2012-08-13T11:07:05-07:00 2011-12-31 990 2011-01-01 340714771 THE UNION HOSPITAL ASSOCIATION UNIO 3303433311 659 Boulevard Dover OH 44622 Eugene A Thorn III 3303640805 2012-05-15 2011 2016-02-24 21:20:13Z Union Hospital Eugene Thorn 659 Boulevard Dover OH 44622 112466199 0 X www.unionhospital.org X 1906 OH To provide excellent quality health care to the community at a competitive price through highly competent people and an integrated provider network. 17 16 1114 119 89276 21129 374856 322846 86019026 86599963 2478243 3792510 10863949 10778143 99736074 101493462 0 0 0 0 49673234 51596199 0 0 51036 48221706 48600647 97894940 100196846 1841134 1296616 149951538 150415888 40072679 44064687 109878859 106351201 Patient Care: Union Hospital Association provides quality medical health care regardless of race, creed, sex, national origin, handicap, age or ability to pay. 0 0 71903565 0 87087979 The Union Hospital Association provided quality medical health care regardless of race, creed, age, sex, national origin, handicap, or the ability to pay. Hospital medical services provided 5900 inpatients a total of 24000 patient days and 242000 outpatient visits a total of 346000 procedures. (251000) 432838 0 Patient and Family support programs, general and other: During 2011, Union Hospital prepared 36,851 meals for residents who were unable to prepare meals for themselves due to a medical condition. These meals are provided at cost and are delivered by a volunteer group, Mobile Meals. The Hospital had 128 volunteers donate 20,633 hourse toward the common purpose of servicing the health care needs of the community. The value of these hours is $165,064 which is returned to the community through lower cost of patient services. The Hospital co sponsors an annual program that provides laboratory tests and blood pressure checks for the residents of the community; these services are provided at or below cost. Medicare and Medicaid made up 45% of the patient care provided. The Hospital aslo participates in a local program called Rainbow Connection, a non profit chairty that is dedicated to meeting the needs of disadvantaged and disabled residents of Tuscarawas County; we write off 50% of all charges for those patients while the program pays the remaining 50%. We also provided to the local Hospice agency a write off specified charges for individuals under this program (138 patients, $165,399). We sponsor a Helpline program that enabled 740 elderly and disabled consumers the opportunity to remain in their homes and feel safe in that setting. Since the Hospital does not probide mental health services as part of its normal operations, we lease building space to Community Professional Services, a mental non profit organization, at $2.04 per square foot, well below the average rate of $11.75 per square foot. Thus the rental rate and related in kind support provided by the Hospital are justified as a continuance of our mission. We operate a 35ft mobile medical vehicle that provides screenings to the areas that would have been underserved. An outreach sports medicine program provides training to various school to promote healthy athletes and physicals at a fraction of the cost. The hospital supports and hosts various groups such as Down Sydrome, RSD, Pain management, cancer supports, etc. We also provide baby sitting and AARP driving courses to the community and sent out 55,000 bi annual healthy living newsletters to the community. 0 0 0 72336403 1 1 0 0 0 0 0 0 0 0 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 1 109 0 1 1114 1 1 1 0 0 0 0 0 0 0 0 0 X 17 16 0 0 0 0 1 0 0 1 1 0 0 1 1 1 1 1 1 1 1 1 1 X X Eugene A Thorn III 3303640805 659 Boulevard Dover OH 44622 John R Herzig 2.00 X 0 0 0 James E Knisely 2.00 X 0 0 0 James J Pringle 2.00 X 0 0 0 Anne E Geib Hanner 2.00 X 0 0 0 Michael B Hovan 2.00 X 0 0 0 Agnes K Swigart 2.00 X 0 0 0 Mark N Kubina 2.00 X 0 0 0 Michael McCombs 2.00 X 0 0 0 Robert A Horn 2.00 X 0 0 0 Craig B Laughlin 2.00 X 0 0 0 Lois E Andreas 2.00 X 0 0 0 Robert E Moore Jr 2.00 X 0 0 0 C Jason Deeds 8.00 X 0 0 0 John E Dooling 2.00 X 0 0 0 Perry L Hershberger 