LICKING MEMORIAL HOSPITAL: Form 990, tax year 2011
View the entire original 990 at ProPublica ↗
- Organization
- LICKING MEMORIAL HOSPITAL (EIN 31-4379519)
- Tax period
- 2011-01-01 to 2011-12-31
- Filed
- 2012-11-08
- IRS object ID
- 201243139349301414
- 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 ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2012-11-08T12:33:48-06:00 | Timestamp |
| Tax Period End Date | 2011-12-31 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 271235638 | EIN |
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MOUNTJOY CHILTON MEDLEY LLP | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 462 S FOURTH ST SUITE 2000 | AddressLine1 |
| City | LOUISVILLE | City |
| State | KY | State |
| ZIP Code | 402023445 | 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 | 314379519 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | LICKING MEMORIAL HOSPITAL | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | LICK | NameControl |
| Phone | 7403484528 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1320 WEST MAIN STREET | AddressLine1 |
| City | NEWARK | City |
| State | OH | State |
| ZIP Code | 43055 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | CYNTHIA L WEBSTER | Name |
| Title | V P OF FINANCIAL SERVICES | Title |
| Phone | 7403484528 | Phone |
| Date Signed | 2012-10-30 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | VICTORIA D BUSTER CPA | Name |
| PTIN | P00024054 | PTIN |
| Phone | 5027491900 | Phone |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2011 | TaxYear |
| Build TS | 2016-02-24 21:20:13Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | ROBERT A MONTAGNESE | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1320 WEST MAIN STREET | AddressLine1 |
| City | NEWARK | City |
| State | OH | State |
| ZIP Code | 43055 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 172134377 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | WWW.LMHEALTH.ORG | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1898 | YearFormation |
| State Legal Domicile | OH | StateLegalDomicile |
| Activity Or Mission Description | TO IMPROVE THE HEALTH OF THE COMMUNITY. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 13 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 13 | NbrIndependentVotingMembers |
| Total Nbr Employees | 1450 | TotalNbrEmployees |
| Total Nbr Volunteers | 158 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 0 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 0 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 166415478 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 169149310 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 221728 | InvestmentIncomePriorYear |
| Investment Income Current Year | 475778 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 1393002 | OtherRevenuePriorYear |
| Other Revenue Current Year | 1916078 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 168030208 | TotalRevenuePriorYear |
| Total Revenue Current Year | 171541166 | 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 | 69941046 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 70764828 | 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 | 73162332 | OtherExpensePriorYear |
| Other Expenses Current Year | 74057718 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 143103378 | TotalExpensesPriorYear |
| Total Expenses Current Year | 144822546 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 24926830 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 26718620 | RevenuesLessExpensesCY |
| Total Assets BOY | 130923203 | TotalAssetsBOY |
| Total Assets EOY | 139138337 | TotalAssetsEOY |
| Total Liabilities BOY | 65708580 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 82385476 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 65214623 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 56752861 | NetAssetsOrFundBalancesEOY |
| Info In Schedule O Part III | X | InfoInScheduleOPartIII |
| Mission Description | LICKING MEMORIAL HOSPITAL EXISTS TO IMPROVE THE HEALTH OF THE COMMUNITY. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 126529634 | Expense |
| Revenue | 169935018 | Revenue |
| Description | LICKING MEMORIAL HOSPITAL (LMH) PROVIDES HEALTHCARE SERVICES WITHOUT REGARD TO A PATIENT'S RACE, CREED, GENDER, DISABILITY, ETHNICITY, AGE, RELIGION, CITIZENSHIP, NATIONAL ORIGIN OR SOURCES OF PAYMENT FOR CARE. ALTHOUGH REIMBURSEMENT FOR SERVICES RENDERED IS CRITICAL TO THE OPERATION AND STABILITY OF LMH, IT IS RECOGNIZED THAT NOT ALL INDIVIDUALS POSSESS THE ABILITY TO PURCHASE ESSENTIAL MEDICAL SERVICES. FURTHER, WE BELIEVE OUR PURPOSE IS TO SERVE THE COMMUNITY BY PROVIDING HEALTHCARE SERVICES AND EDUCATION. THEREFORE, IN KEEPING WITH OUR COMMITMENT TO SERVE ALL MEMBERS OF THE COMMUNITY, WE PROVIDE: - FREE CARE AND/OR SUBSIDIZED CARE - CARE TO PERSONS COVERED BY GOVERNMENTAL PROGRAMS BELOW COST - HEALTH ACTIVITIES AND PROGRAMS FREE-OF-CHARGE TO THE COMMUNITYTHE ACTIVITIES INCLUDE WELLNESS PROGRAMS, COMMUNITY EDUCATION PROGRAMS, AND SPECIAL PROGRAMS FOR THE ELDERLY, HANDICAPPED AND MEDICALLY UNDER SERVED.LMH SERVED 6,867 INPATIENTS AND 976 NEWBORNS FOR A TOTAL OF 23,201 PATIENT DAYS, AND PROVIDED SERVICES TO 286,809 OUTPATIENTS IN 2011.ADDITIONALLY, LMH PROVIDES CARE TO PERSONS COVERED BY GOVERNMENTAL PROGRAMS, BELOW COST IN MANY CASES. TO THE EXTENT REIMBURSEMENT IS BELOW CHARGES, LMH CONSIDERS THESE AMOUNTS TO BE CONTRACTUAL ADJUSTMENTS, WHICH WILL NEVER BE COLLECTED. THE UNREIMBURSED VALUE OF PROVIDING CARE TO THESE PATIENTS AMOUNTED TO $126,848,000 IN 2011.UNCOMPENSATED CARE IS PROVIDED THROUGH MANY REDUCED PRICE SERVICES AND FREE PROGRAMS OFFERED THROUGHOUT THE YEAR BASED UPON ACTIVITIES AND SERVICES LMH BELIEVES WILL SERVE A BONA FIDE COMMUNITY HEALTH NEED. THE HOSPITAL ROUTINELY PROVIDES UNCOMPENSATED CARE TO PATIENTS WHO ARE UNWILLING OR UNABLE TO PAY THEIR HOSPITAL BILLS. IN 2011, LMH WROTE OFF CHARGES OF APPROXIMATELY $16,825,000 IN BAD DEBTS AND $15,745,000 IN CHARITY CARE. | Description |
| Total Program Service Expense | 126529634 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 0 | 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 | 0 | ReportOtherAssets |
| Report Other Liabilities | 1 | ReportOtherLiabilities |
| Report Fin48 Footnote | 1 | ReportFin48Footnote |
| Independent Audit Financial Stmt | 0 | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | 1 | ConsolidatedAuditFinancialStmt |
| School | 0 | School |
| Foreign Office | 0 | ForeignOffice |
| Foreign Activities | 0 | ForeignActivities |
| More Than5000 K To Organizations | 0 | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividuals |
| Professional Fundraising | 0 | ProfessionalFundraising |
| Fundraising Activities | 0 | 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 | 0 | LoanToOfficerOrDQP |
| Grant To Related Person | 0 | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | 0 | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | 0 | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | 0 | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | 0 | DeductibleNonCashContributions |
| Deductible Contributions Of Art | 0 | DeductibleContributionsOfArt |
| Terminated | 0 | Terminated |
| Partial Liquidation | 0 | PartialLiquidation |
| Disregarded Entity | 0 | DisregardedEntity |
| Related Entity | 1 | RelatedEntity |
| Related Org Controlled Entity | 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 | 263 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | 1 | ComplianceWithBackupWitholding |
| Number Of Employees | 1450 | 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 | 13 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 13 | 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 | 1 | CompensationProcessOther |
| Investment In Joint Venture | 0 | InvestmentInJointVenture |
| States Where Copy Of Return Is Filed | OH | StatesWhereCopyOfReturnIsFiled |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | DAVID CLAYPOOL | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 7403484528 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1320 WEST MAIN STREET | AddressLine1 |
