PIKE HEALTH SERVICES INC: Form 990, tax year 2011
View the entire original 990 at ProPublica ↗
- Organization
- PIKE HEALTH SERVICES INC (EIN 31-1072406)
- Tax period
- 2011-01-01 to 2011-12-31
- Filed
- 2012-11-15
- IRS object ID
- 201233209349303053
- Schema version
- 2011v1.2
- 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 J
- Schedule L
- Schedule O
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2012-11-15T10:18:46-06:00 | Timestamp |
| Tax Period End Date | 2011-12-31 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 381357951 | EIN |
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | PLANTE & MORAN PLLC | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 65 EAST STATE ST STE 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 | 2011-01-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 311072406 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | PIKE HEALTH SERVICES INC | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | PIKE | NameControl |
| Phone | 7409476306 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 100 DAWN LANE | AddressLine1 |
| City | WAVERLY | City |
| State | OH | State |
| ZIP Code | 45690 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | CRAIG E SOLLE | Name |
| Title | PRESIDENT & CEO | Title |
| Phone | 7409476306 | Phone |
| Date Signed | 2012-11-14 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | BERNIE OSTROWSKI | Name |
| PTIN | P00366367 | PTIN |
| Phone | 6148493000 | Phone |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2011 | 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 | CRAIG E SOLLE | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 100 DAWN LANE | AddressLine1 |
| City | WAVERLY | City |
| State | OH | State |
| ZIP Code | 45690 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 22628146 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | WWW.PIKECOMMUNITYHOSPITAL.ORG | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1983 | YearFormation |
| State Legal Domicile | OH | StateLegalDomicile |
| Activity Or Mission Description | PIKE HEALTH SERVICES IS A 25-BED CRITICAL ACCESS HOSPITAL AND CLINIC LOCATED IN THE STATE OF OHIO IN PIKE COUNTY. INCLUDED IN THE BED COUNT ARE 21 ACUTE BEDS AND 4 INTENSIVE CARE BEDS WITH AUTHORIZATION FOR SWING BEDS ON AN AS NEEDED BASIS. IN 2011, PIKE HEALTH SERVICES HAD 716 INPATIENT ADMISSIONS, 480 SURGERY CASES (INCLUDING AMBULATORY), AND 16,392 VISITS TO THE EMERGENCY DEPARTMENT. PIKE HEALTH SERVICES PROVIDED CHARITY CARE TO THE COMMUNITY IN THE AMOUNT OF $3,539,375 IN CHARGES FORGONE, BASED ON ESTABLISHED RATES, WITH 13.97% SELF PAY PATIENTS, WHO HAVE NO INSURANCE. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 8 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 7 | NbrIndependentVotingMembers |
| Total Nbr Employees | 341 | TotalNbrEmployees |
| Total Nbr Volunteers | 44 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 290543 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 73327 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 22084750 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 21456193 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 4041 | InvestmentIncomePriorYear |
| Investment Income Current Year | 1549 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 1049170 | OtherRevenuePriorYear |
| Other Revenue Current Year | 999065 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 23428504 | TotalRevenuePriorYear |
| Total Revenue Current Year | 22530134 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 161 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 3350 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 11541000 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 11869383 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 1284 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 11579102 | OtherExpensePriorYear |
| Other Expenses Current Year | 11421614 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 23120263 | TotalExpensesPriorYear |
| Total Expenses Current Year | 23294347 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 308241 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | -764213 | RevenuesLessExpensesCY |
| Total Assets BOY | 13573166 | TotalAssetsBOY |
| Total Assets EOY | 12322628 | TotalAssetsEOY |
| Total Liabilities BOY | 10456285 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 9950904 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 3116881 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 2371724 | NetAssetsOrFundBalancesEOY |
| Info In Schedule O Part III | X | InfoInScheduleOPartIII |
| Mission Description | PIKE HEALTH SERVICES IS HIGH QUALITY; COMPASSIONATE HEALTHCARE; ACCESSIBLE TO THE COMMUNITY; COMMITTED TO EXCELLENCE; RESPECTFUL OF EACH INDIVIDUAL; AND FOUNDED ON SERVICE TO OTHERS. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 20191782 | Expense |