2.00 X 0 0 0 Andrew J Wherley 2.00 X 0 0 0 R Bruce James 40 X X 298166 0 47069 Darwin K Smith 40 X 123775 0 20658 Thomas J Kelly Jr 40 X 242756 0 42750 Eugene A Thorn III 40 X 179816 0 28008 Diana L Boyd 40 X 141805 0 22505 Robert J Craig 40 X 152656 0 29959 Darrin Kuczynski 40 X 503189 169312 50877 James McQuillan 40 X 434616 170143 50877 Scott Holder 40 X 383586 168723 51021 Thomas Teeter 40 X 344271 170143 50877 Nicholas Groch 40 X 250386 0 37988 3055022 678321 432589 36 0 1 0 Emergimed Inc 659 Boulevard Dover OH 44622 Emergency services 4956890 Seneca Medical PO BOX 712361 Cincinnati OH 45271 Seller of medical equipment 2530031 Cardinal Health 5490 Collections Center Drive Chicago IL 60693 Seller of medical drugs 5202423 Anesthesia Care of Union Hospital 659 Boulevard Dover OH 44622 anesthesia and pain care associates 1632819 Laboratory Corp of AM Holdings PO Box 12140 Burlington NC 27216 Laboratory services provider 922456 94 0 1065 0 0 0 321781 0 322846 Net patient revenue 622000 86510687 86510687 0 0 Laboratory services 621500 89276 0 89276 0 0 0 0 0 86599963 3790223 0 0 3790223 0 0 0 0 0 0 0 0 876542 0 517449 0 359093 0 359093 0 0 359093 0 2287 0 0 0 2287 2287 0 0 2287 0 20297046 10455288 9841758 0 0 9841758 Health promotion 900099 52346 52346 0 0 Helpline income 900099 130962 130962 0 0 Athletic training 900099 75395 75395 0 0 318589 318589 0 0 577292 101493462 87087979 89276 13993361 0 0 0 0 0 0 0 0 1182630 0 1182630 0 0 0 0 0 38805173 33369845 5423394 11934 1890584 0 1890584 0 6479954 9800 6470154 0 3237858 2625739 611201 918 174019 174019 0 0 167505 0 167505 0 122535 400 122135 0 0 0 0 0 0 0 0 0 0 0 17419772 13920516 3499106 150 380631 51961 298029 30641 11038665 9767778 1269566 1321 1224417 0 1224417 0 0 0 0 0 1708306 1483072 225231 3 150313 84957 65352 4 0 0 0 0 28036 6917 21119 0 1468194 879448 588746 0 0 0 0 5740960 3591231 2149482 247 853646 7059 846587 0 Bad debt expense 6214662 6214662 0 0 Dues 144095 7331 136673 91 Meals 53070 2435 50634 1 Education expense 65462 23765 41697 0 1646359 115468 1525165 5726 100196846 72336403 27809407 51036 4617638 8075335 0 12913506 13025147 0 0 0 2233630 2158387 1119068 1270233 125133013 73202155 54225261 51930858 50263544 47310158 2394880 2102912 2009690 2009690 20174321 22533168 149951538 150415888 6551536 6488598 27100000 26650000 0 0 3679814 3411487 2741329 7514602 40072679 44064687 X 99298397 96216016 304769 177963 10275693 9957222 109878859 106351201 149951538 150415888 X 1296616 -4824274 X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1105252 1105252 0 55199694 22176276 33023418 0 2593464 2090628 502836 0 65567989 48935251 16632738 0 666614 0 666614 51930858 Assets whose use is limited donor specification 133160 Assets whose use is limited indenture agreement 588 Trust agreements 9957222 Other receivables 10430200 Deferred financing costs 447867 Interest in TVRCC 1564131 22533168 0 Interest payable 128057 Workers compensation payable 354301 Interest rate swap agreement 4856666 Accrued payroll withholdings 1916186 Other payables 259392 7514602 SchD_P10_S00_L02 Schedule D, Part X, Line 2 The hospital is a not for profit corporation exempt from federal inocme taxes under Section 501c3 of the Internal Revenue Code. Therefore no provision has been made for federal income taxes in the accompanying financial statements. In addition the IRS has determined that the Hospital is not a "private foundation" within the meaning of section 509(a) of the code. 1 1 1 X 1 X 1 1 0 1 1 0 0 3887258 0 3887258 0.00043 0 0 12776225 5110693 7665533 0.00084 0 0 0 0 0 0 0 0 16663483 5110693 11552791 0.00127 0 0 409154 40070 369084 0.0004 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 9 0 10063 0 10063 0.00001 9 0 419217 40070 379147 0.00041 9 0 17082700 5150763 11931938 0.00168 13621 0 13621 0.0001 0 0 13621 0 13621 0.0001 0 6214662 48611 29837102 22568185 7268917 X 1 1 Tuscarawas Ambulatory Surgery Center ambulatory surgery center 0.7 0 0.3 Tuscarawas Balley Regional Cancer Center Oncology center 0.5 0 0 DASCO Home Medical Equipment Home medical equipment sales 0.5 0 0 1 1 The Union Hospital Association

