WAYNE MEMORIAL COMMUNITY HEALTH CENTERS: Form 990, tax year 2010

View the entire original 990 at ProPublica ↗

Organization: WAYNE MEMORIAL COMMUNITY HEALTH CENTERS (EIN 23-2180889)
Tax period: 2010-07-01 to 2011-06-30
Filed: 2012-04-17
IRS object ID: 201231109349300703
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 D
Schedule J
Schedule L
Schedule O

Return header ReturnHeader

Field	Value	IRS element (for citing)
Timestamp	2012-04-17T09:26:14-05:00	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	PARENTEBEARD LLC	BusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

Field	Value	IRS element (for citing)
Address Line1	46 PUBLIC SQUARE SUITE 400	AddressLine1
City	WILKESBARRE	City
State	PA	State
ZIP Code	18701	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	232180889	EIN

Name Name

Field	Value	IRS element (for citing)
Business Name Line1	WAYNE MEMORIAL COMMUNITY HEALTH CENTERS	BusinessNameLine1

Field	Value	IRS element (for citing)
Name Control	WAYN	NameControl
Phone	5702531300	Phone

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	601 PARK STREET	AddressLine1
City	HONESDALE	City
State	PA	State
ZIP Code	18431	ZIPCode

Officer Officer

Field	Value	IRS element (for citing)
Name	FREDERICK JACKSON	Name
Title	EXECUTIVE DIRECTOR	Title
Phone	5702531300	Phone
Date Signed	2012-04-16	DateSigned
Authorize Third Party	1	AuthorizeThirdParty

Preparer Preparer

Field	Value	IRS element (for citing)
Name	JULIUS GREEN CPA	Name
Phone	5708200100	Phone

Field	Value	IRS element (for citing)
Tax Year	2010	TaxYear
Build TS	2016-02-24 21:20:13Z	BuildTS

Form 990 IRS990

Field	Value	IRS element (for citing)
Name Of Principal Officer Person	FREDERICK JACKSON	NameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

Field	Value	IRS element (for citing)
Address Line1	601 PARK STREET	AddressLine1
City	HONESDALE	City
State	PA	State
ZIP Code	18431	ZIPCode