| City | NEWARK | City |
| State | OH | State |
| ZIP Code | 43055 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part VII | X | InfoInScheduleOPartVII |
Form990 Part VII Section A Form990PartVIISectionA (20 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | OfficerOfficer | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | Highest Compensated EmployeeHighestCompensatedEmployee |
|---|---|---|---|---|---|---|---|
| PATRICK M JEFFRIES | |||||||
| CHAIRMAN | 1.50 | X | X | 0 | 0 | 0 | |
| LINDA K DALGARN | |||||||
| VICE CHAIRMAN | 1.30 | X | X | 0 | 0 | 0 | |
| KIM FLEMING | |||||||
| TREASURER | 1.30 | X | X | 0 | 0 | 0 | |
| PATRICK D GUANCIALE | |||||||
| SECRETARY | 1.30 | X | X | 0 | 0 | 0 | |
| GUS A ANDREWS | |||||||
| DIRECTOR | 1.30 | X | 0 | 0 | 0 | ||
| MICHAEL D CANTLIN | |||||||
| DIRECTOR | 1.30 | X | 0 | 0 | 0 | ||
| GENE BRANSTOOL | |||||||
| DIRECTOR | 1.30 | X | 0 | 0 | 0 | ||
| NANCY G NEELY | |||||||
| DIRECTOR | 1.30 | X | 0 | 0 | 0 | ||
| BONNIE L MANNING | |||||||
| DIRECTOR | 1.30 | X | 0 | 0 | 0 | ||
| CRAIG R BALDWIN | |||||||
| DIRECTOR | 1.30 | X | 0 | 0 | 0 | ||
| THOMAS MULLADY | |||||||
| DIRECTOR | 1.30 | X | 0 | 0 | 0 | ||
| RICHARD REED | |||||||
| DIRECTOR | 1.30 | X | 0 | 0 | 0 | ||
| F JENNIFER UTREVIS | |||||||
| DIRECTOR | 1.30 | X | 0 | 0 | 0 | ||
| ROBERT MONTAGNESE | |||||||
| PRESIDENT & CEO | 30.00 | X | 368181 | 0 | 91100 | ||
| CINDY WEBSTER | |||||||
| V.P. FINANCIAL SERVICES | 30.00 | X | 151146 | 0 | 8606 | ||
| CRAIG CAIRNS | |||||||
| VP MEDICAL AFFAIRS | 40.00 | 237940 | 0 | 13548 | X | ||
| DEBORAH YOUNG | |||||||
| VP PATIENT CARE | 40.00 | 161005 | 0 | 9167 | X | ||
| SALLIE ARNETT | |||||||
| VP INFO SYSTEMS | 40.00 | 157962 | 0 | 8994 | X | ||
| JEAN GLASER | |||||||
| DIRECTOR OF PHARMACY | 40.00 | 128515 | 0 | 7317 | X | ||
| VERONICA LINK | |||||||
| VP PR & DEVELOPMENT | 14.00 | 143103 | 0 | 8148 | X | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 1347852 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 0 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 146880 | TotalOtherCompensation |
| Number Individuals GT100 K | 29 | 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 |
|---|---|---|---|---|---|
| MEDICAL DOCTOR ASSOCIATES | |||||
| PO BOX 277185 | ATLANTA | GA | 30384 | PHYSICIAN SERVICES | 1950401 |
| JERRY MCCLAIN CONSTRUCTION | |||||
| 51 N 3RD STREET 701 | NEWARK | OH | 43055 | CONSTRUCTION | 825645 |
| TURNER CONSTRUCTION | |||||
| 375 HUDSON STREET | NEW YORK | NY | 10014 | CONSTRUCTION | 695051 |
| GE HEALTHCARE IITS | |||||
| 40 IDX DRIVE | SOUTH BERLINGTON | VT | 05403 | EQUIPMENT MAINTENANCE | 638821 |
| MEDICAL INFORMATION TECHNOLOGY | |||||
| MEDITECH CIRCLE | WESTWOOD | MA | 02090 | SOFTWARE MAINTENANCE | 527435 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 25 | NumberOfContractorsGT100K |
Program Service Revenue ProgramServiceRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | PATIENT REVENUE | Description |
| Business Code | 621110 | BusinessCode |
| Total Revenue Column | 169149310 | TotalRevenueColumn |
| Related Or Exempt Function Income | 169149310 | RelatedOrExemptFunctionIncome |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 169149310 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 475778 | TotalRevenueColumn |
| Exclusion | $475,778 | ExclusionAmount |
Gross Rents GrossRents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 593211 | Real |
Less Rental Expenses LessRentalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 593211 | Real |
Rental Income Or Loss RentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 0 | Real |
Net Rental Income Or Loss NetRentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Other Revenue Misc OtherRevenueMisc (3 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | ExclusionExclusionAmount | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome |
|---|---|---|---|---|
| CAFETERIA | 722210 | 1130370 | $1,130,370 | |
| OTHER SERVICES | 621110 | 508679 | 508679 | |
| VHA FEES & REBATES | 621110 | 277029 | 277029 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 1916078 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 171541166 | TotalRevenueColumn |
| Related Or Exempt Function Income | 169935018 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $1,606,148 | ExclusionAmount |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 619033 | Total |
| Management And General | 619033 | ManagementAndGeneral |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 51319040 | Total |
| Program Services | 44786536 | ProgramServices |
| Management And General | 6532504 | ManagementAndGeneral |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 15068928 | Total |
| Program Services | 13021451 | ProgramServices |
| Management And General | 2047477 | ManagementAndGeneral |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3757827 | Total |
| Program Services | 3272084 | ProgramServices |
| Management And General | 485743 | ManagementAndGeneral |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 107074 | Total |
| Management And General | 107074 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 334715 | Total |
| Management And General | 334715 | ManagementAndGeneral |
Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 98149 | Total |
| Program Services | 98149 | ProgramServices |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 9286745 | Total |
| Program Services | 7883203 | ProgramServices |
| Management And General | 1403542 | ManagementAndGeneral |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 364499 | Total |
| Management And General | 364499 | ManagementAndGeneral |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1633011 | Total |
| Management And General | 1633011 | ManagementAndGeneral |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 38986 | Total |
| Program Services | 36534 | ProgramServices |
| Management And General | 2452 | ManagementAndGeneral |
Conferences Meetings ConferencesMeetings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 390071 | Total |
| Program Services | 260107 | ProgramServices |
| Management And General | 129964 | ManagementAndGeneral |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 826845 | Total |
| Management And General | 826845 | ManagementAndGeneral |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 11374536 | Total |
| Program Services | 8855591 | ProgramServices |
| Management And General | 2518945 | ManagementAndGeneral |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1842059 | Total |
| Program Services | 1842059 | ProgramServices |
Other Expenses OtherExpenses (4 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral |
|---|---|---|---|
| MEDICAL SUPPLIES | 28752730 | 27794312 | 958418 |
| BAD DEBT EXPENSE | 16824894 | 16824894 | |
| EQUIPMENT RENTAL | 2081406 | 1803715 | 277691 |
| MISCELLANEOUS | 101998 | 50999 | 50999 |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 144822546 | Total |
| Program Services | 126529634 | ProgramServices |
| Management And General | 18292912 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3507331 | BOY |
| EOY | 10967375 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 5949809 | BOY |
| EOY | 1664804 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 17673624 | BOY |
| EOY | 18671084 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2322584 | BOY |
| EOY | 2402193 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2246727 | BOY |
| EOY | 1645249 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 181865585 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 103949642 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 84095753 | BOY |
| EOY | 77915943 | EOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 8783917 | BOY |
| EOY | 20850881 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 6343458 | BOY |
| EOY | 5020808 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 130923203 | BOY |
| EOY | 139138337 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 12896301 | BOY |
| EOY | 14168068 | EOY |
Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 20600000 | BOY |
| EOY | 28000000 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 32212279 | BOY |
| EOY | 40217408 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 65708580 | BOY |
| EOY | 82385476 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 65214623 | BOY |
| EOY | 56752861 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 65214623 | BOY |
| EOY | 56752861 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 130923203 | BOY |
| EOY | 139138337 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | 26718620 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | -35180382 | ReconcilationOtherChanges |
| Info In Schedule O Part XII | X | InfoInScheduleOPartXII |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | 0 | AccountantCompileOrReview |
| FS Audited | 1 | FSAudited |
| Audit Committee | 1 | AuditCommittee |
| Financial Statement Consolidated | X | FinancialStatementConsolidated |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital170b1 Aiii | X | Hospital170b1Aiii |
Schedule 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 | $2,370 | OtherActivitiesAmount |
| Total Lobbying Expenditures IIB | 2370 | 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 | LICKING MEMORIAL HOSPITAL PAYS $39,829 IN ANNUAL DUES TO OHIO HOSPITAL ASSOCIATION(OHA). OF THE TOTAL DUES PAID, 5.9% OR $2,350 ARE USED BY OHA TO SUPPORT LOBBYING ACTIVITIES OF THE ASSOCIATION. IN ADDITION, $20 WAS CONTRIBUTED TO SUPPORT A TAX LEVY ON THE COUNTY BALLOT FOR A SENIORS PROGRAM. | Explanation |
Schedule D IRS990ScheduleD
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 912878 | OtherCostOrOtherBasis |
| Book Value | 912878 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 85010741 | OtherCostOrOtherBasis |
| Depreciation | 31465970 | Depreciation |
| Book Value | 53544771 | BookValue |
Leasehold Improvements LeaseholdImprovements
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 2729886 | OtherCostOrOtherBasis |
| Depreciation | 2024682 | Depreciation |
| Book Value | 705204 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 92830480 | OtherCostOrOtherBasis |
| Depreciation | 70458990 | Depreciation |
| Book Value | 22371490 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 381600 | OtherCostOrOtherBasis |
| Book Value | 381600 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 77915943 | TotalOfBookValueLandBuildings |
Other Liabilities OtherLiabilities (4 entries)
| DescriptionDescription | AmountAmount |
|---|---|
| DEFERRED PENSION AND RETIREE LIABILITY | $34,701,529 |
| ACCRUED INTEREST PAYABLE | $83,354 |
| ACCRUED MALPRACTICE | $4,324,519 |
| THIRD PARTY SETTLEMENT | $1,108,006 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 40217408 | TotalOfAmounts |
Form990 Schedule D Part XIV Form990ScheduleDPartXIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: | Identifier |
| Return Reference | PART X: | ReturnReference |
| Explanation | THE FINANCIAL ACCOUNTING STANDARDS BOARD (FASB) HAS ISSUED NEW STANDARDS, CONTAINED IN THE ACCOUNTING STANDARDS CODIFICATION (ASC), CLARIFYING THE ACCOUNTING FOR UNCERTAINITY IN TAXES RECOGNIZED IN ANNUAL FINANCIAL STATEMENTS FOR FISCAL YEARS BEGINNING AFTER DECEMBER 31, 2010. THESE STANDARDS REQUIRE RECOGNITION AND MEASUREMENT OF UNCERTAIN INCOME TAX POSITIONS USING A "MORE-LIKELY-THAN-NOT" APPROACH. THE ORGANIZATION ADOPTED THESE STANDARDS AS OF JANUARY 1, 2011 WITH NO MATERIAL IMPACT ON ITS FINANCIAL STATEMENTS. | Explanation |
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 |
| Pcent250 | X | Pcent250 |
| Free Disc Care Medically Indigent | 1 | FreeDiscCareMedicallyIndigent |
| Amounts Budgeted For Charity Care | 1 | AmountsBudgetedForCharityCare |
| Expenses Exceeded Budget | 0 | ExpensesExceededBudget |
| Annual Community Benefit Report | 1 | AnnualCommunityBenefitReport |
| Report Publically Available | 1 | ReportPublicallyAvailable |
Charity Care At Cost CharityCareAtCost
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 16925 | PersonsServed |
| Total Community Benefit Expense | 9086872 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 3591513 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 5495359 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.04290 | PercentOfTotalExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 30356 | PersonsServed |
| Total Community Benefit Expense | 20341927 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 12727642 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 7614285 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.05950 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 47281 | PersonsServed |
| Total Community Benefit Expense | 29428799 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 16319155 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 13109644 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.10240 | PercentOfTotalExpense |
Community Health Services CommunityHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 16771 | PersonsServed |
| Total Community Benefit Expense | 1508058 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 141794 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 1366264 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.01070 | PercentOfTotalExpense |
Health Professions Education HealthProfessionsEducation
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 811 | PersonsServed |
| Total Community Benefit Expense | 442721 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 18000 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 424721 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00330 | PercentOfTotalExpense |
Subsidized Health Services SubsidizedHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 35199 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 35199 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00030 | PercentOfTotalExpense |
Cash And In Kind Contributions CashAndInKindContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 1085 | PersonsServed |
| Total Community Benefit Expense | 413119 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 150 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 412969 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00320 | PercentOfTotalExpense |
Total Other Benefits TotalOtherBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 18667 | PersonsServed |
| Total Community Benefit Expense | 2399097 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 159944 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 2239153 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.01750 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 65948 | PersonsServed |
| Total Community Benefit Expense | 31827896 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 16479099 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 15348797 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.11990 | PercentOfTotalExpense |
Physical Improvements And Housing PhysicalImprovementsAndHousing
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 320 | PersonsServed |
| Total Community Building Expense | 3565 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 3565 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00000 | PercentOfTotalExpense |
Community Support CommunitySupport
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 1500 | PersonsServed |
| Total Community Building Expense | 36354 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 36354 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00030 | PercentOfTotalExpense |
Leadership Development LeadershipDevelopment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 30 | PersonsServed |
| Total Community Building Expense | 940 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 940 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00000 | PercentOfTotalExpense |
Health Improvement Advocacy HealthImprovementAdvocacy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 320 | PersonsServed |
Workforce Development WorkforceDevelopment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 222 | PersonsServed |
