LODI COMMUNITY HOSPITAL: Form 990, tax year 2011
View the entire original 990 at ProPublica ↗
- Organization
- LODI COMMUNITY HOSPITAL (EIN 34-0718390)
- Tax period
- 2011-01-01 to 2011-12-31
- Filed
- 2012-11-13
- IRS object ID
- 201243189349302599
- Schema version
- 2011v1.2
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
- Return header
- Form 990
- Schedule A
- Schedule B
- Schedule C
- Schedule D
- Schedule H
- Schedule I
- Schedule J
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2012-11-13T12:52:54-06:00 | Timestamp |
| Tax Period End Date | 2011-12-31 | TaxPeriodEndDate |
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2011-01-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 340718390 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | LODI COMMUNITY HOSPITAL | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | LODI | NameControl |
| Phone | 3309485501 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 225 ELYRIA STREET | AddressLine1 |
| City | LODI | City |
| State | OH | State |
| ZIP Code | 44254 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | SUE J MCCARTHY | Name |
| Title | TREASURER | Title |
| Phone | 3309485501 | Phone |
| Date Signed | 2012-11-13 | DateSigned |
| 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 | THOMAS WHELAN | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 225 ELYRIA STREET | AddressLine1 |
| City | LODI | City |
| State | OH | State |
| ZIP Code | 44254 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 18084168 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | WWW.LODIHOSPITAL.COM | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1920 | YearFormation |
| State Legal Domicile | OH | StateLegalDomicile |
| Activity Or Mission Description | TO IMPROVE THE HEALTH AND LIVES OF THE PEOPLE AND COMMUNITIES WE SERVE. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 15 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 12 | NbrIndependentVotingMembers |
| Total Nbr Employees | 185 | TotalNbrEmployees |
| Total Nbr Volunteers | 51 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 6672 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 349425 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 17198910 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 17608762 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 4444 | InvestmentIncomePriorYear |
| Investment Income Current Year | 8283 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 340 | OtherRevenuePriorYear |
| Other Revenue Current Year | 89551 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 17210366 | TotalRevenuePriorYear |
| Total Revenue Current Year | 18056021 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 4000 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 348823 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 8390231 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 8429058 | 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 | 7877161 | OtherExpensePriorYear |
| Other Expenses Current Year | 8501065 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 16271392 | TotalExpensesPriorYear |
| Total Expenses Current Year | 17278946 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 938974 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 777075 | RevenuesLessExpensesCY |
| Total Assets BOY | 9968451 | TotalAssetsBOY |
| Total Assets EOY | 10258336 | TotalAssetsEOY |
| Total Liabilities BOY | 1578588 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 1653508 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 8389863 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 8604828 | NetAssetsOrFundBalancesEOY |
| Mission Description | LODI COMMUNITY HOSPITAL'S MISSION IS TO IMPROVE THE HEALTH AND LIVES OF THE PEOPLE AND COMMUNITIES WE SERVE. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 3476159 | Expense |
| Revenue | 3730847 | Revenue |
| Description | LODI COMMUNITY HOSPITAL IS A 25 BED HOSPITAL OFFERING INPATIENT SERVICES FOR MEDICAL AND SURGICAL PATIENTS. | Description |
Activity2 Activity2
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | 12915449 | Expense |
| Grants | 343021 | Grants |
| Revenue | 13862035 | Revenue |
| Description | LODI COMMUNITY HOSPITAL OFFERS A VARIETY OF OUTPATIENT SERVICES. OUTPATIENT SERVICES OFFERED TO PATIENTS INCLUDE RADIOLOGY, PHYSICAL THERAPY, CARDIAC, SURGERY, MAMMOGRAPHY, SLEEP CENTER, LAB SERVICES AND EMERGENCY SERVICES. | Description |
Activity3 Activity3
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | 15082 | Expense |
| Grants | 5802 | Grants |
| Revenue | 16187 | Revenue |
| Description | LODI COMMUNITY HOSPITAL OFFERS COMMUNITY HEALTH AND EDUCATIONAL SERVICES TO THE LOCAL AND SURROUNDING COMMUNITIES. | Description |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Expense | 16406690 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 1 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 1 | LobbyingActivities |
| Subject To Proxy Tax | 0 | SubjectToProxyTax |
| Donor Advised Funds | 0 | DonorAdvisedFunds |
| Conservation Easements | 0 | ConservationEasements |
| Collections Of Art | 0 | CollectionsOfArt |
| Credit Counseling | 0 | CreditCounseling |
| Term Or Permanent Endowments | 1 | TermOrPermanentEndowments |
| Report Land Bldg Equip | 1 | ReportLandBldgEquip |
| Report Invest Oth Securities | 0 | ReportInvestOthSecurities |
| Report Prog Rel Invest | 0 | ReportProgRelInvest |
| Report Other Assets | 1 | ReportOtherAssets |
| Report Other Liabilities | 1 | ReportOtherLiabilities |
| Report Fin48 Footnote | 0 | 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 | 1 | 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 | 1 | RelatedOrgControlledEntity |
| Transaction Related Entity | 1 | TransactionRelatedEntity |
| Transfers To Exempt Non Chrtbl Org | 0 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 18 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | 1 | ComplianceWithBackupWitholding |
| Number Of Employees | 185 | 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 |
| Form8899 Filed | 0 | Form8899Filed |
| Form1098 C Filed | 0 | Form1098CFiled |
| Indoor Tanning Services | 0 | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 15 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 12 | 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 | 1 | MembersOrStockholders |
| Election Of Board Members | 1 | ElectionOfBoardMembers |
| Decisions Subject To Approval | 1 | DecisionsSubjectToApproval |
| Minutes Of Governing Body | 1 | MinutesOfGoverningBody |
| Minutes Of Committees | 1 | MinutesOfCommittees |
| Officer Mailing Address | 0 | OfficerMailingAddress |
| Local Chapters | 1 | LocalChapters |
| Policies Reference Chapters | 1 | PoliciesReferenceChapters |
| 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 | DEBBIE GORBACH | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 3303446603 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 400 WABASH AVENUE | AddressLine1 |
| City | AKRON | City |
| State | OH | State |
| ZIP Code | 44307 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part VII | X | InfoInScheduleOPartVII |
Form990 Part VII Section A Form990PartVIISectionA (30 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | OfficerOfficer | Highest Compensated EmployeeHighestCompensatedEmployee | FormerFormer |
|---|---|---|---|---|---|---|---|---|
| RORY O'NEIL | ||||||||
| DIRECTOR, THRU 11/11 | 1.00 | X | 0 | 0 | 0 | |||
| HAROLD YOUNG | ||||||||
| SEE SCHEDULE O | 0.80 | X | 0 | 0 | 0 | |||
| BETSY GILDER | ||||||||
| DIRECTOR, THRU 11/11 | 0.50 | X | 0 | 0 | 0 | |||
| JOHN BAKER | ||||||||
| SEE SCHEDULE O | 0.40 | X | 0 | 0 | 0 | |||
| JIM RICE | ||||||||
| SEE SCHEDULE O | 1.20 | X | 0 | 0 | 0 | X | ||
| JIM COLEMAN | ||||||||
| DIRECTOR, THRU 11/11 | 1.00 | X | 0 | 0 | 0 | |||
| THOMAS PICKERING | ||||||||
| DIRECTOR, THRU 11/11 | 1.40 | X | 0 | 0 | 0 | |||
| STEPHEN SEARS | ||||||||