Field	Value	IRS element (for citing)
Gross Receipts	8811025	GrossReceipts
Group Return For Affiliates	0	GroupReturnForAffiliates
Organization501c3	X	Organization501c3
Web Site	WWW.WMH.ORG	WebSite
Type Of Organization Corporation	X	TypeOfOrganizationCorporation
Year Formation	1981	YearFormation
State Legal Domicile	PA	StateLegalDomicile
Activity Or Mission Description	MEDICAL, DENTAL, AND BEHAVIORAL HEALTH SERVICES TO THE RESIDENTS OF THE WAYNE & PIKE COUNTIES OF PA.	ActivityOrMissionDescription
Nbr Voting Members Governing Body	12	NbrVotingMembersGoverningBody
Nbr Independent Voting Members	11	NbrIndependentVotingMembers
Total Nbr Employees	115	TotalNbrEmployees
Total Nbr Volunteers	0	TotalNbrVolunteers
Total Gross UBI	0	TotalGrossUBI
Net Unrelated Business Txbl Income	0	NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year	1964355	ContributionsGrantsPriorYear
Contributions Grants Current Year	1861805	ContributionsGrantsCurrentYear
Program Service Revenue Prior Year	6484068	ProgramServiceRevenuePriorYear
Program Service Revenue CY	6920515	ProgramServiceRevenueCY
Investment Income Prior Year	114	InvestmentIncomePriorYear
Investment Income Current Year	394	InvestmentIncomeCurrentYear
Other Revenue Prior Year	12669	OtherRevenuePriorYear
Other Revenue Current Year	13183	OtherRevenueCurrentYear
Total Revenue Prior Year	8461206	TotalRevenuePriorYear
Total Revenue Current Year	8795897	TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year	0	GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY	0	GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year	0	BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY	0	BenefitsPaidToMembersCY
Salaries Etc Prior Year	5940236	SalariesEtcPriorYear
Salaries Etc Current Year	6763195	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	1895615	OtherExpensePriorYear
Other Expenses Current Year	2358211	OtherExpensesCurrentYear
Total Expenses Prior Year	7835851	TotalExpensesPriorYear
Total Expenses Current Year	9121406	TotalExpensesCurrentYear
Revenues Less Expenses Prior Year	625355	RevenuesLessExpensesPriorYear
Revenues Less Expenses CY	-325509	RevenuesLessExpensesCY
Total Assets BOY	3022876	TotalAssetsBOY
Total Assets EOY	3405099	TotalAssetsEOY
Total Liabilities BOY	2004413	TotalLiabilitiesBOY
Total Liabilities EOY	2712145	TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY	1018463	NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY	692954	NetAssetsOrFundBalancesEOY
Info In Schedule O Part III	X	InfoInScheduleOPartIII
Mission Description	THE MISSION IS TO PROVIDE MEDICAL, DENTAL AND BEHAVIORAL HEALTH SERVICES TO ALL THE RESIDENTS OF WAYNE & PIKE COUNTIES PENNSYLVANIA WITH A SPECIFIC EMPHASIS ON THE UNDERSERVED, LOW INCOME AND UNINSURED.	MissionDescription
Significant New Program Services	0	SignificantNewProgramServices
Significant Change	0	SignificantChange
Expense	8083032	Expense
Revenue	6930488	Revenue
Description	SERVING ALL MEMBERS OF THE COMMUNITY WITH A FOCUS ON THE UNDERSERVED AND DISADVANTAGED, THE WAYNE MEMORIAL COMMUNITY HEALTH CENTERS WILL CREATE AND SUSTAIN A HEALTHY COMMUNITY BY PROVIDING HIGH QUALITY PRIMARY MEDICAL, DENTAL, AND BEHAVIORAL HEALTH CARE IN AN ACCESSIBLE, AFFORDABLE AND NONDISCRIMINATORY MANNER. IN THE YEAR ENDING 2011 WMCHC PROVIDED 29,495 MEDICAL ENCOUNTERS, 3,002 DENTAL ENCOUNTERS, AND 3,334 BEHAVIORAL ENCOUNTERS TO THE RESIDENTS OF WAYNE AND PIKE COUNTIES, PENNSYLVANIA. THE CENTER HAS NINE OFFICES PROVIDING CARE IN THIS SERVICE AREA. WMCHC CONTINUES TO GROW AND ADD PRACTITIONERS AND SERVICE LOCATIONS IN ORDER TO PROVIDE QUALITY MEDICAL, DENTAL, AND BEHAVIORAL HEALTH SERVICES. THE OPERATIONS OF WMCHC RELIEVE GOVERNMENT BURDEN BY PROVIDING CARE TO MEDICAID AND UNINSURED INDIVIDUALS WHO WOULD BE DESTITUTE AND LACKING PROPER CARE WITHOUT INTERVENTION. IN FISCAL 2011, THE CENTERS PROVIDED APPROXIMATELY $265,000 IN CHARITY CARE SERVICES FOR QUALIFYING PATIENTS.	Description
Total Program Service Expense	8083032	TotalProgramServiceExpense
Described In501 C3	1	DescribedIn501C3
Schedule B Required	1	ScheduleBRequired
Political Activities	0	PoliticalActivities
Lobbying Activities	0	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	1	IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt	0	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	0	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	1	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	0	RelatedEntity
Related Org Controlled Entity	0	RelatedOrgControlledEntity
Transaction Related Entity	0	TransactionRelatedEntity
Transfers To Exempt Non Chrtbl Org	0	TransfersToExemptNonChrtblOrg
Activities Conducted Partnership	0	ActivitiesConductedPartnership
Schedule O Required	1	ScheduleORequired
Number Forms Transmitted With1096	35	NumberFormsTransmittedWith1096
Number W2 G Included	0	NumberW2GIncluded
Compliance With Backup Witholding	1	ComplianceWithBackupWitholding
Number Of Employees	115	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
Excess Business Holdings	0	ExcessBusinessHoldings
Indoor Tanning Services	0	IndoorTanningServices
Info In Schedule O Part VI	X	InfoInScheduleOPartVI
Nbr Voting Governing Body Members	12	NbrVotingGoverningBodyMembers
Number Independent Voting Members	11	NumberIndependentVotingMembers
Family Or Business Relationship	1	FamilyOrBusinessRelationship
Delegation Of Management Duties	1	DelegationOfManagementDuties
Changes To Organizing Docs	0	ChangesToOrganizingDocs
Material Diversion Or Misuse	0	MaterialDiversionOrMisuse
Members Or Stockholders	0	MembersOrStockholders
Election Of Board Members	0	ElectionOfBoardMembers
Decisions Subject To Approval	0	DecisionsSubjectToApproval
Minutes Of Governing Body	1	MinutesOfGoverningBody
Minutes Of Committees	1	MinutesOfCommittees
Officer Mailing Address	0	OfficerMailingAddress
Local Chapters	0	LocalChapters
Form990 Provided To Governing Body	1	Form990ProvidedToGoverningBody
Conflict Of Interest Policy	1	ConflictOfInterestPolicy
Annual Disclosure Covered Persons	1	AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement	1	RegularMonitoringEnforcement
Whistleblower Policy	1	WhistleblowerPolicy
Document Retention Policy	1	DocumentRetentionPolicy
Compensation Process CEO	1	CompensationProcessCEO
Compensation Process Other	1	CompensationProcessOther
Investment In Joint Venture	0	InvestmentInJointVenture
States Where Copy Of Return Is Filed	PA	StatesWhereCopyOfReturnIsFiled
Upon Request	X	UponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

