 115428440 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 187373 | InvestmentIncomePriorYear |
| Investment Income Current Year | 175814 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 1811010 | OtherRevenuePriorYear |
| Other Revenue Current Year | 1543831 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 120642530 | TotalRevenuePriorYear |
| Total Revenue Current Year | 117299138 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 161000 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 44359 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 45999778 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 45891037 | 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 | 73054862 | OtherExpensePriorYear |
| Other Expenses Current Year | 70283349 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 119215640 | TotalExpensesPriorYear |
| Total Expenses Current Year | 116218745 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 1426890 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 1080393 | RevenuesLessExpensesCY |
| Total Assets BOY | 84287923 | TotalAssetsBOY |
| Total Assets EOY | 87049156 | TotalAssetsEOY |
| Total Liabilities BOY | 26648001 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 28220286 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 57639922 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 58828870 | NetAssetsOrFundBalancesEOY |
| Info In Schedule O Part III | X | InfoInScheduleOPartIII |
| Mission Description | WE WILL ENCOURAGE WELLNESS AND STRIVE TO IMPROVE THE HEALTH STATUS OF THE PEOPLE AND COMMUNITIES WE SERVE. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 97980941 | Expense |
| Grants | 44359 | Grants |
| Revenue | 115536656 | Revenue |
| Description | SEE SCHEDULE OTHE HOSPITAL ACCEPTS ALL PATIENTS REGARDLESS OF THEIR ABILITY TO PAY. A PATIENT IS CLASSIFIED AS A CHARITY PATIENT BY REFERENCE TO CERTAIN ESTABLISHED POLICIES OF THE HOSPITAL. IN ASSESSING A PATIENT'S INABILITY TO PAY, THE HOSPITAL COMPARES INCURRED CHARGES WITH GENERALLY RECOGNIZED POVERTY INCOME LEVELS AND THE PATIENT'S FINANCIAL RESOURCES. BECAUSE THE HOSPITAL DOES NOT EXPECT TO RECEIVE PAYMENT FOR AMOUNTS DETERMINED TO QUALIFY AS CHARITY CARE, THESE AMOUNTS ARE NOT REPORTED AS NET PATIENT SERVICE REVENUES. CHARITY CARE PROVIDED, BASED ON ESTABLISHED RATES, WAS APPROXIMATELY $7,268,562 AND $7,587,147 IN FISCAL 2011 AND 2010 RESPECTIVELY.CONSISTENT WITH ITS MISSION, THE HOSPITAL PROVIDES COMMUNITY SERVICES INTENDED TO BENEFIT THE UNDERSERVED AND ENHANCE THE HEALTH STATUS OF THE COMMUNITY. THE HOSPITAL OPERATES A 24 HOUR PER DAY, 7 DAY PER WEEK EMERGENCY ROOM PROVIDING CARE TO ALL PATIENTS. THE HOSPITAL OPERATES HOLZER HOSPICE.CONTINUING EDUCATION, CERTIFICATION PROGRAMS, AND INFORMATIONAL SEMINARS ARE CONDUCTED FOR BOTH HOSPITAL AND MEDICAL STAFF. HEALTH FAIRS ARE CONDUCTED AT NO CHARGE. ADDITIONALLY, THE HOSPITAL'S MOBILE UNIT IS TAKEN TO COMMUNITY EVENTS TO PERFORM FREE SCREENINGS, AND DISPENSE EDUCATIONAL MATERIALS. HOSPITAL STAFF ALSO RESPONDS TO REQUESTS FROM EMPLOYERS AND COMMUNITY GROUPS, ALONG WITH SENIOR CITIZEN CENTERS, FOR SCREENINGS AND INFORMATIONAL PROGRAMS. EDUCATIONAL SUPPORT GROUPS, SUCH AS DIABETES AND CANCER, AND AN EDUCATIONAL GROUP MEETING FOR STROKES, ARE SPONSORED BY THE HOSPITAL. THE HOSPITAL'S MEETING ROOMS ARE MADE AVAILABLE TO ORGANIZATIONS AT NO CHARGE FOR HEALTH-RELATED PROGRAMMING AND MEETINGS. ADDITIONALLY, CIVIC AND PROFESSIONAL ORGANIZATIONS ARE INVITED TO THE HOSPITAL REGULARLY FOR PROGRAMS THAT ARE EDUCATIONAL AND INFORMATIONAL ON HEALTH CARE SERVICES AS DEVELOPED.SPEAKERS FROM THE HOSPITAL STAFF ARE AVAILABLE AND RESPOND TO SPEAKING INVITATIONS FOR GROUPS AND ORGANIZATIONS IN THE HOSPITAL'S SERVICE AREA. THE HOSPITAL OFFERS MANY SERVICES TO THE COMMUNITY AT NOMINAL OR NO CHARGE, INCLUDING BLOOD PRESSURE AND BLOOD SUGAR SCREENINGS, CHOLESTEROL CHECKS, HEMOGLOBIN, PULSE OXIMETRY, PROSTATE CHECKS, BONE DENSITY, AND TUMOR REGISTRY. THE PEDIATRIC UNIT WORKS IN CONJUNCTION WITH THE GALLIA COUNTY HEALTH DEPARTMENT IN PROMOTING FREE IMMUNIZATIONS. THE HOSPITAL ALSO PROVIDES EDUCATIONAL PROGRAMS AND SCREENINGS, AND DISCOUNTS AT THE HOSPITAL'S GIFT SHOP, CAFETERIA, AND PHARMACY IN CONJUNCTION WITH ITS MAXWELL 50 PROGRAM. ASSISTANCE IS ALSO PROVIDED TO SENIOR CITIZENS AND OTHER PATIENTS AND THEIR FAMILIES WITH THE SUBMISSIONS OF FORMS FOR INSURANCE, FINANCIAL COUNSELING, AND APPLICATION TO THE MEDICARE AND MEDICAID PROGRAMS FOR HEALTH SERVICE COVERAGE. COSTS ASSOCIATED WITH THESE PROGRAMS ARE INCLUDED IN THE HOSPITAL'S EXPENSES. | Description |
| Total Program Service Expense | 97980941 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 1 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 1 | LobbyingActivities |
| 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 | 1 | 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 | 1 | FundraisingActivities |
| Gaming | 0 | Gaming |
| Hospital | 1 | Hospital |
| Financial Stmt Attached | 1 | FinancialStmtAttached |