| DIRECTOR, THRU 11/11 | 0.60 | X | 0 | 0 | 0 | |||
| JIM SHEPARD | ||||||||
| DIRECTOR, THRU 11/11 | 0.80 | X | 0 | 0 | 0 | |||
| THOMAS WHELAN | ||||||||
| SEE SCHEDULE O | 53.00 | X | 214547 | 0 | 35094 | X | ||
| VINCENT J MCCORKLE | ||||||||
| SEE SCHEDULE O | 0.30 | X | 0 | 1238616 | 24447 | |||
| MARLENE BARKHEIMER | ||||||||
| SEE SCHEDULE O | 0.40 | X | 0 | 0 | 0 | X | ||
| JOE REMINGTON | ||||||||
| DIRECTOR, THRU 11/11 | 1.90 | X | 0 | 0 | 0 | |||
| DAVID BROCKMAN | ||||||||
| SEE SCHEDULE O | 0.80 | X | 0 | 0 | 0 | |||
| THERESA CARTER | ||||||||
| SEE SCHEDULE O | 0.60 | X | 0 | 0 | 0 | |||
| BRET TREIER | ||||||||
| SEE SCHEDULE O | 0.20 | X | 0 | 0 | 0 | |||
| WILLIAM FRANTZ | ||||||||
| SEE SCHEDULE O | 0.70 | X | 0 | 0 | 0 | |||
| MARY BETH C CARROLL | ||||||||
| SEE SCHEDULE O | 1.50 | X | 0 | 0 | 0 | |||
| WILLIAM STEERE | ||||||||
| SEE SCHEDULE O | 1.10 | X | 0 | 0 | 0 | |||
| WILLIAM BABCOX | ||||||||
| SEE SCHEDULE O | 1.90 | X | 0 | 0 | 0 | |||
| ROBERT KAMIENSKI MD | ||||||||
| SEE SCHEDULE O | 5.00 | X | 0 | 309357 | 22947 | |||
| JUSTIN LAVIN MD | ||||||||
| SEE SCHEDULE O | 1.10 | X | 0 | 0 | 0 | |||
| ALAN PAPA | ||||||||
| SEE SCHEDULE O | 0.40 | X | 0 | 483121 | 42535 | |||
| JOSEPH MELI MD | ||||||||
| SEE SCHEDULE O | 0.10 | X | 0 | 287405 | 28975 | |||
| ALAN A GANCI | ||||||||
| SEE SCHEDULE O | 40.50 | 93840 | 0 | 9906 | X | |||
| CRAIG BABBITT | ||||||||
| SECRETARY | 1.00 | 0 | 350783 | 35029 | X | |||
| STEPHEN GARY | ||||||||
| TREASURER | 1.00 | 0 | 365876 | 13563 | X | |||
| BARBARA VIMONT | ||||||||
| ASSISTANT SECRETARY | 1.00 | 0 | 135551 | 28410 | X | |||
| STEPHANIE KOCSIS | ||||||||
| VP NURSING AND OPERATIONS | 44.00 | 102008 | 0 | 10016 | X | |||
| ALAN J BLEYER | ||||||||
| SEE SCHEDULE O | 0.00 | 0 | 543563 | 6165 | X | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 410395 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 3714272 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 257087 | TotalOtherCompensation |
| Number Individuals GT100 K | 2 | NumberIndividualsGT100K |
| Formers Listed | 1 | 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 |
|---|---|---|---|---|---|
| EPMG OF OHIO INC PA | |||||
| 2000 GREEN RD SUITE 300 | ANN ARBOR | MI | 481051571 | ER PHYSICIANS | 564620 |
| AKRON GENERAL HEALTH SYSTEM | |||||
| 400 WABASH AVE | AKRON | OH | 44307 | MANAGEMENT FEE | 470724 |
| RESPIRATORY SUPPORT SERVICES | |||||
| 328 BOSTON MILLS ROAD | HUDSON | OH | 44236 | CARDIOPULMONARY SERVICES | 388392 |
| AKRON GENERAL MEDICAL CENTER | |||||
| 400 WABASH AVE | AKRON | OH | 44307 | LAB PURCHASED SERVICES | 161450 |
| ALLIANCE HEALTHCARE SERVICES | |||||
| PO BOX 96485 | CHICAGO | IL | 606936485 | MRI SERVICES | 138050 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 6 | NumberOfContractorsGT100K |
| Government Grants | 6000 | GovernmentGrants |
| All Other Contributions | 343425 | AllOtherContributions |
| Total Contributions | 349425 | TotalContributions |
Program Service Revenue ProgramServiceRevenue (3 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome |
|---|---|---|---|
| NET PATIENT REVENUE | 900099 | 14240657 | 14240657 |
| MEDICARE/MEDICAID PAYM | 900099 | 3351918 | 3351918 |
| COMMUNITY HEALTH/EDUCA | 900099 | 16187 | 16187 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 17608762 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 6236 | TotalRevenueColumn |
| Exclusion | $6,236 | ExclusionAmount |
Gross Rents GrossRents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 25015 | Real |
Less Rental Expenses LessRentalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 27523 | Real |
Rental Income Or Loss RentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | -2508 | Real |
Net Rental Income Or Loss NetRentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -2508 | TotalRevenueColumn |
| Exclusion | -$2,508 | ExclusionAmount |
Gross Amount Sales Assets GrossAmountSalesAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | 2047 | Other |
Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | 0 | Other |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | 2047 | Other |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 2047 | TotalRevenueColumn |
| Exclusion | $2,047 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Sales Of Inventory | 931 | GrossSalesOfInventory |
| Cost Of Goods Sold | 624 | CostOfGoodsSold |
Net Income Or Loss NetIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 307 | TotalRevenueColumn |
| Related Or Exempt Function Income | 307 | RelatedOrExemptFunctionIncome |
Other Revenue Misc OtherRevenueMisc (2 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | ExclusionExclusionAmount |
|---|---|---|---|
| CAFETERIA | 900099 | 78535 | $78,535 |
| ALL OTHER REVENUE | 900099 | 13217 | $13,217 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 91752 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 18056021 | TotalRevenueColumn |
| Related Or Exempt Function Income | 17609069 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $97,527 | ExclusionAmount |
Grants To Domestic Orgs GrantsToDomesticOrgs
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 345323 | Total |
| Program Services | 345323 | ProgramServices |
Grants To Domestic Individuals GrantsToDomesticIndividuals
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3500 | Total |
| Program Services | 3500 | ProgramServices |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 353388 | Total |
| Management And General | 353388 | ManagementAndGeneral |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 6559567 | Total |
| Program Services | 6559567 | ProgramServices |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 75778 | Total |
| Program Services | 75778 | ProgramServices |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1004629 | Total |
| Program Services | 1004629 | ProgramServices |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 435696 | Total |
| Program Services | 435696 | ProgramServices |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 29181 | Total |
| Management And General | 29181 | ManagementAndGeneral |
Fees For Services Lobbying FeesForServicesLobbying
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 708 | Total |
| Management And General | 708 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2216671 | Total |
| Program Services | 1879023 | ProgramServices |
| Management And General | 337648 | ManagementAndGeneral |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 124682 | Total |
| Program Services | 124682 | ProgramServices |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 525621 | Total |
| Program Services | 504596 | ProgramServices |
| Management And General | 21025 | ManagementAndGeneral |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 202385 | Total |
| Program Services | 194290 | ProgramServices |
| Management And General | 8095 | ManagementAndGeneral |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 817552 | Total |
| Program Services | 784850 | ProgramServices |
| Management And General | 32702 | ManagementAndGeneral |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 45948 | Total |
| Program Services | 44110 | ProgramServices |
| Management And General | 1838 | ManagementAndGeneral |
Conferences Meetings ConferencesMeetings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 6447 | Total |
| Program Services | 6189 | ProgramServices |
| Management And General | 258 | ManagementAndGeneral |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 7840 | Total |
| Management And General | 7840 | ManagementAndGeneral |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 667720 | Total |
| Program Services | 641011 | ProgramServices |
| Management And General | 26709 | ManagementAndGeneral |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 107136 | Total |
| Program Services | 102851 | ProgramServices |
| Management And General | 4285 | ManagementAndGeneral |