| Total Community Building Expense | 4437 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 4437 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00000 | PercentOfTotalExpense |
Other Other
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 8465 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 8465 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00010 | PercentOfTotalExpense |
Total Total
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 2392 | PersonsServed |
| Total Community Building Expense | 53761 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 53761 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00040 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 1 | BadDebtExpenseReported |
| Bad Debt Expense | $16,824,894 | BadDebtExpenseAmount |
| Amount Attributable To | 4921281 | AmountAttributableTo |
| Amount Reimbursed By Medicare | 29636576 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 33306752 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | -3670176 | 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 | LICKING MEMORIAL HOSPITAL | BusinessNameLine1 |
Address Address
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1320 WEST MAIN STREET | AddressLine1 |
| City | NEWARK | City |
| State | OH | State |
| ZIP Code | 43055 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Licensed Hospital | X | LicensedHospital |
| General Medical And Surgical | X | GeneralMedicalAndSurgical |
| Er24 Hours | X | Er24Hours |
Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | LICKING MEMORIAL HOSPITAL | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital Facility Number | 1 | HospitalFacilityNumber |
| Eligibility Criteria Explained | 1 | EligibilityCriteriaExplained |
| Uses FPG Free | 1 | UsesFPGFree |
| FPG Free Percent | 100.000000000000 | FPGFreePercent |
| Uses FPG Discounted | 1 | UsesFPGDiscounted |
| FPG Discount Percent | 250.000000000000 | FPGDiscountPercent |
| Explains Basis | 1 | ExplainsBasis |
| Income Level | X | IncomeLevel |
| Medical Indigency | X | MedicalIndigency |
| 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 |
| Posted In Admission Office | X | PostedInAdmissionOffice |
| Available On Request | X | AvailableOnRequest |
| Actions On Nonpayment | 1 | ActionsOnNonpayment |
| Permit Report To Credit Agency | X | PermitReportToCreditAgency |
| Collection Activities | 0 | CollectionActivities |
| Nondiscrim Emergency Care Policy | 1 | NondiscrimEmergencyCarePolicy |
| Used Other Method | X | UsedOtherMethod |
| Amounts Generally Billed | 0 | AmountsGenerallyBilled |
| Gross Charges | 0 | GrossCharges |
Form990 Schedule H Part VI Form990ScheduleHPartVI (13 entries)
| ExplanationExplanation | IdentifierIdentifier |
|---|---|
| PART I, LINE 6A: THE COMMUNITY BENEFIT REPORT IS PREPARED BY LICKING MEMORIAL HEALTH SYSTEMS AND INCLUDES LICKING MEMORIAL HEALTH SYSTEMS, LICKING MEMORIAL HOSPITAL, LICKING MEMORIAL PROFESSIONAL CORPORATION, LICKING MEMORIAL HEALTH FOUNDATION. | |
| PART I, LINE 7: THE ORGANIZATION USED THE CBISA SOFTWARE TO DETERMINE THE COST ACCOUNTING METHODOLOGY. | |
| 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 $ 16824894. | |
| PART II: IT IS IMPORTANT TO NOTE THAT ALL ACTIVITIES ASSOCIATED WITH LICKING MEMORIAL HEALTH SYSTEMS REFLECT AND FURTHER THE MISSION OF "IMPROVING THE HEALTH OF THE COMMUNITY." WE DEFINE THE HEALTH OF THE COMMUNITY VERY BROADLY IN ORDER TO INCLUDE ACTIVITIES THAT ARE NOT NECESSARILY HEALTH RELATED BUT ACTIVITIES THAT WE BELIEVE ARE CRITICAL TO A HEALTHY COMMUNITY SUCH AS STRONG SCHOOLS, YOUTH PROGRAMS AND THE ARTS. WE PUBLISH A BI-MONTHLY MAGAZINE THAT IS MAILED TO 47,000 HOUSEHOLDS WHICH HIGHLIGHTS ALL OF OUR COMMUNITY BUILDING ACTIVITIES AND OPPORTUNITIES FOR HEALTH EDUCATION AND SCREENING. | |
| PART III, LINE 4: LINE 2 - THE ORGANIZATION USES THE CBISA SOFTWARE FOR COSTING METHODOLOGY, A SOFTWARE PROGRAM ENDORSED BY BOTH THE OHIO HOSPITAL ASSOCIATION AND AMERICAN HOSPITAL ASSOCIATION.LINE 3 - THE ORGANIZATION EMPLOYED A PATIENT SCORING METHODOLOGY WHICH COMBINES NUMEROUS FINANCIAL INDICATORS TO ARRIVE AT A NUMERIC CREDIT SCORE. THIS SCORE INCLUDES THE PATIENTS ABILITY TO PAY BASED ON THE ESTIMATED HOUSEHOLD INCOME AS WELL AS THE PROBABILITY OF PAYMENT BEING MADE BASED ON HISTORICAL CREDIT INFORMATION.LINE 4 - ACCOUNTS RECEIVABLE ARE REDUCED BY AN ALLOWANCE FOR DOUBTFUL ACCOUNTS. IN EVALUATING THE COLLECTIBILITY OF ACCOUNTS RECEIVABLE, THE ORGANIZATION ANALYZES ITS PAST HISTORY AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYOR SOURCES IN EVALUATING THE SUFFICIENCY OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. | |
| PART III, LINE 8: THE MEDICARE SHORTFALL REPRESENTS AN UNDERPAYMENT OF OUR COST FOR PROVIDING SERVICES TO TRADITIONAL MEDICARE PATIENTS, OUR LARGEST PAYER. SINCE THIS SHORTFALL RELATES TO SUCH A LARGE PORTION OF OUR COMMUNITY, WE FEEL THE COST SHORTFALL IS A RELEVANT FACTOR WHEN CONSIDERING COMMUNITY BENEFIT.WE USE THE MEDICARE COST REPORT FOR COSTING METHODOLOGY FOR CALCULATING THE MEDICARE SHORTFALL.IN ADDITION TO TRADITIONAL MEDICARE SHORTFALLS, THE HOSPITAL PROVIDES SERVICES TO MEDICARE HMO PATIENTS AT OR BELOW COST AS A FURTHER BENEFIT TO OUR COMMUNITY. BY ADOPTING THE SAME METHODOLOGY FOR TRADITIONAL MEDICARE ABOVE, THE MEDICARE HMO SHORTFALL AMOUNTED TO $2,860,351.ALONG THAT SAME LINE, THE LICKING MEMORIAL PROFESSIONAL CORPORATION, ANOTHER LMHS SUBSIDIARY, PROVIDED SERVICES TO MEDICARE (TRADITIONAL AND HMO) BENEFICIARIES AT A COST SHORTFALL OF $4,247,104 USING A CBISA SOFTWARE COSTING METHOD. THE CBISA SOFTWARE IS ENDORSED BY BOTH THE OHIO HOSPITAL ASSOCIATION AND THE AMERICAN HOSPITAL ASSOCIATION AS A COSTING METHOD UTILIZED FOR DETERMINING SHORTFALLS. | |
| PART III, LINE 9B: THE PATIENT ACCOUNTING DEPARTMENT IS RESPONSIBLE FOR THE COLLECTION OF PATIENTS' ACCOUNTS. THE OBJECTIVE OF THE DEPARTMENT IS TO COLLECT ACCOUNTS DUE THE HOSPITAL WHILE MAINTAINING POSITIVE GUEST RELATIONS.-PRIOR TO OR UPON ADMISSION, PATIENT INFORMATION IS OBTAINED BY THE REGISTRATION DEPARTMENT. THIS INFORMATION IS FORWARDED TO THE PATIENT ACCOUNT REPRESENTATIVE FOR MEDASSIST, INC. UPON ADMISSION.-WHENEVER POSSIBLE, SELF-PAY INPATIENTS ARE INTERVIEWED BY THE PATIENT ACCOUNT REPRESENTATIVE PRIOR TO DISCHARGE. PATIENTS WILL BE SCREENED FOR POSSIBLE STATE OR FEDERAL PROGRAM ELIGIBILITY, SUCH AS MEDICAID ORSOCIAL SECURITY DISABILITY. IF PATIENTS DO NOT MEET THE CRITERIA FOR THESE PROGRAMS, THEY WILL BE INFORMED OF THE UNCOMPENSATED CARE PROGRAMS AVAILABLE.- ALL STATEMENTS CONTAIN INFORMATION AND GUIDELINES FOR UNCOMPENSATED CARE. | |
| PART V, SECTION B, LINE 19D: THE HOSPITAL HAS A FINANCIAL ASSISTANCE POLICY IN PLACE THAT DISCOUNTS CARE TO THOSE APPLYING FOR AND MEETING THE INCOME LIMITS FOR DISCOUNTED CARE AT A RATE THAT IS GREATER THAN THE LOWEST NEGOTIATED COMMERCIAL INSURANCE RATE. | LICKING MEMORIAL HOSPITAL |
| PART VI, LINE 2: WITH A MISSION OF "IMPROVING THE HEALTH OF THE COMMUNITY," LICKING MEMORIAL HEALTH SYSTEMS CONTINUOUSLY MONITORS AND ASSESSES THE NEEDS OF OUR COMMUNITY. WE DO THIS IN A VARIETY OF WAYS. OUR ENTIRE LEADERSHIP TEAM IS VERY ACTIVE IN THE COMMUNITY, SERVING ON LOCAL, NOT-FOR-PROFIT BOARDS AND IN SERVICE CLUBS SUCH AS ROTARY AND KIWANIS. AS THE LARGEST EMPLOYER IN LICKING COUNTY, THE COMMUNITY LOOKS TO OUR MANAGEMENT STAFF FOR SUPPORT AND INVOLVEMENT IN MOST, IF NOT ALL, MAJOR INITIATIVES. THIS COMMUNITY INVOLVEMENT PROVIDES THE OPPORTUNITY TO COLLECT INFORMATION REGARDING THE NEEDS OF THE DIFFERENT ORGANIZATIONS. SENIOR MANAGEMENT IS VERY RESPONSIVE IN PROVIDING ASSISTANCE WHERE NEEDED AS THIS INFORMATION BECOMES AVAILABLE. THE BOARDS OF DIRECTORS FOR LICKING MEMORIAL HOSPITAL AND LICKING MEMORIAL HEALTH SYSTEMS ARE VERY INTERESTED AND ACTIVELY ENGAGED IN THE COMMUNITY; THEREFORE, THEY ARE A GREAT RESOURCE IN MAKING ADMINISTRATION AWARE OF NEEDS. IN ADDITION, THE BOARD RECEIVES A MONTHLY REPORT AT EACH BOARD MEETING, HIGHLIGHTING ALL OF THE COMMUNITY ACTIVITIES SUPPORTED BY THE HOSPITAL INCLUDING DONATIONS MADE DURING THAT MONTH, HEALTH FAIRS AND HEALTH SCREENINGS, MANAGEMENT AND PHYSICIANS SPEAKING IN THE COMMUNITY, ETC. PROVIDING