| 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 | 1 | 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 | 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 | 84 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | 1 | ComplianceWithBackupWitholding |
| Number Of Employees | 1251 | 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 | 1 | QuidProQuoContributions |
| Quid Pro Quo Disclosure | 1 | QuidProQuoDisclosure |
| 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 | 12 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 8 | 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 | 1 | MembersOrStockholders |
| Election Of Board Members | 0 | ElectionOfBoardMembers |
| Decisions Subject To Approval | 1 | 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 | KENNETH PAYNE | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 7404465060 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 100 JACKSON PIKE | AddressLine1 |
| City | GALLIPOLIS | City |
| State | OH | State |
| ZIP Code | 45631 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part VII | X | InfoInScheduleOPartVII |
Form990 Part VII Section A Form990PartVIISectionA (25 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | OfficerOfficer | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | Highest Compensated EmployeeHighestCompensatedEmployee |
|---|---|---|---|---|---|---|---|
| JAMES R PHILLIPPE | |||||||
| CEO | 40.00 | X | X | 286391 | 0 | 4318 | |
| BRENT SAUNDERS | |||||||
| PRES/CEO-HCHS | 40.00 | X | X | 299928 | 0 | 0 | |
| ALAN A STOCKMEISTER | |||||||
| VICE CHAIRMAN | 0.80 | X | X | 0 | 19000 | 0 | |
| PHIL A BOWMAN PARTIAL YEAR | |||||||
| SECRETARY | 0.80 | X | X | 0 | 17750 | 0 | |
| STEVE CHAPMAN CPA | |||||||
| CHAIRMAN | 0.80 | X | X | 0 | 18750 | 0 | |
| THOMAS TOPE | |||||||
| TRUSTEE, FORMER PRES/CEO-HCHS | 0.80 | X | 427722 | 0 | 0 | ||
| DANNY HOLSCHUH | |||||||
| TRUSTEE | 0.80 | X | 0 | 18500 | 0 | ||
| LARRY KIDD | |||||||
| TREASURER | 0.80 | X | X | 0 | 18750 | 0 | |
| M SUZANNE MIZE MD | |||||||
| TRUSTEE | 0.80 | X | 0 | 0 | 0 | ||
| PAUL M REED | |||||||
| TRUSTEE | 0.80 | X | 0 | 3250 | 0 | ||
| GARY ROACH | |||||||
| TRUSTEE | 0.80 | X | 0 | 16500 | 0 | ||
| REX E SHENEFIELD PARTIAL YEAR | |||||||
| TRUSTEE | 0.80 | X | 0 | 0 | 0 | ||
| RYAN SMITH PARTIAL YEAR | |||||||
| SECRETARY | 0.80 | X | X | 0 | 19500 | 0 | |
| VERLIN L SWAIN PARTIAL YEAR | |||||||
| TRUSTEE | 0.80 | X | 0 | 19000 | 0 | ||
| JAMAL HADDAD MD | |||||||
| TRUSTEE | 0.80 | X | 0 | 0 | 0 | ||
| KENNETH PAYNE | |||||||
| CFO | 40.00 | X | 265766 | 0 | 8098 | ||
| LISA HALLEY | |||||||
| VP SYSTEM HUMAN RESOURCES | 40.00 | X | 97193 | 0 | 1852 | ||
| JOHN V VIALL MD | |||||||
| VP MEDICAL AFFAIRS | 40.00 | X | 153099 | 0 | 7316 | ||
| JOHN ALLEN | |||||||
| VP INFORMATION SYSTEMS | 40.00 | X | 220844 | 0 | 8712 | ||
| LEE SALTZGABER MD | |||||||
| VP CLINICAL EFFECTIVENESS | 40.00 | X | 47104 | 0 | 2009 | ||
| CHRISTOPHER MARAZON | |||||||
| PHYSICIAN | 40.00 | 155917 | 0 | 4242 | X | ||
| GERALD VALLEE | |||||||
| PHYSICIAN | 40.00 | 188653 | 0 | 0 | X | ||
| SHANE E EPHLIN | |||||||
| PHARMACIST | 40.00 | 155175 | 0 | 4342 | X | ||
| ELAINE K BROWN | |||||||
| PHARMACIST | 40.00 | 150868 | 0 | 3109 | X | ||
| TERRY J SPURLIN | |||||||
| PHARMACIST | 40.00 | 141123 | 0 | 6738 | X | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 2589783 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 151000 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 50736 | TotalOtherCompensation |
| Number Individuals GT100 K | 27 | NumberIndividualsGT100K |
| Formers Listed | 1 | 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 |
|---|---|---|---|---|---|
| HOLZER CLINIC | |||||
| 90 JACKSON PIKE | GALLIPOLIS | OH | 45631 | PHYSICIANS | 10223737 |
| PLANTE & MORAN PLLC | |||||
| 67400 NORTHWESTERN HIGHWAY | SOUTHFIELD | MI | 48034 | ACCOUNTING | 459649 |
| EXECUTIVE HEALTH RESOURCES | |||||
| PO BOX 822688 | PHILADELPHIA | PA | 19073 | E H R COMPLIANCE SVCS | 382946 |
| FMC DS GALLIPOLIS | |||||
| PO BOX 101518 | ATLANTA | GA | 30303 | DIALYSIS | 264612 |
| MED SCRIBE INFORMATION SYSTEM | |||||
| 3325 HENDRICKS AVE | JACKSONVILLE | FL | 32207 | TRANSCRIPTIONS | 246304 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 11 | NumberOfContractorsGT100K |
| Fundraising Events | 13548 | FundraisingEvents |
| Related Organizations | 130270 | RelatedOrganizations |
| All Other Contributions | 7235 | AllOtherContributions |
| Total Contributions | 151053 | TotalContributions |
Program Service Revenue ProgramServiceRevenue (4 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome |
|---|---|---|---|
| NET PATIENT SERVICES | 622110 | 113632029 | 113632029 |
| HCAP | 622110 | 1212483 | 1212483 |
| LIFELINE INCOME | 622110 | 321724 | 321724 |
| RENTAL INCOME | 531120 | 262204 | 262204 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 115428440 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 147588 | TotalRevenueColumn |
| Exclusion | $147,588 | ExclusionAmount |
Gross Rents GrossRents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 233475 | Real |
Less Rental Expenses LessRentalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 60697 | Real |