Other Expenses OtherExpenses (4 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral |
|---|---|---|---|
| PROVISION FOR BAD DEBTS | 2569541 | 2569541 | |
| MEDICAL SUPPLIES | 710940 | 710940 | |
| MGMT FEE TO AGHS | 409069 | 409069 | |
| DUES | 31350 | 10399 | 20951 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 28274 | Total |
| Program Services | 646 | ProgramServices |
| Management And General | 27628 | ManagementAndGeneral |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 17278946 | Total |
| Program Services | 16406690 | ProgramServices |
| Management And General | 872256 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 753699 | BOY |
| EOY | 1497761 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2360318 | BOY |
| EOY | 1971931 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 51982 | BOY |
| EOY | 56160 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 221235 | BOY |
| EOY | 194033 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 13207083 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 7664894 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 5919727 | BOY |
| EOY | 5542189 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 661490 | BOY |
| EOY | 996262 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 9968451 | BOY |
| EOY | 10258336 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1034445 | BOY |
| EOY | 1201457 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 544143 | BOY |
| EOY | 452051 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1578588 | BOY |
| EOY | 1653508 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 8053061 | BOY |
| EOY | 7921524 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 336802 | BOY |
| EOY | 683304 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 8389863 | BOY |
| EOY | 8604828 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 9968451 | BOY |
| EOY | 10258336 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | 777075 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | -562110 | ReconcilationOtherChanges |
| 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 B IRS990ScheduleB
Contributor Info ContributorInfo
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor Number | RESTRICTED | ContributorNumber |
Contributor Name Business ContributorNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor Address US ContributorAddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Aggregate Contributions | RESTRICTED | AggregateContributions |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | 0 | Volunteers |
| Paid Staff Or Management | 0 | PaidStaffOrManagement |
| Media Advertisements | 0 | MediaAdvertisements |
| Mailings Members | 0 | MailingsMembers |
| Publications Or Broadcast | 0 | PublicationsOrBroadcast |
| Grants Other Organizations | 1 | GrantsOtherOrganizations |
| Grants Other Organizations | $708 | GrantsOtherOrganizationsAmount |
| Direct Contact Legislators | 0 | DirectContactLegislators |
| Rallies Demonstrations | 0 | RalliesDemonstrations |
| Other Activities | 0 | OtherActivities |
| Total Lobbying Expenditures IIB | 708 | TotalLobbyingExpendituresIIB |
| Not Described In501c3 | 0 | NotDescribedIn501c3 |
Form990 Schedule C Part IV Form990ScheduleCPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | PART IV, SUPPLEMENTAL INFORMATION: | Identifier |
| Explanation | PART II-B, LINE 1 (F), GRANTS TO OTHER ORGANIZATIONS FOR LOBBYING PURPOSES: LODI COMMUNITY HOSPITAL IS A DUES PAYING MEMBER OF THE OHIO HOSPITAL ASSOCIATION (OHA). A PORTION OF OUR DUES (LISTED ABOVE) IS USED BY OHA FOR LOBBYING ACTIVITIES. | Explanation |
Schedule D IRS990ScheduleD
Current Year CurrentYear
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 336802 | BeginningOfYearBalance |
| Contributions | 343021 | Contributions |
| Investment Earnings Or Losses | 3481 | InvestmentEarningsOrLosses |
| End Of Year Balance | 683304 | EndOfYearBalance |
Current Year Minus1 Year CurrentYearMinus1Year
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 132986 | BeginningOfYearBalance |
| Contributions | 200000 | Contributions |
| Investment Earnings Or Losses | 3816 | InvestmentEarningsOrLosses |
| End Of Year Balance | 336802 | EndOfYearBalance |
Current Year Minus2 Years CurrentYearMinus2Years
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 148776 | BeginningOfYearBalance |
| Other Expenditures | 15790 | OtherExpenditures |
| End Of Year Balance | 132986 | EndOfYearBalance |
Current Year Minus3 Years CurrentYearMinus3Years
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 155416 | BeginningOfYearBalance |
| Other Expenditures | 6640 | OtherExpenditures |
| End Of Year Balance | 148776 | EndOfYearBalance |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Term Endowment EOY Balance | 1.00000 | TermEndowmentEOYBalance |
| Endowments Held By Unrelated Orgs | 0 | EndowmentsHeldByUnrelatedOrgs |
| Endowments Held By Related Orgs | 1 | EndowmentsHeldByRelatedOrgs |
| Are Related Orgs Listed Schedule R | 1 | AreRelatedOrgsListedScheduleR |
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 98793 | OtherCostOrOtherBasis |
| Book Value | 98793 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 7921536 | OtherCostOrOtherBasis |
| Depreciation | 3987475 | Depreciation |
| Book Value | 3934061 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 4718396 | OtherCostOrOtherBasis |
| Depreciation | 3361172 | Depreciation |
| Book Value | 1357224 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 468358 | OtherCostOrOtherBasis |
| Depreciation | 316247 | Depreciation |
| Book Value | 152111 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 5542189 | TotalOfBookValueLandBuildings |
Other Assets OtherAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | INTEREST IN FOUNDATION NET ASSETS | Description |
| Book Value | 996262 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | 996262 | TotalBookValueOtherAssets |
Other Liabilities OtherLiabilities (3 entries)
| DescriptionDescription | AmountAmount |
|---|---|
| ESTIMATED MEDICARE SETTLEMENT DUE | $130,650 |
| ACCRUED SELF INSURANCE CLAIMS PAYABLE | $150,191 |
| ASSET RETIREMENT OBLIGATION | $171,210 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 452051 | TotalOfAmounts |
| Total Revenue | 18056021 | TotalRevenue |
| Total Expenses | 17278946 | TotalExpenses |
| Excess Or Deficit For Year | 777075 | ExcessOrDeficitForYear |
| Other | -$11,729 | OtherAmount |
| Total Adjustments | -11729 | TotalAdjustments |
| Excess Or Deficit Per FS | 765346 | ExcessOrDeficitPerFS |
| Tot Revenue Etc Audited Fincl Stmt | 14820723 | TotRevenueEtcAuditedFinclStmt |
| Other Revenues | -2920424 | OtherRevenues |
| Revenue Not Rptd F990 | -2920424 | RevenueNotRptdF990 |
| Revenue Subtotal | 17741147 | RevenueSubtotal |
| Other Revenues Not Included | 314874 | OtherRevenuesNotIncluded |
| Revenue Not Rptd On Fin Stmt | 314874 | RevenueNotRptdOnFinStmt |
| Total Revenue Per Form990 | 18056021 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 14055377 | TotExpensesEtcAuditedFinclStmt |
| Other Expenses Included | 83613 | OtherExpensesIncluded |
| Expenses Not Rptd F990 | 83613 | ExpensesNotRptdF990 |
| Expenses Subtotal | 13971764 | ExpensesSubtotal |
| Other Expenses Not Included | 3307182 | OtherExpensesNotIncluded |
| Expenses Not Rptd On Fin Stmt | 3307182 | ExpensesNotRptdOnFinStmt |
| Total Expenses Per Form990 | 17278946 | TotalExpensesPerForm990 |
Form990 Schedule D Part XIV Form990ScheduleDPartXIV (6 entries)
| IdentifierIdentifier | ExplanationExplanation |
|---|---|
| PART XI, LINE 8 - OTHER ADJUSTMENTS: | CHANGE IN INTEREST IN FOUNDATION UNRESTRICTED NET ASSETS -11,729. |
| PART XII, LINE 2D - OTHER ADJUSTMENTS: | MANAGEMENT FEE TO AFFILIATE -409,069. GRANTS & OTHER ASSISTANCE TO GOVERNMENTS & ORGANIZATIONS IN THE U.S. -2,302. NET ASSETS RELEASED FROM RESTRICTIONS FOR OPERATIONS 55,466. CHANGE IN INTEREST IN FOUNDATION UNRESTRICTED NET ASSETS -11,729. PROVISION FOR BAD DEBTS -2,569,541. OTHER PURCHASED SERVICES REPAID 11,220. PURCHASE DISCOUNTS 5,171. U.S. TREASURY HIRE ACT REFUND 360. |