Field	Value	IRS element (for citing)
Business Name Line1	ADMINISTRATION	BusinessNameLine1

Field	Value	IRS element (for citing)
Telephone Number	5702531300	TelephoneNumber

Address US AddressUS

Field	Value	IRS element (for citing)
Address Line1	601 PARK STREET	AddressLine1
City	HONESDALE	City
State	PA	State
ZIP Code	18431	ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (23 entries)

TitleTitle	Average Hours Per WeekAverageHoursPerWeek	Individual Trustee Or DirectorIndividualTrusteeOrDirector	OfficerOfficer	Reportable Comp From OrganizationReportableCompFromOrganization	Reportable Comp From Related OrgsReportableCompFromRelatedOrgs	Other CompensationOtherCompensation	Key EmployeeKeyEmployee	Highest Compensated EmployeeHighestCompensatedEmployee
JUSTIN O'DONNELL
CHAIR	1.00	X	X	0	0	0
PETER ROGERS
VICE-CHAIR	1.00	X	X	0	0	0
MICHAEL CLIFFORD
TREASURER	1.00	X	X	0	0	0
SANDY MAXSON
SECRETARY	1.00	X	X	0	0	0
STEVE BURLEIN
USER - MEMBER	1.00	X		0	0	0
DOREEN FITZGERALD
USER - MEMBER	1.00	X		0	0	0
ANN FOSTER
NON USER - MEMBER	1.00	X		0	0	0
SUSAN GABRIELSON
NON USER - MEMBER	1.00	X		0	0	0
DAVID HOFF
USER - MEMBER	1.00	X		0	0	0
MARIA SHELP
NON USER - MEMBER	1.00	X		0	0	0
FREDERICK JACKSON
CEO	40.00		X	128294	0	19839
DR ROBERT GORRELL
PHYSICIAN	40.00			297654	0	21029	X
DR SEAN MCVEIGH
PHYSICIAN	40.00			277242	0	28670	X
DR ROBERT DOHNOR
PHYSICIAN	40.00			159896	0	20162	X
DR PEDRO MENCIA
PHYSICIAN	40.00			296904	0	29991	X
DR HOON YOO
PHYSICIAN	40.00			268052	0	26637	X
DR BRIAN LENCZEWSKI
PHYSICIAN	40.00			257536	0	12029	X
DR EUN SUZANNA YOO
PHYSICIAN	40.00			159374	0	0	X
DR CATALINA DINU
PHYSICIAN	40.00			125495	0	2447		X
DR BRIAN BROWN
PHYSICIAN	40.00			156001	0	13775		X
DR WAWRZYNIEC STEPCZAK
PHYSICIAN	40.00			134327	0	20175		X
DR JOHN WEISENREIDER
PHYSICIAN	40.00			127536	0	15929		X
DR VANCE JONES
PHYSICIAN	40.00			141302	0	20593		X