659 Boulevard Dover OH 44622

X X X The Union Hospital Association 1 1 1 100 1 300 1 X 1 1 X X X 1 X X X X 1 X X X X X 1 X 0 0 4 Tuscarawas Ambulatory Surgery Center

320 Oxford Street Dover OH 44622

Ambulatory surgery center Tuscarawas Valley Regional Cancer Center

659 Boulevard Dover OH 44622

Physician oncology center Union Physician Services

300 Medical Park Drive Suite 101 C Dover OH 44622

Physician offices DASCO UH Home Medical Equipment LLC

375 North West Street Westerville OH 43082

Home medical equipment sales SchH_P01_S00_L07 Schedule H, Part I, Line 7 Used the ratio of patient cost to charges from Worksheet 2 to calculate charity care reported. SchH_P01_S00_L072f Schedule H, Part I, Line 7, Column f Bad debt $6,214,662 SchH_P02_S00_L00 Schedule H, Part II The Hospital has numerous community building activities. Project Search welcomes mentally handicapped or learning disabled youth into the workforce to give the young adults the ability to learn workforce traits and skills and to be more socially interactive. The Hospital provides space for a classroom setting and internship positions for this program. Many of these youth have secured positions from this program. We provide clinical rotations for numerous nursing and technical programs retlated to healthcare. These programs secure the youth to the area, we also host and offer numerous support groups for various illnesses and social concerns. SchH_P03_S0A_L04 Schedule H, Part III, Section A, Line 4 Patient accounts receivable are due in full when billed. Accounts are considered delinquent and subsequently written off as bad debt based on individual credit evaluation and circumstances of the account. Line 2 represents 3% of gross patient revenue as seen as being uncollectible by self pay patients which is based upon historical trending valuations. A bad debt expense footnote is not presented in the notes to the financial statements. SchH_P03_S0B_L08 Schedule H, Part III, Section B, Line 8 Amounts are generated by the Medicare cost report which utilizes a department cost to charge methodology. SchH_P03_S0C_L09b Schedule H, Part III, Section C, Line 9b The Hospital will refund any monies paid on an account deemed charity care or that qualifies for financial assistance once that assessment has been determined. The account is then written off to such classification and any or all collections will cease after the determination has been made. SchH_P05_S0B_L11 Schedule H, Part V, Section B, Line 11 Charges are consistent with all payers. SchH_P06_S00_L02 Schedule H, Part VI, Line 2 Our Community Wellness department is committed to addressing the health assessments of our community. The department compiled data gathered by utilizing secondary sources such as the CDC and Ohio Obesity prevention. We have identified six areas that are of high concern in our community; they are cancer, diabetes, heart disease and strokes, physical activity and fitness, tobacco use, and the overall education of the community on health issues. In response to the areas of concern, the Hospital offers blood pressure screening, cholesterol screenings, fasting blood sugar tests, and vascular screening at reduced costs or free to members of the community basis. We also have cancer prevention day which includes pap smears, mammograms and skin cancer exams at a free or reduced cost. In response to the obesity and physical activity risks, the Hospital sponsors the annual