| PART XII, LINE 4B - OTHER ADJUSTMENTS: | COST OF GOODS SOLD FOR SALE OF SUPPLIES -624. RENTAL EXPENSES -27,523. ESTATE OF BONNY KAHL CONTRIBUTIONS 343,021. |
| PART XIII, LINE 2D - OTHER ADJUSTMENTS: | COST OF GOODS SOLD FOR SALE OF SUPPLIES 624. NET ASSETS RELEASED FROM RESTRICTIONS FOR OPERATIONS 55,466. RENTAL EXPENSES 27,523. |
| PART XIII, LINE 4B - OTHER ADJUSTMENTS: | MANAGEMENT FEE TO AFFILIATE 409,069. GRANTS & OTHER ASSISTANCE TO GOVERNMENTS & ORGANIZATIONS IN THE U.S. 2,302. OTHER PURCHASED SERVICES REPAID -11,220. PURCHASE DISCOUNTS -5,171. PROVISION FOR BAD DEBTS 2,569,541. U.S. TREASURY HIRE ACT REFUND -360. ESTATE OF BONNY KAHL CONTRIBUTIONS TRANSFERRED TO AKRON GENERAL FOUNDATION 343,021. |
| LODI COMMUNITY HOSPITAL ADOPTED FIN48 IN 2007 AS REQUIRED. NO FOOTNOTE DISCLOSURES WERE REQUIRED UNDER GAAP AS PARTNERS PHYSICIAN GROUP DOES NOT HAVE ANY MATERIAL TAX CONTINGENCIES THAT REQUIRED SUCH DISCLOSURES. |
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 |
| Pcent200 | X | Pcent200 |
| FPG Reference Discounted Care | 1 | FPGReferenceDiscountedCare |
| Pcent400 | X | Pcent400 |
| Free Disc Care Medically Indigent | 1 | FreeDiscCareMedicallyIndigent |
| Amounts Budgeted For Charity Care | 1 | AmountsBudgetedForCharityCare |
| Expenses Exceeded Budget | 1 | ExpensesExceededBudget |
| Unable To Provide Care | 0 | UnableToProvideCare |
| Annual Community Benefit Report | 0 | AnnualCommunityBenefitReport |
Charity Care At Cost CharityCareAtCost
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 475235 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 0 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 475235 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.03230 | PercentOfTotalExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 2462687 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 1191481 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 1271206 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.08640 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 2937922 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 1191481 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 1746441 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.11870 | PercentOfTotalExpense |
Community Health Services CommunityHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 282063 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 47128 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 234935 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.01600 | PercentOfTotalExpense |
Health Professions Education HealthProfessionsEducation
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 100975 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 100975 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00690 | PercentOfTotalExpense |
Cash And In Kind Contributions CashAndInKindContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 372834 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 343021 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 29813 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00200 | PercentOfTotalExpense |
Total Other Benefits TotalOtherBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 755872 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 390149 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 365723 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.02490 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 3693794 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 1581630 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 2112164 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.14360 | PercentOfTotalExpense |
Other Other
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 16229 | TotalCommunityBuildingExpense |
| Direct Offsetting Revenue | 16229 | DirectOffsettingRevenue |
Total Total
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 16229 | TotalCommunityBuildingExpense |
| Direct Offsetting Revenue | 16229 | DirectOffsettingRevenue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 1 | BadDebtExpenseReported |
| Bad Debt Expense | $1,031,350 | BadDebtExpenseAmount |
| Amount Reimbursed By Medicare | 4040609 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 3928903 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | 111706 | 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 | LODI COMMUNITY HOSPITAL | BusinessNameLine1 |
Address Address
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 225 ELYRIA ST | AddressLine1 |
| City | LODI | City |
| State | OH | State |
| ZIP Code | 44254 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Licensed Hospital | X | LicensedHospital |
| General Medical And Surgical | X | GeneralMedicalAndSurgical |
| Critical Access Hospital | X | CriticalAccessHospital |
| Er24 Hours | X | Er24Hours |
Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | LODI COMMMUNITY HOSPITAL | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital Facility Number | 1 | HospitalFacilityNumber |
| CHNA Conducted | 0 | CHNAConducted |
| Eligibility Criteria Explained | 1 | EligibilityCriteriaExplained |
| Uses FPG Free | 1 | UsesFPGFree |
| FPG Free Percent | 200.000000000000 | FPGFreePercent |
| Uses FPG Discounted | 1 | UsesFPGDiscounted |
| FPG Discount Percent | 400.000000000000 | FPGDiscountPercent |
| Explains Basis | 1 | ExplainsBasis |
| Income Level | X | IncomeLevel |
| 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 |
| Provided On Admission | X | ProvidedOnAdmission |
| Available On Request | X | AvailableOnRequest |
| Other Publicity | X | OtherPublicity |
| Actions On Nonpayment | 1 | ActionsOnNonpayment |
| Collection Activities | 0 | CollectionActivities |
| Nondiscrim Emergency Care Policy | 1 | NondiscrimEmergencyCarePolicy |
| Average Negotiated Rates | X | AverageNegotiatedRates |
| Amounts Generally Billed | 0 | AmountsGenerallyBilled |
| Gross Charges | 0 | GrossCharges |
Form990 Schedule H Part V Section C Form990ScheduleHPartVSectionC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Other Facilities | 2 | NumberOfOtherFacilities |
Other Facilities OtherFacilities (2 entries)
| Address Line1Address/AddressLine1 | CityAddress/City | StateAddress/State | ZIP CodeAddress/ZIPCode | Facility TypeFacilityType |
|---|---|---|---|---|
| LODI COMMUNITY CARE CENTER | ||||
| 402 HIGHLAND | LODI | OH | 44254 | PHYSICIANS OFFICE |
| LODI COMMUNITY CARE CENTER | ||||
| 221 ELYRIA ST | LODI | OH | 44254 | PHYSICIANS OFFICE |
Form990 Schedule H Part VI Form990ScheduleHPartVI (10 entries)
| ExplanationExplanation | IdentifierIdentifier |
|---|---|
| PART I, LINE 6A: LODI COMMUNITY HOSPITAL IS A MEMBER OF AKRON GENERAL HEALTH SYSTEM. AKRON GENERAL HEALTH SYSTEM PREPARES AN ANNUAL COMMUNITY BENEFIT REPORT THAT INCLUDES THE ACTIVITIES OF LODI COMMUNITY HOSPITAL. | |
| PART I, LINE 7: COLUMN (F): IN CALCULATING THE PERCENTAGE OF TOTAL EXPENSE REPORTED IN COLUMN (F), TOTAL EXPENSES AS REPORTED ON FORM 990, PART IX, LINE 25, COLUMN (A) WERE REDUCED BY $2,569,541 - THE AMOUNT OF BAD DEBT EXPENSE INCLUDED ON THAT LINE. | |
| PART III, LINE 4: THE PROVISION FOR BAD DEBTS IS BASED UPON MANAGEMENT'S ASSESSMENT OF HISTORICAL AND EXPECTED NET COLLECTIONS CONSIDERING HISTORICAL BUSINESS AND ECONOMIC CONDITIONS, TRENDS IN HEALTH CARE COVERAGE AND OTHER COLLECTION INDICATORS. PERIODICALLY THROUGHOUT THE YEAR, MANAGEMENT ASSESSES THE ADEQUACY OF THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS BASED UPON HISTORICAL WRITE-OFF EXPERIENCE BY PAYOR CATEGORY. THE RESULTS OF THIS REVIEW ARE THEN USED TO MAKE ANY MODIFICATIONS TO THE PROVISION FOR BAD DEBTS TO ESTABLISH AN APPROPRIATE ALLOWANCE FOR UNCOLLECTIBLE RECEIVABLES.AFTER SATISFACTION OF AMOUNTS DUE FROM INSURANCE, LCH FOLLOWS ESTABLISHED GUIDELINES FOR PLACING CERTAIN PAST-DUE PATIENT BALANCES WITH COLLECTION AGENCIES, SUBJECT TO THE TERMS OF CERTAIN RESTRICTIONS ON COLLECTION EFFORTS AS DETERMINED BY LCH. | |