Field	Value	IRS element (for citing)
Total Reportable Comp From Org	2529613	TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs	0	TotalReportableCompFrmRltdOrgs
Total Other Compensation	231276	TotalOtherCompensation
Number Individuals GT100 K	14	NumberIndividualsGT100K
Formers Listed	0	FormersListed
Total Comp GT150 K	1	TotalCompGT150K
Compensation From Other Sources	0	CompensationFromOtherSources

Contractor Compensation ContractorCompensation (3 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1	CityAddressOfContractor/AddressUS/City	StateAddressOfContractor/AddressUS/State	ZIP CodeAddressOfContractor/AddressUS/ZIPCode	Description Of ServicesDescriptionOfServices	CompensationCompensation
COMP HEALTH MEDICAL STAFFING
PO BOX 9726	DALLAS	TX	753972670	MEDICAL STAFFING	375118
CHARLES W GRIMM CONSTRUCTION INC
228 NEW STREET	WAYMART	PA	18472	CONSTRUCTION WORK	110629
WAYNE MEMORIAL HEALTH SYSTEM
601 PARK STREET	HONESDALE	PA	18431	MANAGEMENT FEES	107748

Field	Value	IRS element (for citing)
Number Of Contractors GT100 K	3	NumberOfContractorsGT100K
Government Grants	754523	GovernmentGrants
All Other Contributions	1107282	AllOtherContributions
Total Contributions	1861805	TotalContributions

Program Service Revenue ProgramServiceRevenue

Field	Value	IRS element (for citing)
Description	NET PATIENT SERVICE RE	Description
Business Code	621110	BusinessCode
Total Revenue Column	6920515	TotalRevenueColumn
Related Or Exempt Function Income	6920515	RelatedOrExemptFunctionIncome

Field	Value	IRS element (for citing)
Total Program Service Revenue	6920515	TotalProgramServiceRevenue

Investment Income InvestmentIncome

Field	Value	IRS element (for citing)
Total Revenue Column	394	TotalRevenueColumn
Exclusion	$394	ExclusionAmount

Gross Rents GrossRents

Field	Value	IRS element (for citing)
Real	18910	Real

Less Rental Expenses LessRentalExpenses

Field	Value	IRS element (for citing)
Real	15128	Real

Rental Income Or Loss RentalIncomeOrLoss

Field	Value	IRS element (for citing)
Real	3782	Real

Net Rental Income Or Loss NetRentalIncomeOrLoss

Field	Value	IRS element (for citing)
Total Revenue Column	3782	TotalRevenueColumn
Related Or Exempt Function Income	572	RelatedOrExemptFunctionIncome
Exclusion	$3,210	ExclusionAmount

Other Revenue Misc OtherRevenueMisc (2 entries)

DescriptionDescription	Business CodeBusinessCode	Total Revenue ColumnTotalRevenueColumn	Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome
MISCELLANEOUS CONTRACT	900099	8576	8576
PURCHASE DISCOUNTS	900099	825	825

Field	Value	IRS element (for citing)
Total Other Revenue	9401	TotalOtherRevenue

Total Revenue TotalRevenue

Field	Value	IRS element (for citing)
Total Revenue Column	8795897	TotalRevenueColumn
Related Or Exempt Function Income	6930488	RelatedOrExemptFunctionIncome
Unrelated Business Revenue	0	UnrelatedBusinessRevenue
Exclusion	$3,604	ExclusionAmount

Comp Current Officers Directors CompCurrentOfficersDirectors

Field	Value	IRS element (for citing)
Total	2280590	Total
Program Services	2132457	ProgramServices
Management And General	148133	ManagementAndGeneral

Other Salaries And Wages OtherSalariesAndWages

Field	Value	IRS element (for citing)
Total	3259539	Total
Program Services	2842800	ProgramServices
Management And General	416739	ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