| Grants | 3350 | Grants |
| Revenue | 21456193 | Revenue |
| Description | SEE SCHEDULE OPIKE HEALTH SERVICES IS A 25-BED CRITICAL ACCESS HOSPITAL AND PHYSICIAN PRACTICE LOCATED IN THE STATE OF OHIO IN PIKE COUNTY. INCLUDED IN THE BED COUNT ARE 21 ACUTE BEDS AND 4 INTENSIVE CARE BEDS WITH AUTHORIZATION FOR SWING BEDS ON AN AS NEEDED BASIS. IN 2011, PIKE HEALTH SERVICES HAD 716 INPATIENT ADMISSIONS, 480 SURGERY CASES (INCLUDING AMBULATORY), AND 16,392 VISITS TO THE EMERGENCY DEPARTMENT. PIKE HEALTH SERVICES PROVIDED CHARITY CARE TO THE COMMUNITY IN THE AMOUNT OF $3,539,375, INCLUDING 13.97% SELF PAY PATIENTS, WHO HAVE NO INSURANCE.PIKE HEALTH SERVICE'S COMMUNITY OUTREACH ACTIVITY HAS SERVED 2,257 CITIZENS IN VARIOUS PROGRAMS THROUGHOUT PIKE COUNTY. DURING THE YEAR, THEY PARTICIPATED IN 50 HEALTH FAIRS AND 41 SCREENING AND EDUCATIONAL CLINICS FOR DIABETES, CHOLESTEROL AND ARTHRITIS. ADDITIONALLY THEY SUPPORT THE YOUNG RESIDENTS OF THE COUNTY IN VARIOUS PROGRAMS INCLUDING HEAD START AND CHILD SAFETY PRESENTATIONS. | Description |
| Total Program Service Expense | 20191782 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 1 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 1 | LobbyingActivities |
| Subject To Proxy Tax | 0 | SubjectToProxyTax |
| Donor Advised Funds | 0 | DonorAdvisedFunds |
| Conservation Easements | 0 | ConservationEasements |
| Collections Of Art | 0 | CollectionsOfArt |
| Credit Counseling | 0 | CreditCounseling |
| Term Or Permanent Endowments | 0 | TermOrPermanentEndowments |
| Report Land Bldg Equip | 1 | ReportLandBldgEquip |
| Report Invest Oth Securities | 0 | ReportInvestOthSecurities |
| Report Prog Rel Invest | 0 | ReportProgRelInvest |
| Report Other Assets | 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 | 1 | FundraisingActivities |
| Gaming | 0 | Gaming |
| Hospital | 1 | Hospital |
| Financial Stmt Attached | 1 | FinancialStmtAttached |
| 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 | 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 | 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 | 85 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | 1 | ComplianceWithBackupWitholding |
| Number Of Employees | 341 | NumberOfEmployees |
| Employment Tax Returns Filed | 1 | EmploymentTaxReturnsFiled |
| Unrelated Business Income | 0 | UnrelatedBusinessIncome |
| Foreign Financial Account | 0 | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTrans |
| Taxable Party Notification | 0 | TaxablePartyNotification |
| Non Deductible Contributions | 0 | NonDeductibleContributions |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributions |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | 0 | FundsToPayPremiums |
| Premiums Paid | 0 | PremiumsPaid |
| Indoor Tanning Services | 0 | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 8 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 7 | NumberIndependentVotingMembers |
| Family Or Business Relationship | 0 | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | 0 | DelegationOfManagementDuties |
| Changes To Organizing Docs | 0 | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuse |
| Members Or Stockholders | 0 | MembersOrStockholders |
| Election Of Board Members | 0 | ElectionOfBoardMembers |
| Decisions Subject To Approval | 0 | DecisionsSubjectToApproval |
| Minutes Of Governing Body | 1 | MinutesOfGoverningBody |
| Minutes Of Committees | 1 | MinutesOfCommittees |
| Officer Mailing Address | 0 | OfficerMailingAddress |
| Local Chapters | 0 | LocalChapters |
| Form990 Provided To Governing Body | 1 | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | 1 | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | 1 | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | 1 | RegularMonitoringEnforcement |
| Whistleblower Policy | 1 | WhistleblowerPolicy |
| Document Retention Policy | 1 | DocumentRetentionPolicy |
| Compensation Process CEO | 1 | CompensationProcessCEO |
| Compensation Process Other | 0 | CompensationProcessOther |
| Investment In Joint Venture | 0 | InvestmentInJointVenture |
| States Where Copy Of Return Is Filed | OH | StatesWhereCopyOfReturnIsFiled |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CRAIG SOLLE | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 7409476310 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 100 DAWN LANE | AddressLine1 |
| City | WAVERLY | City |
| State | OH | State |
| ZIP Code | 45690 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionA (18 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | OfficerOfficer | Highest Compensated EmployeeHighestCompensatedEmployee |
|---|---|---|---|---|---|---|---|
| CATHERINE FARINET | |||||||
| CHIEF OF MEDICAL STAFF | 37.50 | X | 202627 | 0 | 14619 | ||
| TONY FISH | |||||||
| CHAIRMAN | 0.10 | X | 0 | 0 | 0 | X | |
| VAL FRANCIS | |||||||
| VICE CHAIRMAN | 0.10 | X | 0 | 0 | 0 | X | |