| PART III, LINE 9B: LODI COMMUNITY HOSPITAL'S BAD DEBT COLLECTION POLICY ADDRESSES HOW TO IDENTIFY AND PROCESS PATIENTS' ACCOUNTS FOR QUALIFICATION AS CHARITY CARE OR OTHER FINANCIAL ASSISTANCE. AT REGISTRATION/ADMISSION A SCREENING PROCESS IDENTIFIES THOSE PATIENTS WITHOUT INSURANCE. THOSE PATIENT ACCOUNTS ARE AUTOMATICALLY CHECKED FOR POSSIBLE MEDICAID OR OTHER FINANCIAL ASSISTANCE ELIGIBILITY. WHERE ELEGIBILITY IS ESTABLISHED, THE PATIENT RECEIVES ASSISTANCE AFTER COMPLETING ANY REQUIRED APPLICATIONS. PATIENTS WHO QUALIFY FOR 100% CHARITY CARE WILL HAVE THEIR CHARGES WRITTEN OFF AS SUCH AND NO COLLECTION EFFORTS WILL FOLLOW. PATIENTS THAT QUALIFY FOR A SLIDING SCALE DISCOUNT THROUGH CHARITY CARE WILL HAVE THEIR STATEMENT ADJUSTED ACCORDINGLY. IF THE ADJUSTED BALANCE IS UNPAID, THE ADJUSTED BALANCE GOES TO COLLECTIONS IN ACCORDANCE WITH POLICY FOR ALL BAD DEBT ACCOUNTS. | |
| PART V, SECTION B, LINE 13G: FOR UNINSURED AND UNDERINSURED PATIENTS, OUR FINANCIAL COUNSELORS OR ELIGIBILITY VENDOR STAFF REACH OUT UPON ADMISSION, OR AS SOON AS POSSIBLE THEREAFTER, TO EXPLAIN THE PROGRAMS FOR FREE OR DISCOUNTED CARE AND TO ASSESS ELIGIBILITY FOR MEDICAID AND OTHER VARIOUS PROGRAMS (VETERAN'S ADMINISTRATION, COBRA, OTHER LOCAL PROGRAMS, ETC.).FOR SCHEDULED OUTPATIENT SERVICES, FINANCIAL COUNSELORS ATTEMPT TO CONTACT THE PATIENT PRIOR TO SERVICE TO SCREEN UNINSURED PATIENTS FOR POSSIBLE ASSISTANCE/PAYMENT SOLUTIONS. IF UNABLE TO CONTACT PATIENT PRIOR TO THE SERVICE, WE ATTEMPT TO SCREEN ON THE DAY OF SERVICE OR AS SOON THEREAFTER AS POSSIBLE.FOR UNSCHEDULED EMERGENCY SERVICES, SCREENING MAY BE COMPLETED DURING THE VISIT WHEN PATIENT IS ABLE. OTHERWISE, ATTEMPTS TO CONTACT THE PATIENT ARE MADE BY THE FINANCIAL COUNSELING STAFF.IN EITHER CASE, IF WE ARE UNABLE TO CONTACT THE PATIENT, THE FINANCIAL ASSISTANCE INFORMATION IS ON EACH BILLING STATEMENT SENT TO THE PATIENT.IF THE PATIENT IS DETERMINED TO BE LIKELY ELIGIBLE FOR MEDICAID, THE ELIGIBILITY VENDOR STAFF ASSIST AND REPRESENT THE PATIENT THROUGHOUT THE APPLICATION PROCESS (UPON APPROVAL FROM THE PATIENT). IN ADDITION TO SIGNAGE, BROCHURES EXPLAINING OUR PROGRAMS ARE IN ALL OF OUR REGISTRATION AREAS. OUR WELCOME PACKETS ALSO INCLUDE INFORMATION AS DOES OUR WEBSITE. ALL STATEMENTS MAILED TO PATIENTS INCLUDE A NOTICE THAT OUR FINANCIAL ASSISTANCE APPLICATIONS ARE ON THE BACK OF THE STATEMENT. PHONE NUMBERS ARE PROVIDED FOR ASSISTANCE.FOR SCHEDULED OUTPATIENT SERVICES, FINANCIAL COUNSELORS ATTEMPT TO CONTACT THE PATIENT PRIOR TO SERVICE TO SCREEN UNINSURED PATIENTS FOR POSSIBLE ASSISTANCE/PAYMENT SOLUTIONS. IF UNABLE TO CONTACT PATIENT PRIOR TO THE SERVICE, WE ATTEMPT TO SCREEN ON THE DAY OF SERVICE OR AS SOON THEREAFTER AS POSSIBLE. | LODI COMMMUNITY HOSPITAL |
| PART VI, LINE 2: THERE ARE A VARIETY OF NEEDS ASSESSMENT METHODS EMPLOYED BY LODI COMMUNITY HOSPITAL IN DETERMINING THE HEALTH NEEDS OF THE COMMUNITY IT SERVES. FOR MEDICAL STAFFING AND SERVICES, A COMBINATION OF FACTORS INCLUDING THE COMMUNITY'S DEMOGRAPHICS AND HEALTH NEEDS, THE DEMOGRAPHICS OF MEDICAL STAFF (PHYSICIAN AGE, SPECIALTY, ETC...) ARE WEIGHED TO DETERMINE WHERE RESOURCES SHOULD BE CONCENTRATED IN ORDER TO MEET CURRENT AND FUTURE HEALTHCARE NEEDS OF THE COMMUNITY. LODI COMMUNITY HOSPITAL PARTICIPATES IN HEALTHCARE INITIATIVES OF STATE AND LOCAL HEALTH DEPARTMENTS, EITHER SOLELY OR IN CONCERT WITH OTHER HEALTHCARE PROVIDERS, DEPENDING ON THE INITIATIVE. LODI COMMUNITY HOSPITAL HAS WORKED WITH LOCAL CHURCHES AND SOCIAL WELFARE ORGANIZATIONS TO IDENTIFY AND SERVICE HEALTHCARE NEEDS OF PERSONS WHO ARE UNDERSERVED BY GOVERNMENT PROGRAMS OR WHO HAVE FALLEN COMPLETELY THROUGH GOVERNMENT SAFETY NETS. | |
| PART VI, LINE 3: FINANCIAL ASSISTANCE APPLICATIONS ARE ON THE BACK OF EVERY PATIENT STATEMENT AS WELL AS MESSAGES INFORMING PATIENTS THAT ASSISTANCE IS AVAILABLE - VIA WEBSITE, AUTOMATED ATTENDANT OR CUSTOMER SERVICE LINE, SUCH MESSAGES ALSO ARE CONSPICUOUSLY POSTED IN PATIENT AREAS AND THROUGHOUT OUR FACILITIES. | |
| PART VI, LINE 4: LODI COMMUNITY HOSPITAL IS LOCATED IN SOUTHERN MEDINA COUNTY AND SERVES THE POPULATION OF 174,035 PEOPLE IN MEDINA. THE MEDIAN AGE OF RESIDENTS IN MEDINA IS 36.6 AND THE MEDIAN HOUSEHOLD INCOME IS $55,811. THE DOMINANT INDUSTRIES IN THE AREA ARE AGRICULTURE, MANUFACTURING, RETAIL AND GOVERNMENT. LODI COMMUNITY HOSPITAL ALSO SERVES A LARGE AMISH POPULATION. WHILE MEDINA COUNTY'S UNEMPLOYMENT RATE IS AT 6.0% THE SURROUNDING COUNTIES' RATES ARE HIGHER; LORAIN IS 8.0%, WAYNE IS 6.3% AND ASHLAND IS 7.4% WITH THE STATE OF OHIO AT 7.4%. | |
| PART VI, LINE 5: IN ORDER TO ENSURE THE FURTHERANCE OF LODI COMMUNITY HOSPITAL'S EXEMPT PURPOSE, ITS BOARD OF DIRECTORS CONSISTS OF COMMUNITY MEMBERS - THE MAJORITY OF WHOM ARE INDEPENDENT. THE SIZE OF THE BOARD - 16 IN 2011 - IS DESIGNED TO BE LARGE ENOUGH TO PROVIDE SUFFICIENT EXPERTISE AND DIVERSITY FOR AN ORGANIZATION OF THIS SIZE WITHOUT BEING TOO LARGE TO MANAGE ITSELF. THE BOARD, AS WELL AS SENIOR MANAGEMENT AND MEDICAL STAFF LEADERS, ARE CHARGED BY POLICY WITH THE EXPECTATION THAT PERSONS IN SUCH POSITIONS WILL ADVOCATE STRONG TIES BETWEEN THE ORGANIZATION AND THE COMMUNITY IT SERVES. AMONG OTHER THINGS THE POLICY CITES THE ASSUMPTION OF BOARD POSITIONS WITH SERVICE ORGANIZATIONS AND COMMUNITY AGENCIES AS WAYS TO PROMOTE SUCH TIES. THROUGH THE HEALTH SYSTEM'S COMMUNITY HEALTH COMMITTEE, LODI COMMUNITY HOSPITAL RECEIVES CONSIDERABLE SUPPORT IN MAINTAINING CONTACTS WITH A DIVERSE CROSS SECTION OF ITS COMMUNITY. THE COMMUNITY HEALTH COMMITTEE SUPPORTS INITIATIVES DESIGNED TO MEET THE NEEDS OF VULNERABLE, DISADVANTAGED POPULATIONS AND THOSE WHO LACK ACCESS TO QUALITY HEALTH CARE. THE MAJORITY OF THE COMMUNITY MEMBERS ARE INDEPENDENT ARE INDEPENDENT COMMUNITY MEMBERS WHOSE FOCUSED MISSION PROVIDES AN IMPORTANT ACCESS POINT FOR GROUPS WITHIN THE COMMUNITY.LODI COMMUNITY HOSPITAL ALSO MAINTAINS AN OPEN MEDICAL STAFF.LODI COMMUNITY HOSPITAL IS BOUND BY LAW TO REINVEST ANY SURPLUS FROM OPERATIONS INTO ITS FACILITIES AND PROGRAMS IN FURTHERANCE OF ITS EXEMPT PURPOSE, PROMOTING THE HEALTH OF THE COMMUNITY IT SERVES. | |
| PART VI, LINE 6: AKRON GENERAL HEALTH SYSTEM IS A NOT-FOR-PROFIT HEALTHCARE ORGANIZATION WITH THE MISSION OF IMPROVING THE HEALTH AND LIVES OF PATIENTS AND THE COMMUNITY, AKRON GENERAL HEALTH SYSTEM INCLUDES: AKRON GENERAL MEDICAL CENTER, A 537-BED TEACHING AND RESEARCH MEDICAL CENTER, AND EDWIN SHAW REHAB, THE AREA'S LARGEST PROVIDER OF REHABILITATION SERVICES: AKRON GENERAL PARTNERS, WHICH INCLUDES PARTNERS PHYSICIAN GROUP, THE AKRON GENERAL HEALTH & WELLNESS CENTERS, LODI COMMUNITY HOSPITAL, COMMUNITY HEALTH CENTERS AND OTHER COMPANIES; AKRON GENERAL COMMUNITY HEALTH VENTURES, WHICH INCLUDES VISITING NURSE SERVICE AND AFFILIATES. THE LARGEST AND MOST COMPREHENSIVE PROVIDER OF HOME HEALTHCARE SERVICES IN OHIO, AND ROSE LANE HEALTH CENTER; AND AKRON GENERAL DEVELOPMENT FOUNDATION.AKRON GENERAL HEALTH SYSTEM BRINGS TOGETHER A NETWORK OF HEALTH CARE FACILITIES AND STAFF WITH A RICH HERITAGE OF EXCEPTIONAL CARE. IT IS AN INTEGRATED HEALTH SYSTEM THAT PROVIDES HIGH-QUALITY HEALTHCARE FOR PATIENTS AND COMMUNITY THROUGHOUT THEIR ENTIRE LIFE - BIRTHS, INPATIENT AND OUTPATIENT SERVICES FOR ADULTS, EMERGENCY CARE, HOME CARE, WELLNESS, DURABLE MEDICAL EQUIPMENT AND HOSPICE SERVICES. |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Records Maintained | 1 | RecordsMaintained |
Recipient Table RecipientTable
Recipient Name Business RecipientNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | AKRON GENERAL FOUNDATION | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 400 WABASH AVENUE | AddressLine1 |
| City | AKRON | City |
| State | OH | State |
| ZIP Code | 44307 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN Of Recipient | 341127047 | EINOfRecipient |
| IRC Section | 501 (C) (3) | IRCSection |