Rental Income Or Loss RentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 172778 | Real |
Net Rental Income Or Loss NetRentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 172778 | TotalRevenueColumn |
| Exclusion | $172,778 | ExclusionAmount |
Gross Amount Sales Assets GrossAmountSalesAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 4678239 | Securities |
| Other | 2812 | Other |
Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 4649804 | Securities |
| Other | 3021 | Other |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 28435 | Securities |
| Other | -209 | Other |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 28226 | TotalRevenueColumn |
| Exclusion | $28,226 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Income Fundraising Events | 13895 | GrossIncomeFundraisingEvents |
| Cntrbtns Rprtd Fundraising Events | 13548 | CntrbtnsRprtdFundraisingEvents |
| Fundraising Direct Expenses | 33286 | FundraisingDirectExpenses |
Net Income From Fundraising Events NetIncomeFromFundraisingEvents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -19391 | TotalRevenueColumn |
| Exclusion | -$19,391 | ExclusionAmount |
Other Revenue Misc OtherRevenueMisc (3 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Unrelated Business RevenueUnrelatedBusinessRevenue | ExclusionExclusionAmount |
|---|---|---|---|---|
| CAFETERIA SALES | 722320 | 941794 | 74132 | $867,662 |
| LAUNDRY INCOME | 812300 | 178243 | 178243 | |
| GIFT SHOP SALES | 900099 | 119567 | $119,567 |
Miscellaneous Revenue MiscellaneousRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 150840 | TotalRevenueColumn |
| Related Or Exempt Function Income | 108216 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 42624 | UnrelatedBusinessRevenue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 1390444 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 117299138 | TotalRevenueColumn |
| Related Or Exempt Function Income | 115536656 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 294999 | UnrelatedBusinessRevenue |
| Exclusion | $1,316,430 | ExclusionAmount |
Grants To Domestic Orgs GrantsToDomesticOrgs
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 42359 | Total |
| Program Services | 42359 | ProgramServices |
Grants To Domestic Individuals GrantsToDomesticIndividuals
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2000 | Total |
| Program Services | 2000 | ProgramServices |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1611259 | Total |
| Management And General | 1611259 | ManagementAndGeneral |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 34714659 | Total |
| Program Services | 28205660 | ProgramServices |
| Management And General | 6508999 | ManagementAndGeneral |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 4922 | Total |
| Program Services | 3999 | ProgramServices |
| Management And General | 923 | ManagementAndGeneral |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 6470821 | Total |
| Program Services | 5257542 | ProgramServices |
| Management And General | 1213279 | ManagementAndGeneral |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3089376 | Total |
| Program Services | 2510118 | ProgramServices |
| Management And General | 579258 | ManagementAndGeneral |
Fees For Services Management FeesForServicesManagement
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1583679 | Total |
| Management And General | 1583679 | ManagementAndGeneral |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | -128407 | Total |
| Management And General | -128407 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 72770 | Total |
| Management And General | 72770 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 31918361 | Total |
| Program Services | 26734820 | ProgramServices |
| Management And General | 5183541 | ManagementAndGeneral |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 20345484 | Total |
| Program Services | 19684663 | ProgramServices |
| Management And General | 660821 | ManagementAndGeneral |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 73596 | Total |
| Program Services | 61644 | ProgramServices |
| Management And General | 11952 | ManagementAndGeneral |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1974881 | Total |
| Program Services | 1777393 | ProgramServices |
| Management And General | 197488 | ManagementAndGeneral |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 639106 | Total |
| Program Services | 535315 | ProgramServices |
| Management And General | 103791 | ManagementAndGeneral |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 489182 | Total |
| Program Services | 440264 | ProgramServices |
| Management And General | 48918 | ManagementAndGeneral |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 5205429 | Total |
| Program Services | 4684886 | ProgramServices |
| Management And General | 520543 | ManagementAndGeneral |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 662458 | Total |
| Program Services | 596212 | ProgramServices |
| Management And General | 66246 | ManagementAndGeneral |