ALL OF THIS INFORMATION TO THE BOARD ALLOWS THEM TO BE SUPPORTIVE AS ADMINISTRATION RECOMMENDS IMPLEMENTING NEW SERVICES OR ENHANCING EXISTING OFFERINGS.ORGANIZED UNDER THE HOSPITAL CORPORATION IS A 75 MEMBER DEVELOPMENT COUNCIL WHOSE PURPOSE IS TO EDUCATE THE COMMUNITY ABOUT THE HOSPITAL AND TO COMPLETE FUNDRAISING ACTIVITIES IN SUPPORT OF THE ORGANIZATION. THE MEMBERS OF THE DEVELOPMENT COUNCIL ARE COMMUNITY LEADERS REPRESENTING ALL AREAS OF BUSINESS, INDUSTRY AND EDUCATION IN THE COMMUNITY. THESE ARE INDIVIDUALS WHO HAVE THEIR "FINGERS ON THE PULSE" OF THE COMMUNITY, AND ONE OF THEIR RESPONSIBILITIES AS AMBASSADORS IS TO MAKE THE ADMINISTRATION AWARE OF NEEDS IN THE COMMUNITY ESPECIALLY PERTAINING TO HEALTH CARE. AMONG MANY OUTREACH ACTIVITIES OF THE DEVELOPMENT COUNCIL, PROBABLY THE MOST PRODUCTIVE ARE THE COMMUNITY LEADER ROUNDTABLES THAT ARE SPONSORED BY THIS GROUP. THESE ARE LUNCHEONS SCHEDULED MONTHLY WITH THE HEALTH SYSTEMS CEO. DEVELOPMENT COUNCIL MEMBERS SERVE AS HOSTS, AND THEY INVITE 20-25 INDIVIDUALS REPRESENTING SIMILAR INTERESTS. SOME EXAMPLES OF RECENT ROUNDTABLE GROUPS ARE SCHOOL NURSES, SCHOOL ATHLETIC DIRECTORS AND COACHES, REALTORS, FIRE CHIEFS, LOCAL POLITICIANS, ETC. THESE FORUMS ARE ALWAYS VERY INFORMATIVE FOR BOTH THE ATTENDEES AND THE ADMINISTRATION AS WE SHARE INFORMATION ABOUT THE HOSPITAL AND THEN ASK FOR FEEDBACK FROM THE COMMUNITY LEADERS WHO ARE PRESENT. MANY TIMES, IDEAS FOR HOSPITAL INITIATIVES COME FROM THESE EVENTS.ANOTHER ACTIVITY OF THE DEVELOPMENT COUNCIL IS A QUARTERLY CORPORATE BREAKFAST. THESE EDUCATIONAL SESSIONS NORMALLY DRAW 100-125 ATTENDEES FOR BREAKFAST AND PROVIDE AN OPPORTUNITY TO EDUCATE THE COMMUNITY LEADERSHIP REGARDING HOSPITAL ACTIVITIES AND TO PROVIDE AN OPEN FORUM TO DISCUSS HEALTH CARE AND OTHER NEEDS WITHIN THE COMMUNITY. SPEAKERS AT THESE EVENTS HAVE RANGED FROM PHYSICIANS TALKING ABOUT HEART, VASCULAR, ENDOCRINOLOGY, CARING FOR AGING PATIENTS, AND SLEEP MEDICINE, TO OUR DIRECTOR OF PASTORAL CARE TALKING ABOUT HOW HIS DEPARTMENT OF THE HOSPITAL SERVES THE PATIENTS AND THE COMMUNITY. THE HEALTH SYSTEMS' WEBSITE PROVIDES DETAILED INFORMATION ON THE VARIOUS PROGRAMS AVAILABLE AND PROVIDES A MECHANISM FOR COMMUNITY FEEDBACK. ALL REQUESTS COMING THROUGH THE WEBSITE RECEIVE A RESPONSE.AN AFFILIATED PHYSICIAN GROUP, KNOWN AS THE LICKING MEMORIAL PROFESSIONAL CORPORATION, PROVIDES PHYSICIAN INPUT REGARDING THE NEEDS THEY IDENTIFY IN THEIR DAILY PRACTICE AND COMMUNITY INVOLVEMENT. THESE OBSERVATIONS ARE DISCUSSED WITH ADMINISTRATION FOR DEVELOPMENT OF PROGRAMS AND SERVICES TO ADDRESS SUCH NEEDS. | |
| PART VI, LINE 3: LICKING MEMORIAL HEALTH SYSTEMS PROVIDES CARE TO THE ENTIRE COMMUNITY REGARDLESS OF ABILITY TO PAY. THAT MESSAGE IS SHARED WITH THE COMMUNITY IN A VARIETY OF WAYS. THE HEALTH SYSTEMS' WEBSITE PROVIDES INFORMATION ON ASSISTANCE IN PAYING HOSPITAL BILLS. IN ADDITION, THE BILLING STATEMENT SENT TO THE PATIENT OR GUARANTOR PROVIDES INSTRUCTIONS FOR ACCESSING CHARITY CARE. ASSISTANCE INFORMATION IS ALSO PROVIDED TO INDIVIDUALS WHO CONTACT THE BILLING OFFICE TO DISCUSS DIFFICULTY IN MAKING PAYMENT. THE HEALTH SYSTEMS CONTRACTS WITH AN ELIGIBILITY COMPANY TO SCREEN AND IDENTIFY PATIENTS WHO ARE ELIGIBLE FOR ASSISTANCE AT CERTAIN POINTS OF SERVICE WITHIN THE ORGANIZATION. WE ALSO EMPLOY THE USE OF EARLY-OUT AGENCIES TO PERFORM SELF-PAY BILLING SERVICES ON OUR BEHALF. THESE AGENCIES ROUTINELY IDENTIFY PATIENTS WHO ARE ELIGIBLE FOR ASSISTANCE AND PROVIDE APPLICATIONS FOR COMPLETION. THE HEALTH SYSTEMS PROVIDES ASSISTANCE TO THOSE WHO ARE ABOVE THE FEDERAL POVERTY LEVEL BY OFFERING DISCOUNTED CARE BASED ON A SLIDING SCALE UP TO 250% OF THE FEDERAL POVERTY LEVEL. IN ADDITION, THE ORGANIZATION PROVIDES FREE OR DISCOUNTED CARE FOR THOSE WHO ARE CONSIDERED TO BE MEDICALLY INDIGENT. THE DEVELOPMENT COUNCIL (AMBASSADORS) HAVE BEEN EDUCATED ABOUT OUR COMMITMENT TO PROVIDE CARE FOR THE ENTIRE COMMUNITY AND THAT MESSAGE IS SHARED IN THE COMMUNITY THROUGH THEIR GRASS ROOTS EFFORTS. | |
| PART VI, LINE 4: LICKING MEMORIAL HOSPITAL LOCATED IN NEWARK, OHIO THIRTY THREE MILES EAST OF COLUMBUS. THE CITY OF NEWARK HAS A POPULATION OF ABOUT 50,000 PEOPLE WITH A MEDIAN INCOME OF APPROXIMATELY $41,000. THE HOSPITAL SERVES THE COMMUNITY OF NEWARK AND LICKING COUNTY. LICKING COUNTY HAS A POPULATION OF APPROXIMATELY 166,000 (PER U.S. CENSUS BUREAU), A PER CAPITA INCOME OF APPROXIMATELY $26,000 AND AN UNEMPLOYMENT RATE OF 8.0%. | |
| PART VI, LINE 5: THE SYSTEM PROVIDED A VARIETY OF COMMUNITY SERVICES, WHICH INCLUDED PARTICIPATION IN MANY COMMUNITY HEALTH FAIRS THROUGHOUT THE COUNTY TO ENCOURAGE AND ADVANCE HEALTHCARE EDUCATION IN AREA SCHOOLS, CHURCHES AND BUSINESSES; PROVIDED VARIOUS SEMINARS AT NOMINAL CHARGES RELATED TO LAMAZE, CAESARIAN SECTIONS, SIBLING PREPARATION, INFANT AND CHILD CPR, BABYSITTING EDUCATION, AND BREASTFEEDING; PROVIDED SUPPORT GROUPS FOR VICTIMS AND FAMILIES OF CANCER, DIABETES, AND PULMONARY AND HEART DISEASE; PROVIDED ASSISTANCE TO EDUCATORS THROUGH OUR WORK WITH STUDENT NURSES, OCCUPATIONAL THERAPY, AND PHYSICAL THERAPY INTERNS; PROVIDED SPEAKERS TO SCHOOLS, BUSINESSES CIVIC GROUPS AND OTHER ORGANIZATIONS ON HEALTH CARE SUBJECTS. SEE SCHEDULE O FOR A DETAILED LISTING OF VARIOUS PROGRAMS AND INDIVIDUALS SERVED BY THE HEALTH SYSTEM. | |
| PART VI, LINE 6: LICKING MEMORIAL HEALTH SYSTEMS (THE SYSTEM) IS A NONPROFIT CORPORATION ORGANIZED UNDER THE LAWS OF THE STATE OF OHIO TO PROVIDE AND PROMOTE HEALTH CARE SERVICES IN CENTRAL OHIO.THE SYSTEM IS THE PARENT ORGANIZATION AND SOLE CORPORATE MEMBER OF LICKING MEMORIAL HOSPITAL (THE HOSPITAL), LICKING MEMORIAL HEALTH FOUNDATION (THE FOUNDATION), AND LICKING MEMORIAL PROFESSIONAL CORPORATION (THE PROFESSIONAL CORPORATION).THE PROFESSIONAL CORPORATION EMPLOYS A STAFF OF PHYSICIANS AND SUPPORT PERSONNEL TO FURTHER THE SYSTEM'S CHARITABLE PURPOSE. THE PROFESSIONAL CORPORATION HAS A SOLE PHYSICIAN SHAREHOLDER, WHO, UNDER A SHARED CONTROL AGREEMENT, ASSIGNED THE VOTING RIGHTS OF THE STOCK TO THE SYSTEM. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Committee | X | CompensationCommittee |
| Independent Consultant | X | IndependentConsultant |
| Form990 Of Other Organizations | X | Form990OfOtherOrganizations |
| Written Employment Contract | X | WrittenEmploymentContract |
| Compensation Survey | X | CompensationSurvey |
| Board Or Committee Approval | X | BoardOrCommitteeApproval |
| Severance Payment | 0 | SeverancePayment |
| Supplemental Nonqual Retire Plan | 1 | 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 (6 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| ROBERT MONTAGNESE | |||||||||||||
| 348335 | 0 | 521 | 0 | 19325 | 0 | 91100 | 0 | 0 | 0 | 459281 | 0 | 0 | 0 |
| CINDY WEBSTER | |||||||||||||
| 139170 | 0 | 521 | 0 | 11455 | 0 | 8606 | 0 | 0 | 0 | 159752 | 0 | 0 | 0 |
| CRAIG CAIRNS | |||||||||||||
| 225119 | 0 | 521 | 0 | 12300 | 0 | 13548 | 0 | 0 | 0 | 251488 | 0 | 0 | 0 |
| DEBORAH YOUNG | |||||||||||||
| 148933 | 0 | 521 | 0 | 11551 | 0 | 9167 | 0 | 0 | 0 | 170172 | 0 | 0 | 0 |
| SALLIE ARNETT | |||||||||||||
| 145919 | 0 | 521 | 0 | 11522 | 0 | 8994 | 0 | 0 | 0 | 166956 | 0 | 0 | 0 |
| VERONICA LINK | |||||||||||||
| 131205 | 0 | 521 | 0 | 11377 | 0 | 8148 | 0 | 0 | 0 | 151251 | 0 | 0 | 0 |
Form990 Schedule J Part III Form990ScheduleJPartIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Reference | PART I, LINE 4B | ReturnReference |
| Explanation | ROBERT MONTAGNESE, PRESIDENT, PARTICIPATES IN A SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN (SERP). A CONTRIBUTION WAS MADE TO THE PLAN ON HIS BEHALF FOR THE 2011 YEAR IN THE AMOUNT OF $70,136. | Explanation |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (10 entries)
| Return ReferenceReturnReference | ExplanationExplanation | IdentifierIdentifier |
|---|---|---|
| FORM 990, PART VI, SECTION B, LINE 11 | A DRAFT OF THE RETURN IS REVIEWED FIRST BY INTERNAL MANAGEMENT. AFTER INTERNAL MANAGEMENT HAS REVIEWED THE RETURN AND ANY CHANGES ARE MADE A DRAFT IS MADE AVAILABLE FOR REVIEW AND PRESENTATION TO THE BOARD. ONCE THE COMMENTS FROM THE BOARD ARE REVIEWED THE FINAL RETURN IS PREPARED AND SIGNED BY THE VICE PRESIDENT OF FINANCIAL SERVICES. | |