| Amount Of Cash Grant | 343021 | AmountOfCashGrant |
| Purpose Of Grant | REHAB SERVICES | PurposeOfGrant |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Nbr Of501 C3 And Govt Grants | 1 | TotalNbrOf501C3AndGovtGrants |
| Total Nbr Of Other Organizations | 0 | TotalNbrOfOtherOrganizations |
Form990 Schedule I Part IV Form990ScheduleIPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | PROCEDURE FOR MONITORING GRANTS IN THE U.S.: | Identifier |
| Return Reference | PART I, LINE 2: | ReturnReference |
| Explanation | SCHEDULE I, PART I, LINE 2: ASSISTANCE IS OCCASIONALLY PROVIDED TO COMMUNITY BASED NON-PROFIT ORGANIZATIONS OR LOCAL GOVERNMENT EVENTS. GENERALLY, ASSISTANCE IS LIMITED TO SPECIFIC EVENTS/PURPOSES WHERE THE ASSISTANCE IS SPENT IMMEDIATELY BY THE DONEE. ON RARE OCCASIONS-SUCH AS THE DONATIONS TO AKRON GENERAL FOUNDATION MADE IN 2011-THE ASSISTANCE RESULTS IN A FUND BALANCE WITH THE DONEE. HERE THE FUND BALANCE IS FOR THE BENEFIT OF THE LODI COMMUNITY FOR REHABILITATION SERVICES. LODI COMMUNITY HOSPITAL HAS DIRECT ACCESS TO MONTHLY REPORTS ON THE FUND BALANCES AND ALL USES OF THE FUND BALANCES. | Explanation |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Idemnification Gross Up Payments | X | IdemnificationGrossUpPayments |
| Discretionary Spending Account | X | DiscretionarySpendingAccount |
| Written Policy Re T And E Expenses | 1 | WrittenPolicyReTAndEExpenses |
| Substantiation Required | 1 | SubstantiationRequired |
| Compensation Committee | X | CompensationCommittee |
| Independent Consultant | X | IndependentConsultant |
| Form990 Of Other Organizations | X | Form990OfOtherOrganizations |
| 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 (9 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| THOMAS WHELAN | |||||||||||||
| 174410 | 0 | 0 | 0 | 40137 | 0 | 15480 | 0 | 19614 | 0 | 249641 | 0 | 0 | 0 |
| VINCENT J MCCORKLE | |||||||||||||
| 0 | 791084 | 0 | 179219 | 0 | 268313 | 0 | 9800 | 0 | 14647 | 0 | 1263063 | 0 | 0 |
| ROBERT KAMIENSKI MD | |||||||||||||
| 0 | 274231 | 0 | 26515 | 0 | 8611 | 0 | 9800 | 0 | 13147 | 0 | 332304 | 0 | 0 |
| ALAN PAPA | |||||||||||||
| 0 | 308218 | 0 | 30000 | 0 | 144903 | 0 | 22942 | 0 | 19593 | 0 | 525656 | 0 | 0 |
| JOSEPH MELI MD | |||||||||||||
| 0 | 270076 | 0 | 15000 | 0 | 2329 | 0 | 12071 | 0 | 16904 | 0 | 316380 | 0 | 0 |
| CRAIG BABBITT | |||||||||||||
| 0 | 278986 | 0 | 0 | 0 | 71797 | 0 | 16269 | 0 | 18760 | 0 | 385812 | 0 | 0 |
| STEPHEN GARY | |||||||||||||
| 0 | 296353 | 0 | 0 | 0 | 69523 | 0 | 0 | 0 | 13563 | 0 | 379439 | 0 | 0 |
| BARBARA VIMONT | |||||||||||||
| 0 | 131683 | 0 | 0 | 0 | 3868 | 0 | 14256 | 0 | 14154 | 0 | 163961 | 0 | 0 |
| ALAN J BLEYER | |||||||||||||
| 0 | 18173 | 0 | 0 | 0 | 525390 | 0 | 6165 | 0 | 0 | 0 | 549728 | 0 | 543563 |
Form990 Schedule J Part III Form990ScheduleJPartIII (3 entries)
| Return ReferenceReturnReference | ExplanationExplanation | IdentifierIdentifier |
|---|---|---|
| PART I, LINE 1A | THE EXPENSES INDICATED IN PART I, LINE 1 ARE TAXABLE BENEFITS. AS SUCH THEY ARE PART OF TOTAL COMPENSATION. TOTAL COMPENSATION IS TESTED FOR REASONABLENESS AS DESCRIBED IN SCHEDULE O FOR FORM 990, PART VI, SECTION B, LINES 15A AND B. DISCRETIONARY SPENDING ACCOUNT A PORTION OF THE EMPLOYEES' TAXABLE INCOME IS DESIGNATED AS A DISCRETIONARY SPENDING ACCOUNT BENEFIT. THE RECIPIENTS ARE TAXED ON THE ENTIRE VALUE OF THE BENEFIT. THE NET AMOUNT MAY THEN BE APPLIED TO ONE OR MORE OF A LIMITED NUMBER OF CHOICES AVAILABLE UNDER THIS BENEFIT. IF ANY OF THE NET AMOUNT REMAINS AFTER CHOOSING FROM SUCH OPTIONS, IT IS APPLIED TOWARD THE RECIPIENT'S NON-QUALIFIED RETIREMENT BENEFIT. THIS BENEFIT WAS OFFERED TO EMPLOYEES AT THE VICE PRESIDENT LEVEL AND ABOVE. IN 2011, 1 EMPLOYEE CHOSE THIS BENEFIT. TAX INDEMNIFICATION AND GROSS-UP PAYMENTS SUPPLEMENTAL RETIREMENT IS GROSSED-UP FOR TAX PURPOSES. THE GROSS-UP AND THE BENEFIT BOTH ARE TAXED AND ARE INCLUDED IN TOTAL COMPENSATION. TOTAL COMPENSATION IS TESTED FOR REASONABLENESS AS DESCRIBED IN SCHEDULE O FOR FORM 990, PART VI, SECTION B, LINES 15A AND B. THIS BENEFIT WAS OFFERED TO EMPLOYEES AT THE VICE PRESIDENT LEVEL AND ABOVE. IN 2011, 1 EMPLOYEE RECEIVED THIS BENEFIT. NOTE THAT, TAX INDEMNIFICATION IS NOT OFFERED AS A BENEFIT. | |
| PART I, LINE 4B | ALAN BLEYER SEPARATED FROM SERVICE DURING 2009. UNDER THE TERMS OF HIS SEVERANCE AGREEMENT, MR. BLEYER RECEIVED PAYMENTS TOTALING $543,563 IN 2011. AT 12/31/2011 THE BALANCE OF THE ACCRUED LIABILITY FOR THE REMAINDER OF MR. BLEYER'S SEVERANCE AGREEMENT TOTALED $135,536. LINE 4B: THE FOLLOWING EMPLOYEES RECEIVED EMPLOYER CONTRIBUTIONS TO A NONQUALIFIED TAXABLE PLAN. THE BENEFIT IS PAID BY AKRON GENERAL HEALTH SYSTEM (RELATIONSHIP DESCRIBED BELOW). THE CONTRIBUTIONS WERE TAXABLE TO THE EMPLOYEES IN 2011. THOMAS WHELAN - $21,600 VINCENT MCCORKLE - $117,995 STEPHEN GARY - $18,047 ALAN J. BLEYER - $126,748 ALAN PAPA - $29,856 | |
| PART III | RELATED ORGANIZATION COMPENSATION AKRON GENERAL HEALTH SYSTEM (FEIN 34-1546466) IS THE SOLE MEMBER OF AKRON GENERAL MEDICAL CENTER (FEIN 34-0714478). AKRON GENERAL MEDICAL CENTER IS THE SOLE MEMBER OF LODI COMMUNITY HOSPITAL. THE INDIVIDUALS LISTED BELOW ARE (OR WERE) FULL TIME PAID EMPLOYEES OF AKRON GENERAL HEALTH SYSTEM. THE AMOUNTS SHOWN IN SCHEDULE J PART II REFLECT COMPENSATION FOR SERVICES TO THAT ORGANIZATION. VINCENT J. MCCORKLE ALAN J. BLEYER (FORMER) CRAIG M. BABBITT BARBARA VIMONT STEPHEN M. GARY | SUPPLEMENTAL INFORMATION |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (9 entries)
| Return ReferenceReturnReference | ExplanationExplanation | IdentifierIdentifier |
|---|---|---|
| FORM 990, PART VI, SECTION A, LINE 6 | LODI COMMUNITY HOSPITAL HAS ONE MEMBER, AKRON GENERAL PARTNERS. AKRON GENERAL PARTNERS IS ORGANIZED IN OHIO AS A NON-PROFIT ORGANIZATION AND IS RECOGNIZED AS EXEMPT FROM FEDERAL INCOME TAX UNDER IRC 501(C)(3). AKRON GENERAL PARTNERS IS NOT A PRIVATE FOUNDATION. | |
| FORM 990, PART VI, SECTION A, LINE 7A | AKRON GENERAL PARTNERS IS THE SOLE MEMBER OF LODI COMMUNITY HOSPITAL. AKRON GENERAL HEALTH SYSTEM IS THE SOLE MEMBER OF AKRON GENERAL PARTNERS. THE ORGANIZATION FOLLOWS THE PRACTICE UNDER WHICH LODI COMMUNITY HOSPITAL CURRENT BOARD SUGGESTS CANDIDATES FOR OPENINGS ON ITS BOARD, THAT ARE THEN REVIEWED FOR APPROVAL BY AKRON GENERAL HEALTH SYSTEM'S BOARD. | |
| FORM 990, PART VI, SECTION A, LINE 7B | AKRON GENERAL PARTNERS IS THE SOLE MEMBER OF LODI COMMUNITY HOSPITAL. AKRON GENERAL HEALTH SYSTEM IS THE SOLE MEMBER OF AKRON GENERAL PARTNERS. AKRON GENERAL HEALTH SYSTEM'S RESPONSIBILITIES INCLUDE PROVIDING LONG TERM PLANNING, ESTABLISHING SYSTEM POLICIES AND PROCEDURES, FINANCIAL MANAGEMENT, AND ASSISTING ORGANIZATIONS WITHIN THE SYSTEM IN CARRYING OUT THIER EXEMPT PROGRAMS. GENERALLY, AKRON GENERAL HEALTH SYSTEM LIMITS ITS POWER OF APPROVAL OVER DECISIONS MADE BY THE BOARD OF LODI COMMUNITY HOSPITAL TO THOSE CONCERNING MEMBERSHIP OF THAT BOARD AND THAT ORGANIZATION'S ANNUAL BUDGET. | |
| FORM 990, PART VI, SECTION B, LINE 11 | LODI COMMUNITY HOSPITAL IS A MEMBER OF THE AKRON GENERAL HEALTH SYSTEM. LODI COMMUNITY HOSPITAL PREPARES ITS FORM 990 INTERNALLY. THE RETURN IS SUBJECT TO FINANCIAL REVIEW BY THE CHIEF FINANCIAL OFFICER OF AKRON GENERAL HEALTH SYSTEM, THE VICE PRESIDENT OF ACCOUNTING AND FINANCE OF AKRON GENERAL HEALTH SYSTEM, AND REVIEWED FOR COMPLIANCE WITH THE REPORTING REQUIREMENTS OF FORM 990 BY THE DIRECTOR OF CORPORATE TAX FOR AKRON GENERAL HEALTH SYSTEM. | |
