2012-05-14T14:39:28-05:00 2011-06-30 PLANTE & MORAN PLLC 65 EAST STATE ST STE 600 COLUMBUS OH 43215 990 2010-07-01 311417566 SOUTHERN OHIO MEDICAL CENTER TITLE HOLDING COMPANY SOUT 7403567622 1805 27TH STREET PORTSMOUTH OH 45662 DEAN WRAY 7403567622 2012-05-08 1 BERNIE OSTROWSKI 6148493000 2010 2016-02-24 21:20:13Z MR RANDAL ARNETT 1805 27TH STREET PORTSMOUTH OH 45662 2368111 0 X N/A X 1994 OH OWN AND MANAGE REAL ESTATE ON BEHALF OF SOUTHERN OHIO MEDICAL CENTER, A RELATED 501(C)(3) ORGANIZATION. 11 6 0 6 0 0 0 0 1922712 2356015 -2126 -1535 0 0 1920586 2354480 489000 619317 0 0 0 0 0 0 0 2619108 2809394 3108108 3428711 -1187522 -1074231 20751749 19659912 217167 199561 20534582 19460351 X WE WILL MAKE A DIFFERENCE. AT SOMC, OUR MISSION IS TO MAKE A DIFFERENCE. WE STRIVE TO LIVE OUT THAT MISSION BY PROVIDING OUR REGION WITH THE HIGHEST QUALITY OF CARE, DELIVERED BY PROFESSIONALS WHO ARE AMONG THE BEST IN THEIR FIELDS. WE EXTEND THAT CARE AND PASSION TO MAKE A DIFFERENCE IN THE COMMUNITY BY BEING A VERY GOOD NEIGHBOR, EMPLOYER, AND COMMUNITY SUPPORTER. 0 0 MAINTAINED AND MANAGED REAL PROPERTY USED TO ACCOMPLISH THE EXEMPT PURPOSES OF SOUTHERN OHIO MEDICAL CENTER, A RELATED IRC SEC. 501(C)(3) ORGANIZATION. 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 X 11 6 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 X RICHARD GILCHER 7403567622 1248 KINNEYS LANE PORTSMOUTH OH 45662 ROBERT E DEVER 2.00 X X 0 0 0 RANDAL ARNETT 2.00 X X 0 681059 300785 STEVEN A CONLEY 2.00 X 0 0 0 GARY DUZAN 2.00 X X 0 0 0 DAVID HANZEL MD 2.00 X 0 0 0 GEORGE LAWSON 2.00 X X 0 0 0 RITA RICE-MORRIS PHD 2.00 X 0 0 0 JOHN TURJOMAN MD 2.00 X X 0 0 0 ERNESTO BANALAGAY MD 2.00 X X 0 20959 0 DAVID FOWLER 2.00 X 0 0 0 GEORGE V LAWSON MD 2.00 X 0 0 0 JAMES W STAKER 2.00 X 0 0 0 DEAN WRAY 2.00 X 0 345786 125933 0 1047804 426718 0 0 1 0 0 RENTAL INCOME 532000 2356015 2356015 2356015 12096 13631 -1535 -1535 -1535 2354480 2356015 0 -1535 619317 399990 90206 897223 9684 1412291 3428711 34713958 15054046 20751749 19659912 20751749 19659912 217167 199561 217167 199561 X 20534582 19460351 20534582 19460351 20751749 19659912 -1074231 0 X X 0 1 1 X 0 558581 558581 18184530 8408753 9775777 14790 12046 2744 15283841 6115310 9168531 672216 517937 154279 19659912 1 SOMC MEDICAL CARE FOUNDATION INC 1248 KINNEYS LANE PORTSMOUTH OH 45662 311374523 501(C)(3) 619317 FORGIVENESS OF RENTAL CHARGES 1 0 PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, PART I, LINE 2: SOUTHERN OHIO MEDICAL CENTER TITLE HOLDING COMPANY FORGAVE RENTAL INCOME CHARGED TO RELATED, EXEMPT ORGANIZATIONS. 