| LINDA B SHOEMAKER | |||||||
| SECRETARY | 0.10 | X | 0 | 0 | 0 | X | |
| MELBY WILLIAMS | |||||||
| TREASURER | 0.10 | X | 0 | 0 | 0 | X | |
| TOD BURKETT | |||||||
| TRUSTEE | 0.10 | X | 0 | 0 | 0 | ||
| DENNIS MILLER | |||||||
| TRUSTEE | 0.10 | X | 0 | 0 | 0 | ||
| MARGARET FOILL | |||||||
| TRUSTEE | 0.10 | X | 0 | 0 | 0 | ||
| REV RONALD HINES | |||||||
| TRUSTEE | 0.10 | X | 0 | 0 | 0 | ||
| CRAIG E SOLLE | |||||||
| PRESIDENT AND CEO | 37.50 | 115586 | 0 | 19093 | X | ||
| LINDA JAMES | |||||||
| VP PATIENT CARE | 37.50 | 76573 | 0 | 10797 | X | ||
| SHARON NOVAK | |||||||
| VP FINANCE/CFO | 37.50 | 78698 | 0 | 10905 | X | ||
| TINA PERKO | |||||||
| VP OPERATIONS | 37.50 | 69503 | 0 | 10595 | X | ||
| CINDY INGRAM | |||||||
| CRNA | 37.50 | 219391 | 0 | 25934 | X | ||
| DAVID KESSLER | |||||||
| DOCTOR | 37.50 | 208886 | 0 | 6487 | X | ||
| ELLIS FRAZIER | |||||||
| DOCTOR | 37.50 | 168866 | 0 | 13657 | X | ||
| JOHN CRAWFORD | |||||||
| DOCTOR | 37.50 | 154628 | 0 | 23994 | X | ||
| CHERYL SMITH | |||||||
| PHARMACIST | 37.50 | 109637 | 0 | 3430 | X | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 1404395 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 0 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 139511 | TotalOtherCompensation |
| Number Individuals GT100 K | 8 | NumberIndividualsGT100K |
| Formers Listed | 0 | FormersListed |
| Total Comp GT150 K | 1 | TotalCompGT150K |
| Compensation From Other Sources | 0 | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (5 entries)
| Address Line1AddressOfContractor/AddressUS/AddressLine1 | CityAddressOfContractor/AddressUS/City | StateAddressOfContractor/AddressUS/State | ZIP CodeAddressOfContractor/AddressUS/ZIPCode | Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|---|---|---|---|
| PREMIER HEALTH CARE SERVICES INC | |||||
| 221 CONGRESS PARK DRIVE | DAYTON | OH | 45456 | EMERGENCY DEPT PHYSICIANS | 575600 |
| M MODAL SERVICES LTD | |||||
| PO BOX 102467 | ATLANTA | GA | 30368 | TRANSCRIPTION | 237548 |
| QUEST DIAGNOSTICS | |||||
| 12436 COLLECTIONS CENTER DR | CHICAGO | IL | 60693 | LAB TESTING | 212451 |
| SIEMENS MEDICAL SOLUTIONS | |||||
| 51 VALLEY STREAM PARKWAY | MALVERN | PA | 19355 | SERVICE CONTRACT | 155043 |
| PHILLIPS HEALTHCARE | |||||
| 22100 BOTHELL EVERETT HIGHWAY | BOGHELL | WA | 98021 | SERVICE CONTRACT | 137890 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 6 | NumberOfContractorsGT100K |
| Fundraising Events | 7400 | FundraisingEvents |
| Government Grants | 65187 | GovernmentGrants |
| All Other Contributions | 740 | AllOtherContributions |
| Total Contributions | 73327 | TotalContributions |
Program Service Revenue ProgramServiceRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | PROGRAM SERVICES | Description |
| Business Code | 621110 | BusinessCode |
| Total Revenue Column | 21456193 | TotalRevenueColumn |
| Related Or Exempt Function Income | 21456193 | RelatedOrExemptFunctionIncome |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 21456193 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 667 | TotalRevenueColumn |
| Exclusion | $667 | ExclusionAmount |
Gross Rents GrossRents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 10668 | Real |
Less Rental Expenses LessRentalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 46068 | Real |
Rental Income Or Loss RentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | -35400 | Real |
Net Rental Income Or Loss NetRentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -35400 | TotalRevenueColumn |
| Exclusion | -$35,400 | ExclusionAmount |
Gross Amount Sales Assets GrossAmountSalesAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | 46374 | Other |
Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | 45492 | Other |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | 882 | Other |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 882 | TotalRevenueColumn |
| Exclusion | $882 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Income Fundraising Events | 23965 | GrossIncomeFundraisingEvents |
| Cntrbtns Rprtd Fundraising Events | 7400 | CntrbtnsRprtdFundraisingEvents |
| Fundraising Direct Expenses | 6452 | FundraisingDirectExpenses |
Net Income From Fundraising Events NetIncomeFromFundraisingEvents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 17513 | TotalRevenueColumn |
| Exclusion | $17,513 | ExclusionAmount |
Other Revenue Misc OtherRevenueMisc (2 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | ExclusionExclusionAmount |
|---|---|---|---|
| COUNTY TAX LEVY | 621110 | 962714 | $962,714 |
| CAFETERIA REVENUE | 621110 | 54238 | $54,238 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 1016952 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 22530134 | TotalRevenueColumn |
| Related Or Exempt Function Income | 21456193 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $1,000,614 | ExclusionAmount |