| FORM 990, PART VI, SECTION B, LINE 12C | THE ORGANIZATION REQUIRES ALL BOARD MEMBERS AND KEY EMPLOYEES TO SIGN A CONFLICT OF INTEREST STATEMENT ONCE A YEAR. THE ORGANIZATION DOES NOT PERMIT BOARD MEMBERS TO HAVE A CONFLICT OF INTEREST. IF A BOARD MEMBER HAS A CONFLICT OF INTEREST THEY ARE ASKED TO RESIGN FROM THE BOARD. | |
| FORM 990, PART VI, SECTION B, LINE 15 | THE ORGANIZATION HAS AN INDEPENDENT COMPENSATION COMMITTEE THAT DETERMINES THE COMPENSATION FOR THE CEO THAT IS THEN APPROVED BY THE BOARD. THE CEO DETERMINES THE COMPENSATION FOR THE OTHER OFFICERS BASED UPON INDEPENDENT SALARY SURVEYS. | |
| FORM 990, PART VI, SECTION C, LINE 19 | THE ORGANIZATION DOES NOT MAKE ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC. | |
| FORM 990, PAGE 7, PART VII: | EACH OF THE INDIVIDUALS LISTED BELOW WORKS FOR RELATED ORGANIZATIONS. THEIR AVERAGE HOURS WORKED EACH WEEK WITH THE RELATED ORGANIZATIONS ARE ALSO NOTED. CINDY WEBSTER - 10 HOURS/WEEK ROBERT MONTAGNESE - 10 HOURS/WEEK VERONICA LINK - 26 HOURS/WEEK | TIME SPENT WITH RELATED ORGANIZATIONS |
| FORM 990, PART XI, LINE 5: | NET UNREALIZED LOSSES ON INVESTMENTS: -137,364. CHANGE IN MINIMUM PENSION LIABILITY -13,067,839. CHANGE IN RETIREE BENEFIT PLAN -79,579. NET ASSET TRANSFERS WITH RELATED 501(C)(3) -21,895,600. TOTAL TO FORM 990, PART XI, LINE 5: -35,180,382. | CHANGES IN NET ASSETS OR FUND BALANCES: |
| FORM 990, PAGE 12, PART XII LINE 2C: | THERE WAS NO CHANGE IN THE OVERSIGHT PROCESS OR SELECTION PROCESS OF THE INDEPENDENT AUDITOR. LICKING MEMORIAL HOSPITAL CONTINUES TO BE AUDITED AS PART OF THE LICKING MEMORIAL HEALTH SYSTEMS CONSOLIDATED GROUP. LICKING MEMORIAL HOSPITAL IS INCLUDED IN THE LICKING MEMORIAL HEALTH SYSTEMS CONSOLIDATED FINANCIAL STATEMENTS. THE ORGANIZATION HAS A FINANCE COMMITTEE THAT OVERSEES THE AUDIT OF THE FINANCIAL STATEMENTS AND THE SELECTION OF THE INDEPENDENT ACCOUNTANT. | |
| FORM 990, PAGE 2 PROGRAM SERVICES | MONETARY INPUTS OUTPUTS EXPENSES OFFSETS BENEFIT PERSONS 12 LEAD EKG PROJECT CARDIOLOGY (1712) 11,633 0 11,633 UNKNOWN 20TH CENTURY CLUB DONATIONS DEVELOPMENT (1955) 2,660 0 2,660 UNKNOWN AARP SPEAKER PUBLIC RELATIONS (1956) 348 0 348 25 ADVANTAGE CLUB SILVER SNEAKERS SPEAKER PUBLIC RELATIONS (1956) 66 0 66 10 ALEXANDRIA BUCKEYE SENIORS SPEAKER PUBLIC RELATIONS (1956) 132 0 132 80 AMERICA HERITAGE GIRLS TROOP IN KIND DONATIONS DEVELOPMENT (1955) 72 0 72 UNKNOWN AMERICAN CANCER SOCIETY SPONSORSHIPS DEVELOPMENT (1955) 2,861 0 2,861 UNKNOWN AMERICAN RED CROSS OF LICKING COUNTY EVENT SPONSORSHIPS DEVELOPMENT (1955) 1,000 0 1,000 UNKNOWN ARE YOU AT RISK FOR A HEART ATTACK? PROCESS IMPROVEMENT (1945) 178 0 178 5 ART FROM THE HEART DEVELOPMENT (1955) 8,465 0 8,465 222 ASK THE DOC AT SHEPHERD HILL OP CHEMICAL DEPENDENCY (1692) 10,211 0 10,211 1,303 AUTOMATED EXTERNAL DEFIBRILLATORS EMERGENCY DEPT (1678) 23,566 0 23,566 UNKNOWN BEATING HOLIDAY STRESS PROCESS IMPROVEMENT (1945) 147 0 147 11 BEHAVIORAL HEALTH CARE PARTNERS CASH DONATIONS DEVELOPMENT (1955) 250 0 250 UNKNOWN BEHAVIORAL HEALTH CARE PARTNERS IN KIND DONATIONS DEVELOPMENT (1955) 2,080 0 2,080 UNKNOWN BIG BROTHERS BIG SISTERS OF LICKING AND PERRY COUNTY DONATION DEVELOPMENT (1955) 40 0 40 UNKNOWN BIG BROTHERS/BIG SISTERS EVENT SPONSORSHIPS DEVELOPMENT (1955) 5,000 0 5,000 UNKNOWN BLESSED SACRAMENT SCHOOL SPONSORSHIPS DEVELOPMENT (1955) 100 0 100 UNKNOWN BOEING HEALTH & WELLNESS FAIR SPEAKER COMMUNITY CASE MANAGEMENT (1976) 202 0 202 400 BOY SCOUTS OF AMERICA SIMON KENTON COUNCIL DONATIONS DEVELOPMENT (1955) 950 0 950 UNKNOWN BREAST CA AWARENESS DAY FREE MAMMOGRAMS RADIOLOGY (1721) 13,272 0 13,272 57 BREAST CANCER AWARENESS & SCREENING EDUCATION (1616) 616 0 616 4 BREAST FEEDING BASICS MATERNAL CHILD (1646) 10,157 7,720 2,437 688 BREASTFEEDING PROMOTION & SUPPORT PROGRAM MATERNAL CHILD (1646) 56,800 0 56,800 355 C TEC ANNUAL RECOGNITION BRUNCH & EVENT SPONSOR DEVELOPMENT (1955) 200 0 200 UNKNOWN CADE AND KATELYN FUND COMMITTEE EVENT SPONSOR DEVELOPMENT (1955) 100 0 100 UNKNOWN CALL TO COLLEGE MEMORIAL DONATION DEVELOPMENT (1955) 3,000 0 3,000 UNKNOWN CAMP FEELIN' FINE RESPIRATORY THERAPY (1736) 5,701 0 5,701 40 CAMP O'BANNON EVENT SPONSOR DEVELOPMENT (1955) 50 0 50 UNKNOWN CAR SEAT INSTALLATION/EDUCATION MATERNAL CHILD (1646) 281 0 281 2 CAROL STRAWN CENTER SPONSORSHIP DEVELOPMENT (1955) 440 0 440 UNKNOWN CBISA SOFTWARE FISCAL SERVICES (1901) 900 0 900 UNKNOWN CENTER FOR DISABILITY SERVICES EVENT SPONSOR DEVELOPMENT (1955) 350 0 350 UNKNOWN CENTER FOR VISUALLY IMPAIRED SPONSORSHIP DEVELOPMENT (1955) 750 0 750 UNKNOWN CEREBRAL PALSY PATIENT CASH DONATION FOR COMMUNICATION DEVICE DEVELOPMENT (1955) 8,302 0 8,302 UNKNOWN CHERRY VALLEY ELEMENTARY IN KIND DONATIONS DEVELOPMENT (1955) 125 0 125 UNKNOWN CHILD SUPPORT AGENCY SPEAKERS PUBLIC RELATIONS (1956) 392 0 392 47 CHILDREN'S READING FOUNDATION OF LICKING COUNTY DONATION DEVELOPMENT (1955) 2,500 0 2,500 UNKNOWN CITY OF HEATH SOFTBALL TEAM SPONSORSHIP DEVELOPMENT (1955) 325 0 325 UNKNOWN CITY OF NEWARK PARKS AND RECREATION TENT LOAN DEVELOPMENT (1955) 313 0 313 UNKNOWN CLINICAL EDUCATION OF ECHOSONOGRAPHERS (CARDIOLOGY) CARDIOLOGY (1712) 13,858 0 13,858 4 COMMUNITY BENEFIT REPORTING HOURS FISCAL SERVICES (1901) 6,283 0 6,283 UNKNOWN COMMUNITY BOARD/COMMITTEE MEETINGS (COMMUNITY BENEFIT) EXECUTIVE ADMIN (1950) 16,280 0 16,280 200 COMMUNITY BOARD/COMMITTEE MEETINGS (COMMUNITY SUPPORT) EXECUTIVE ADMIN (1950) 33,756 0 33,756 1,000 COMMUNITY BOARD/COMMITTEE MEETINGS (PHYSICAL IMPROVEMENTS/HOUSING) EXECUTIVE ADMIN (1950) 718 0 718 320 COMMUNITY BOARD/COMMITTEE MEETINGS (WORKFORCE DEVELOPMENT) EXECUTIVE ADMIN (1950) 2,253 0 2,253 UNKNOWN COMMUNITY CASE MANAGEMENT SERVICES COMMUNITY CASE MANAGEMENT (1976) 681,979 129,364 552,615 UNKNOWN COMMUNITY HEALTH & RECOVERY BOARD CASH DONATIONS DEVELOPMENT (1955) 200 0 200 UNKNOWN COMMUNITY HEALTH ASSESSMENT COMMITTEE PROCESS IMPROVEMENT (1945) 966 0 966 UNKNOWN COTC LPN CLASS PUBLIC RELATIONS (1956) 287 0 287 57 COTC RADIOLOGY CLASS PUBLIC RELATIONS (1956) 102 0 102 20 CTEC SPEAKER PUBLIC RELATIONS (1956) 220 0 220 3 CTEC MEDICAL ASSISTANT EXTERNSHIP PROGRAM EXECUTIVE ADMIN LMHP (7445) 20,939 0 20,939 5 CTEC OUTSTANDING STUDENT AWARD SPONSORSHIP DEVELOPMENT (1955) 200 0 200 UNKNOWN DENISON MOVIE NIGHT HEALTH SCREENINGS PUBLIC RELATIONS (1956) 57 0 57 25 DENISON FRESHMAN CAREER FAIR HUMAN RESOURCES (1951) 1,300 0 1,300 300 DENISON UNIVERSITY SPEAKER PUBLIC RELATIONS (1956) 543 0 543 53 DENISON UNIVERSITY EMPLOYEE HEALTH FAIR PUBLIC RELATIONS (1956) 735 0 735 200 DENTISTRY FROM THE HEART COMMUNITY HEALTH EDUCATION PUBLIC RELATIONS (1956) 244 0 244 140 DENTISTRY FROM THE HEART IN KIND DONATIONS DEVELOPMENT (1955) 148 0 148 UNKNOWN DIABETES AWARENESS EDUCATION (1616) 537 0 537 5 DIGESTIVE DISORDERS PROCESS IMPROVEMENT (1945) 1,834 0 1,834 37 DINING WITH DIABETES PROCESS IMPROVEMENT (1945) 3,270 0 3,270 61 DONATION OF BEDS TO COLLEGES DEVELOPMENT (1955) 18,215 0 18,215 UNKNOWN DONATION OF LABORATORY SUPPLIES LAB (1702) 28 0 28 36 DONATION OF MEAT TO SALVATION ARMY DEVELOPMENT (1955) 511 0 511 UNKNOWN DONATION OF SUPPLIES TO IMPOVERISHED COUNTRIES PURCHASING (1675) 199,084 0 199,084 UNKNOWN DRUG ASSISTANT INDIGENT DRUG RECOVERY EXECUTIVE ADMIN LMHP (7445) 54,297 0 54,297 1,449 EMERGENCY SERVICES FOR INDIGENT PATIENTS FISCAL SERVICES (1901) 142,591 0 142,591 UNKNOWN ENGLEFIELD OIL SPEAKER PUBLIC RELATIONS (1956) 243 0 243 290 ETNA LIONS CRUISE IN HEALTH FAIR PUBLIC RELATIONS (1956) 289 0 289 30 EXERCISE & WEIGHT LOSS PROCESS IMPROVEMENT (1945) 473 0 473 4 FAMILY & FRIENDS INFANT AND CHILD CPR MATERNAL CHILD (1646) 1,699 610 1,089 126 FINDING HELP FOR HEALTH CARE NEEDS PROCESS IMPROVEMENT (1945) 106 0 106 7 FIRST METHODIST CHURCH SPEAKER PUBLIC RELATIONS (1956) 124 0 124 31 FIRST UNITED METHODIST CHURCH, NEWARK COMMUNITY SUPPORT DEVELOPMENT (1955) 379 0 379 UNKNOWN GIS RUNNING CLUB CASH DONATIONS DEVELOPMENT (1955) 250 0 250 UNKNOWN GLENN'S MARKET SCREENINGS COMMUNITY CASE MANAGEMENT (1976) 1,710 0 1,710 145 GOODWILL INDUSTRIES CAREER DAY PUBLIC RELATIONS (1956) 52 0 52 7 GRANVILLE HIGH SCHOOL SPEAKER PUBLIC RELATIONS (1956) 144 0 144 800 GRANVILLE HIGH SCHOOL SPONSORSHIP DEVELOPMENT (1955) 1,700 0 1,700 UNKNOWN GRANVILLE MIDDLE SCHOOL SPEAKER PUBLIC RELATIONS (1956) 577 0 577 48 GRANVILLE ROTARY CLUB SPEAKER PUBLIC RELATIONS (1956) 191 0 191 50 GREYSTONE COURT ASSOCIATES FUNDRAISER IN KIND DONATIONS DEVELOPMENT (1955) 374 0 374 UNKNOWN HALLOWEEN ON THE SQUARE VOLUNTEERS (1970) 616 0 616 500 HARTFORD FAIR HEALTH SCREENINGS & HEALTH EDUCATION PUBLIC RELATIONS (1956) 10,514 0 10,514 1,500 HARTFORD LIBRARY ASSOCIATION SPONSORSHIP DEVELOPMENT (1955) 200 0 200 UNKNOWN HARVEST FEDERAL CREDIT UNION SPEAKER PUBLIC RELATIONS (1956) 24 0 24 7 HEALTHY AGING PROCESS IMPROVEMENT (1945) 619 0 619 33 HEALTHY HOLIDAY RECIPES PROCESS IMPROVEMENT (1945) 102 0 102 14 HEALTHY MEALS ON A SHOESTRING BUDGET PROCESS IMPROVEMENT (1945) 572 0 572 17 HEARING LOSS & SPEECH THERAPY PROCESS IMPROVEMENT (1945) 619 0 619 35 HEARTBEATS OF LICKING COUNTY EVENT SPONSORSHIP DEVELOPMENT (1955) 450 0 450 UNKNOWN HEATH FIRE DEPARTMENT OPEN HOUSE PUBLIC RELATIONS (1956) 76 0 76 350 HEATH HIGH SCHOOL CASH DONATIONS DEVELOPMENT (1955) 150 0 150 UNKNOWN | COMMUNITY BENEFIT FOR LICKING MEMORIAL HEALTH SYSTEM CONSOLIDATED GROUP |