| FORM 990, PART VI, SECTION B, LINE 12C | LODI COMMUNITY HOSPITAL IS A MEMBER OF THE AKRON GENERAL HEALTH SYSTEM (SYSTEM). AKRON GENERAL HEALTH SYSTEM IS THE PARENT ORGANIZATION OF THE SYSTEM AND AS SUCH IT DETERMINES CERTAIN POLICIES AND PROCEDURES APPLICABLE TO ALL MEMBER ORGANIZATIONS. IN THE CASE OF CONFLICT OF INTEREST REPORTING, AKRON GENERAL HEALTH SYSTEM NOT ONLY DETERMINES THE POLICY AND THE PROCEDURE, IT CARRIES OUT THE PROCEDURE FOR ALL SYSTEM ORGANIZATIONS ITSELF. A CONFLICT OF INTEREST QUESTIONNAIRE IS DISTRIBUTED TO ALL BOARD MEMBERS, MANAGEMENT PERSONNEL, EMPLOYED PHYSICIANS AND ANY OTHER PERSONNEL THAT HAVE BEEN DESIGNATED BY MANAGEMENT. THE DISTRIBUTION COVERS ALL SYSTEM ORGANIZATIONS. ALL RESPONSES THAT INDICATE A PERCEIVED CONFLICT OF INTEREST ARE TURNED OVER TO THE GOVERNANCE AND COMPLIANCE COMMITTEE (THE COMMITTEE) OF AKRON GENERAL HEALTH SYSTEM FOR REVIEW. THE COMMITTEE MAKES A DETERMINATION AS TO WHETHER THE PERCEIVED CONFLICT IS LIKELY TO BE AN ACTUAL CONFLICT, THE MATERIALITY OF ANY ACTUAL CONFLICTS AND THE EXTENT OF SAFEGUARD REQUIRED FOR ANY ACTUAL CONFLICTS. SAFEGUARDS INCLUDE, BUT ARE NOT LIMITED TO, REQUIRING, IN THE CASE OF A BOARD MEMBER, THAT THE PERSON RECUSE HIMSELF OR HERSELF FROM ANY DISCUSSIONS OR VOTING THAT MAY BE AFFECTED BY TEH CONFLICT, REQUIRING THE PERSON TO DISENGAGE FROM THE CONDUCT CREATING THE CONFLICT OR REQUIRING THE PERSON TO RESIGN FROM THE POSITION AFFECTED BY THE CONFLICT. THIS PROCESS IS CONDUCTED BY AKRON GENERAL HEALTH SYSTEM'S LEGAL DEPARTMENT ANNUALLY IN JANUARY. THE CONFLICT OF INTEREST LETTER PUTS THE RECIPIENT ON NOTICE THAT HE OR SHE IS UNDER AN ONGOING DUTY TO REPORT ANY POTENTIAL CONFLICTS THAT MAY ARISE SUBSEQUENT TO THIS FORMAL PROCESS. SUBSEQUENT EVENT REPORTING IS MONITORED BY AKRON GENERAL HEALTH SYSTEM'S LEGAL DEPARTMENT. ANY SUBSEQUENTLY REPORTED ITEMS ARE SUBJECT TO THE AFORMENTIONED REVIEW PROCESS BY AKRON GENERAL HEALTH SYSTEM'S GOVERNANCE AND COMPLIANCE COMMITTEE. | |
| FORM 990, PART VI, SECTION B, LINE 15 | THE REPORTING ORGANIZATION IS A MEMBER OF THE AKRON GENERAL HEALTH SYSTEM. THE EXEMPT PURPOSE OF THE SYSTEM PARENT, AKRON GENERAL HEALTH SYSTEM (AGHS), IS TO SUPPORT THE MEMBERS OF THAT SYSTEM. ONE OF THE SUPPORT SERVICES THAT AGHS PROVIDES IS DETERMINING THE COMPENSATION OF THE TOP MANAGEMENT PERSONNEL OF THE REPORTING ORGANIZATION. AGHS FOLLOWS A PROCESS FOR DETERMINING THE COMPENSATION OF THE REPORTING ORGANIZATION'S TOP MANAGEMENT PERSONNEL THAT IS BASED ON THE SAFE HARBOR DESCRIBED BY INTERNAL REVENUE CODE SECTION 4958 FOR ESTABLISHING THE PRESUMPTION OF REASONABLE COMPENSATION. THEREFORE, THE PROCESS CALLS FOR RECOMMENDATIONS - DEVELOPED BY AN INDEPENDENT COMPENSATION CONSULTANT, BASED ON COMPARABLE MARKET DATA FROM PUBLISHED SURVEYS AND THE FORMS 990 OF COMPARABLE ORGANIZATIONS - THAT ARE WITHIN THE RANGE OF THE COMPENSATION OF SIMILARLY SITUATED PERSONS AT SIMILARLY SITUATED ORGANIZATIONS. THESE RECOMMENDATIONS ARE REVIEWED BY THE COMPENSATION COMMITTEE OF THE REPORTING ORGANIZATION'S BOARD OF DIRECTORS. THE COMPENSATION COMMITTEE IS COMPRISED OF INDEPENDENT PERSONS AND THE DELIBERATIONS ARE DOCUMENTED, CONTEMPORANEOUSLY, IN THE COMMITTEE'S MINUTES. THE COMPENSATION FOR ALL TOP MANAGEMENT WAS REVIEWED FOR REASONABLENESS USING THIS PROCESS IN 2008. | |
| FORM 990, PART VI, SECTION C, LINE 19 | CURRENTLY, LODI COMMUNITY HOSPITAL DOES NOT MAKE ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, OR ITS FINANCIAL STATEMENTS GENERALLY AVAILABLE TO THE PUBLIC. LODI COMMUNITY HSOPITAL DOES MAKE THESE DOCUMENTS AVAILABLE ON A CASE BY CASE BASIS. | |
| FORM 990, PART VII, COLUMNS A AND B | VINCENT J. MCCORKLE - MR. MCCORKLE SERVED AS MEMBER EX OFFICIO OF THE BOARD OF DIRECTORS FOR THE REPORTING ORGANIZATION. MR. MCCORKLE ALSO SERVED AS CEO AND MEMBER EX-OFFICIO OF THE BOARD OF DIRECTORS FOR AKRON GENERAL HEALTH SYSTEM, AVERAGING 55.0 PER WEEK ON THOSE DUTIES. IN ADDITION, MR. MCCORKLE SERVED AS MEMBER EX-OFFICIO OF THE BOARD OF DIRECTORS OF THE FOLLOWING RELATED ORGANIZATIONS, AVERAGE HOURS PER WEEK CORRESPONDING: AKRON GENERAL PARTNERS - .3 COMMNUITY HEALTH VENTURES, INC. - .3 AKRON GENERAL MEDICAL CENTER - 2.0 AKRON GENERAL FOUNDATION - .3 NHV PHYSCIANS PROFESSIONAL CORPORATION - .3 VISITING NURSE SERVICE - .3 VISITING HOURS, INC. - .3 HOSPICE CARE OHIO - .3 MARLENE BARKHEIMER - SERVED AS DIRECTOR AND VICE CHAIR OF THE BOARD OF DIRECTORS OF LODI COMMUNITY HOSPITAL THROUGH OCTOBER 31, 2011. ON OCTOBER 31, 2011 LODI COMMUNITY HOSPITAL'S CODE OF REGULATIONS WAS AMENDED MAKING THE AKRON GENERAL HOSPITALS BOARD OF DIRECTORS THE GOVERNING BODY OF LODI COMMUNITY HOSPITAL. MS. BARHEIMER WAS APPOINTED TO THAT BODY ON OCTOBER 31, 2012. HAROLD YOUNG - SERVED AS A MEMBER OF THE BOARD OF DIRECTORS OF LODI COMMUNITY HOSPITAL THROUGH OCTOBER 31, 2011. ON OCTOBER 31, 2011 LODI COMMUNITY HOSPITAL'S CODE OF REGULATIONS WAS AMENDED MAKING THE AKRON GENERAL HOSPITALS BOARD OF DIRECTORS THE GOVERNING BODY OF LODI COMMUNITY HOSPITAL. MR. YOUNG WAS APPOINTED TO THAT BODY ON OCTOBER 31, 2012. JOHN BAKER - SERVED AS A MEMBER OF THE BOARD OF DIRECTORS OF LODI COMMUNITY HOSPITAL THROUGH OCTOBER 31, 2011. ON OCTOBER 31, 2011 LODI COMMUNITY HOSPITAL'S CODE OF REGULATIONS WAS AMENDED MAKING THE AKRON GENERAL HOSPITALS BOARD OF DIRECTORS THE GOVERNING BODY OF LODI COMMUNITY HOSPITAL. MR. BAKER WAS APPOINTED TO THAT BODY ON OCTOBER 31, 2012. JIM RICE - SERVED AS A MEMBER OF THE BOARD OF DIRECTORS OF LODI COMMUNITY HOSPITAL THROUGH OCTOBER 31, 2011. ON OCTOBER 31, 2011 LODI COMMUNITY HOSPITAL'S CODE OF REGULATIONS WAS AMENDED MAKING THE AKRON GENERAL HOSPITALS BOARD OF DIRECTORS THE GOVERNING BODY OF LODI COMMUNITY HOSPITAL. MR. RICE WAS APPOINTED TO THAT BODY ON OCTOBER 31, 2012. THOMAS WHELAN - MR. WHELAN SERVED AS PRESIDENT OF LODI COMMUNITY HOSPITAL FOR THE ENTIRE YEAR, AVERAGING 53.0 HOURS PER WEEK ON THOSE DUTIES. MR. WHELAN ALSO SERVED AS A MEMBER EX OFFICIO OF THE BOARD OF DIRECTORS OF THE REPORTING ORGANIZATION THROUGH OCTOBER 31, 2011. EFFECTIVE OCTOBER 31, 2011, THE ARTICLES OF LODI COMMUNITY HOSPITAL WERE AMENDED MAKING THE BOARD OF DIRECTORS OF AKRON GENERAL MEDICAL CENTER THE GOVERNING BODY OF LODI COMMUNITY HOSPITAL. WILLIAM BABCOX - ON OCTOBER 31, 2011 LODI COMMUNITY HOSPITAL'S CODE OF REGULATIONS WAS AMENDED MAKING THE AKRON GENERAL HOSPITALS BOARD OF DIRECTORS THE GOVERNING BODY OF LODI COMMUNITY HOSPITAL. MR. BABCOX ALREADY WAS A MEMBER OF THAT BODY ON OCTOBER 31, 2011. MR. BABCOX ALSO SERVED AS A MEMBER OF THE BOARD OF DIRECTORS OF THE FOLLOWING RELATED ORGANIZATION, AVERAGE HOURS PER WEEK CORRESPONDING: AKRON GENERAL HEALTH SYSTEM - 1.0 AKRON GENERAL MEDICAL CENTER - 1.9 DAVID BROCKMAN - ON OCTOBER 31, 2011 LODI COMMUNITY HOSPITAL'S CODE OF REGULATIONS WAS AMENDED MAKING THE AKRON GENERAL HOSPITALS BOARD OF DIRECTORS THE GOVERNING BODY OF LODI COMMUNITY HOSPITAL. MR. BROCKMAN ALREADY WAS A MEMBER OF THAT BODY ON OCTOBER 31, 2011. MR. BROCKMAN ALSO SERVED AS A MEMBER OF THE BOARD OF DIRECTORS OF THE FOLLOWING RELATED ORGANIZATION, AVERAGE HOURS PER WEEK CORRESPONDING: AKRON GENERAL MEDICAL CENTER - .8 AKRON GENERAL FOUNDATION - .5 THERESA CARTER - ON OCTOBER 31, 2011 LODI COMMUNITY HOSPITAL'S CODE OF REGULATIONS WAS AMENDED MAKING THE AKRON GENERAL HOSPITALS BOARD OF DIRECTORS THE GOVERNING BODY OF LODI COMMUNITY HOSPITAL. MS. CARTER ALREADY WAS A MEMBER OF THAT BODY ON OCTOBER 31, 2011. MS. CARTER ALSO SERVED AS A MEMBER OF THE BOARD OF DIRECTORS OF THE FOLLOWING RELATED ORGANIZATION, AVERAGE HOURS PER WEEK CORRESPONDING: AKRON GENERAL MEDICAL CENTER - .6 BRET TREIER - ON OCTOBER 31, 2011 LODI COMMUNITY HOSPITAL'S CODE OF REGULATIONS WAS AMENDED MAKING THE AKRON GENERAL HOSPITALS BOARD OF DIRECTORS THE GOVERNING BODY OF LODI COMMUNITY HOSPITAL. MR. TREIER ALREADY WAS A MEMBEER OF THAT BODY ON OCTOBER 31, 2011. MR. TREIER ALSO SERVED AS A MEMBER OF THE BOARD OF DIRECTORS OF THE FOLLOWING RELATED ORGANIZATION, AVERAGE HOURS PER WEEK CORRESPONDING: AKRON GENERAL MEDICAL CENTER - .2 AKRON GENERAL PARTNERS - .2 WILLIAM FRANTZ - ON OCTOBER 31, 2011 LODI COMMUNITY HOSPITAL'S CODE OF REGULATIONS WAS AMENDED MAKING THE AKRON GENERAL HOSPITALS BOARD OF DIRECTORS THE GOVERNING BODY OF LODI COMMUNITY HOSPITAL. MR. FRANTZ ALREADY WAS A MEMBER OF THAT BODY ON OCTOBER 31, 2011. MR. FRANTZ ALSO SERVED AS A MEMBER OF THE BOARD OF DIRECTORS OF THE FOLLOWING RELATED ORGANIZATION, AVERAGE HOURS PER WEEK CORRESPONDING: AKRON GENERAL MEDICAL CENTER - .7 MARY