Other Expenses OtherExpenses (5 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices |
|---|---|---|
| BAD DEBTS | 6311759 | 6311759 |
| FRANCHISE FEE | 727643 | 727643 |
| RECRUITMENT | 158435 | 158435 |
| COLLECTION FEES | 152824 | 152824 |
| LICENSURE FEES | 79250 | 79250 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 16899 | Total |
| Program Services | 14155 | ProgramServices |
| Management And General | 2744 | ManagementAndGeneral |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 116218745 | Total |
| Program Services | 97980941 | ProgramServices |
| Management And General | 18237804 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2768 | BOY |
| EOY | 62214 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 10167894 | BOY |
| EOY | 9097399 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 11020489 | BOY |
| EOY | 10482625 | EOY |
Receivables From Officers Etc ReceivablesFromOfficersEtc
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | 18179 | EOY |
Other Notes Loans Receivable Net OtherNotesLoansReceivableNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1559419 | BOY |
| EOY | 998229 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1902643 | BOY |
| EOY | 2185234 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 939569 | BOY |
| EOY | 1288150 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 134049070 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 104999048 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 27049615 | BOY |
| EOY | 29050022 | EOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | 10669686 | EOY |
Investments Other Securities InvestmentsOtherSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3672724 | BOY |
Investments Program Related InvestmentsProgramRelated
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 7630173 | BOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 20342629 | BOY |
| EOY | 23197418 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 84287923 | BOY |
| EOY | 87049156 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 16955247 | BOY |
| EOY | 15521322 | EOY |
Deferred Revenue DeferredRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 35585 | BOY |
Tax Exempt Bond Liabilities TaxExemptBondLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 7831142 | BOY |
| EOY | 6031142 | EOY |
Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 832506 | BOY |
| EOY | 5513921 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 993521 | BOY |
| EOY | 1153901 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 26648001 | BOY |
| EOY | 28220286 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 57470080 | BOY |
| EOY | 58642470 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 169842 | BOY |
| EOY | 186400 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 57639922 | BOY |
| EOY | 58828870 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 84287923 | BOY |
| EOY | 87049156 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | 1080393 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | 108557 | 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 |
| Audit Committee | 1 | AuditCommittee |
| Financial Statement Consolidated | X | FinancialStatementConsolidated |
| 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 | $1,646 | OtherActivitiesAmount |
| Total Lobbying Expenditures IIB | 1646 | TotalLobbyingExpendituresIIB |
| Not Described In501c3 | 0 | NotDescribedIn501c3 |
Form990 Schedule C Part IV Form990ScheduleCPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | EXPLANATION OF OTHER LOBBYING ACTIVITIES: | Identifier |
| Return Reference | PART II-B, LINE 1I: | ReturnReference |
| Explanation | A PORTION OF DUES PAID TO THE OHIO HOSPITAL ASSOCIATION RELATES TO LOBBYING ACTIVITY. | Explanation |
Schedule D IRS990ScheduleD
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 451456 | OtherCostOrOtherBasis |
| Book Value | 451456 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 35714444 | OtherCostOrOtherBasis |
| Depreciation | 23932846 | Depreciation |
| Book Value | 11781598 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 89506816 | OtherCostOrOtherBasis |
| Depreciation | 78078033 | Depreciation |
| Book Value | 11428783 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 8376354 | OtherCostOrOtherBasis |
| Depreciation | 2988169 | Depreciation |
| Book Value | 5388185 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 29050022 | TotalOfBookValueLandBuildings |
Other Assets OtherAssets (3 entries)
| DescriptionDescription | Book ValueBookValue |
|---|---|
| OTHER ASSETS | 1111568 |
| BOND ISSUE COSTS | 172197 |
| RELATED PARTY RECEIVABLE | 21913653 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | 23197418 | TotalBookValueOtherAssets |
Other Liabilities OtherLiabilities (2 entries)
| DescriptionDescription | AmountAmount |
|---|---|
| COST REPORT SETTLEMENTS | $131,906 |
| RELATED PARTY PAYABLE | $1,021,995 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 1153901 | TotalOfAmounts |
Form990 Schedule D Part XIV Form990ScheduleDPartXIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: | Identifier |