Grants To Domestic Individuals GrantsToDomesticIndividuals
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3350 | Total |
| Program Services | 3350 | ProgramServices |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 409156 | Total |
| Management And General | 409156 | ManagementAndGeneral |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 8685348 | Total |
| Program Services | 7627713 | ProgramServices |
| Management And General | 1057386 | ManagementAndGeneral |
| Fundraising | 249 | Fundraising |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1869452 | Total |
| Program Services | 1584838 | ProgramServices |
| Management And General | 284614 | ManagementAndGeneral |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 280314 | Total |
| Program Services | 268624 | ProgramServices |
| Management And General | 11690 | ManagementAndGeneral |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 625113 | Total |
| Program Services | 516587 | ProgramServices |
| Management And General | 108526 | ManagementAndGeneral |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 8167 | Total |
| Management And General | 8167 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 90216 | Total |
| Management And General | 90216 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2862941 | Total |
| Program Services | 2340477 | ProgramServices |
| Management And General | 522248 | ManagementAndGeneral |
| Fundraising | 216 | Fundraising |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 16084 | Total |
| Management And General | 16084 | ManagementAndGeneral |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2374013 | Total |
| Program Services | 2002156 | ProgramServices |
| Management And General | 371728 | ManagementAndGeneral |
| Fundraising | 129 | Fundraising |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3324 | Total |
| Management And General | 3324 | ManagementAndGeneral |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 447213 | Total |
| Program Services | 402492 | ProgramServices |
| Management And General | 44721 | ManagementAndGeneral |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 20729 | Total |
| Program Services | 15039 | ProgramServices |
| Management And General | 5690 | ManagementAndGeneral |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 485039 | Total |
| Program Services | 436535 | ProgramServices |
| Management And General | 48504 | ManagementAndGeneral |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1093310 | Total |
| Program Services | 983635 | ProgramServices |
| Management And General | 109675 | ManagementAndGeneral |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 440700 | Total |
| Program Services | 440700 | ProgramServices |
Other Expenses OtherExpenses (4 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral |
|---|---|---|---|
| BAD DEBT EXPENSE | 3523309 | 3523309 | |
| BILLING EXPENSE | 21569 | 21569 | |
| CONTINUING EDUCATION | 14040 | 11292 | 2748 |
| LAB EXPENSE | 7591 | 7591 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 13369 | Total |
| Program Services | 5875 | ProgramServices |
| Management And General | 6804 | ManagementAndGeneral |
| Fundraising | 690 | Fundraising |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 23294347 | Total |
| Program Services | 20191782 | ProgramServices |
| Management And General | 3101281 | ManagementAndGeneral |
| Fundraising | 1284 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 109731 | BOY |
| EOY | 167282 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 14378 | BOY |
| EOY | 93545 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1756848 | BOY |
| EOY | 2094661 | EOY |
Receivables From Officers Etc ReceivablesFromOfficersEtc
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 31710 | BOY |
| EOY | 18710 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 245475 | BOY |
| EOY | 255839 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 207346 | BOY |
| EOY | 151323 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 25104878 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 17811223 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 8278691 | BOY |
| EOY | 7293655 | EOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1255047 | BOY |
| EOY | 1258687 | EOY |
Investments Other Securities InvestmentsOtherSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 95975 | BOY |
| EOY | 166824 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1577965 | BOY |
| EOY | 822102 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 13573166 | BOY |
| EOY | 12322628 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3007420 | BOY |
| EOY | 3906272 | EOY |
Tax Exempt Bond Liabilities TaxExemptBondLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 5270000 | BOY |
| EOY | 4790000 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2178865 | BOY |