0 1 0 RANDAL ARNETT 0 488017 0 165763 0 27279 0 278475 0 22310 0 981844 0 0 DEAN WRAY 0 257114 0 70500 0 18172 0 106175 0 19758 0 471719 0 0 PART I, LINE 4B SOUTHERN OHIO MEDICAL CENTER, A RELATED ORGANIZATION, MADE CONTRIBUTIONS TO A SERP FOR RANDAL ARNETT AND DEAN WRAY IN THE AMOUNTS OF $261,325 AND $91,475 RESPECTIVELY. THE SERP PLAN IS AVAILABLE ONLY TO INDIVIDUALS WHO HAVE HELD AN EXECUTIVE POSITION FOR ONE YEAR. THE SERP WILL VEST UPON THE EXECUTIVE REACHING A SPECIFIED AGE. IF AN EXECUTIVE SEVERS EMPLOYMENT OR IS TERMINATED, A NONCOMPETE AGREEMENT IS IN PLACE FOR 2 YEARS. THE EXECUTIVE FORFEITS ANY SERP PAYMENTS IF HE/SHE DOES NOT CONFORM TO THE NONCOMPETE AGREEMENT. THE SERP CONTRIBUTIONS LISTED ABOVE ARE INCLUDED IN COMPENSATION REPORTED IN SCHEDULE J, PART II, COLUMN C. SUPPLEMENTAL INFORMATION PART III PART I, LINE 3: COMPENSATION PAID TO THE ORGANIZATION'S CEO IS ESTABLISHED BY A RELATED ORGANIZATION AND INCLUDES USE OF AN INDEPENDENT COMPENSATION CONSULTANT, COMPENSATION SURVEYS, A WRITTEN EMPLOYMENT CONTRACT, AND APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE. FORM 990, PART VI, SECTION A, LINE 6 SOMC TITLE HOLDING COMPANY IS ORGANIZED AS A SUBSIDIARY OF SOUTHERN OHIO MEDICAL CENTER, THE PARENT ORGANIZATION AND SOLE VOTING MEMBER FOR THE CONSOLIDATED GROUP. FORM 990, PART VI, SECTION A, LINE 7A SOUTHERN OHIO MEDICAL CENTER TITLE HOLDING COMPANY'S BOARD OF DIRECTORS ARE ELECTED BY SOUTHERN OHIO MEDICAL CENTER'S BOARD OF DIRECTORS. FORM 990, PART VI, SECTION A, LINE 7B SOUTHERN OHIO MEDICAL CENTER TITLE HOLDING COMPANY'S DECISIONS THAT ARE MADE BY THEIR BOARD OF DIRECTORS CAN BE OVERRULED BY SOUTHERN OHIO MEDICAL CENTER'S BOARD OF DIRECTORS. FORM 990, PART VI, SECTION B, LINE 11 FORM 990 INFORMATION IS COMPILED IN THE ACCOUNTING DEPARTMENT THEN SENT TO THE INDEPENDENT TAX ACCOUNTANTS TO ANALYZE THE INFORMATION AND COMPLETE THE TAX RETURN. THE FORM IS THEN REVIEWED BY FINANCIAL STAFF, TIED OUT TO THE TRIAL BALANCE, AND E-MAILED TO THE BOARD. IN ADDITION, THE CFO PRESENTS FORM 990 TO THE BOARD EXECUTIVE COMPENSATION COMMITTEE BEFORE FILING WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C CONFLICT OF INTEREST STATEMENTS ARE FILLED OUT ANNUALLY IN JANUARY FOR OFFICERS AND FOR NEW AND RETURNING BOARD MEMBERS. COMPLETED CONFLICT OF INTEREST STATEMENTS ARE REVIEWED BY THE