| Return Reference | PART X: | ReturnReference |
| Explanation | THE INTERNAL REVENUE SERVICE HAS RULED THAT THE SYSTEM IS EXEMPT FROM FEDERAL INCOME TAXES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AS A PUBLIC CHARITY DESCRIBED IN SECTION 509(A)(2); ACCORDINGLY, NO PROVISION FOR FEDERAL INCOME TAXES HAS BEEN MADE IN THE CONSOLIDATED FINANCIAL STATEMENTS. ALL OF THE SYSTEM'S SUBSIDIARIES, WITH THE EXCEPTION OF HOLZER VANGUARD, HAVE ALSO BEEN DETERMINED TO BE TAX EXEMPT BY THE INTERNAL REVENUE SERVICE. HOLZER VANGUARD IS A TAXABLE CORPORATION. IT FILES INCOME TAX RETURNS BASED ON ITS TAXABLE INCOME. FOR THE YEARS ENDED JUNE 30, 2011 AND 2010, FEDERAL INCOME TAXES WERE NOT SIGNIFICANT. 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 2008. | Explanation |
Schedule G IRS990ScheduleG
Events Information EventsInformation
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Event1 | GOLF OUTING | NameOfEvent1 |
| Gross Receipts Event1 | 27443 | GrossReceiptsEvent1 |
| Charitable Contributions Event1 | 13548 | CharitableContributionsEvent1 |
| Gross Revenue Event1 | 13895 | GrossRevenueEvent1 |
| Other Direct Expenses Event1 | 33286 | OtherDirectExpensesEvent1 |
| Gross Receipts Total | 27443 | GrossReceiptsTotal |
| Charitable Contributions Total | 13548 | CharitableContributionsTotal |
| Gross Revenue Total Events | 13895 | GrossRevenueTotalEvents |
| Other Direct Expenses Total Events | 33286 | OtherDirectExpensesTotalEvents |
| Direct Expense Summary Events | 33286 | DirectExpenseSummaryEvents |
| Net Income Summary | -19391 | NetIncomeSummary |
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 |
| Pcent100 | X | Pcent100 |
| FPG Reference Discounted Care | 1 | FPGReferenceDiscountedCare |
| Pcent300 | X | Pcent300 |
| Free Disc Care Medically Indigent | 1 | FreeDiscCareMedicallyIndigent |
| Amounts Budgeted For Charity Care | 1 | AmountsBudgetedForCharityCare |
| Expenses Exceeded Budget | 1 | ExpensesExceededBudget |
| Unable To Provide Care | 0 | UnableToProvideCare |
| Annual Community Benefit Report | 0 | AnnualCommunityBenefitReport |
Charity Care At Cost CharityCareAtCost
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 2624946 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 2624946 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.02390 | PercentOfTotalExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 15226248 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 9864543 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 5361705 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.04880 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 17851194 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 9864543 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 7986651 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.07270 | PercentOfTotalExpense |
Community Health Services CommunityHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 6171 | PersonsServed |
| Total Community Benefit Expense | 115360 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 0 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 115360 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00100 | PercentOfTotalExpense |
Health Professions Education HealthProfessionsEducation
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 1557 | PersonsServed |
| Total Community Benefit Expense | 71589 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 0 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 71589 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00070 | PercentOfTotalExpense |
Cash And In Kind Contributions CashAndInKindContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 10987 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 0 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 10987 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00010 | PercentOfTotalExpense |
Total Other Benefits TotalOtherBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 7728 | PersonsServed |
| Total Community Benefit Expense | 197936 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 197936 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00180 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 7728 | PersonsServed |
| Total Community Benefit Expense | 18049130 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 9864543 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 8184587 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.07450 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 0 | BadDebtExpenseReported |
| Bad Debt Expense | $2,441,715 | BadDebtExpenseAmount |
| Amount Attributable To | 0 | AmountAttributableTo |
| Amount Reimbursed By Medicare | 31986781 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 39417765 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | -7430984 | 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 | HOLZER HOSPITAL FOUNDATION | BusinessNameLine1 |
Address Address
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 100 JACKSON PIKE | AddressLine1 |
| City | GALLIPOLIS | City |
| State | OH | State |