| EOY | 1254632 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 10456285 | BOY |
| EOY | 9950904 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3116881 | BOY |
| EOY | 2371724 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3116881 | BOY |
| EOY | 2371724 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 13573166 | BOY |
| EOY | 12322628 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | -764213 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | 19056 | 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 | 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 | $899 | OtherActivitiesAmount |
| Total Lobbying Expenditures IIB | 899 | TotalLobbyingExpendituresIIB |
| Not Described In501c3 | 0 | NotDescribedIn501c3 |
Form990 Schedule C Part IV Form990ScheduleCPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | EXPLANATION OF LOBBYING ACTIVITIES: | Identifier |
| Return Reference | PART II-B, LINE 1: | ReturnReference |
| Explanation | OHIO HOSPITAL ASSOCIATION STRATEGIC ISSUES AND ENERGY LITIGATION ASSESSMENT. | Explanation |
Schedule D IRS990ScheduleD
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 244450 | OtherCostOrOtherBasis |
| Book Value | 244450 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 13169649 | OtherCostOrOtherBasis |
| Depreciation | 7608373 | Depreciation |
| Book Value | 5561276 | BookValue |
Leasehold Improvements LeaseholdImprovements
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 18000 | OtherCostOrOtherBasis |
| Depreciation | 7100 | Depreciation |
| Book Value | 10900 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 11214758 | OtherCostOrOtherBasis |
| Depreciation | 9915814 | Depreciation |
| Book Value | 1298944 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 458021 | OtherCostOrOtherBasis |
| Depreciation | 279936 | Depreciation |
| Book Value | 178085 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 7293655 | TotalOfBookValueLandBuildings |
Other Assets OtherAssets (3 entries)
| DescriptionDescription | Book ValueBookValue |
|---|---|
| OTHER RECEIVABLES | 533414 |
| DEFERRED FINANCING COSTS | 135175 |
| COST REPORT SETTLEMENT RECEIVABLE | 153513 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | 822102 | TotalBookValueOtherAssets |
Other Liabilities OtherLiabilities (4 entries)
| DescriptionDescription | AmountAmount |
|---|---|
| CAPITAL LEASE OBLIGATION | $581,867 |
| ESTIMATED THIRD-PARTY PAYOR SETTLEMENTS | $18,634 |
| LINE OF CREDIT | $600,125 |
| OTHER NOTES PAYABLE | $54,006 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 1254632 | TotalOfAmounts |
| Total Revenue | 22530134 | TotalRevenue |
| Total Expenses | 23294347 | TotalExpenses |
| Excess Or Deficit For Year | -764213 | ExcessOrDeficitForYear |
| Net Unrealized GL On Investments | 19056 | NetUnrealizedGLOnInvestments |
| Total Adjustments | 19056 | TotalAdjustments |
| Excess Or Deficit Per FS | -745157 | ExcessOrDeficitPerFS |
| Tot Revenue Etc Audited Fincl Stmt | 22539894 | TotRevenueEtcAuditedFinclStmt |
| Net Unrealized Gains Investments | 19056 | NetUnrealizedGainsInvestments |
| Other Revenues | -61816 | OtherRevenues |
| Revenue Not Rptd F990 | -42760 | RevenueNotRptdF990 |
| Revenue Subtotal | 22582654 | RevenueSubtotal |
| Other Revenues Not Included | -52520 | OtherRevenuesNotIncluded |
| Revenue Not Rptd On Fin Stmt | -52520 | RevenueNotRptdOnFinStmt |
| Total Revenue Per Form990 | 22530134 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 23285051 | TotExpensesEtcAuditedFinclStmt |
| Other Expenses Included | 52520 | OtherExpensesIncluded |
| Expenses Not Rptd F990 | 52520 | ExpensesNotRptdF990 |
| Expenses Subtotal | 23232531 | ExpensesSubtotal |
| Other Expenses Not Included | 61816 | OtherExpensesNotIncluded |
| Expenses Not Rptd On Fin Stmt | 61816 | ExpensesNotRptdOnFinStmt |
| Total Expenses Per Form990 | 23294347 | TotalExpensesPerForm990 |
Form990 Schedule D Part XIV Form990ScheduleDPartXIV (5 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: | PART X: | THE INTERNAL REVENUE SERVICE HAS RULED THAT THE HOSPITAL IS EXEMPT FROM FEDERAL INCOME TAXES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. THE HOSPITAL IS NO LONGER SUBJECT TO U.S. FEDERAL, STATE, AND LOCAL TAX EXAMINATIONS BY TAX AUTHORITIES FOR YEARS BEFORE 2007. |
| PART XII, LINE 2D - OTHER ADJUSTMENTS: | CHARITY CARE & BAD DEBT EXPENSES -61,816. | |
| PART XII, LINE 4B - OTHER ADJUSTMENTS: | RECLASS RENTAL EXPENSES -46,068. RECLASS FUNDRAISING EXPENSES -6,452. | |
| PART XIII, LINE 2D - OTHER ADJUSTMENTS: | RECLASS RENTAL EXPENSES 46,068. RECLASS FUNDRAISING EXPENSES 6,452. | |
| PART XIII, LINE 4B - OTHER ADJUSTMENTS: | CHARITY CARE & BAD DEBT EXPENSES 61,816. |
Schedule G IRS990ScheduleG
Events Information EventsInformation
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Event1 | FESTIVAL OF TREES | NameOfEvent1 |
| Gross Receipts Event1 | 31365 | GrossReceiptsEvent1 |