AUDIT & COMPLIANCE COMMITTEE. ANY CONFLICTS ARE DOCUMENTED IN THE MINUTES AND ADDRESSED. CONFLICTS OF INTEREST ARE RAISED BY OFFICERS OR BOARD MEMBERS ONCE THEY ARE KNOWN BY THE INDIVIDUAL. BOARD MEMBERS ABSTAIN FROM VOTING IF A CONFLICT IS IDENTIFIED THAT THE BOARD MEMBER IS INVOLVED WITH. FORM 990, PART VI, SECTION B, LINE 15 COMPENSATION REVIEW IS COMPLETED BY A RELATED ORGANIZATION, SOUTHERN OHIO MEDICAL CENTER. ON AN ANNUAL BASIS, AN INDEPENDENT CONSULTANT PROVIDES THE BOARD COMPENSATION COMMITTEE WITH COMPARABLE DATA AND OTHER FACTS WHICH ARE USED BY THE COMMITTEE TO DETERMINE EXECUTIVE PAY PHILOSOPHY. THE DECISIONS FOR OFFICER COMPENSATION ARE DOCUMENTED IN THE BOARD COMPENSATION COMMITTEE MINUTES, WHICH WAS LAST PERFORMED DURING 2011. THIS COMMITTEE DETERMINES THE CEO'S PAY AND SETS PAY RANGES FOR THE OTHER EXECUTIVES. FORM 990, PART VI, SECTION C, LINE 19 SOUTHERN OHIO MEDICAL CENTER TITLE HOLDING COMPANY PROVIDES ITS FINANCIAL STATEMENTS TO THE PUBLIC THROUGH ITS BOND DISCLOSURE. GOVERNING DOCUMENTS AND THE CONFLICT OF INTEREST POLICY ARE MADE AVAILABLE TO THE PUBLIC ON SOUTHERN OHIO MEDICAL CENTER'S WEBSITE. FORM 990, PART XI, LINE 2C: THE ORGANIZATION HAS A COMMITTEE RESPONSIBLE FOR OVERSIGHT OF THE AUDIT AND SELECTION OF AN INDEPENDENT ACCOUNTANT. THE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. FORM 990, PART VII: THE FOLLOWING OFFICERS DEVOTED TIME TO SOUTHERN OHIO MEDICAL CENTER: RANDAL ARNETT 40 HOURS DEAN WRAY 40 HOURS SOUTHERN OHIO MEDICAL CENTER 1248 KINNEYS LANE PORTSMOUTH OH 45662 310678022 HEALTH CARE OH 501(C)(3) 3 N/A 0 SOMC FOUNDATION INC 1805 27TH STREET PORTSMOUTH OH 45662 311564440 HOLD INVESTMENTS FOR BENEFIT OF SOUTHERN OHIO MEDICAL CENTER OH 501(C)(3) LINE 11A, I SOUTHERN OHIO MEDICAL CENTER 1 SOMC MEDICAL CARE FOUNDATION INC 1248 KINNEYS LANE PORTSMOUTH OH 45662 311374523 MEDICINE AND SURGERY OH 501(C)(3) LINE 11A, I SOUTHERN OHIO MEDICAL CENTER 1 THE FRIENDS OF SOUTHERN OHIO MEDICAL CENTER 1805 27TH STREET PORTSMOUTH OH 45662 310677520 FUNDRAISING OH 501(C)(3) LINE 11A, I SOUTHERN OHIO MEDICAL CENTER 1 1 1 0 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0 SOUTHERN OHIO MEDICAL CENTER I 1675127 RENTAL CHARGES PER CONTRACT SOUTHERN OHIO MEDICAL CENTER P 1608877 ALLOCATION OF COSTS SOMC MEDICAL CARE FOUNDATION A 619317 RENTAL CHARGES PER CONTRACT SOMC MEDICAL CARE FOUNDATION B 619317 FORGIVENESS OF RENTAL CHARGES SOUTHERN OHIO MEDICAL CENTER N 308074 ALLOCATION OF COSTS