| ZIP Code | 45631 | 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 | NOT APPLICABLE | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital Facility Number | 1 | HospitalFacilityNumber |
Form990 Schedule H Part V Section C Form990ScheduleHPartVSectionC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Other Facilities | 3 | NumberOfOtherFacilities |
Other Facilities OtherFacilities (3 entries)
| Address Line1Address/AddressLine1 | CityAddress/City | StateAddress/State | ZIP CodeAddress/ZIPCode | Facility TypeFacilityType |
|---|---|---|---|---|
| PHYSICIAN'S OFFICE-DR TIMOTHY DAMRON | ||||
| 2881 SR 160 | GALLIPOLIS | OH | 45631 | GENERAL, MEDICAL & SURGICAL |
| PHYSICIAN'S OFFICE-DR LINDA ALSTON | ||||
| 2881 SR 160 | GALLIPOLIS | OH | 45631 | GENERAL, MEDICAL & SURGICAL |
| MEDICAL PLAZA | ||||
| 100 JACKSON PIKE | GALLIPOLIS | OH | 45631 | GENERAL, MEDICAL & SURGICAL |
Form990 Schedule H Part VI Form990ScheduleHPartVI (13 entries)
| ExplanationExplanation |
|---|
| PART I, LINE 3C: NOT APPLICABLE |
| PART I, LINE 6A: NOT APPLICABLE |
| PART I, LINE 7: EXPENSES WERE CALCULATED USING THE COST-TO-CHARGE RATIO FROM WORKSHEET 2. |
| 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 $ 6319759. |
| PART II: NOT APPLICABLE |
| PART III, LINE 4: BAD DEBT WAS RECORDED AT GROSS CHARGES ONCE AN ACCOUNT HAD BEEN THROUGH MULTIPLE ATTEMPTS FOR PAYMENT. IT WAS THEN SUBMITTED FOR COLLECTIONS, LESS ANY AMOUNTS THAT MAY HAVE BEEN PAID THROUGH INSURANCE OR PRIVATE PAYMENTS. BAD DEBT AT COST WAS CALCULATED USING A COST-TO-CHARGE RATIO. NONE OF THE BAD DEBT AT COST IS TREATED AS COMMUNITY BENEFIT. NONE OF THE BAD DEBT AT COST IS LIKELY ATTRIBUTABLE TO PATIENTS ELIGIBLE FOR CHARITY CARE. IF IT IS UNCLEAR WHETHER AN ACCOUNT MAY QUALIFY AS CHARITY, IT IS FIRST ASSUMED TO BE CHARITY, NOT BAD DEBT, UNTIL ADDITIONAL INFORMATION SHOWS OTHERWISE.FOOTNOTE FROM FINANCIAL STATEMENTS: 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. |
| PART III, LINE 8: MEDICARE COSTS AS REPORTED IN THE MEDICARE COST REPORT WERE CALCULATED USING A COST-TO-CHARGE RATIO METHODOLOGY AS REQUIRED FOR COMPLETING THE MEDICARE COST REPORT. NONE OF THE MEDICARE SHORTFALL IS TREATED AS COMMUNITY BENEFIT. |
| PART III, LINE 9B: FOUR PATIENT STATEMENTS ARE SENT TO NON-MEDICARE ACCOUNTS. FIVE PATIENT STATEMENTS ARE SENT TO MEDICARE ACCOUNTS. IF NO PATIENT PAYMENT RESPONSE, ACCOUNTS ARE SELECTED AND PROCESSED TO BAD DEBT. THIS POLICY APPLIES TO PATIENTS WHO QUALIFY UNDER THE CHARITY CARE/FINANCIAL ASSISTANCE POLICY. |
| PART VI, LINE 3: NOTICES ARE POSTED THAT SPECIFY THE RIGHTS OF THESE INDIVIDUALS TO RECEIVE WITHOUT CHARGE BASIC, MEDICALLY NECESSARY HOSPITAL-LEVEL SERVICES. THE POSTINGS ARE PRINTED IN ENGLISH AND SPANISH AND ARE LOCATED IN ADMISSIONS AREAS, THE BUSINESS OFFICE, AND THE EMERGENCY DEPARTMENT. PATIENT STATEMENTS CONTAIN FEDERAL POVERTY GUIDELINES, AN EXPLANATION OF WHAT SERVICES MAY QUALIFY FOR FREE CARE, AND INFORMATION ON HOW TO APPLY. THE ORGANIZATION ALSO EMPLOYS FINANCIAL ADVOCATES AND BENEFIT ELIGIBILITY COORDINATORS TO ASSIST IN THE INFORMATION/EDUCATION PROCESS. |
| PART VI, LINE 4: THE PRIMARY SERVICE AREA FOR HOLZER HOSPITAL FOUNDATION IS COMPRISED OF THE FOUR-COUNTRY AREA OF GALLIA, JACKSON, AND MEIGS COUNTIES IN OHIO, AND MASON COUNTY IN WEST VIRGINIA. THE SECONDARY SERVICE AREA INCLUDES PARTS OF VINTON, LAWRENCE, ATHENS, AND SCIOTO COUNTIES IN OHIO, AND JACKSON COUNTY IN WEST VIRGINIA. |
| PART VI, LINE 6: HOLZER MEDICAL CENTER BELIEVES THAT EDUCATIONAL AND PREVENTATIVE SERVICES ARE IMPERITIVE TO IMPROVING THE HEALTH OF OUR COMMUNITY. AS SUCH, THE COMMUNITY HEALTH AND WELLNESS DEPARTMENT AT HOLZER MEDICAL CENTER ORGANIZES AND PROVIDES HEALTH SCREENINGS THROUGHOUT THE YEAR AT OUR CAMPUS, AT VARIOUS FAIRS AND FESTIVALS IN THE COMMUNITY, AT OUR LOCAL SCHOOLS AND ALSO AT AREA BUSINESSES. NO-COST HEALTH SCREENINGS INCLUDE: BLOOD PRESSURE, GLUCOSE, CHOLESTEROL, BONE DENSITY AND BODY COMPOSITION SCREENINGS. SOME OF OUR LARGER COMMUNITY EVENTS INCLUDE: GALLIA COUNTY FAIR, MEIGS COUNTY FAIR, MASON COUNTY FAIR, BUCKEYE RURAL ELECTRIC EMPLOYEE HEALTH FAIR, BUCKEYE RURAL ELECTRIC ANNUAL MEETING AND HOLZER CENTER FOR CANCER FAIR. HOLZER MEDICAL CENTER ALSO HOSTS A MONTHLY DIABETES EDUCATION MEETING, MS SUPPORT GROUP, CANCER SUPPORT GROUP AND PROVIDES HEALTH SCREENING TO SENIOR CITIZENS IN OUR SERVICE AREA AND SPEAKERS THROUGHOUT THE YEAR TO DISCUSS VARIOUS MEDICAL TOPICS TO COMMUNITY GROUPS. ALONG WITH THESE NO-COST SCREENINGS, THE COMMUNITY HEALTH AND WELLNESS DEPARTMENT PROVIDES EDUCATIONAL INFORMATION TO LOCAL ORGANIZATIONS TO PROMOTE HEALTH AND WELLNESS FOR THEIR EMPLOYEES. IN ALL, APPROXIMATELY 4,500 SCREENINGS WERE PERFORMED BY HOLZER MEDICAL CENTER NURSES OR TECHNICIANS IN FISCAL YEAR 2010. |
| PART VI, LINE 7: HOLZER MEDICAL CENTER AND HOLZER MEDICAL CENTER-JACKSON COMPRISE THE TWO HOSPITALS IN THE SYSTEM, WITH HOLZER MEDICAL CENTER ACCOUNTING FOR 82% OF HOSPITAL ADMISSIONS. HOLZER MEDICAL CENTER IS LOCATED IN GALLIA COUNTY AND HOLZER MEDICAL CENTER-JACKSON IS LOCATED IN JACKSON COUNTY. ALL HEALTH SCREENINGS AND PATIENT EDUCATION IS PROVIDED BY STAFF IN AREAS WITHIN OUR PRIMARY SERVICE AREA WHICH INCLUDES GALLIA, JACKSON AND MEIGS COUNTIES IN OHIO AND MASON COUNTY, WEST VIRGINIA AS WELL AS SOME SERVICES PROVIDED IN OUR SECONDARY SERVICE AREA. |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Records Maintained | 1 | RecordsMaintained |