| Charitable Contributions Event1 | 7400 | CharitableContributionsEvent1 |
| Gross Revenue Event1 | 23965 | GrossRevenueEvent1 |
| Other Direct Expenses Event1 | 6452 | OtherDirectExpensesEvent1 |
| Gross Receipts Total | 31365 | GrossReceiptsTotal |
| Charitable Contributions Total | 7400 | CharitableContributionsTotal |
| Gross Revenue Total Events | 23965 | GrossRevenueTotalEvents |
| Other Direct Expenses Total Events | 6452 | OtherDirectExpensesTotalEvents |
| Direct Expense Summary Events | 6452 | DirectExpenseSummaryEvents |
| Net Income Summary | 17513 | 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 |
| Pcent200 D | X | Pcent200D |
| 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 | 1 | AnnualCommunityBenefitReport |
| Report Publically Available | 1 | ReportPublicallyAvailable |
Charity Care At Cost CharityCareAtCost
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 2193835 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 972045 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 1221790 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.06180 | PercentOfTotalExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 5913732 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 2843382 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 3070350 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.15530 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 8107567 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 3815427 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 4292140 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.21710 | PercentOfTotalExpense |
Community Health Services CommunityHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 12226 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 1382 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 10844 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00050 | PercentOfTotalExpense |
Total Other Benefits TotalOtherBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 12226 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 1382 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 10844 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00050 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 8119793 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 3816809 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 4302984 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.21760 | PercentOfTotalExpense |
Coalition Building CoalitionBuilding
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 9 | NumberOfActivitiesOrPrograms |
| Persons Served | 707 | PersonsServed |
| Total Community Building Expense | 2560 | TotalCommunityBuildingExpense |
| Direct Offsetting Revenue | 1787 | DirectOffsettingRevenue |
| Net Community Building Expense | 773 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00000 | PercentOfTotalExpense |
Total Total
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 9 | NumberOfActivitiesOrPrograms |
| Persons Served | 707 | PersonsServed |
| Total Community Building Expense | 2560 | TotalCommunityBuildingExpense |
| Direct Offsetting Revenue | 1787 | DirectOffsettingRevenue |
| Net Community Building Expense | 773 | NetCommunityBuildingExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 1 | BadDebtExpenseReported |
| Bad Debt Expense | $3,523,309 | BadDebtExpenseAmount |
| Amount Attributable To | 0 | AmountAttributableTo |
| Amount Reimbursed By Medicare | 6965728 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 6896760 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | 68968 | 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 | PIKE COMMUNITY HOSPITAL | BusinessNameLine1 |
Address Address
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 100 DAWN LANE | AddressLine1 |
| City | WAVERLY | City |
| State | OH | State |
| ZIP Code | 45690 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Licensed Hospital | X | LicensedHospital |
| General Medical And Surgical | X | GeneralMedicalAndSurgical |
| Critical Access Hospital | X | CriticalAccessHospital |
| 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 | PIKE HEALTH SERVICES INC | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital Facility Number | 1 | HospitalFacilityNumber |
| CHNA Conducted | 1 | CHNAConducted |
| Community Definition | X | CommunityDefinition |
| Community Demographics | X | CommunityDemographics |
| Existing Resources | X | ExistingResources |
| How Data Obtained | X | HowDataObtained |
| Community Health Needs | X | CommunityHealthNeeds |
| Other Health Issues | X | OtherHealthIssues |
| Identifying Process | X | IdentifyingProcess |
| Consulting Process | X | ConsultingProcess |
| Information Gaps | X | InformationGaps |
| Other | X | Other |
| Needs Assessment Conducted | 10 | NeedsAssessmentConducted |
| Take Into Account | 1 | TakeIntoAccount |