Field	Value	IRS element (for citing)
Total	210931	Total
Program Services	176448	ProgramServices
Management And General	34483	ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

Field	Value	IRS element (for citing)
Total	674809	Total
Program Services	564492	ProgramServices
Management And General	110317	ManagementAndGeneral

Payroll Taxes PayrollTaxes

Field	Value	IRS element (for citing)
Total	337326	Total
Program Services	308138	ProgramServices
Management And General	29188	ManagementAndGeneral

Fees For Services Management FeesForServicesManagement

Field	Value	IRS element (for citing)
Total	107748	Total
Management And General	107748	ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

Field	Value	IRS element (for citing)
Total	1686	Total
Management And General	1686	ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

Field	Value	IRS element (for citing)
Total	30425	Total
Management And General	30425	ManagementAndGeneral

Fees For Services Other FeesForServicesOther

Field	Value	IRS element (for citing)
Total	623554	Total
Program Services	601780	ProgramServices
Management And General	21774	ManagementAndGeneral

Advertising Advertising

Field	Value	IRS element (for citing)
Total	22425	Total
Program Services	22253	ProgramServices
Management And General	172	ManagementAndGeneral

Office Expenses OfficeExpenses

Field	Value	IRS element (for citing)
Total	658136	Total
Program Services	617113	ProgramServices
Management And General	41023	ManagementAndGeneral

Occupancy Occupancy

Field	Value	IRS element (for citing)
Total	408157	Total
Program Services	400190	ProgramServices
Management And General	7967	ManagementAndGeneral

Travel Travel

Field	Value	IRS element (for citing)
Total	8704	Total
Program Services	8704	ProgramServices

Interest Interest

Field	Value	IRS element (for citing)
Total	38621	Total
Management And General	38621	ManagementAndGeneral

Depreciation Depletion DepreciationDepletion

Field	Value	IRS element (for citing)
Total	125939	Total
Program Services	95138	ProgramServices
Management And General	30801	ManagementAndGeneral

Insurance Insurance

Field	Value	IRS element (for citing)
Total	95153	Total
Program Services	95153	ProgramServices

Other Expenses OtherExpenses (5 entries)

DescriptionDescription	TotalTotal	Program ServicesProgramServices	Management And GeneralManagementAndGeneral
BAD DEBT EXPENSE	159399	159399
DUES	32364	21521	10843
OUTSIDE TRAINING	30083	21629	8454
REPAIRS AND MAINTENANCE	13815	13815
LEASEHOLD IMPROVEMENTS	2002	2002

Total Functional Expenses TotalFunctionalExpenses

Field	Value	IRS element (for citing)
Total	9121406	Total
Program Services	8083032	ProgramServices
Management And General	1038374	ManagementAndGeneral
Fundraising	0	Fundraising

Savings And Temp Cash Investments SavingsAndTempCashInvestments

Field	Value	IRS element (for citing)
BOY	117766	BOY
EOY	103025	EOY

Pledges And Grants Receivable PledgesAndGrantsReceivable

Field	Value	IRS element (for citing)
BOY	62683	BOY
EOY	0	EOY

Accounts Receivable AccountsReceivable

Field	Value	IRS element (for citing)
BOY	725598	BOY
EOY	699140	EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

Field	Value	IRS element (for citing)
BOY	56018	BOY
EOY	67750	EOY

Field	Value	IRS element (for citing)
Land Buildings Equipment Basis	1220009	LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec	342827	LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

Field	Value	IRS element (for citing)
BOY	805004	BOY
EOY	877182	EOY

Other Assets Total OtherAssetsTotal

Field	Value	IRS element (for citing)
BOY	1255807	BOY
EOY	1658002	EOY

Total Assets TotalAssets

Field	Value	IRS element (for citing)
BOY	3022876	BOY
EOY	3405099	EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