Run for Home marathon training sessions, supports the fit youth initiative, and maintains a walking trail. For the general health of the community we also teach classes on bicycle helmet safety, AARP driver safety, babysitting basics, CPR, and smoking cessation. SchH_P06_S00_L03 Schedule H, Part VI, Line 3 Inpatients are given an informational booklet upon admission to the hospital, this booklet contains information regarding contact with patient accounts, accepted insurances and other payment options for the insured or uninsured. The Hospital also employees a patient financial specialist who meets with the patient and or family to discuss family size, income and other qualifying information for the various charity care programs. Financial assistance information is not provided at discharge but provided with the initial statement. The Hospital also discusses with the patients and family the availablity of state and federal programs for medical care. SchH_P06_S00_L04 Schedule H, Part VI, Line 4 Tuscarawas County is one of the 88 counties of the State of Ohio. The county has a population of approximately 91,000 residents with 25% under the age of 25 and 25% between the ages of 45 and 62. It is predominately a caucasion county in a rural setting with 7.2% of families being below the federal poverty level. 30% of adults smoke and 31% are obese or overweight; heart disease and strokes are the prevalent health issues of the county. To help counteract these issues, the Hospital provides numerous blood pressure, cholesterol and blood sugar screenings throughout the year. The Hospital also provides smoking cessation programs and sponsors youth and adult fitness initiatives and marathon trainings and sponsors to combat the obesity epidemic. SchH_P06_S00_L05 Schedule H, Part VI, Line 5 The Hospital provides many low cost clinics for blood pressure, cholesterol screenings, cancer screenings, and diabetes clinics to the area to help the community stay healthy and prevent diseases. We offer health fairs and promote health speakers on various health and safety issues to the community at no charge. The board is made up of individuals representing the community, there is an open medical staff and all surplus funds are used to make the Hospital a better organization for its community. SchH_P06_S00_L07 Schedule H, Part VI, Line 7 Community benefit report is not filed with any state. X X 0 0 0 0 0 0 0 0 0 R Bruce James 298166 0 0 0 0 0 14700 0 32369 0 345235 0 0 0 Darwin K Smith 123775 0 0 0 0 0 6987 0 13671 0 144433 0 0 0 Diana L Boyd 141805 0 0 0 0 0 7872 0 14633 0 164310 0 0 0 Robert J Craig 152656 0 0 0 0 0 7633 0 22326 0 182615 0 0 0 Eugene A Thorn III 179816 0 0 0 0 0 10789 0 17219 0 207824 0 0 0 Thomas J Kelly Jr 242756 0 0 0 0 0 14565 0 28185 0 285506 0 0 0 Darrin Kuczynski 302980 169312 200209 0 0 0 9569 0 41308 0 554066 169312 0 0 James McQuillan 302980 170143 131636 0 0 0 9569 0 41308 0 485493 170143 0 0 Scott Holder 302980 168723 80606 0 0 0 9568 0 41453 0 434607 168723 0 0 Thomas Teeter 302980 170143 41291 0 0 0 9569 0 41308 0 395148 170143 0 0 Nicholas Groch 250386 0 0 0 0 0 5404 0 32584 0 288374 0 0 0 Tuscarawas County Ohio 346002853 90069baa2 2009-10-15 27515000 Re issue of 1993 and 2001 bonds 1 1 0 0 0 0 0 0 0 484184 0 0 2969070 0 0 2009 1 0 1 1 0 0 0 0 0 0 0 1 0 1 1 RBS Citizens NA 20.5 0 0 0 0 0 F990_P06_S0A_L06 Form 990, Part VI, Section A, Line 6 The Hospital has a 17 member board of trustees