| Other Facilities | 1 | OtherFacilities |
| CHNA Widely Available | 1 | CHNAWidelyAvailable |
| On Request | X | OnRequest |
| Participate Community Plan | X | ParticipateCommunityPlan |
| Adopt Budget | X | AdoptBudget |
| Prioritize Services | X | PrioritizeServices |
| All Needs Addressed | 1 | AllNeedsAddressed |
| Eligibility Criteria Explained | 1 | EligibilityCriteriaExplained |
| Uses FPG Free | 1 | UsesFPGFree |
| FPG Free Percent | 100.000000000000 | FPGFreePercent |
| Uses FPG Discounted | 1 | UsesFPGDiscounted |
| FPG Discount Percent | 200.000000000000 | FPGDiscountPercent |
| Explains Basis | 1 | ExplainsBasis |
| Income Level | X | IncomeLevel |
| Asset Level | X | AssetLevel |
| Medical Indigency | X | MedicalIndigency |
| Insurance Status | X | InsuranceStatus |
| Uninsured Discount | X | UninsuredDiscount |
| Medicaid Medicare | X | MedicaidMedicare |
| State Regulation | X | StateRegulation |
| Explains Application Method | 1 | ExplainsApplicationMethod |
| Includes Publicity Measures | 1 | IncludesPublicityMeasures |
| Posted On Website | X | PostedOnWebsite |
| Attached To Invoices | X | AttachedToInvoices |
| Posted In Emergency Room | X | PostedInEmergencyRoom |
| Provided On Admission | X | ProvidedOnAdmission |
| Actions On Nonpayment | 1 | ActionsOnNonpayment |
| Collection Activities | 0 | CollectionActivities |
| Nondiscrim Emergency Care Policy | 1 | NondiscrimEmergencyCarePolicy |
| Average Negotiated Rates | X | AverageNegotiatedRates |
| Used Other Method | X | UsedOtherMethod |
| Amounts Generally Billed | 0 | AmountsGenerallyBilled |
| Gross Charges | 0 | GrossCharges |
Form990 Schedule H Part VI Form990ScheduleHPartVI (18 entries)
| ExplanationExplanation | IdentifierIdentifier | Return ReferenceReturnReference |
|---|---|---|
| PART I, LINE 3C: N/A | ||
| PART I, LINE 6A: N/A | ||
| PART I, LINE 7: TOTAL COMMUNITY BENEFIT EXPENSE RELATED TO CHARITY CARE WAS CALCULATED USING A COST-TO-CHARGE RATIO AS CALCULATED USING SCHEDULE H WORKSHEET 2. TOTAL COMMUNITY BENEFIT RELATED TO MEDICAID WAS CALCULATED FROM THE MEDICAID COST REPORT. | ||
| 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 $ 3523309. | ||
| PART II: THE HEALTH OF THE COMMUNITY IS PROMOTED THROUGH NUMEROUS SCREENING AND EDUCATION ACTIVIES FOR DIABETES, CHOLESTEROL AND OTHER CIRCULATORY DISEASES. THE EDUCATION IS PROVIDED BY THE HOSPITAL AND OTHER HEALTH PROMOTING GROUPS IN THE COMMUNITY. ADDITIONALLY, THE HOSPITAL PARTICIPATES IN HEALTH FAIRS AND CLINICS FOR SENIOR GROUPS AND LOCAL BUSINESSES. ONGOING EDUCATION IN FIRST AID AND CPR IS GIVEN THROUGHOUT THE COMMUNITY. | ||
| PART III, LINE 4: 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 HOSPITAL'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.BAD DEBT EXPENSE WAS CALCULATED USING ACTUAL UNCOLLECTIBLE AMOUNTS PER THE FINANCIAL STATEMENTS. WE DO NOT BELIEVE BAD DEBT SHOULD BE INCLUDED AS A COMMUNITY BENEFIT. NONE OF THE BAD DEBT EXPENSE COULD BE ATTRIBUTED TO PATIENTS ELIGIBLE UNDER THE FINANCIAL ASSISTANCE POLICY. ON A REGULAR BASIS, AMOUNTS INCLUDED IN BAD DEBT THAT COULD QUALIFY FOR FINANCIAL ASSISTANCE ARE RECLASSED OUT OF BAD DEBT TO HCAP OR CHARITY CARE. | ||
| PART III, LINE 8: MEDICARE ALLOWABLE COSTS WERE CALCULATED FROM THE MEDICARE COST REPORT. WE DO NOT BELIEVE THE COST OF MEDICARE SHOULD BE INCLUDED AS A COMMUNITY BENEFIT. MEDICARE ALLOWABLE COSTS REPORTED ON THE COST REPORT WERE DETERMINED USING A COST-TO-CHARGE RATIO IN ACCORDANCE WITH MEDICARE REQUIREMENTS. | ||
| PART III, LINE 9B: ALL TYPES OF PATIENTS MUST COMPLETE APPLICATIONS FOR FINANCIAL ASSISTANCE. IF THE PATIENT DOES NOT, ALL PATIENTS WILL BE TREATED EQUALLY PER THE COLLECTION POLICY. IF THE PATIENT DOES COMPLETE THE APPLICATION AND QUALIFIES, THEIR ACCOUNT WILL BE ADJUSTED PER THE POLICY. | ||
| PART V, SECTION B, LINE 1J: THE COMMUNITY NEEDS ASSESSMENT ALSO DESCRIBES THE ECONOMIC IMPACT ON THE COMMUNITY IN THE NUMBER OF EMPLOYEES AND WAGES ALONG WITH THE STATE AND LOCAL TAX AS WELL AS THE GOALS OF THE REGION. | PIKE HEALTH SERVICES, INC. | |
| PART V, SECTION B, LINE 3: THE HOSPITAL TOOK INTO ACCOUNT INPUT FROM PERSONS WHO REPRESENT THE COMMUNITY THROUGH SURVEYS OF PATIENTS OF THE HOSPITAL AND THROUGH REPRESENTATIVES AT THE OHIO DEPARTMENT OF HEALTH RURAL FLEX PROGRAM. | PIKE HEALTH SERVICES, INC. | |
| PART V, SECTION B, LINE 4: THE HOSPITAL FACILITY NEEDS ASSESSMENT WAS CONDUCTED WITH THE FOLLOWING HOSPITAL FACILITIES: ADAMS COUNTY REGIONAL MEDICAL CENTER, DOCTORS HOSPITAL NELSONVILLE, FAYETTE COUNTY MEMORIAL HOSPITAL, ADENA GREENFIELD MEDICAL CENTER, HIGHLAND HOSPITAL, AND HOLZER MEDICAL CENTER DISTRICT JACKSON | PIKE HEALTH SERVICES, INC. | |