BETH C CARROLL - ON OCTOBER 31, 2011 LODI COMMUNITY HOSPITAL'S CODE OF REGULATIONS WAS AMENDED MAKING THE AKRON GENERAL HOSPITALS BOARD OF DIRECTORS THE GOVERNING BODY OF LODI COMMUNITY HOSPITAL. MS. CARROLL ALREADY WAS A MEMBER OF THAT BODY ON OCTOBER 31, 2011. MS. CARROLL ALSO SERVED AS A MEMBER OF THE BOARD OF DIRECTORS OF THE FOLLOWING RELATED ORGANIZATION, AVERAGE HOURS PER WEEK CORRESPONDING: AKRON GENERAL MEDICAL CENTER - 1.5 WILLIAM STEERE - ON OCTOBER 31, 2011 LODI COMMUNITY HOSPITAL'S CODE OF REGULATIONS WAS AMENDED MAKING THE AKRON GENERAL HOSPITALS BOARD OF DIRECTORS THE GOVERNING BODY OF LODI COMMUNITY HOSPITAL. MR. STEERE ALREADY WAS A MEMBER OF THAT BODY ON OCTOBER 31, 2011. MR. STEERE ALSO SERVED AS A MEMBER OF THE BOARD OF DIRECTORS OF THE FOLLOWING RELATED ORGANIZATION, AVERAGE HOURS PER WEEK CORRESPONDING: AKRON GENERAL HEALTH SYSTEM - 4.8 AKRON GENERAL MEDICAL CENTER - 1.1 ROBERT KAMIENSKI, MD - ON OCTOBER 31, 2011 LODI COMMUNITY HOSPITAL'S CODE OF REGULATIONS WAS AMENDED MAKING THE AKRON GENERAL HOSPITALS BOARD OF DIRECTORS THE GOVERNING BODY OF LODI COMMUNITY HOSPITAL. DR. KAMIENSKI ALREADY WAS A MEMBER OF THAT BODY ON OCTOBER 31, 2011. DR. KAMIENSKI ALSO SERVED AS A MEMBER OF THE BOARD OF DIRECTORS OF THE FOLLOWING RELATED ORGANIZATION, AVERAGE HOURS PER WEEK CORRESPONDING: AKRON GENERAL MEDICAL CENTER - 5.0 IN ADDITION, DR. KAMIENSKI WAS EMPLOYED BY NHV PHYSICIANS PROFESSIONAL CORPORATION SPENDING AN AVERAGE OF 55 HOURS WEEKLY ON THOSE DUTIES. JUSTIN LAVIN, MD - ON OCTOBER 31, 2011 LODI COMMUNITY HOSPITAL'S CODE OF REGULATIONS WAS AMENDED MAKING THE AKRON GENERAL HOSPITALS BOARD OF DIRECTORS THE GOVERNING BODY OF LODI COMMUNITY HOSPITAL. DR. LAVIN ALREADY WAS A MEMBER OF THAT BODY ON OCTOBER 31, 2011. DR. LAVIN ALSO SERVED AS A MEMBER OF THE BOARD OF DIRECTORS OF THE FOLLOWING RELATED ORGANIZATION, AVERAGE HOURS PER WEEK CORRESPONDING: AKRON GENERAL MEDICAL CENTER - 1.1 ALAN PAPA - ON OCTOBER 31, 2011 LODI COMMUNITY HOSPITAL'S CODE OF REGULATIONS WAS AMENDED MAKING THE AKRON GENERAL HOSPITALS BOARD OF DIRECTORS THE GOVERNING BODY OF LODI COMMUNITY HOSPITAL. MR. PAPA ALREADY WAS A MEMBER OF THAT BODY ON OCTOBER 31, 2011. MR. PAPA ALSO SERVED AS PRESIDENT AND AS A MEMBER OF THE BOARD OF DIRECTORS OF AKRON GENERAL MEDICAL CENTER SPENDING AN AVERAGE OF 40.4 HOURS PER WEEK ON THOSE DUTIES. IN ADDITION, MR. PAPA SERVED AS A MEMBER OF THE BOARD OF DIRECTORS OF THE FOLLOWING RELATED ORGANIZATION, AVERAGE HOURS PER WEEK CORRESPONDING: PARTNERS PHYSICIAN GROUP - .2 JOSEPH MELI, MD - ON OCTOBER 31, 2011 LODI COMMUNITY HOSPITAL'S CODE OF REGULATIONS WAS AMENDED MAKING THE AKRON GENERAL HOSPITALS BOARD OF DIRECTORS THE GOVERNING BODY OF LODI COMMUNITY HOSPITAL. DR. MELI ALREADY WAS A MEMBER OF THAT BODY ON OCTOBER 31, 2011. DR. MELI ALSO SERVED AS A MEMBER OF THE BOARD OF DIRECTORS OF THE FOLLOWING RELATED ORGANIZATION, AVERAGE HOURS PER WEEK CORRESPONDING: AKRON GENERAL MEDICAL CENTER - 0.1 IN ADDITION, DR. MELI WAS EMPLOYED BY NHV PHYSICIANS PROFESSIONAL CORPORATION SPENDING AN AVERAGE OF 55 HOURS WEEKLY ON THOSE DUTIES. ALAN J. BLEYER - MR. BLEYER IS A FORMER DIRECTOR EX OFFICIO OF THE REPORTING ORGANIZATION. MR. BLEYER IS THE FORMER CHIEF EXECUTIVE OFFICER OF AKRON GENERAL HEALTH SYSTEM. MR. BLEYER SEPARATED FROM SERVICE IN 2009 AND THE COMPENSATION SHOWN IS PAID BY AKRON GENERAL HEALTH SYSTEM IN ACCORDANCE WITH MR. BLEYER'S SEVERANCE AGREEMENT. | TITLE AND HOURS FOR RELATED ORGANIZATION |
| FORM 990, PART XI, LINE 5: | CHANGE IN INTEREST IN FOUNDATION UNRESTRICTED NET ASSETS -11,729. CHANGE IN INTEREST IN FOUNDATION TEMPORARILY RESTRICTED NET ASSETS 3,481. GRANT FUNDING FOR CAPITAL 20,036. TRANSFER TO/FROM AFFILIATES -916,919. CONTRIBUTIONS FROM ESTATE OF BONNY KAHL 343,021. TOTAL TO FORM 990, PART XI, LINE 5: -562,110. | CHANGES IN NET ASSETS OR FUND BALANCES: |
Schedule R IRS990ScheduleR
Form990 Schedule R Part II Form990ScheduleRPartII (12 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivities | Legal Domicile StateLegalDomicileState | Exempt Code SectionExemptCodeSection | Public Charity StatusPublicCharityStatus | Business Name Line1DirectControllingEntityName/BusinessNameLine1 | Controlled OrgControlledOrg |
|---|---|---|---|---|---|---|---|---|---|---|
| AKRON GENERAL HEALTH SYSTEM | ||||||||||
| 400 WABASH AVENUE | AKRON | OH | 44307 | 341546466 | SUPPORTING ORGANIZATION | OH | IRC 501(C)(3) | 11C, FI | NONE | 0 |
| AKRON GENERAL PARTNERS INC | ||||||||||
| 400 WABASH AVENUE | AKRON | OH | 44307 | 201801493 | SUPPORTING ORGANIZATION | OH | IRC 501(C)(3) | 11A | AKRON GENERAL HEALTH SYSTEM | 1 |
| AKRON GENERAL FOUNDATION | ||||||||||
| 400 WABASH AVENUE | AKRON | OH | 44307 | 341127047 | FUNDRAISING | OH | IRC 501(C)(3) | 7 | AKRON GENERAL HEALTH SYSTEM | 1 |
| COMMUNITY HEALTH VENTURES INC | ||||||||||
| 1 HOME CARE PLACE | AKRON | OH | 44320 | 341478435 | SUPPORTING ORGANIZATION | OH | IRC 501(C)(3) | 11C, FI | AKRON GENERAL HEALTH SYSTEM | 1 |
| AKRON GENERAL MEDICAL CENTER | ||||||||||
| 400 WABASH AVENUE | AKRON | OH | 44307 | 340714478 | HOSPITAL | OH | IRC 501(C)(3) | 3 | AKRON GENERAL HEALTH SYSTEM | 1 |
| PARTNERS PHYSICIAN GROUP | ||||||||||
| 400 WABASH AVENUE | AKRON | OH | 44307 | 341843403 | COMMUNITY HEALTH SERVICES | OH | IRC 501(C)(3) | 9 | AKRON GENERAL PARTNERS INC | 1 |
| NHV PHYSICIANS PROFESSIONAL CORPORATION | ||||||||||
| 400 WABASH AVENUE | AKRON | OH | 44307 | 341818688 | PRIMARY & SPECIALTY OUTPATIENT HEALTHCARE | OH | IRC 501(C)(3) | 11A | PARTNERS PHYSICIAN GROUP | 1 |
| AKRON GENERAL MEDICAL CENTER SELF INSURANCE TRUST FUND | ||||||||||
| 400 WABASH AVENUE | AKRON | OH | 44307 | 341243687 | SUPPORTING ORGANIZATION | OH | IRC 501(C)(3) | 11A | AKRON GENERAL MEDICAL CENTER | 1 |
| VISITING NURSE SERVICE INC | ||||||||||
| 1 HOME CARE PLACE | AKRON | OH | 44320 | 340714779 | HOME HEALTH CARE | OH | IRC 501(C)(3) | 9 | COMMUNITY HEALTH VENTURES INC | 1 |
| HOSPICE CARE OHIO INC | ||||||||||
| 1 HOME CARE PLACE | AKRON | OH | 44320 | 341771508 | HOSPICE SERVICES | OH | IRC 501(C)(3) | 9 | COMMUNITY HEALTH VENTURES INC | 1 |
| VISITING HOURS INC | ||||||||||
| 1 HOME CARE PLACE | AKRON | OH | 44320 | 341347010 | HOME HEALTH CARE | OH | IRC 501(C)(3) | 9 | COMMUNITY HEALTH VENTURES INC | 1 |
| ROSE LANE INC | ||||||||||
| 5425 HIGH MILL AVENUE NW | MASSILLON | OH | 44646 | 341527202 | NURSING HOME | OH | IRC 501(C)(3) | 9 | COMMUNITY HEALTH VENTURES INC | 1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | 0 | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | 0 | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | 0 | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | 0 | 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 | 0 | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | 0 | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | 0 | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | 0 | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | 0 | SharingOfFacilities |
| Sharing Of Paid Employees | 1 | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | 1 | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | 1 | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | 1 | OtherTransferToOtherOrg |
| Other Transfer From Other Org | 0 | OtherTransferFromOtherOrg |
Transactions Related Orgs Table TransactionsRelatedOrgsTable (8 entries)
| Transaction TypeTransactionType | Amount InvolvedAmountInvolved | Method Of Amt DeterminationMethodOfAmtDetermination |
|---|---|---|
| AKRON GENERAL HEALTH SYSTEM | ||
| N | 653440 | FAIR MARKET VALUE |
| AKRON GENERAL HEALTH SYSTEM | ||
| O | 90300 | FAIR MARKET VALUE |
| AKRON GENERAL MEDICAL CENTER | ||
| Q | 1870446 | COST |
| AKRON GENERAL MEDICAL CENTER | ||
| P | 2072536 | COST |
| AKRON GENERAL MEDICAL CENTER | ||
| O | 112089 | COST |
| PARTNERS PHYSICIAN GROUP | ||
| P | 664615 | COST |
| PARTNERS PHYSICIAN GROUP | ||
| O | 665618 | COST |
| AKRON GENERAL FOUNDATION | ||
| B | 343021 | FAIR MARKET VALUE |