who oversee the management of the Hospital. All monthly financial reporting is presented to the board of trustees. The trustees also oversee the hiring of any upper manangement and the approval of all capital and operating budgets. F990_P06_S0B_L11b Form 990, Part VI, Section B, Line 11b The 990 is prepared internally by the Hospital's staff accountant. The general ledger is reconciled to the appropriate schedules on the form and to the auditied financial statements. After this review it is then forwarded to the Vice President of Finance who reviews it for completeness and accuracy. After his review it is then submitted to the Finance Committee made up of Board of Truestee members; after the committee review it is then forwarded to the Board of Trustees for review and approval. The return is also reviewed by an independent accounting firm. F990_P06_S0B_L12c Form 990, Part VI, Section B, Line 12c Officers and board members are required to annually review the conflict of interest policy and make known any conflicts that may or have arose or any other discloseable event. If any notable event is disclosed it is reported to the Hospital CEO and Chairman of the Board of Trustees. Additionally, all financial transactions are reviewed through the Hospital's accounting systems. F990_P06_S0B_L15 Form 990, Part VI, Section B, Line 15 Compensation amounts are established based upon the appropriate healthcare industry standards and related surveys. Compensation amounts for key management is reviewed by the Executive Committee of the Board of Trustees. F990_P06_S0C_L19 Form 990, Part VI, Section C, Line 19 The public at anytime may inquire at the administrative office in the main hospital building and ask for a copy of the Form 990. The general public may also go to the Hospitals website to view the annual report and our Community Benefit Report. F990_P11_S00_L05 Form 990, Part XI, Line 5 $(4,448,769) unrealized loss on investments and swaps; $(387,096) noncontrolling interest purchase $11,591 change in minority interest. Union Hospital Medical Services 659 Boulevard Dover OH 44622 270273520 Physcian offices OH 5738035 0 N/A Union Physcian Services 659 Boulevard Dover OH 44622 264215547 Physcian office OH 1227640 2492821 N/A Tuscarawas Valley Regional Cancer Center 659 Boulevard Dover OH 44622 340000100 Physician and Hospital Organization OH 501c3 3 N/A 0 Union Hospital Auxillary 659 Boulevard Dover OH 44622 341204928 fundraising for the Hospital OH 501c3 11-III-FI N/A 0 Tuscarawas Ambulatory Surgery Center 320 Oxford St Dover OH 44622 311525875 ambulatory surgery center OH N/A Related 703000 1607449 0 0 0.7 Dasco Union Hospital Home Medical Equipment LLC 375 N West St Westerville OH 43082 270495743 durable medical equipment sales OH N/A Unrelated 61909 52476 0 0 0.5 Valley Healthcare Inc 659 Boulevard Dover OH 44622 341654921 Inactive OH N/A C 0 0 1 Union Care Corporation 659 Boulevard Dover OH 44622 341556177 Inactive OH N/A C 0 0 1 Union Pharmaceutical Care 659 Boulevard Dover OH 44622 043588229 retail pharmacy sales OH N/A C -1357 2029 1 1 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 Tuscarawas Ambulatory Surgery Center a-iv 400505 Fair market of space as determined by lease agreement. Dasco Union Hospital Home Medical Equipment LLC a-iv 13600 Fair market of of space as determined by lease agreement. Tuscarawas Ambulatory Surgery Center i 400505 Lease of building as determined by lease agreement.