| HEATH HIGH SCHOOL IN KIND DONATION DEVELOPMENT (1955) 124 0 124 UNKNOWN HEBRON HEALTH FAIR SCREENINGS PUBLIC RELATIONS (1956) 904 0 904 40 HERBAL AND OVER THE COUNTER MEDICATIONS PROCESS IMPROVEMENT (1945) 198 0 198 11 HERITAGE MIDDLE SCHOOL SPEAKER PUBLIC RELATIONS (1956) 273 0 273 25 HOPEWELL FEDERAL CREDIT UNION SPEAKER PUBLIC RELATIONS (1956) 87 0 87 30 HOSPICE OF CENTRAL OHIO SPONSORSHIPS DEVELOPMENT (1955) 800 0 800 UNKNOWN HOW TO ADJUST YOUR INSULIN PROCESS IMPROVEMENT (1945) 132 0 132 2 HSMP MANAGEMENT INSTITUTE DONATION DEVELOPMENT (1955) 1,000 0 1,000 UNKNOWN IMMUNIZATION OF PATIENTS AGES 65 AND OVER FOR TD EXECUTIVE ADMIN LMHP (7445) 7,019 0 7,019 261 INFECTION CONTROL LECTURE LAB (1702) 95 0 95 8 JOHN CLEM ELEMENTARY JUST SAY NO CLUB SPEAKER PUBLIC RELATIONS (1956) 304 0 304 60 KEEPING THE BEAT CPR EDUCATION PROCESS IMPROVEMENT (1945) 406 0 406 15 KINDERGARTEN CELEBRATION IN KIND DONATIONS DEVELOPMENT (1955) 500 0 500 450 LAKEWOOD GIRLS SUMMER SOFTBALL SPONSORSHIP DEVELOPMENT (1955) 350 0 350 UNKNOWN LAKEWOOD LITTLE LEAGUE SPONSORSHIP DEVELOPMENT (1955) 325 0 325 UNKNOWN LC CHAMBER OF COMMERCE BUSINESS AFTER HOURS SPEAKER PUBLIC RELATIONS (1956) 104 0 104 200 LC UNITED WAY ANNUAL MEETING SPONSORSHIP DEVELOPMENT (1955) 270 0 270 UNKNOWN LCESC JR. HIGH CAREER EXPLORATION HUMAN RESOURCES (1951) 793 0 793 13 LEADS HEAD START DONATION DEVELOPMENT (1955) 1,085 0 1,085 UNKNOWN LEADS HEADSTART SPEAKER PUBLIC RELATIONS (1956) 70 0 70 5 LEARN, GROW, AND PLAY DAYCARE AND DEVELOPMENT CENTER SPEAKER PUBLIC RELATIONS (1956) 38 0 38 14 LEGEND ELEMENTARY IN KIND DONATIONS DEVELOPMENT (1955) 50 0 50 UNKNOWN LESTER WILLIAMS PRIDE IN THE RED HELMET SCHOLARSHIP FUND DEVELOPMENT (1955) 100 0 100 UNKNOWN LICCO INC. SPONSORSHIP DEVELOPMENT (1955) 250 0 250 UNKNOWN LICKING COUNTY AGING PROGRAM SPEAKER PUBLIC RELATIONS (1956) 207 0 207 36 LICKING COUNTY AGING PROGRAM SPONSORSHIPS DEVELOPMENT (1955) 10,000 0 10,000 UNKNOWN LICKING COUNTY BABE RUTH ALL STARS SPONSORSHIPS DEVELOPMENT (1955) 300 0 300 UNKNOWN LICKING COUNTY BOARD OF MRDD SPEAKER PUBLIC RELATIONS (1956) 129 0 129 22 LICKING COUNTY BOARD OF MRDD SPONSORSHIP DEVELOPMENT (1955) 375 0 375 UNKNOWN LICKING COUNTY CHAMBER OF COMMERCE SPEAKER PUBLIC RELATIONS (1956) 147 0 147 150 LICKING COUNTY CHAMBER OF COMMERCE EVENT SPONSOR DEVELOPMENT (1955) 3,670 0 3,670 UNKNOWN LICKING COUNTY COALITION FOR HOUSING EVENT SPONSOR DEVELOPMENT (1955) 300 0 300 UNKNOWN LICKING COUNTY COALITION OF CARE DONATION DEVELOPMENT (1955) 500 0 500 UNKNOWN LICKING COUNTY DEPARTMENT OF JOB AND FAMILY SERVICES DONATIONS DEVELOPMENT (1955) 3,000 0 3,000 UNKNOWN LICKING COUNTY FAMILY YMCA CASH DONATIONS DEVELOPMENT (1955) 7,500 0 7,500 UNKNOWN LICKING COUNTY FAMILY YMCA IN KIND DONATIONS DEVELOPMENT (1955) 24 0 24 UNKNOWN LICKING COUNTY FAMILY YMCA WESTERN BRANCH CAMPAIGN DONATION DEVELOPMENT (1955) 5,000 0 5,000 UNKNOWN LICKING COUNTY FOUNDATION SPONSORSHIP DEVELOPMENT (1955) 5,000 0 5,000 UNKNOWN LICKING COUNTY HEALTH DEPARTMENT SCREENING AND SURVIVOR SUPPORT PUBLIC RELATIONS (1956) 1,136 0 1,136 38 LICKING COUNTY HEALTH DEPARTMENT CHLAMYDIA/GC SCREENINGS LAB (1702) 4,221 0 4,221 108 LICKING COUNTY HEALTH DEPARTMENT DONATION DEVELOPMENT (1955) 400 0 400 UNKNOWN LICKING COUNTY HUMANE SOCIETY DONATIONS/SPONSORSHIPS DEVELOPMENT (1955) 50 0 50 UNKNOWN LICKING COUNTY JOB AND FAMILY SERVICES/EMPLOYEE HEALTH & WELLNESS PUBLIC RELATIONS (1956) 383 0 383 120 LICKING COUNTY JUNIOR ACHIEVEMENT CASH DONATIONS DEVELOPMENT (1955) 350 0 350 UNKNOWN LICKING COUNTY LEADERSHIP PROGRAM DEVELOPMENT (1955) 940 0 940 30 LICKING COUNTY POLICE CHIEF'S ASSOCIATION POLICE (1842) 119 0 119 UNKNOWN LICKING COUNTY PRAYER PARTNERS DONATION DEVELOPMENT (1955) 120 0 120 UNKNOWN LICKING COUNTY RETIRED TEACHERS SPEAKER PUBLIC RELATIONS (1956) 93 0 93 50 LICKING COUNTY WELLNESS FAIR INFORMATION TABLE PUBLIC RELATIONS (1956) 117 0 117 88 LICKING KNOX GOODWILL INDUSTRIES IN KIND DONATIONS DEVELOPMENT (1955) 400 0 400 UNKNOWN LICKING VALLEY CHURCH OF CHRIST SPONSORSHIPS DEVELOPMENT (1955) 100 0 100 UNKNOWN LICKING VALLEY HIGH SCHOOL CASH DONATIONS DEVELOPMENT (1955) 3,500 0 3,500 UNKNOWN LICKING VALLEY HIGH SCHOOL IN KIND DONATIONS DEVELOPMENT (1955) 80 0 80 UNKNOWN LICKING VALLEY YOUTH SPORTS ASSOCIATION DONATION DEVELOPMENT (1955) 825 0 825 UNKNOWN LIFE LOCAL SPEAKERS AT THE BRYN DU MANSION PUBLIC RELATIONS (1956) 120 0 120 4 LIFELINE OF OHIO ORGAN PROCUREMENT (LOOP) FISCAL SERVICES (1901) 8,534 0 8,534 1 LIONS CLUB OF HEBRON SPEAKER PUBLIC RELATIONS (1956) 82 0 82 16 LOOK UP CENTER CASH DONATIONS DEVELOPMENT (1955) 9,431 0 9,431 UNKNOWN MAKING TRACKS FOR CELIACS IN KIND DONATIONS DEVELOPMENT (1955) 100 0 100 UNKNOWN MENTAL HEALTH AMERICA SPEAKERS PUBLIC RELATIONS (1956) 747 0 747 70 MENTAL HEALTH AMERICA OF LICKING COUNTY SPONSORSHIPS DEVELOPMENT (1955) 1,100 0 1,100 UNKNOWN MISSION TRIP DRUGS AND SUPPLIES DEVELOPMENT (1955) 536 0 536 UNKNOWN MOMENTIVE PERFORMANCE MATERIALS SPEAKER PUBLIC RELATIONS (1956) 238 0 238 20 MONDAY TALKS PUBLIC RELATIONS (1956) 717 0 717 100 MUSIC AND ARTS FESTIVAL INFORMATION TABLE PUBLIC RELATIONS (1956) 318 0 318 1,250 NATIONAL MULTIPLE SCLEROSIS SOCIETY DONATION DEVELOPMENT (1955) 500 0 500 UNKNOWN NEW BEGININGS CASH DONATIONS DEVELOPMENT (1955) 250 0 250 UNKNOWN NEWARK AREA ZONTA CLUB SPONSORSHIP DEVELOPMENT (1955) 500 0 500 UNKNOWN NEWARK CAMPUS DEVELOPMENT FUND CONTRIBUTION DEVELOPMENT (1955) 25,000 0 25,000 UNKNOWN NEWARK CATHOLIC COMMUNITY SUPPORT DEVELOPMENT (1955) 373 0 373 UNKNOWN NEWARK CATHOLIC HIGH SCHOOL ATHLETIC DEPT. SPONSORSHIPS DEVELOPMENT (1955) 700 0 700 UNKNOWN NEWARK FIREFIGHTERS IAFF LOCAL 109 5K DONATION DEVELOPMENT (1955) 50 0 50 UNKNOWN NEWARK GENERALS HOCKEY CLUB SPONSORSHIP DEVELOPMENT (1955) 500 0 500 UNKNOWN NEWARK GRANVILLE SYMPHONY ORCHESTRA SPONSORSHIP DEVELOPMENT (1955) 2,500 0 2,500 UNKNOWN NEWARK HIGH SCHOOL SPONSORSHIP DEVELOPMENT (1955) 1,050 0 1,050 UNKNOWN NEWARK MIDLAND THEATRE SPONSORSHIP DEVELOPMENT (1955) 5,344 0 5,344 UNKNOWN NEWBORN BASICS MATERNAL CHILD (1646) 892 320 572 79 NORTH NEWARK LITTLE LEAGUE VARSITY AND FARM SPONSORSHIP DEVELOPMENT (1955) 600 0 600 UNKNOWN NORTHRIDGE ATHLETIC BOOSTERS DONATION DEVELOPMENT (1955) 500 0 500 UNKNOWN NORTHRIDGE SCHOOL DISTRICT SPEAKER PUBLIC RELATIONS (1956) 61 0 61 130 OBSESSIVE COMPULSIVE DISORDER PROCESS IMPROVEMENT (1945) 259 0 259 34 ODOT HEALTH FAIR PUBLIC RELATIONS (1956) 637 0 637 60 OHIO CANCER RESEARCH ASSOCIATES DONATION DEVELOPMENT (1955) 4,500 0 4,500 UNKNOWN OHIO PHYSICIANS HEALTH PROGRAM CASH DONATIONS DEVELOPMENT (1955) 1,000 0 1,000 UNKNOWN OPERATION FEED IN KIND DONATIONS VOLUNTEERS (1970) 12,605 0 12,605 UNKNOWN OSU LAB CLASS SPEAKER LAB (1702) 120 0 120 30 OSU SPEAKER PUBLIC RELATIONS (1956) 194 0 194 45 OUR SAVIOR LUTHERAN DONATION DEVELOPMENT (1955) 232 0 232 UNKNOWN OUR SAVIOR LUTHERAN CHURCH INFORMATION TABLE PUBLIC RELATIONS (1956) 228 0 228 600 PAR EXCELLENCE SPEAKERS PUBLIC RELATIONS (1956) 148 0 148 90 PAR EXCELLENCE ACADEMY SPONSORSHIP DEVELOPMENT (1955) 2,000 0 2,000 UNKNOWN PARKINSON SUPPORT GROUP SPEAKER PUBLIC RELATIONS (1956) 434 0 434 78 PATASKALA MOVIE NIGHT HEALTH SCREENINGS PUBLIC RELATIONS (1956) 228 0 228 50 PATASKALA ELEMENTARY SPEAKER PUBLIC RELATIONS (1956) 86 0 86 7 PATASKALA ELEMENTARY CAREER DAY DEVELOPMENT (1955) 39 0 39 UNKNOWN | ||