Recipient Table RecipientTable
Recipient Name Business RecipientNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | HOLZER FOUNDATION | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 100 JACKSON PIKE | AddressLine1 |
| City | GALLIPOLIS | City |
| State | OH | State |
| ZIP Code | 45631 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN Of Recipient | 310927482 | EINOfRecipient |
| IRC Section | 501(C) | IRCSection |
| Amount Of Cash Grant | 42359 | AmountOfCashGrant |
| Purpose Of Grant | GENERAL SUPPORT | PurposeOfGrant |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Nbr Of501 C3 And Govt Grants | 1 | TotalNbrOf501C3AndGovtGrants |
| Total Nbr Of Other Organizations | 0 | TotalNbrOfOtherOrganizations |
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 MAY PROVIDE FUNDS TO RELATED EXEMPT ORGANIZATIONS. | Explanation |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Independent Consultant | X | IndependentConsultant |
| Written Employment Contract | X | WrittenEmploymentContract |
| Board Or Committee Approval | X | BoardOrCommitteeApproval |
| Severance Payment | 1 | 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 (10 entries)
| 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| JAMES R PHILLIPPE | |||||||||||||
| 286391 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 4318 | 0 | 290709 | 0 | 0 | 0 |
| BRENT SAUNDERS | |||||||||||||
| 299928 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 299928 | 0 | 0 | 0 |
| THOMAS TOPE | |||||||||||||
| 0 | 0 | 0 | 0 | 427722 | 0 | 0 | 0 | 0 | 0 | 427722 | 0 | 0 | 0 |
| KENNETH PAYNE | |||||||||||||
| 265766 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 8098 | 0 | 273864 | 0 | 0 | 0 |
| JOHN V VIALL MD | |||||||||||||
| 153099 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 7316 | 0 | 160415 | 0 | 0 | 0 |
| JOHN ALLEN | |||||||||||||
| 220844 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 8712 | 0 | 229556 | 0 | 0 | 0 |
| CHRISTOPHER MARAZON | |||||||||||||
| 155917 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 4242 | 0 | 160159 | 0 | 0 | 0 |
| GERALD VALLEE | |||||||||||||
| 188653 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 188653 | 0 | 0 | 0 |
| SHANE E EPHLIN | |||||||||||||
| 155175 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 4342 | 0 | 159517 | 0 | 0 | 0 |
| ELAINE K BROWN | |||||||||||||
| 150868 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 3109 | 0 | 153977 | 0 | 0 | 0 |
Form990 Schedule J Part III Form990ScheduleJPartIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Reference | PART I, LINE 4A | ReturnReference |
| Explanation | DURING THE CALENDAR YEAR, THOMAS TOPE RECEIVED SEVERANCE PAY IN THE AMOUNT OF $427,722. UNDER THE TERMS OF THE SEVERANCE AGREEMENT, MR. TOPE WILL RECEIVE 100% OF BASE SALARY AND OTHER BENEFITS AS OF THE TERMINATION DATE, 7/1/09, THROUGH 1/1/11. HE WILL ALSO BE ENTITLED TO AN ANNUAL AUTO ALLOWANCE, PARTICIPATION IN THE HOSPITAL'S GROUP LIFE INSURANCE PLAN, QUARTERLY PAYMENTS DIRECTLY FROM THE HOSPITAL TO MR. TOPE IN AN AMOUNT EQUAL TO THE 457(F) CONTRIBUTION, AND OTHER PENSION PLAN PAYMENTS DIRECTLY FROM THE HOSPITAL TO MR. TOPE BASED ON THE MAXIMUM DEFFERAL ALLOWED. FOLLOWING THIS 18 MONTH PERIOD, MR. TOPE WILL ALSO RECEIVE AN AMOUNT EQUAL TO 22 WEEKS OF BASE SALARY, PLUS 4 WEEKS OF BASE SALARY AS ADDITIONAL RETIREMENT CONSIDERATION (BASED ON THE SALARY IN EFFECT AT THE TERMINATION DATE). | Explanation |
Schedule L IRS990ScheduleL
Loan Table LoanTable
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Person | SHANE EPHLIN | NamePerson |
| Purpose Of Loan | STUDENT LOAN | PurposeOfLoan |
| Loan From Organization | X | LoanFromOrganization |
| Original Principal | $118,162 | OriginalPrincipalAmount |
| Balance Due | 18179 | BalanceDue |
| Default | 0 | Default |
| Approved By Board | 1 | ApprovedByBoard |
| Written Agreement | 1 | WrittenAgreement |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Balance Due | 18179 | TotalBalanceDue |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (10 entries)
| IdentifierIdentifier | ExplanationExplanation | Return ReferenceReturnReference |
|---|---|---|
| FORM 990, PART VI, SECTION A, LINE 6 | HOLZER CONSOLIDATED HEALTH SYSTEMS IS THE SOLE MEMBER OF THE ORGANIZATION. | |
| FORM 990, PART VI, SECTION A, LINE 7B | HOLZER HOSPITAL FOUNDATION'S DECISIONS THAT ARE MADE BY THEIR BOARD OF DIRECTORS CAN BE OVERRULED BY HOLZER CONSOLIDATED HEALTH SYSTEM'S BOARD OF DIRECTORS. | |
| FORM 990, PART VI, SECTION B, LINE 11 | THE CONTROLLER AND THE CFO OF HOLZER CONSOLIDATED HEALTH SYSTEMS REVIEW FORM 990. A COPY WILL BE PROVIDED TO ALL BOARD MEMBERS PRIOR TO FILING. | |