| PART V, SECTION B, LINE 19D: THE HOSPITAL FACILITY TAILORS THE PAYMENT PLANS FOR FAP-ELIGIBLE INDIVIDUALS TO EACH PATIENT. THE HOSPITAL FACILITY WORKS WITH PATIENTS TO NEGOIATE AMOUNTS THAT ARE REASONABLE AND PAYMENTS ARE ALWAYS DISCOUNTED. THE HOSPITAL FACILITY'S MAXIMUM AMOUNTS CHARGED TO FAP-ELIGIBLE INDIVIDUALS GENERALLY FALLS IN LINE WITH THE AVERAGE OF ITS THREE LOWEST NEGOTIATED COMMERCIAL INSURANCE RATES. | PIKE HEALTH SERVICES, INC. | |
| PART VI, LINE 2: PIKE PROVIDES SCREENING ACTIVITIES THROUGHOUT THE COMMUNITY. THERE IS A LARGE POPULATION OF SENIORS AND MEDICARE RECIPIENTS WHO BENEFIT. PIKE ALSO PARTNERS WITH THE YMCA TO PROVIDE DIABETES SCREENINGS. THERE IS NO FORMAL NEEDS ASSESSMENT HOWEVER FOR THE FUTURE THE HOSPITAL IS IN THE PROCESS OF DEVELOPING A MORE COMPREHENSIVE ASSESSMENT BASED ON SURVEYS TO MEMBERS OF THE COMMUNITY. | ||
| PART VI, LINE 3: ELIGIBILITY FOR ASSISTANCE SIGNAGE IS POSTED THROUGHOUT THE HOSPITAL (AT ALL PARTIENT ENTRANCES) AND BROCHURES ARE AVAILABLE THROUGHOUT THE HOSPITAL AND PHYSICIAN OFFICES. AWARENESS OF THE ASSISTANCE PROGRAMS ARE PROMOTED THROUGH MANY HEALTH FAIRS AND SCREENINGS. ALL PATIENTS WITHOUT THIRD PARTY COVERAGE ARE GIVEN CHARITY APPLICATIONS AT THE TIME OF REGISTRATION. | ||
| PART VI, LINE 4: PIKE COMMUNITY HOSPITAL SERVES A POPULATION OF 28,700 PEOPLE IN PIKE COUNTY, OHIO. THE PIKE COUNTY PER CAPITA INCOME IS $31,649. 15.10% OF THE POPULATION FALLS BELOW THE FEDERAL POVERTY LEVEL. OVER 10% OF THE POPULATION IS OVER 65 YEARS OF AGE. | ||
| PART VI, LINE 5: PIKE HEALTH SERVICES, INC. STRIVES TO MEET THE HEALTHCARE NEEDS OF ITS COMMUNITY. PIKE HEALTH SERVICE'S COMMUNITY OUTREACH ACTIVITY INCLUDES PARTICIPATION IN HEALTH FAIRS, SCREENINGS, AND EDUCATIONAL CLINICS FOR DIABETES, CHOLESTEROL AND ARTHRITIS. ADDITIONALLY, THEY SUPPORT THE YOUNG RESIDENTS OF THE COUNTY IN VARIOUS PROGRAMS INCLUDING HEAD START AND CHILD SAFETY PRESENTATIONS. MEDICAL AND HOSPITAL STAFF ARE ACTIVE PARTICIPATANTS ON NUMEROUS BOARDS THROUGHOUT THE AREA IN AN EFFORT TO PROMOTE COMMUNITY HEALTH AND HEALTHIER LIFESTYLES. | ||
| PART VI, LINE 6: N/A | ||
| OH | REPORTS FILED WITH STATES | PART VI, LINE 7 |
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 (5 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| CATHERINE FARINET | |||||||||||||
| 202627 | 0 | 0 | 0 | 0 | 0 | 6075 | 0 | 8544 | 0 | 217246 | 0 | 0 | 0 |
| CINDY INGRAM | |||||||||||||
| 219391 | 0 | 0 | 0 | 0 | 0 | 6719 | 0 | 19215 | 0 | 245325 | 0 | 0 | 0 |
| DAVID KESSLER | |||||||||||||
| 208886 | 0 | 0 | 0 | 0 | 0 | 6262 | 0 | 225 | 0 | 215373 | 0 | 0 | 0 |
| ELLIS FRAZIER | |||||||||||||
| 168866 | 0 | 0 | 0 | 0 | 0 | 5125 | 0 | 8532 | 0 | 182523 | 0 | 0 | 0 |
| JOHN CRAWFORD | |||||||||||||
| 154628 | 0 | 0 | 0 | 0 | 0 | 4809 | 0 | 19185 | 0 | 178622 | 0 | 0 | 0 |
Schedule L IRS990ScheduleL
Loan Table LoanTable
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Person | CINDY INGRAM | NamePerson |
| Purpose Of Loan | TUITION ASSISTANCE, TO BE FORGIVEN WITH HOURS WORKED OVER 7 YEARS. | PurposeOfLoan |
| Loan From Organization | X | LoanFromOrganization |
| Original Principal | $127,960 | OriginalPrincipalAmount |
| Balance Due | 18710 | BalanceDue |
| Default | 0 | Default |
| Approved By Board | 1 | ApprovedByBoard |
| Written Agreement | 1 | WrittenAgreement |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Balance Due | 18710 | TotalBalanceDue |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (7 entries)
| Return ReferenceReturnReference | ExplanationExplanation | IdentifierIdentifier |
|---|---|---|
| FORM 990, PART VI, SECTION B, LINE 11 | THE CEO OR VICE PRESIDENT OF FINANCE REVIEWS THE FORM 990 AND THE BOARD WILL BE PRESENTED WITH A COPY OF THE FORM 990 PRIOR TO FILING. | |
| FORM 990, PART VI, SECTION B, LINE 12C | OFFICERS, BOARD MEMBERS, AND KEY EMPLOYEES ARE REQUIRED TO REVIEW AND DISCLOSE CONFLICTS OF INTEREST BY AN ANNUAL FORM SIGN-OFF. THROUGHOUT THE YEAR, BOARD MEMBERS ARE REQUIRED TO DISCLOSE ANY CONFLICT OF INTERESTS THAT ARISE AND MUST REFRAIN FROM VOTING ON ANY ISSUES IN WHICH A CONFLICT OF INTEREST IS PRESENT. | |
| FORM 990, PART VI, SECTION B, LINE 15A | INDIVIDUAL BOARD MEMBERS EVALUATE THE CEO ANNUALLY, AND THEN DETERMINE RECOMMENDATIONS AS TO THE CEO'S COMPENSATION. ANY CEO COMPENSATION DECISIONS ARE DOCUMENTED. OTHER OFFICERS' COMPENSATION IS REVIEWED ANNUALLY BY THE CEO AND THE COMPENSATION DECISIONS ARE DOCUMENTED. THE ORGANIZATION USES A WRITTEN EMPLOYEE CONTRACT AND UTILIZES THE OHIO HOSPITAL ASSOCIATION'S COMPENSATION STUDIES TO DETERMINE COMPENSATION LEVELS FOR BOTH THE CEO AND OTHER OFFICERS. | |
| FORM 990, PART VI, SECTION C, LINE 19 | THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST. | |
| FORM 990, PART XI, LINE 5: | NET UNREALIZED GAINS ON INVESTMENTS: 19,056. | CHANGES IN NET ASSETS OR FUND BALANCES: |
| FORM 990, PART XII, LINE 2C: | THE BOARD OF DIRECTORS OVERSEES THE AUDIT PROCESS AND APPROVES THE INDEPENDENT AUDIT FIRM. THIS PROCESS HAS NOT CHANGED FROM PRIOR YEARS. | |
| FORM 990, PAGE 1, LINE C | PIKE COMMUNITY HOSPITAL; PIKE MEDICAL & SURGICAL ASSOCIATES | DOING BUSINESS AS: |