| PATASKALA HISTORICAL TOWN HALL INC. SPONSORSHIP DEVELOPMENT (1955) 290 0 290 UNKNOWN PEDIATRIC DENTAL CLINIC DENTAL CLINIC (1958) 96,000 3,695 92,305 UNKNOWN PELOTONIA CASH DONATIONS DEVELOPMENT (1955) 2,500 0 2,500 UNKNOWN PINK STRIDES TRAIL RUN & WELLNESS WALK DONATION DEVELOPMENT (1955) 448 0 448 140 PRECEPTING NURSING STUDENTS 4N & 4S 4 SOUTH (1614) 37,187 0 37,187 20 PRECEPTING NURSING STUDENTS 5S 5 SOUTH (1612) 8,173 0 8,173 3 PRECEPTING NURSING STUDENTS GI LAB ENDO DIAGNOSTIC LAB (1676) 4,587 0 4,587 2 PRECEPTING NURSING STUDENTS ICU, CCU, ER INTENSIVE CARE (1640) 21,285 0 21,285 11 PRECEPTING NURSING STUDENTS MATERNAL CHILD MATERNAL CHILD (1646) 9,171 0 9,171 4 PRECEPTING NURSING STUDENTS OUTPATIENT CLINIC OUTPATIENT CLINIC (1685) 3,405 0 3,405 1 PRECEPTING NURSING STUDENTS WOUND CLINIC WOUND CLINIC (1677) 4,138 0 4,138 1 PRECEPTING STUDENTS OCCUPATIONAL THERAPY OCCUPATIONAL THERAPY (1700) 17,058 0 17,058 3 PRECEPTING STUDENTS PACU/OR SURGERY (1660) 19,187 0 19,187 6 PRECEPTING STUDENTS PHARMACY PHARMACY (1730) 49,262 18,000 31,262 6 PRECEPTING STUDENTS RADIOLOGY RADIOLOGY (1721) 98,184 0 98,184 34 PRECEPTORSHIPS FOR CERTIFIED NURSE PRACTITIONER STUDENTS FAMILY PRACTICE EAST (7425) 27,621 0 27,621 7 PRECEPTORSHIPS FOR ULTRASOUND STUDENTS VASCULAR LAB NEURO VASCULAR LAB (1674) 8,597 0 8,597 2 PREMIERE SPEAKERS DEVELOPMENT (1955) 4,961 0 4,961 UNKNOWN PROSTATE CANCER AWARENESS EDUCATION (1616) 1,011 0 1,011 15 QUICK MEALS FOR WEIGHT LOSS PROCESS IMPROVEMENT (1945) 30 0 30 11 RED CROSS BLOOD DRIVE EDUCATION (1616) 6,136 0 6,136 258 RED DRESS EVENT PUBLIC RELATIONS (1956) 25,482 0 25,482 350 RELAY FOR LIFE COMMUNITY SUPPORT DEVELOPMENT (1955) 517 0 517 UNKNOWN RENDY MURRY INDEPENDENT LIVING SPEAKER PUBLIC RELATIONS (1956) 122 0 122 17 RESOURCE CENTER/MEDICAL LIBRARY RESOURCE CENTER (1975) 1,427 0 1,427 UNKNOWN ROTARY CLUB OF GRANVILLE SPONSORSHIP DEVELOPMENT (1955) 4,500 0 4,500 UNKNOWN ROTARY CLUB OF NEWARK HEATH IN KIND DONATIONS DEVELOPMENT (1955) 296 0 296 UNKNOWN ROTARY CLUB OF PATASKALA SPONSORSHIP DEVELOPMENT (1955) 175 0 175 UNKNOWN SAINT VINCENT HAVEN CASH DONATIONS DEVELOPMENT (1955) 200 0 200 UNKNOWN SALVATION ARMY CHILDREN'S DAY CAMP DEVELOPMENT (1955) 445 0 445 45 SALVATION ARMY OF LICKING COUNTY DONATION DEVELOPMENT (1955) 200 0 200 UNKNOWN SCHOOL OF ALLIED MEDICAL PROFESSIONS ALUMNI SOCIETY SPONSORSHIPS DEVELOPMENT (1955) 150 150 0 UNKNOWN SHERIDAN HIGH SCHOOL HEALTH EXPO PUBLIC RELATIONS (1956) 329 0 329 60 SIBLING PREPARATION CLASS MATERNAL CHILD (1646) 341 85 256 35 SKIN CANCER AWARENESS AND SCREENING PROCESS IMPROVEMENT (1945) 1,202 0 1,202 9 SPORTS PHYSICALS & ECG'S TAMARACK SPORTS PHYSICALS (7487) 39,467 0 39,467 1,300 ST. FRANCIS CHURCH SPEAKER PUBLIC RELATIONS (1956) 562 0 562 51 ST. FRANCIS DE SALES SCHOOL & PARISH SPONSORSHIPS DEVELOPMENT (1955) 100 0 100 UNKNOWN ST. FRANCIS PARISH FESTIVAL COMMUNITY SUPPORT DEVELOPMENT (1955) 281 0 281 UNKNOWN STATE FARM HEALTH AND FITNESS DAY VOLUNTEERS (1970) 592 0 592 350 STUDENT INTERNSHIPS COMMUNITY CASE MANAGEMENT COMMUNITY CASE MANAGEMENT (1976) 18,350 0 18,350 6 STUDENT INTERNSHIPS LABORATORY LAB (1702) 19,617 0 19,617 2 STUDENT INTERNSHIPS MEDICAL ASSISTANT PROGRAM PAIN CLINIC PAIN MGMT (1690) 2,493 0 2,493 1 STUDENT INTERNSHIPS PHYSICAL THERAPY & SPEECH THERAPY REHAB CENTER (1737) 42,395 0 42,395 6 STUDENT NURSE & OTHER HEALTH PROFESSIONALS MANAGEMENT PROCESS EDUCATION (1616) 10,315 0 10,315 UNKNOWN STUDENT NURSE & OTHER HEALTH PROFESSIONALS ORIENTATION EDUCATION (1616) 6,899 0 6,899 687 SUMMER FOOD SAFETY PROCESS IMPROVEMENT (1945) 146 0 146 1 SUPERMARKET SWEEP FOOD PANTRY NETWORK CASH DONATIONS DEVELOPMENT (1955) 100 0 100 UNKNOWN TAMARACK FARMS DAIRY HEALTH FAIR SCREENINGS PUBLIC RELATIONS (1956) 128 0 128 41 TAXI TOKENS FISCAL SERVICES (1901) 83 0 83 UNKNOWN THE ENERGY COOPERATIVE SPEAKER PUBLIC RELATIONS (1956) 664 0 664 220 THYROID DISEASE PROCESS IMPROVEMENT (1945) 1,784 0 1,784 105 TIPS TO QUIT SMOKING PROCESS IMPROVEMENT (1945) 91 0 91 1 TOBACCO CESSATION PROGRAM TOBACCO CESSATION (1693) 221,351 0 221,351 439 TOPS HEALTHY WEIGHT LOSS GROUP EDUCATION PUBLIC RELATIONS (1956) 370 0 370 67 TUSKEGEE NATIONAL ALUMNI ASSOCIATION SPONSORSHIP DEVELOPMENT (1955) 1,000 0 1,000 UNKNOWN UNITED METHODIST CHURCH SPEAKER PUBLIC RELATIONS (1956) 493 0 493 70 UNITED WAY CAMPAIGN IN KIND DONATIONS HUMAN RESOURCES (1951) 3,000 0 3,000 UNKNOWN UNITED WAY DAY OF CARING DEVELOPMENT (1955) 2,847 0 2,847 UNKNOWN UNITED WAY DAY OF CARING IN KIND DONATIONS DEVELOPMENT (1955) 99 0 99 UNKNOWN VOLUNTEERS TWIGS & EVENTS VOLUNTEERS (1970) 0 0 0 319 WALK & TALK WITH A DOC COMMUNITY CASE MANAGEMENT (1976) 379 0 379 3 WATKINS HIGH SCHOOL DONATIONS DEVELOPMENT (1955) 600 0 600 UNKNOWN WELLNESS CENTER AT C TEC COMMUNITY BENEFIT C TEC (1977) 73,153 0 73,153 236 WEST LICKING FIRE DEPARTMENT SPEAKER & SCREENINGS PUBLIC RELATIONS (1956) 696 0 696 215 WEST MAIN STREET BILL BOARD BEHIND MCN DONATION PUBLIC RELATIONS (1956) 500 0 500 UNKNOWN WHAT'S IN A NUMBER: HOW TO MAKE SENSE OF YOUR BLOOD SUGAR NUMBERS PROCESS IMPROVEMENT (1945) 51 0 51 1 YMCA MOVIE NIGHT HEALTH SCREENINGS PUBLIC RELATIONS (1956) 122 0 122 40 YMCA SPEAKER PUBLIC RELATIONS (1956) 628 0 628 48 YMCA HEALTH AND FITNESS FEST PUBLIC RELATIONS (1956) 2,863 0 2,863 200 ZERGER HALL SPEAKER PUBLIC RELATIONS (1956) 83 0 83 12 NUMBER OF PROGRAMS 261 GRAND TOTALS 2,452,858 159,944 2,292,914 21,059 BENEFITS FOR POOR: TOTAL EXPENSE OFFSETTING REVENUE NET BENEFIT PERSONS TRADITIONAL CHARITY CARE $11,009,247 $2,238,807 $8,770,440 16,925 UNPAID COST OF MEDICAID $33,899,446 $18,293,424 $15,606,022 30,356 GRAND TOTALS $47,361,551 $20,692,175 $26,669,376 68,340 |
Schedule R IRS990ScheduleR
Form990 Schedule R Part II Form990ScheduleRPartII (3 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivities | Legal Domicile StateLegalDomicileState | Exempt Code SectionExemptCodeSection | Public Charity StatusPublicCharityStatus | Direct Controlling Entity NADirectControllingEntityNA | Controlled OrgControlledOrg | Business Name Line1DirectControllingEntityName/BusinessNameLine1 |
|---|---|---|---|---|---|---|---|---|---|---|---|
| LICKING MEMORIAL HEALTH SYSTEMS | |||||||||||
| 1320 WEST MAIN STREET | NEWARK | OH | 43055 | 311096218 | PARENT COMPANY FOR THE NONPROFIT OPERATION OF HEALTHCARE ORGANIZATIONS | OH | 501(C)(3) | 11 TYPE III - FI | N/A | 0 | |
| LICKING MEMORIAL HEALTH FOUNDATION | |||||||||||
| 1320 WEST MAIN STREET | NEWARK | OH | 43055 | 311096217 | PROVIDE FUNDING FOR HEALTHCARE PROGRAMS | OH | 501(C)(3) | 11 TYPE I | 0 | LICKING MEMORIAL HEALTH SYSTEMS | |
| LICKING MEMORIAL PROFESSIONAL CORPORATION | |||||||||||
| 1320 WEST MAIN STREET | NEWARK | OH | 43055 | 311425530 | HEALTHCARE ORGANIZATION | OH | 501(C)(3) | 9 | 0 | LICKING MEMORIAL HEALTH SYSTEMS | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | 0 | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | 1 | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | 1 | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | 1 | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | 0 | LoansOrGuaranteesFromOtherOrg |
| Sale Of Assets To Other Org | 0 | SaleOfAssetsToOtherOrg |
| Purchase Of Assets From Other Org | 0 | PurchaseOfAssetsFromOtherOrg |
| Exchange Of Assets | 0 | ExchangeOfAssets |
| Rental Of Facilities To Other Orgs | 1 | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | 1 | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | 0 | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | 1 | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | 1 | SharingOfFacilities |
| Sharing Of Paid Employees | 1 | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | 1 | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | 1 | OtherTransferToOtherOrg |
| Other Transfer From Other Org | 1 | OtherTransferFromOtherOrg |