Field	Value	IRS element (for citing)
BOY	870970	BOY
EOY	1164402	EOY

Unsecured Notes Loans Payable UnsecuredNotesLoansPayable

Field	Value	IRS element (for citing)
BOY	1050000	BOY
EOY	1449922	EOY

Other Liabilities OtherLiabilities

Field	Value	IRS element (for citing)
BOY	83443	BOY
EOY	97821	EOY

Total Liabilities TotalLiabilities

Field	Value	IRS element (for citing)
BOY	2004413	BOY
EOY	2712145	EOY

Field	Value	IRS element (for citing)
Follow SFAS117	X	FollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

Field	Value	IRS element (for citing)
BOY	1018463	BOY
EOY	687029	EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

Field	Value	IRS element (for citing)
EOY	5925	EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

Field	Value	IRS element (for citing)
BOY	1018463	BOY
EOY	692954	EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

Field	Value	IRS element (for citing)
BOY	3022876	BOY
EOY	3405099	EOY

Field	Value	IRS element (for citing)
Reconcilation Revenue Expenses	-325509	ReconcilationRevenueExpenses
Reconcilation Other Changes	0	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 Separate	X	FinancialStatementSeparate
Federal Grant Audit Required	1	FederalGrantAuditRequired
Federal Grant Audit Performed	1	FederalGrantAuditPerformed

Schedule A IRS990ScheduleA

Field	Value	IRS element (for citing)
Supporting Organization509a3	X	SupportingOrganization509a3
Supporting Org509a3 Type2	X	SupportingOrg509a3Type2
Certification Checkbox	X	CertificationCheckbox
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	WAYNE MEMORIAL HOSPITAL	BusinessNameLine1

Field	Value	IRS element (for citing)
EIN	240798839	EIN
Type Of Organization	7	TypeOfOrganization
Listed In Governing Doc	0	ListedInGoverningDoc
Organized In US	1	OrganizedInUS
Amount	$0	Amount

Field	Value	IRS element (for citing)
Total Number Of Supported Orgs	1	TotalNumberOfSupportedOrgs
Sum Of Amounts	0	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

Leasehold Improvements LeaseholdImprovements

Field	Value	IRS element (for citing)
Investment Cost Or Other Basis	370319	InvestmentCostOrOtherBasis
Depreciation	38011	Depreciation
Book Value	332308	BookValue

Equipment Equipment

Field	Value	IRS element (for citing)
Investment Cost Or Other Basis	837557	InvestmentCostOrOtherBasis
Depreciation	304816	Depreciation
Book Value	532741	BookValue

Other Land Buildings OtherLandBuildings

Field	Value	IRS element (for citing)
Investment Cost Or Other Basis	12133	InvestmentCostOrOtherBasis
Book Value	12133	BookValue

Field	Value	IRS element (for citing)
Total Of Book Value Land Buildings	877182	TotalOfBookValueLandBuildings

Other Assets OtherAssets

Field	Value	IRS element (for citing)
Description	ESTIMATED THIRD-PARTY SETTLEMENTS	Description
Book Value	1658002	BookValue

Field	Value	IRS element (for citing)
Total Book Value Other Assets	1658002	TotalBookValueOtherAssets

Other Liabilities OtherLiabilities

Field	Value	IRS element (for citing)
Description	DUE TO WAYNE MEMORIAL HOSPITAL	Description
Amount	$97,821	Amount

Field	Value	IRS element (for citing)
Total Of Amounts	97821	TotalOfAmounts
Total Revenue	8795897	TotalRevenue
Total Expenses	9121406	TotalExpenses
Excess Or Deficit For Year	-325509	ExcessOrDeficitForYear
Total Adjustments	0	TotalAdjustments
Excess Or Deficit Per FS	-325509	ExcessOrDeficitPerFS
Tot Revenue Etc Audited Fincl Stmt	8811025	TotRevenueEtcAuditedFinclStmt
Revenue Not Rptd F990	0	RevenueNotRptdF990
Revenue Subtotal	8811025	RevenueSubtotal
Other Revenues Not Included	-15128	OtherRevenuesNotIncluded
Revenue Not Rptd On Fin Stmt	-15128	RevenueNotRptdOnFinStmt
Total Revenue Per Form990	8795897	TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt	9136534	TotExpensesEtcAuditedFinclStmt
Other Expenses Included	15128	OtherExpensesIncluded
Expenses Not Rptd F990	15128	ExpensesNotRptdF990
Expenses Subtotal	9121406	ExpensesSubtotal
Expenses Not Rptd On Fin Stmt	0	ExpensesNotRptdOnFinStmt
Total Expenses Per Form990	9121406	TotalExpensesPerForm990