| CONFLICT OF INTEREST STATEMENTS ARE COMPLETED ANNUALLY BY ALL BOARD MEMBERS, OFFICERS, AND EMPLOYEES, AND ARE REVIEWED BY THE CONFLICT OF INTEREST REVIEW COMMITTEE. MEMBERS OF THE BOARD ARE AWARE THAT THEY SHOULD DISCLOSE CONFLICTS WHEN THEY ARISE, AND MEMBERS ABSTAIN FROM PARTICIPATING IN DISCUSSIONS OR VOTING ON MATTERS WHERE A CONFLICT IS PRESENT. | FORM 990, PART VI, SECTION B, LINE 12C | |
| THE HOLZER CONSOLIDATED HEALTH SYSTEM BOARD APPROVES COMPENSATION OF THE CEO AND OTHER OFFICERS. THE BOARD UTILIZES WAGE RECOMMENDATIONS FROM AN UNRELATED CONSULTANT TO DETERMINE THE COMPENSATION. THE CEO MAY BE INVOLVED IN DETERMINING OTHER OFFICERS' COMPENSATION, HOWEVER THE ULTIMATE DECISION RESTS WITH THE BOARD. THE COMPENSATION DECISIONS THAT ARE MADE ARE DOCUMENTED IN THE BOARD MINUTES. THE PROCESS WAS LAST UNDERTAKEN DURING DECEMBER 2011. | FORM 990, PART VI, SECTION B, LINE 15 | |
| THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. | FORM 990, PART VI, SECTION C, LINE 19 | |
| THE FOLLOWING TRUSTEES DEVOTED TIME TO HOLZER CONSOLIDATED HEALTH SYSTEMS: ALAN A. STOCKMEISTER 1 HRS PHIL A. BOWMAN 1 HRS STEVE CHAPMAN, CPA 1 HRS LARRY KIDD 1 HRS RYAN SMITH 1 HRS PAUL M. REED 1 HRS GARY ROACH 1 HRS DANNY HOLSCHUH 1 HRS VERLIN SWAIN 1 HRS | FORM 990, PAGE 7, PART VII: | |
| CHANGES IN NET ASSETS OR FUND BALANCES: | NET UNREALIZED GAINS ON INVESTMENTS: 66,198. GRANTS REPORTED ON PART IX NOT RECORDED ON FINANCIALS 42,359. TOTAL TO FORM 990, PART XI, LINE 5: 108,557. | FORM 990, PART XI, LINE 5: |
| THE AUDIT OVERSIGHT PROCESS AND THE PROCESS OF SELECTION OF AN INDEPENDENT ACCOUNTANT HAVE NOT CHANGED FROM THE PRIOR YEAR. | FORM 990, PART XII, LINE 2C: | |
| DOING BUSINESS AS: HOLZER MEDICAL CENTER HOLZER MEDICAL CENTER - GALLIPOLIS | FORM 990, PAGE 1, LINE C: |
Schedule R IRS990ScheduleR
Form990 Schedule R Part II Form990ScheduleRPartII (4 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 | Direct Controlling Entity NADirectControllingEntityNA |
|---|---|---|---|---|---|---|---|---|---|---|---|
| HOLZER MEDICAL CENTER - JACKSON | |||||||||||
| 100 JACKSON PIKE | GALLIPOLIS | OH | 45631 | 311724085 | HEALTH CARE | OH | 501(C)(3) | LINE 3 | HOLZER CONSOLIDATED HEALTH SYSTEMS | 1 | |
| HOLZER FOUNDATION | |||||||||||
| 100 JACKSON PIKE | GALLIPOLIS | OH | 45631 | 310927482 | CONTINUING ADVANCEMENT OF HEALTH AND MEDICAL CARE | OH | 501(C)(3) | LINE 7 | HOLZER CONSOLIDATED HEALTH SYSTEMS | 1 | |
| HOLZER CONSOLIDATED HEALTH SYSTEMS | |||||||||||
| 100 JACKSON PIKE | GALLIPOLIS | OH | 45631 | 311156690 | MANAGEMENT SERVICES | OH | 501(C)(3) | LINE 11A, I | 0 | N/A | |
| HOLZER SENIOR CARE CENTER | |||||||||||
| 380 COLONIAL DRIVE | BIDWELL | OH | 45614 | 311534051 | SKILLED NURSING FACILITY | OH | 501(C)(3) | LINE 9 | HOLZER CONSOLIDATED HEALTH SYSTEMS | 1 | |
Form990 Schedule R Part III Form990ScheduleRPartIII
Name Of Related Org NameOfRelatedOrg
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | HOLZER CARDIOVASCULAR LLC | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 90 JACKSON PIKE | AddressLine1 |
| City | GALLIPOLIS | City |
| State | OH | State |
| ZIP Code | 45631 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 311780671 | EIN |
| Primary Activity | MEDICAL | PrimaryActivity |
| Legal Domicile State | OH | LegalDomicileState |
| Direct Controlling Entity NA | N/A | DirectControllingEntityNA |
Form990 Schedule R Part IV Form990ScheduleRPartIV
Name Of Related Org NameOfRelatedOrg
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | HOLZER VANGUARD | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 100 JACKSON PIKE | AddressLine1 |
| City | GALLIPOLIS | City |
| State | OH | State |
| ZIP Code | 45631 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 311192567 | EIN |
| Primary Activity | STOCK HOLDING COMPANY | PrimaryActivity |
| Legal Domicile State | OH | LegalDomicileState |
| Direct Controlling Entity NA | N/A | DirectControllingEntityNA |
| Type Of Entity | C | TypeOfEntity |
| 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 | 1 | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | 0 | LoansOrGuaranteesFromOtherOrg |
| 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 | 1 | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | 1 | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | 1 | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | 1 | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | 1 | 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 | 0 | OtherTransferToOtherOrg |
| Other Transfer From Other Org | 0 | OtherTransferFromOtherOrg |
Transactions Related Orgs Table TransactionsRelatedOrgsTable (6 entries)
| Transaction TypeTransactionType | Amount InvolvedAmountInvolved | Method Of Amt DeterminationMethodOfAmtDetermination |
|---|---|---|
| HOLZER CONSOLIDATED HEALTH SYSTEMS | ||
| I | 262206 | PER LEASE CONTRACT |
| HOLZER CONSOLIDATED HEALTH SYSTEMS | ||
| J | 373557 | PER LEASE CONTRACT |
| HOLZER CONSOLIDATED HEALTH SYSTEMS | ||
| L | 1045106 | PER MANAGEMENT AGREEMENT |
| HOLZER FOUNDATION | ||
| C | 130270 | ALLOCATION OF COSTS |
| HOLZER CARDIOVASCULAR INSTITUTE LLC | ||
| L | 9700000 | PER MANAGEMENT AGREEMENT |
| HOLZER CONSOLIDATED HEALTH SYSTEMS | ||
| K | 500000 | PER MANAGEMENT AGREEMENT |