Form990 Schedule D Part XIV Form990ScheduleDPartXIV (3 entries)

IdentifierIdentifier	Return ReferenceReturnReference	ExplanationExplanation
DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48:	PART X:	PART X, LINE 2: THE CORPORATION IS A NOT-FOR-PROFIT CORPORATION AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND IS EXEMPT FROM FEDERAL INCOME TAXES ON ITS EXEMPT INCOME UNDER SECTION 501(A) OF THE INTERNAL REVENUE CODE. THE CORPORATION ACCOUNTS FOR UNCERTAINTY IN INCOME TAXES USING A RECOGNITION THRESHOLD OF MORE-LIKELY-THAN-NOT TO BE SUSTAINED UPON EXAMINATION BY THE APPROPRIATE TAXING AUTHORITY. MEASUREMENT OF THE TAX UNCERTAINTY OCCURS IF THE RECOGNITION THRESHOLD HAS BEEN MET. MANAGEMENT DETERMINED THAT THERE WERE NO TAX UNCERTAINTIES THAT MET THE RECOGNITION THRESHOLD IN 2011 AND 2010.
PART XII, LINE 4B - OTHER ADJUSTMENTS:		RENTAL EXPENSES -15,128.
PART XIII, LINE 2D - OTHER ADJUSTMENTS:		RENTAL EXPENSES 15,128.

Schedule J IRS990ScheduleJ

Field	Value	IRS element (for citing)
Compensation Committee	X	CompensationCommittee
Written Employment Contract	X	WrittenEmploymentContract
Compensation Survey	X	CompensationSurvey
Board Or Committee Approval	X	BoardOrCommitteeApproval
Severance Payment	0	SeverancePayment
Supplemental Nonqual Retire Plan	0	SupplementalNonqualRetirePlan
Equity Based Comp Arrangement	0	EquityBasedCompArrangement
Comp Based On Revenue Of Filing Org	0	CompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related Orgs	0	CompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing Org	0	CompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate Orgs	0	CompBasedNetEarningsRelateOrgs
Any Non Fixed Payments	0	AnyNonFixedPayments
Initial Contract Exception	0	InitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (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
DR ROBERT GORRELL
297654	0	0	0	0	0	9000	0	12029	0	318683	0	0	0
DR SEAN MCVEIGH
277242	0	0	0	0	0	16641	0	12029	0	305912	0	0	0
DR ROBERT DOHNOR
137821	0	22075	0	0	0	9725	0	10437	0	180058	0	0	0
DR PEDRO MENCIA
267541	0	29363	0	0	0	17962	0	12029	0	326895	0	0	0
DR HOON YOO
268052	0	0	0	0	0	16200	0	10437	0	294689	0	0	0
DR BRIAN LENCZEWSKI
257536	0	0	0	0	0	0	0	12029	0	269565	0	0	0
DR EUN SUZANNA YOO
159374	0	0	0	0	0	0	0	0	0	159374	0	0	0
DR BRIAN BROWN
110833	0	45168	0	0	0	9392	0	4383	0	169776	0	0	0
DR WAWRZYNIEC STEPCZAK
134327	0	0	0	0	0	8146	0	12029	0	154502	0	0	0
DR VANCE JONES
111165	0	30137	0	0	0	8564	0	12029	0	161895	0	0	0

Schedule L IRS990ScheduleL

Form990 Schedule L Part IV Form990ScheduleLPartIV

Name Of Interested Person NameOfInterestedPerson

Field	Value	IRS element (for citing)
Name Person	PETER ROGERS VICE-CHAIRMAN OF BOAR	NamePerson

Field	Value	IRS element (for citing)
Relationship	INSURANCE BROKER	Relationship
Amount Of Transaction	53000	AmountOfTransaction
Description Of Transaction	PROVIDES D & O LIABILITY INSURANCE FOR WAYNE MEMORIAL HEALTH SYSTEMS, A RELATED ORGANIZATION	DescriptionOfTransaction
Sharing Of Revenues	0	SharingOfRevenues

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (7 entries)

IdentifierIdentifier	ExplanationExplanation	Return ReferenceReturnReference
FORM 990, PART VI, SECTION A, LINE 2	QUESTIONNAIRES ARE SENT TO EVERY BOARD MEMBER ON AN ANNUAL BASIS. NO RELATIONSHIPS WERE NOTED BETWEEN THE ORGANIZATION'S OFFICERS, DIRECTORS, TRUSTEES, OR KEY EMPLOYEES.
FORM 990, PART VI, SECTION A, LINE 3	THE WAYNE COMMUNITY HEALTH CENTERS PAY MANAGEMENT FEES FOR SUPPORT SERVICES TO WAYNE MEMORIAL HEALTH SYSTEM INC.
FORM 990, PART VI, SECTION B, LINE 11	AN E-MAIL IS DISTRIBUTED TO ALL BOARD MEMBERS BEFORE THE 990 IS FILED FOR THEIR REVIEW. THE 990 WILL BE DISCUSSED AND REVIEWED AT THE FOLLOWING FULL BOARD MEETING PRIOR TO FILING THE RETURN.
	CONFLICT OF INTEREST STATEMENTS ARE COMPLETED BY EVERY BOARD MEMBER AND MANAGER ANNUALLY. EACH INDIVIDUAL SIGNS AND RETURNS THE STATEMENTS TO THE ADMINISTRATION OFFICE. THE EXECUTIVE SECRETARY IS RESPONSIBLE FOR MONITORING COMPLIANCE WITH ANY CONFLICT OF INTEREST THROUGHOUT THE YEAR. IF A CONFLICT ARISES, THE PERSON WITH THE CONFLICT WILL RECUSE THEMSELVES FROM VOTING AND/OR DISCUSSING THE MATTER.	FORM 990, PART VI, SECTION B, LINE 12C
	WAYNE MEMORIAL COMMUNITY HEALTH CENTERS UTILIZE A COMMITTEE OF THE BOARD CALLED THE EXECUTIVE COMMITTEE TO SET COMPENSATION FOR ITS CEO. FOR OTHER KEY EMPLOYEES (DOCTORS) WAYNE MEMORIAL COMMUNITY HEALTH CENTERS USES WRITTEN EMPLOYMENT AGREEMENTS FOR THEIR COMPENSATION. THESE AGREEMENTS ARE APPROVED BY THE BOARD OR EXECUTIVE COMMITTEE. THE EXECUTIVE COMMITTEE IS MADE UP OF INDEPENDENT DIRECTORS, WHO, USE DATA FROM THE NATIONAL ASSOCIATION OF COMMUNITY HEALTH CENTERS FOR COMPARATIVE PURPOSES. THE COMMITTEE USES THE SALARY DATA AND COMPARATIVE REVENUE, COMPLEXITY, SIZE OF FQHC, AND THE GEOGRAPHIC REGION TO DETERMINE A REASONABLE SALARY FOR THE CEO. THE EXECUTIVE COMMITTEE KEEPS MINUTES TO DOCUMENT THE DELIBERATION AND DECISION MAKING PROCESS. THE PROCESS NORMALLY OCCURS IN OCTOBER OF THE YEAR THE COMPENSATION CHANGE IS GRANTED.	FORM 990, PART VI, SECTION B, LINE 15
	FORM 990, PART VI, SECTION C, LINE 19: THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND/OR FINANCIAL STATEMENTS AVAILABLE TO PUBLIC UPON REQUEST.	FORM 990, PART VI, SECTION C, LINE 19
	THE PROCESSES USED BY THE COMMITTEE THAT ASSUMES RESPONSIBILITY FOR THE OVERSIGHT OF THE AUDIT OF THE ORGANIZATION'S FINANCIAL STATEMENTS AND THE SELECTION OF AN INDEPENDENT ACCOUNTANT HAVE NOT CHANGED FROM THE PRIOR YEAR.	FORM 990, PART XII, LINE 2C: